Post-intervention Data Collection Research Articles

A Hybrid Digital Parenting Program Delivered Within the Malaysian Preschool System: Protocol for a Feasibility Study of a Small-Scale Factorial Cluster Randomized Trial.

The United Nations' Sustainable Development Goal 4, and particularly target 4.2, which seeks to ensure that, by 2030, all children have access to quality early childhood development, care, and preprimary education so that they are ready for primary education, is far from being achieved. The COVID-19 pandemic compromised progress by disrupting education, reducing access to well-being resources, and increasing family violence. Evidence from low- and middle-income countries suggests that in-person parenting interventions are effective at improving child learning and preventing family violence. However, scaling up these programs is challenging because of resource constraints. Integrating digital and human-delivered intervention components is a potential solution to these challenges. There is a need to understand the feasibility and effectiveness of such interventions in low-resource settings. This study aims to determine the feasibility and effectiveness of a digital parenting program (called Naungan Kasih in Bahasa Melayu [Protection through Love]) delivered in Malaysia, with varying combinations of 2 components included to encourage engagement. The study is framed around the following objectives: (1) to determine the recruitment, retention, and engagement rates in each intervention condition; (2) to document implementation fidelity; (3) to explore program acceptability among key stakeholders; (4) to estimate intervention costs; and (5) to provide indications of the effectiveness of the 2 components. This 10-week factorial cluster randomized trial compares ParentText, a chatbot that delivers parenting and family violence prevention content to caregivers of preschool-aged children in combination with 2 engagement components: (1) a WhatsApp support group and (2) either 1 or 2 in-person sessions. The trial aims to recruit 160 primary and 160 secondary caregivers of children aged 4-6 years from 8 schools split equally across 2 locations: Kuala Lumpur and Negeri Sembilan. The primary outcomes concern the feasibility and acceptability of the intervention and its components, including recruitment, retention, and engagement. The effectiveness outcomes include caregiver parenting practices, mental health and relationship quality, and child development. The evaluation involves mixed methods: quantitative caregiver surveys, digitally tracked engagement data of caregivers' use of the digital intervention components, direct assessments of children, and focus group discussions with caregivers and key stakeholders. Overall, 208 parents were recruited at baseline December 2023: 151 (72.6%) primary caregivers and 57 (27.4%) secondary caregivers. In January 2024, of these 208 parents, 168 (80.8%) enrolled in the program, which was completed in February. Postintervention data collection was completed in March 2024. Findings will be reported in the second half of 2024. This is the first factorial cluster randomized trial to assess the feasibility of a hybrid human-digital playful parenting program in Southeast Asia. The results will inform a large-scale optimization trial to establish the most effective, cost-effective, and scalable version of the intervention. OSF Registries; https://osf.io/f32ky. DERR1-10.2196/55491.

Cross-Education Effects of Hip Strengthening in Individuals with Chronic Ankle Instability

ABSTRACT Introduction/Purpose Chronic ankle instability (CAI) is associated with reduced balance, lumbopelvic stability, and hip strength. Accordingly, hip strengthening is an effective intervention for individuals with CAI. Cross-education through unilateral exercise is also beneficial to individuals with CAI, but cross-education effects of hip strengthening remain unknown. The purpose of this study was to determine cross-education effects of hip strengthening in individuals with CAI. Methods Thirty individuals with CAI were randomized into control (CON) and hip strengthening (HIP) groups. Baseline and postintervention tests of the uninvolved limb included lumbopelvic stability (unilateral hip bridge), handheld dynamometry (isometric hip extension, abduction, and external rotation strength), and balance (Star Excursion Balance Test (SEBT) in anterior, posterolateral (PL), and posteromedial directions). After baseline testing, HIP completed progressive hip strengthening of the involved limb three times per week for 8 wk, and CON did not. Repeated-measures analyses of variance assessed the effects of group and time on each outcome. Each group’s mean changes from baseline to postintervention were assessed via effect sizes. Statistical significance was set a priori at P < 0.05. Results Of the 30 participants enrolled, 10 did not complete the postintervention data collection. Multiple imputations estimated missing data, and an intention-to-treat analysis was conducted. There were no significant group-by-time interactions for hip strength, balance, or lumbopelvic stability. HIP exhibited moderate effect sizes for SEBT-PL and hip bridge. All other effect sizes were small or negligible. Conclusions We did not identify a clear cross-education effect following unilateral hip strengthening in a cohort with CAI. Examination of baseline to postintervention effect sizes indicate a potential trend toward improved balance and lumbopelvic stability of the HIP group.

