Postintervention Qualitative Interviews Research Articles

Video feedback for young babies and maternal perinatal mental illness: intervention adaptation, feasibility and acceptability.

We aimed to adapt, pilot and explore experiences of receiving and delivering the video feedback intervention for positive parenting (VIPP) for 2 to 6 month old babies, mothers experiencing moderate to severe perinatal mental health difficulties and perinatal mental health clinicians. The VIPP intervention was adapted to include developmentally appropriate activities and developmental psychoeducation for 2 to 6 month olds, alongside psychoeducation on emotion regulation, and then piloted in 14 mothers experiencing moderate to severe perinatal mental health difficulties (registration ISRCTN64237883). Observational and self-reported pre-post outcome data on parenting and parent-infant mental health was collected, and post-intervention qualitative interviews were conducted with participating mothers and clinicians. Consent (67%), intervention completion (79%) and follow-up rates (93%) were high. Effect sizes on pre-post outcome measures indicated large improvements in parenting confidence and perceptions of the parent-infant relationship, and a medium-size improvement in maternal sensitivity. In qualitative interviews, clinicians and mothers described how mothers' initial anxieties about being filmed were allayed through receiving positive and strengths-focussed feedback, boosting their self-confidence, and that the video feedback facilitated identification of young babies' subtle behavioural cues and moments of mother-infant connection. Streamlining the information provided on maternal emotion regulation, and allowing increased use of clinical judgement to tailor intervention delivery, were suggested to optimise intervention feasibility and acceptability. It is feasible and acceptable to implement VIPP with very young babies and their mothers experiencing perinatal mental health difficulties. A fully powered randomised controlled trial is required to establish intervention efficacy.

Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia

BackgroundPatients from culturally and linguistically diverse (CALD) backgrounds often face difficulties in accessing health and social care services. This study explored the feasibility and acceptability of involving community health workers (CHWs) as bilingual community navigators (BCNs) in general practice setting, to help patients from CALD backgrounds access health and social care services in Australia.MethodsThis research was conducted in two general practices in Sydney where most patients are from specific CALD backgrounds (Chinese in one practice and Samoan in other). Three CHWs trained as BCNs were placed in these practices to help patients access health and social care service. A mixed-method design was followed to explore the feasibility and acceptability of this intervention including analysis of a record of services provided by BCNs and post-intervention qualitative interviews with patients, practice staff and BCNs exploring the feasibility and acceptability of the BCNs’ role. The record was analyzed using descriptive statistics and interviews were audio-recorded, transcribed, and thematically analyzed.ResultsBCNs served a total of 95 patients, providing help with referral to other services (52.6%), information about appointments (46.3%), local resources (12.6%) or available social benefits (23.2%). Most patients received one service from BCNs with the average duration of appointments being half an hour. Overall, BCNs fitted in well within the practices and patients as well as staff of participating practices accepted them well. Their role was facilitated by patients’ felt need for and acceptance of BCNs’ services, recruitment of BCNs from the patient community, as well as BCNs’ training and motivation for their role. Major barriers for patients to access BCNs’ services included lack of awareness of the BCNs’ roles among some patients and practice staff, unavailability of information about local culture specific services, and inadequate time and health system knowledge by BCNs. Limited funding support and the short timeframe of the project were major limitations of the project.ConclusionBCNs’ placement in general practice was feasible and acceptable to patients and staff in these practices. This first step needs to be followed by accredited training, development of the workforce and establishing systems for supervision in order to sustain the program. Future research is needed on the extension of the intrevention to other practices and culture groups.

128 A single-arm pilot study of an adapted Serious Illness Care Program for older patients with acute myeloid leukemia and myelodysplastic syndromes