Effects Of Mat Pilates On Range Of Motion, Balance, Flexibility And Functional Mobility In People With Parkinson’s

This study is a two-arm randomized controlled trial that analyzed the effects of Mat Pilates on range of motion, balance, flexibility and functional mobility in people with Parkinson’s. 23 individuals were randomized in Mat Pilates group and control group, pre and post-intervention data collection were made evaluating shoulder amplitude (Absolute Axis 360); balance (Mini-BESTest); flexibility (Sit and reach test); and functional mobility (TUG). The results showed significant intragroup differences in Mat Pilates group on balance (p<0.001), functional mobility (p=0.011), range of motion of the right shoulder in abduction (p=0.002) and left shoulder in abduction (p=0.006), although, in flexibility there were no significant differences. There were no intergroup differences and the intragroup presented worsening results in right shoulder flexion (p=0.008). A Mat Pilates protocol can be a complementary treatment to improve balance, functional mobility and shoulder range of motion in abduction in people with Parkinson’s disease. Keywords: Physical exercise; Rehabilitation; Neurodegenerative diseases; Pilates.

Diabetic Distress in Adults with Type II Diabetic Mellitus: A Community Based Study

Abstract Background: Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictive instructions. Diabetic distress (DD) refers to an emotional state where people experience feelings such as stress, guilt, or denial that arise from the living with diabetes and the burden of self-management. This study was done to assess the DD in rural and urban area of north Karnataka. Methodology: A nonrandomized educational interventional study (before and after comparative study without control) with 129 urban and 63 rural study participants was conducted in urban and rural field practice area of S. Nijalingappa Medical College, Bagalkot. Data were collected using pretested and predesigned pro forma which included sociodemographic details and DD score scale. Health education intervention was followed by postintervention data collection. Results: Most of the participants were in their old age. Male predominance was seen. Most of the participants belonged to Hindu religion (57% in rural and 69% in urban) and illiterate (46.5% in rural and 41.3% in urban). There was a significant reduction in DD (mean difference = 0.7, standard deviation = 0.7), when the study participants were given educational intervention. Conclusion: To combat the stress associated with diabetes, it is important to educate the patient to adapt with change in their lifestyle following the diagnosis of diabetes.

The protocol of the Easy-Net prospective project to improve the appropriateness of caesarean section in Calabria Region.

Italy is one of the European Countries with the highest caesarean section (CS) rate and large regional and local variability. In 2021, Calabria Region ranked as the third Italian region for the highest CS rate (38.5%). Calabria Region has joined the "Easy-Net" network program of Ministry of Health (NET-2016-02364191) on the evaluation of audit & feedback (A&F) interventions (Easy-Net https://easy-net.info/). The Easy-Net project is coordinated by The Department of Epidemiology of the Lazio Regional Health Service, and led for the Calabria Region by the Pugliese-Ciaccio Hospital of Catanzaro, with the Italian Ministry of Health and the Italian National Institute of Health. This project aims to reduce CS rate in Calabria Region, through A&F strategy interventions to improve perinatal care quality and maternal and neonatal outcomes. The adopted multi-strategic approach involves the use of Robson's classification to improve the appropriateness of the CS indications, and the A&F activities to identify health professionals' training needs and offer training update. This article describes the protocol of the Easy-Net WP6 study, "Prospective audit and feedback approach: efficacy in improving healthcare practice and reducing the caesarean section rate" (NET-2016-02364191-6). The project is organized in five phases which envisage the pre-intervention data collection relating to indicators of interest and staff attitudes on CS indication and A&F strategy. The 12 months of A&F interventions will be followed by the post-intervention data collection and the evaluation of appropriateness indicators and determinants. A study aimed at women is also planned to detect opinions regarding the use of CS. The study protocol was approved by the Ethics Committee of the Pugliese Ciaccio Hospital.

An implementation strategy package (video education, HIV self-testing, and co-location) improves PrEP implementation for pregnant women in antenatal care clinics in western Kenya.

Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization and the Kenyan Ministry of Health for HIV prevention in pregnancy and postpartum for women at risk for HIV. Integration of PrEP into antenatal care is promising, but delivery gaps exist in the face of healthcare provider shortages in resource-limited settings. Between May and November 2021, we conducted a difference-in-differences study (3 months pre-intervention data collection and 3 months post-intervention data collection) analyzing four intervention facilities, where the strategies were implemented, and four comparison facilities, where no strategies were implemented. We tested a combination of three implementation strategies-video-based PrEP information in the waiting bay, HIV self-testing, and dispensing of PrEP in the antenatal care rooms-to improve PrEP delivery. We compared absolute changes in the proportion of antenatal attendees screened for PrEP (PrEP penetration), the proportion receiving all PrEP-specific steps in a visit (HIV testing, risk screening, and PrEP counseling) (PrEP fidelity), and client PrEP knowledge, client satisfaction, and waiting time and service time (a priori outcomes); post hoc, we compared the proportion offered PrEP (PrEP offer) and completing HIV testing. We measured provider perceptions of the acceptability and appropriateness of the implementation strategies. We observed significant improvements in PrEP penetration, PrEP offer, satisfaction, and knowledge (p < 0.05) and improvements in fidelity that trended towards significance (p = 0.057). PrEP penetration increased 5 percentage points (p = 0.008), PrEP fidelity increased 8 percentage points (p = 0.057), and PrEP offer increased 4 percentage points (p = 0.003) in intervention vs. comparison facilities. Client PrEP knowledge increased by 1.7 out of 6 total points (p < 0.001) and client satisfaction increased by 0.7 out of 24 total points (p = 0.003) in intervention vs. comparison facilities. We observed no changes in service time (0.09-min decrease; p = 0.435) and a small increase in waiting time (0.33-min increase; p = 0.005). HIV testing among those eligible did not change (1.5 percentage point decrease, p = 0.800). Providers felt the implementation strategies were acceptable and appropriate (median acceptability: 20/20; median appropriateness: 19.5/20). However, absolute levels of each step of the PrEP cascade remained suboptimal. An implementation strategy package with video information, HIV self-testing, and co-location of medication dispensing enhanced PrEP delivery across several implementation outcomes and client satisfaction, while not substantially increasing wait time or decreasing provider-client contact time. ClinicalTrials.gov , identifier, NCT04712994.

Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder

ABSTRACT Purpose Addiction-focused eye movement desensitization reprocessing (AF-EMDR) is a viable add-on therapy to treat memories that drive addiction cravings. However, little research has explored AF-EMDR and its effects in people with substance abuse disorder (SUD). The purposes of this study were to determine the feasibility of conducting AF-EMDR and to test the preliminary efficacy of AF-EMDR on overall cravings experienced by persons with SUD, craving, perseverations associated with addiction, and irrational cognitions related to addiction. Methods This pilot study used a two-arm randomized controlled trial (RCT) design with an experimental group (AF-EMDR + cognitive behavioral therapy [CBT]) and a control group (CBT Only). Thirty participants were recruited from a residential program or a partial hospitalization program in a recovery center in Florida, from October 2021 through January 2022 and randomly assigned to the experimental group (n = 15) or the control group (n = 15). Results All participants adhered to the four-session 60-min AF-EMDR intervention and post-intervention data collection; 98.33% completed all four sessions. Results indicated significant reductions in cravings, perseverative thoughts about substance of choice, and irrational cognitions among participants in both the experimental (AF-EMDR + CBT) and control (CBT Only) groups during the intervention; however, there was no significant difference between groups. Conclusions The results showed positive trends in decreasing craving. However, more clinical trials with a larger sample are necessary to assess the efficacy and sustainability of such effects in persons with SUD.

Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial

IntroductionDespite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in...

The influence of AmeriCorps members on ecosystem management

Millions of acres of public lands across the United States (U.S.) face imminent threats from invasive species and wildfires, jeopardizing ecosystem health, wildlife habitats, recreational resources, and community safety. The responsible agencies, including the U.S. Forest Service, National Park Service, Bureau of Land Management, and state park agencies, are limited in their capacity to effectively manage these lands. Consequently, AmeriCorps members play a crucial role in curbing invasive species proliferation and mitigating wildfire fuel loads, safeguarding communities, and habitats. Here, the results of a national evaluation to assess the impact of AmeriCorps members on invasive species and wildfire fuel loads is presented. This study is a comprehensive analysis of AmeriCorps members' effectiveness in achieving ecosystem management objectives, revealing positive responses in native species cover and notable improvements in treated plots. AmeriCorps units that yielded significant results operated under specific temperature conditions and adhered to distinct pre- and post-intervention data collection intervals. Despite occasional challenges, the overall efficacy of AmeriCorps' efforts in eradicating targeted invasive species and promoting positive native species responses was confirmed. While linear regression models indicated successful forest fuel mitigation in AmeriCorps programs, the Difference-in-Difference models revealed less conspicuous outcomes, suggesting limited modifications in parameters such as the height of the lowest living branch, canopy cover, and litter depth. By analyzing data from multiple AmeriCorps programs in diverse geographic regions, this study contributes valuable insights into the effectiveness of AmeriCorps programs in ecological conservation. It represents one of the first multi-state and comprehensive examinations of AmeriCorps members' effectiveness in invasive species management and wildfire fuel mitigation in the USA, underscoring its significance in the field of ecosystem management.

Utilisation of Health and Nutrition Community Interventions to Reach Every Last One of the Most Vulnerable Children: Evidence from A Lifesaving Three-Year Project in Fragile Somalia

Objectives: Somalia has some of the worst infant, child and maternal mortality ratios in the world and was unable to achieve its Millennium Development Goals of health and nutrition. This study aimed to examine whether the project achieved its intended outcome in fragile Somalia. Design: The study adopted a quantitative and analysis method. Setting: Data collection involved household surveys and anthropometric measurements. A pre-and post-intervention data collection and analysis was conducted aimed at comparing the performance of the priority indicators, determining if the change was significant with a 95% confidence interval. Participants: It was with caregivers, mainly women of reproductive age (15-49 years) and children 0-59 months as the main participants. Main Outcome Measures: The focus was on Baseline compare to end line, End line Puntland Vs Somaliland and Key indicators to National Targets. Descriptive and inferential statistical analysis of the household questionnaires was conducted using SPSS data analysis software. Cross-tabulation using the McNemar’s Chi-square test was used to compare key outcomes. Results: From baseline to end line, there was statistically significant improvement breastfeeding practices, mothers practice for health timing and spacing of pregnancy, mothers practicing the recommended child birth practices care for children under five when sick and a reduction in the utilization of pregnancy care services and practice of vaccination of children. Comparison of Key indicators to National Targets revealed that the project achieved more in appropriate treatment of childhood illnesses, delivery practices, contractive use, infant and young child feeding, but fell short in the immunization services and ANC services. Conclusions: The health and nutrition care system in Somalia remains weak, poorly resourced and inequitably distributed with the root causes being multipronged. However, the results from this study show that if interventions are appropriately funded, there will always be improvement in the key health and nutrition indicators.