OBJECTIVES/GOALS: We adapted the Serious Illness Care Program (SICP), an evidence-based intervention designed to promote early serious illness conversation, to be delivered via telehealth for older patients with acute myeloid leukemia and myelodysplastic syndromes. The purpose of this study is to assess the feasibility and usability of the adapted intervention. METHODS/STUDY POPULATION: We are conducting a single-arm pilot study of an adapted SICP that is delivered via telehealth for older patients with AML or MDS (>=60 years) and their caregivers (if available). The adapted SICP includes: 1) Patient preparation pamphlet: sent to patient prior the visit with their clinician, 2) Geriatric assessment: completed by study team and provided to clinician prior to their visit with the patient, 3) A 30-60 minute telehealth visit with their primary oncologist or oncology advance practitioner, 4) Serious Illness Conversation Guide (SICG): used by the clinician during the visit to elicit patient values, 5) Family guide: provided to patient following their visit to help patient’s share their values with their family, 6) Electronic medical record note template for clinicians to document their visit the patient. RESULTS/ANTICIPATED RESULTS: We hypothesize that the adapted SICP intervention will be feasible and usable. We will assess feasibility based on retention rate (percent of patients who consent and complete the visit); >80% is considered feasible. Usability will be assessed using the telehealth usability questionnaire; an average score of >5 is considered usable. Other measures include psychological health, advance care planning engagement, quality of life, and disease understanding. We plan to enroll 20 patients in this study. To date, 11 patients have consented to participate, 10 patients have scheduled SICP visits, 9 patients have completed their visits, 7 patients have completed post-intervention qualitative interviews, and 4 patients have completed post-intervention surveys. DISCUSSION/SIGNIFICANCE: The adapted telehealth-based SICP may promote early serious illness conversation, patient-reported outcomes, and end-of-life experience for older patients with AML and MDS. Results from this study will be used to inform development of clinical trials testing the impact of the adapted SICP on patient- and caregiver-reported outcomes.

A randomised, controlled, feasibility trial of an online, self-guided breathlessness supportive intervention (SELF-BREATHE) for individuals with chronic breathlessness due to advanced disease.

SELF-BREATHE is a complex, transdiagnostic, supportive, digital breathlessness intervention co-developed with patients. SELF-BREATHE seeks to build capacity and resilience within health services by improving the lives of people with chronic breathlessness using nonpharmacological, self-management approaches. This study aimed to determine whether SELF-BREATHE is feasible to deliver and acceptable to patients living with chronic breathlessness. A parallel, two-arm, single-blind, single-centre, randomised controlled, mixed-methods feasibility trial with participants allocated to 1) intervention group (SELF-BREATHE) or 2) control group (usual National Health Service (NHS) care). The setting was a large multisite NHS foundation trust in south-east London, UK. The participants were patients living with chronic breathlessness due to advanced malignant or nonmalignant disease(s). Participants were randomly allocated (1:1) to an online, self-guided, breathlessness supportive intervention (SELF-BREATHE) and usual care or usual care alone, over 6 weeks. The a priori progression criteria were ≥30% of eligible patients given an information sheet consented to participate; ≥60% of participants logged on and accessed SELF-BREATHE within 2 weeks; and ≥70% of patients reported the methodology and intervention as acceptable. Between January 2021 and January 2022, 52 (47%) out of 110 eligible patients consented and were randomised. Of those randomised to SELF-BREATHE, 19 (73%) out of 26 logged on and used SELF-BREATHE for a mean±sd (range) 9±8 (1-33) times over 6 weeks. 36 (70%) of the 52 randomised participants completed and returned the end-of-study postal questionnaires. SELF-BREATHE users reported it to be acceptable. Post-intervention qualitative interviews demonstrated that SELF-BREATHE was acceptable and valued by users, improving breathlessness during daily life and at points of breathlessness crisis. These data support the feasibility of moving to a fully powered, randomised controlled efficacy trial with minor modifications to minimise missing data (i.e. multiple methods of data collection: face-to-face, telephone, video assessment and by post).

A Patient-Centered Communication Tool for Older Patients with Acute Myeloid Leukemia, Their Caregivers, and Oncologists: A Single Arm Pilot Study

Introduction: Aging-related vulnerabilities (e.g. functional impairment) are prevalent in older adults with AML and can affect the risks and benefits of treatment. Shared decision making (SDM) is an important component of patient-centered care. To achieve SDM, patients must be informed about their disease, treatment options, and prognosis, and their values should be incorporated into treatment decisions. We previously developed and adapted a patient-centered communication tool [University of Rochester-Geriatric Oncology Assessment for acute myeloid Leukemia (UR-GOAL)] for older adults with AML (Figure 1a). The UR-GOAL tool assesses aging-related vulnerabilities, patient values, and prognostic awareness among older patients with AML. In this study, we assessed the feasibility and usability of the UR-GOAL tool for use in AML treatment decision making. Methods: We conducted a single arm pilot study at the Wilmot Cancer Institute and affiliated community oncology practices. We recruited adults (≥60 years) with newly diagnosed AML, their caregivers, and oncologists. The UR-GOAL tool includes: a) AML educational video, b) geriatric assessment to assess aging-related vulnerabilities, c) Best-Worst Scaling to assess patient values (Figure 1b), and d) assessment of prognostic awareness. A summary report is provided to the patient and oncologist at completion of the tool. The primary feasibility metric was retention rate (>50% was considered feasible). We collected recruitment rate, usefulness (Preparation for Decision Making Scale, range 1-5; higher is better), usability, and clinical outcomes including AML knowledge (range 0-14, higher is better), perceived efficacy in communicating with the oncologist (range 5-25, higher is better), SDM (SDM-Q-9, range 0-100; higher is better), and patient-centered communication (PCC-Ca, range 0-5; higher is better). We used paired t-tests or Wilcoxon signed-rank tests to assess changes in measures from baseline to post-intervention. Due to the pilot nature of the study and small sample size, hypothesis testing was performed at α=0.10 (2-tailed). We conducted post-intervention qualitative interviews to gather feedback. Results: We included 15 patients (mean age=76, range 64-88), 12 caregivers (mean age=69 years, range 47-86), and 5 oncologists. Most patients (93%) were white and non-Hispanic. Enrollment rate was 84% and retention rate was 73%. Mean scores on the Preparation for Decision Making Scale were 3.8 (SD 0.7) and 3.5 (SD 1.2), among patients and caregivers, respectively. On usability survey, majority of patients (>90%) agreed that the UR-GOAL tool helped them understand AML and its treatment options, identify questions for their doctor, understand their values, and make more informed decisions. At baseline, mean AML knowledge scores among patients and caregivers were 6.0 (SD 1.1) and 5.7 (SD 1.3), respectively, which increased to 6.6 (SD 1.7; p=0.22) and 7.3 (SD 0.8; p=0.03) post-intervention. Perceived efficacy in communicating with the oncologist increased from baseline to post-intervention for both patients [mean +1.5 (SD 3.0; p=0.15)] and caregivers [mean +1.6 (SD 1.6; p=0.02)]. At post-intervention, mean patient scores on SDM-Q-9 and PCC-Ca were 89.4 (SD 14.4) and 4.4 (SD 0.5), respectively. Mean score on PCC-Ca was 93.5 (SD 8.1) for caregivers. Together, these scores indicate high level of SDM and patient-centered communication. In qualitative interviews, patients felt the educational video was easy to understand and suggested that they have the opportunity to re-watch the video as needed. Patients found the summary report helpful, and one patient noted referencing the report during subsequent visits with their oncologist. Oncologists did not perceive the tool to be burdensome to them or patients, and felt the summary report was easy to interpret. Oncologists felt the tool provided them with useful insight into the patient's understanding of their diagnosis and prognosis. Conclusion: We demonstrated it is feasible to incorporate a patient-centered communication tool to support older patients with AML, their caregivers, and oncologists in making treatment decisions. The UR-GOAL tool may improve patient and caregiver knowledge of AML and perceived efficacy in interacting with the oncologist. A pilot randomized controlled trial is ongoing to evaluate the preliminary efficacy of the UR-GOAL tool on SDM and communication. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA

ObjectivesTo evaluate feasibility and acceptability of a group-based nature recreation intervention (nature hiking) and control condition (urban hiking) for military Veterans with post-traumatic stress disorder (PTSD).Design and settingA pilot randomised...

Incorporating a brief intervention for personalised cancer risk assessment to promote behaviour change into primary care: a multi-methods pilot study