Lessons learned from the pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands

BackgroundThe Republic of the Marshall Islands (RMI) has a high rate of type 2 diabetes mellitus (T2DM). To address the high rate of T2DM, we tested a culturally adapted family model of diabetes self-management education and support (F-DSMES). We report the results of the 12-month post-intervention data collection and describe the lessons learned from the delivery of the F-DSMES intervention. MethodsRecruitment took place in four churches in Majuro and included 10 h of content delivered over 8–10 weeks. Forty-one participants with T2DM were included. The primary study outcome was glycemic control measured by a change in HbA1c. We also conducted participant interviews to document the participant-reported barriers encountered during the F-DSMES intervention. ResultsParticipants did not show improvements in their biometric markers; however, participants did show improvement on multiple measures of diabetes knowledge and family support. We identified five areas to improve future interventions: 1) issues with recruitment, retention, and attendance; 2) needing help accessing information and additional healthcare provider counseling; 3) struggles with adhering to diet recommendations; 4) difficulty getting exercise, and 5) improving lessons within the intervention. ConclusionAlthough the biomarker data did not show improvement, valuable information was gained to improve the development of larger-scale trials. The results provide evidence of the need for these trials and the desire of participants to continue pursuing this effort. Others doing similar work in other low-to-middle income countries will need to take into consideration the potential barriers and facilitators within participants’ social and physical environments.

Quality of Documentation in Paediatric Supracondylar Fractures: A Quality Improvement Project.

Introduction Supracondylar fractures are the most common elbow fractures in children. Their documentation and management must be done fully and correctly. This Quality Improvement Project (QIP) assessed the quality of documentation for paediatric supracondylar fractures admitted, in accordance with the British Orthopaedic Association Standards for Trauma (BOAST). Methods We present a case series of supracondylar fractures presenting to a single UK-based district general hospital from January 2018 - October 2021. We performed a quality improvement intervention starting in November2020. The retrospective data prior to intervention (January 2018-November 2020) were deemed "pre-intervention". Prospective "post-intervention" data were collected from April to October 2021.After "pre-intervention" data analysis, an intervention in the form of a documentation proforma was developed and multidisciplinary teaching sessions were delivered. Post-intervention prospective data collection followed from April - October 2021. Results There were 48 and 26 patients in cycles one and two, respectively. The mean age was 6.4(SD 3.5) and 6.5 (SD 2.7) years, respectively; 42/48 in cycle one and all 26/26 in cycle two required operative management.The mean time to surgery was 1.3 and 0.96 days, respectively. Post-intervention, cycle two showed a reduction in patients with "no neurovascular documentation" pre-reduction (17% vs 12%) and an increase in patients documented as having "neurovascular status intact" (NVI) (44% vs 69%). In post-operative documentation, there was an improvement in documentation with 73% of patients having a post-operative neurovascular assessment documented, versus 50% in thepre-intervention cohort. Conclusion This QIP provided some early improvement in the documentation but with room for future progress as the project continues. It showed proformas can be an effective tool in implementing positive change. It also highlights the need for continuous clinical education across the multidisciplinary teams managing trauma.

Identifying existing approaches used to evaluate the sustainability of evidence-based interventions in healthcare: an integrative review

BackgroundThere is limited evidence to evaluate the sustainability of evidence-based interventions (EBIs) for healthcare improvement. Through an integrative review, we aimed to identify approaches to evaluate the sustainability of evidence-based interventions (EBIs) and sustainability outcomes.MethodsFollowing Whittemore and Knafl’s methodological process: (1) problem identification; (2) literature search; (3) data evaluation; (4) data analysis; and (5) presentation, a comprehensive search strategy was applied across five databases. Included studies were not restricted by research design; and had to evaluate the sustainability of an EBI in a healthcare context. We assessed the methodological quality of studies using the Mixed Methods Appraisal Tool.ResultsOf 18,783 articles retrieved, 64 fit the inclusion criteria. Qualitative designs were most commonly used for evaluation (48%), with individual interviews as the predominant data collection method. Timing of data collection varied widely with post-intervention data collection most frequent (89%). Of the 64 studies, 44% used a framework, 26% used a model, 11% used a tool, 5% used an instrument, and 14% used theory as their primary approach to evaluate sustainability. Most studies (77%) did not measure sustainability outcomes, rather these studies focused on sustainability determinants.DiscussionIt is unclear which approach/approaches are most effective for evaluating sustainability and what measures and outcomes are most commonly used. There is a disconnect between evaluating the factors that may shape sustainability and the outcomes approaches employed to measure sustainability. Our review offers methodological recommendations for sustainability evaluation research and highlights the importance in understanding mechanisms of sustainability to advance the field.