BackgroundApproximately 40% of cancers could be prevented if people lived healthier lifestyles. We have developed a theory-based brief intervention to share personalised cancer risk information and promote behaviour change within primary care. This study aimed to assess the feasibility and acceptability of incorporating this intervention into primary care consultations.MethodPatients eligible for an NHS Health Check or annual chronic disease review at five general practices were invited to participate in a non-randomised pilot study. In addition to the NHS Health Check or chronic disease review, those receiving the intervention were provided with their estimated risk of developing the most common preventable cancers alongside tailored behaviour change advice. Patients completed online questionnaires at baseline, immediately post-consultation and at 3-month follow-up. Consultations were audio/video recorded. Patients (n = 12) and healthcare professionals (HCPs) (n = 7) participated in post-intervention qualitative interviews that were analysed using thematic analysis.Results62 patients took part. Thirty-four attended for an NHS Health Check plus the intervention; 7 for a standard NHS Health Check; 16 for a chronic disease review plus the intervention; and 5 for a standard chronic disease review. The mean time for delivery of the intervention was 9.6 min (SD 3) within NHS Health Checks and 9 min (SD 4) within chronic disease reviews. Fidelity of delivery of the intervention was high. Data from the questionnaires demonstrates potential improvements in health-related behaviours following the intervention. Patients receiving the intervention found the cancer risk information and lifestyle advice understandable, useful and motivating. HCPs felt that the intervention fitted well within NHS Health Checks and facilitated conversations around behaviour change. Integrating the intervention within chronic disease reviews was more challenging.ConclusionsIncorporating a risk-based intervention to promote behaviour change for cancer prevention into primary care consultations is feasible and acceptable to both patients and HCPs. A randomised trial is now needed to assess the effect on health behaviours. When designing that trial, and other prevention activities within primary care, it is necessary to consider challenges around patient recruitment, the HCP contact time needed for delivery of interventions, and how best to integrate discussions about disease risk within routine care.

Being Present 2.0: Online Mindfulness-Based Program for Metastatic Gastrointestinal Cancer Patients and Caregivers.

PurposeA metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers, which may be alleviated by mindfulness interventions. Research on scalable, tailored, online mindfulness training programs is needed. We sought to test the feasibility and acceptability of a remotely delivered 8-week mindfulness-based intervention, Being Present 2.0 (BP2.0).MethodsWe performed a single-arm feasibility study of BP2.0 among patients with any metastatic gastrointestinal cancer receiving chemotherapy, with or without an informal caregiver. Participants were instructed to practice mindfulness using pre-recorded guided meditations 5 times per week using a study-specific website and to attend a weekly live, interactive virtual meeting facilitated by a trained instructor. The web-based platform enabled direct measurement of adherence.ResultsThe study enrolled 46 of 74 (62%) patients contacted, together with 23 caregivers (69 participants total), from May to October 2018. Median patient age was 52 (range 20-70 years), 39% were male, 67% non-Hispanic white, 65% had colorectal cancer, and 78% lived outside of San Francisco. The top reasons cited for participation were to reduce stress/anxiety and learn how to meditate. Mean baseline National Comprehensive Cancer Network Distress Thermometer (NCCN DT) scores were 4.7 (patients) and 5.8 (caregivers). The study discontinuation rate was 20% (eight patients and six caregivers). Among the remaining 55 participants, 43 (78%) listened to at least one audio recording and/or attended at least one virtual meeting, although adherence data was incomplete. The retention rate was 71%, with 39 participants completing at least one follow-up assessment. In post-intervention qualitative interviews, 88% of respondents reported a positive experience. Compared to baseline, participants reported significantly reduced post-intervention NCCN DT scores (mean 3.1; P = .012).ConclusionThe BP2.0 online mindfulness-based program is feasible and acceptable for patients with metastatic gastrointestinal cancer and caregivers. These results will guide plans for a follow-up efficacy study. ClinicalTrials.gov Identifier: NCT03528863.

Reducing cardiovascular disease risk among families with familial hypercholesterolaemia by improving diet and physical activity: a randomised controlled feasibility trial

ObjectiveFamilial hypercholesterolaemia (FH) elevates low-density lipoprotein cholesterol (LDL-C) and increases cardiovascular disease (CVD) risk. This study aimed to provide evidence for the feasibility of conducting a randomised controlled trial to...

P1.16-11 A Dyad-Based Mindfulness Cancer Recovery Program for Survivors and Family Members to Reduce Lung Cancer Symptoms

Although the five-year survival rate for individuals with NSCLC stages I-IIIa, is increasing, excessive symptom burden remains a distressing problem that negatively impacts quality of life. Our long-term goal is to improve clinical outcomes for survivors of localized lung cancer (NSCLC; stages I–IIIa). The study objective is to test a tailored intervention, Breathe Easier, which encompasses meditation, varying levels of yoga, and breathing exercises to evaluate feasibility and preliminary effects for survivors and family members (dyads). A community-based participatory research approach was used to adapt a mindfulness-based cancer recovery program. Using a prospective, one-group, repeated measures, mixed method design, this study collected feasibility and preliminary data to test the hypothesis that survivors and family members (dyads) who receive an 8-week intervention will demonstrate (a) less dyspnea, (b) less fatigue, (c) improved sleep quality and quantity, (d) improved exercise tolerance and (e) less stress immediately after the intervention. The intervention known as “Breathe Easier” consisted of breathing exercises, individual and partner sitting, standing and floor yoga movements, meditations and participant interaction. The outcome variables were measured pre and immediately post intervention by the FACIT Dyspnea Short Form (Parts 1 and 2), FACIT Fatigue Scale v.4. Pittsburgh Sleep Quality Index, 6-Minute Walk Test, and the Perceived Stress Scale v.4. Post-intervention qualitative interviews were conducted. Descriptive statistics were obtained for five quantitative feasibility measures (recruitment, retention, intervention dose, adherence, acceptability). Thematic analysis was used to interpret the qualitative data. In six iterations of the intervention,164 survivors were reached, and 32 dyads enrolled (62 participants; 20% recruitment and 94% retention rates). Survivors were 44% male and 62% African American. Among all, 74% were not current smokers, 22% used oxygen, and 71% completed a six-minute walk test post-intervention. Adherence was demonstrated by good attendance and exceeding expectations on home assignments for breathing exercises and meditations. All participants practiced gentle movements (yoga), meeting approximately 80% of expectations. Survivors reported completing daily home assignments slightly more than family members. All agreed that the intervention materials were easy to use, learning yoga and breathing exercises helped, and involving a family member was important. For each outcome variable, differences in survivors versus partners were calculated. Survivors had less dyspnea and perceived stress over time. Both groups had improved fatigue and sleep scores. Interview data enriched the understanding of feasibility and preliminary outcome measures. Six themes illustrated participants’ experiences: (1) Learning to Breathe Easier, (2) Enhanced Closeness with Committed Partners, (3) Stretching, Releasing Tension, and Feeling Energized, (4) Interacting with Others as Beneficial, (5) Refocused on Living, and (6) Sustainability as a Decision. Recruitment, retention, adherence, and acceptability demonstrated strong feasibility. Preliminary outcome data indicate benefits over time for both survivors and family members.

Adolescents With Overweight or Obesity: A Qualitative Study of Participation in an Internet-Based Program to Increase Physical Activity.

Adolescents who are overweight or obese are reported to be less active than their peers. Motivation is a critical factor in sustaining physical activity and thereby positive health outcomes. This qualitative study explores how participation in a 12-week Internet-based intervention study, Young & Active, influenced the participants’ short-term and long-term motivation to increase and sustain physical activity. The overall purpose of Young & Active was to design, test, and evaluate a health-promoting Internet-based program for use in the school health services in Norway. The program was informed by self-determination theory and motivational interviewing. Two postintervention qualitative research interviews were conducted with 21 adolescents, aged 13 to 14 years, with a 9- to 12-month interval. The adolescents were recruited from a total of 84 participants from the Young & Active study intervention group. Data were analyzed using qualitative content analysis. Self-determination theory was used as a theoretical and explanatory framework. Following the motivational continuum from self-determination theory, all adolescents showed changes in motivation, from extrinsic toward more intrinsic motivation, and for some, a reversal after completing the program. Analysis of the adolescents’ utterances formed patterns that could be divided into four main categories: (a) reinforcement of a habit, (b) promotion of competence and enjoyment, (c) boost of temporary change, and (d) reinforcement of adverse habits. An Internet-based intervention may help adolescents increase and sustain physical activity if participation is based on self-choice and if they have sufficient support in their social environments. The intervention alone is not enough to support adolescents who are less motivated or have other challenges in life and may even provoke resistance and reinforce negative health behavior. Such a program may be used together with face-to-face counseling in school health services, provided that it is further refined on a larger scale and that the counseling is performed by qualified health service professionals.

When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults.

BackgroundA telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity.ObjectiveThe goal of this project was to increase older adults’ daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation.MethodsThe Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis.ResultsTwenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns.ConclusionsA telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place.