Study protocol: Evaluation of the ‘Flavour School’ sensory food education programme: a cluster-randomised controlled trial in UK primary school children, aged 4–7 years, to determine impact on confidence and curiosity in tasting vegetables and fruit

BackgroundMany children would benefit from a diet richer in vegetables and fruit. ‘Flavour School’ is a programme of ‘sensory food education’, which aims to increase children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This study will conduct a cluster-randomised controlled trial to assess the outcomes of the Flavour School programme in primary school children aged 4–7 years.MethodsFour hundred plus children from 4+ schools will either complete the Flavour School programme (experimental group) or have no intervention with normal school teaching (control group), cluster-randomised within-schools, by school class. Baseline data collection will consist of video recorded behavioural observation during a tasting activity, and post-intervention data collection will repeat this activity after the experimental group have completed the intervention. Process measures will be assessed using a teacher engagement feedback questionnaire.DiscussionThis study will provide causal data on the efficacy of a sensory food education intervention for increasing children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This new knowledge will help educators and policy makers to make evidence based decisions on uptake of sensory food education.Trial registrationISRCTN: 40249947 Date assigned 17 March 2020 Last edited 22 September 2021 Version 1.2Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools)

Observing pedestrian-vehicle traffic conflicts in school zones to evaluate the effectiveness of road safety interventions and reduce injuries in Ghana, Vietnam, and Mexico, 2019-2021.

Daily more than 3,000 children are injured or killed on the road, often along the school route. Road traffic crashes and resulting injuries are preventable. More can be done to reduce injuries and save lives. Traffic Conflict Techniques (TCTs) are simple methods of collecting observational data to evaluate the effectiveness of road safety interventions through counting and analyzing traffic conflicts. A TCT Toolkit was developed and piloted to analyze pedestrian-vehicle traffic conflicts in school zones in low- and middle-income countries. Three non-governmental organizations in Ghana, Vietnam, and Mexico applied three TCTs from the TCT Toolkit to collect traffic conflict data before (pre-intervention) and after (post-intervention) road safety intervention implementation. As the number of traffic conflicts was often less than 100, confidence intervals (CIs) based on gamma distributions were calculated for the traffic conflict rate. Using the calculated traffic conflict rate, the difference between pre- and post-intervention rates was assessed by determining overlap of the CIs. When CIs did not overlap, the difference was said to be statistically significant at the 0.05 level. For each method, results indicated a decrease in traffic conflicts between pre- and post-intervention data collection periods. Pre- and post-intervention traffic conflict rates with non-overlapping CIs demonstrated the results were statistically significant, providing evidence that the road safety interventions were effective. TCTs are relatively low-cost and simple techniques that provide an opportunity to base road safety improvement decisions on real-world data. TCTs are effective in objectively evaluating road safety interventions and can help decision-makers evaluate strategies for improving road safety, preventing injuries and saving lives.

The feasibility and acceptability of a pilot randomized controlled trial testing pharmacy-based HPV vaccine completion.

Immunizing pharmacists can administer vaccines; however, they are less likely to administer adolescent vaccines such as vaccines that protect against human papillomavirus (HPV). Although past research has recommended incorporating pharmacists to increase adolescent vaccination, few intervention studies have tested healthcare delivery models that incorporate pharmacists to aid in vaccine series completion. This research explored the feasibility and acceptability of an intervention in which pharmacists administered booster doses of the HPV vaccine series. Between April 2019 and February 2020, the research team recruited participants for a pilot randomized controlled trial hosted in one federally qualified health center (FQHC) clinic. Researchers asked intervention group participants to complete the HPV vaccine series with their community pharmacists and control group participants to complete the series at their FQHC. We conducted a pre- and post-intervention surveys and in-depth interviews with both intervention and control group participants. A total of 33 parents of children who received the first dose of the HPV vaccine enrolled in the study of whom 8 intervention and 11 control group participants completed post-intervention data collection. Although there were no statistically significant changes in vaccine completion and in psychometric variables, we did find that pharmacist-delivered HPV vaccination was acceptable, due, primarily, to convenience. Barriers to receiving pharmacist-administered vaccines included pharmacies' lack of stocking the vaccine and insurance-related barriers to care. Although a promising and acceptable healthcare delivery approach, there are still barriers for caregivers to have their children vaccinated against HPV at their community pharmacies.

A Feasibility Randomized Controlled Trial of a Parenting Intervention Offered to Women With Severe Mental Health Problems and Delivered in a Mother and Baby Unit Setting: The IMAgINE Study Outcomes.

BackgroundApproximately 1–2% of mothers may experience severe mental illness (SMI) requiring admission to an inpatient Mother and Baby Unit (MBU). MBUs aim to provide mental health assessment and treatment and strengthen the mother-infant relationship, essential for infant development. Whilst MBUs offer various interventions, they do not routinely offer structured parenting interventions. The Baby Triple P Positive Parenting Program (BTP) was developed to enhance parenting competence, psychological coping and the quality of partner and other social support. Guided by lived experience consultation, we aimed to determine the feasibility and acceptability of delivering BTP plus Treatment as Usual (TAU) in this setting.MethodA multi-site, parallel-group, single-blind pilot randomized controlled trial (registration: ISRCTN12765736) comparing BTP+TAU to TAU in participants, recruited from two MBUs in England. The Baby Triple P intervention consisted of eight parenting sessions, with the final four being delivered over the telephone following MBU discharge. Feasibility outcomes were participant intervention engagement and study retention. Clinical outcomes including maternal parenting competence, bonding and mental health outcomes were assessed at baseline, post-baseline/intervention (10 weeks) and six-month follow-up. Data were analyzed using descriptive statistics and linear regression models. An economic feasibility analysis was also conducted.ResultsThirty-seven of the 67 eligible participants consented; 34 were randomized (16 to BTP+TAU and 18 to TAU), of whom 20 were retained at post-intervention data collection and 21 at six-month follow-up. Twelve participants (75%) completed the intervention, which was rated as highly acceptable. Clinical outcomes signaled potential improvements in maternal parenting competence, bonding, mood and mental health symptomatology in participants who received the intervention. Healthcare resource use and EQ-5D-5L questionnaires were well-completed by participants. Delivering BTP in this setting is estimated to cost £443-822 per participant.ConclusionsThis is the first trial of a parenting intervention in a MBU setting. BTP is feasible and acceptable to mothers with SMI, with a promising signal for treatment efficacy. Although minor modifications may be required for the collection of observer-rated measures post-MBU discharge, the findings indicate that a larger, definitive trial could be conducted, especially if the setting is extended to include perinatal mental health community settings.

Implementation of an adverse childhood experiences screening protocol for adults at an outpatient medical psychology practice

Objective: Despite an abundance of evidence supporting screening adults for adverse childhood experiences (ACEs), the gap between this knowledge and screening persists. Evidence suggests that screening is warranted, feasible, and desired by patients. This feasibility study aimed to educate and train staff and providers on ACE screening and implement an ACE screening policy and protocol at an outpatient medical psychology practice. The two expected outcomes of this project, provider knowledge after ACE training and provider compliance with the ACE screening protocol, were measured to determine if a clinical practice change occurred.Methods: A quasi-experimental design with a pre-test/post-test was used to determine increases in provider knowledge following an ACEs training intervention. Additionally, post-intervention only data collection was used to determine compliance with ACE screening protocol, to determine practice change and feasibility of continued protocol use.Results: The project results indicated that the implementation of the ACE screening protocol was feasible. Thirty-three adult clients new to the practice completed the ACE screening. Of the 33 clients screened during the 12-week study, 26 clients had an ACE score of three or higher, and 14 (42%) received therapy referrals based on their ACE score after education and discussion by the intake therapist. Weekly chart checks revealed that 100% of clients screened received, at a minimum, the educational packet regarding the impact of ACEs on physical and mental health. The protocol encouraged providers to promote evidence-based interventions to mitigate the potential untoward outcomes associated with ACEs.Conclusions: These findings reflected a change in knowledge based on education and indicated that educational intervention was effective.

793 COLLATERAL HISTORY IN PATIENTS WITH CONFUSION

Abstract Introduction The aims of the project were to intervene early on admission, by taking a collateral history for patients with confusion; to improve the quality and detail of collateral history being taken to better establish certain clinically important specks of information. These include triggers for delirium, the patient’s baseline cognition, any patterns in the change of a patient’s cognition to help determine if a patient was displaying aspects of a certain type of dementia prior to admission, baseline mobility and housing situation, baseline continence, history of substance misuse and alcohol etc. Ultimately, this project aims to identify next of kin from which collateral history can be obtained, but also to establish a firm communication platform to facilitate future discussions on behalf of patients undergoing delirium. This will ultimately, improve care but also making sure family members are involved early on in admission, exploring their ideas, concerns, and expectations. Methods We created a collateral history template booklet that was introduced to a geriatric ward. Specific parameters were set and measured, pre-intervention and post-intervention. A second round of post-intervention data collection was performed with an improved collateral history sheet outlook. We measured the outcome of 22 collateral histories for each round. Results We found that in both rounds, post intervention, there was an improved outcome compared to pre-intervention in almost all the parameters that were measured. For example, in 100% of the collateral histories there was documentation of the patient’s baseline concentrations and attention, issues with orientation, issues with expressive and receptive dysphasia and the main concerns of the next of kin, any problems with executive functioning and the baseline functional status of the patients. Conclusion The collateral history, both improved the overall quality and the quantity of the information gathered in patients with confusion and, contributed to a structured management.

A feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients

ObjectivesTo investigate the feasibility of delivering a low-dose mindfulness-based stress reduction (MBSR) intervention among prediabetes/diabetes patients in a clinical setting. Design and settingThis was a single-arm, mixed methods, feasibility study among prediabetes/diabetes patients at a healthcare center in United States. InterventionThe low-dose MBSR intervention was delivered in group format over 4 waves and each wave comprised 8–10 h of 8 sessions over 6–8 weeks. Main outcome measuresWe evaluated recruitment, adherence, and attrition rates, participants’ satisfaction, motivation and barriers of low-dose MBSR. Psychological, behavioral, and physical measures were compared between pre- and post-intervention. ResultsWe enrolled 19 participants of 34 eligible individuals with a recruitment rate of 55.9%. Among 19 enrolled participants, 4 dropped out after baseline data collection and did not attend any session and 1 attended one session but did not finish post-intervention data collection, resulting in an attrition rate of 26.3%. Among 15 participants attending at least one session, 46.7% attended all sessions and 80.0% attended at least 5 sessions. Qualitative analysis among 11 participants indicated that 90.9% had positive overall experience with the intervention. Compared to pre-intervention, there was a significant reduction in depression score (mean reduction = 5.04, SD = 7.66, p = 0.02), a higher proportion of engaging in flexibility exercises (42.86% vs. 85.71%, p = 0.01) and a lower level of glycosylated hemoglobin (HbA1c) (mean reduction = 1.43%, SD = 2.54%, p = 0.03) at post-intervention. ConclusionsDelivering a low-dose MBSR intervention to prediabetes/diabetes patients in a primary care setting is feasible. Future studies with randomized controlled design and larger sample are warranted.