Being Present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers.

A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers. Mindfulness interventions can reduce distress and improve quality of life in cancer patients. However, standard mindfulness training relies on in-person instruction, which is often not practical for either patients receiving chemotherapy or their caregivers. In the Being Present single arm pilot study, we designed and tested an 8-week audio-based mindfulness meditation program for patients with metastatic colorectal cancer receiving chemotherapy with or without a participating caregiver. The study accrued 33 of 74 (45%) eligible patients consenting together with 20 family caregivers (53 participants total) within nine months. Forty-one participants were evaluable (77%); 10 of 12 cases of attrition were attributable to hospitalization or death. Median participant age was 51 (range 21–78 years); 38% were men. Baseline levels of distress were similar in patients and caregivers. The top reasons for participation cited in pre-intervention interviews were to increase relaxation/calm, improve mood/emotions, and reduce stress/anxiety. In measures of adherence, 59% of responses to weekly texts asking: “Have you practiced today?” were “Yes” and 59% of interviewees reported practicing >50% of the time. Compared to baseline, post-intervention surveys demonstrated significantly reduced distress (p = 0.01) and anxiety (p = 0.03); as well as increased non-reactivity (p<0.01), and feeling at peace (p<0.01). Post-intervention qualitative interviews, where 71% of participants reported benefit, were consistent with quantitative findings. In the interviews, participants spontaneously described reduced stress/anxiety and increased relaxation/calm. Benefits appeared to be accentuated in patient-caregiver pairs as compared to unpaired patients. Seventy-nine percent of participants reported plans for continued practice after study completion. We conclude that the Being Present audio-based mindfulness meditation program is of interest to, feasible, and acceptable for patients with metastatic colorectal cancer and caregivers, with initial evidence of efficacy. These results will guide plans for a follow-up study.Trial registration: ClinicalTrials.gov NCT02423720

Developing inclusive residential care for older lesbian, gay, bisexual and trans ( LGBT ) people: An evaluation of the Care Home Challenge action research project

There have been substantial achievements in legislative and human rights for lesbian, gay, bisexual and transgender (LGBT) older people and their visibility in health and social care has equally increased. These appear to have surpassed the ability of care services to meet their needs given documented concerns about the accessibility, inclusiveness and safety of care services particularly institutionalised care. This requires systemic change not easy to operationalise. This paper describes an action research initiative where six care homes belonging to a national care provider, collaborated to assess and develop their services with the support of local LGBT "Community Advisors" and academic partners. Framed within Rogers' (2003) change management framework and combined with a participatory leadership approach, a programme of intervention was implemented comprising structured activities around seven key areas thought to promote LGBT inclusion. A formal evaluation was conducted involving 35 pre- and post-intervention qualitative interviews with 18 people (community advisors; care home managers and senior managers). The findings are presented across three key themes (1) starting points on the journey; (2) challenges encountered along the journey (organisational and interpersonal); and (3) making change happen; opportunities, initiatives and gains. We make recommendations on the value of a programme approach for achieving tangible outcomes that demonstrate increased inclusion for older LGBT people living in long-term care settings.

Simple to Use: Reflections From a Mobile Sleep Study Pilot

Background: Difficulty falling asleep and staying asleep are common problems that affect over 30 million Americans. Additionally, we know that military personnel and Veterans often have insomnia problems post deployment. Home sleep monitors can be used to diagnose sleep disorders and determine if the sleep issue cause is a physical issue, such as obstructive sleep apnea. Some non-physiological causes may be improved by focusing on behavioral change, which can be assisted by mobile health (mHealth) technologies. In addition, mHealth apps are an increasingly popular method to deliver behavioral change interventions for a variety of conditions, with the cognitive behavioral therapy for Insomnia Coach app (CBT-i Coach) being particularly popular (it has been downloaded over 80,000 times in 86 countries). Objective: In this pilot trial we assessed the usability and feasibility of mobile health information technologies (HITs) designed to reduce sleep problems in post-9/11 Veterans with chronic insomnia. We used the CBT-i Coach mobile app (based on cognitive behavioral therapy for insomnia) and supplemented it with usage instructions to enhance self-management. Participants also used a home-based sleep monitor (WatchPAT) to obtain objective sleep data to assess possible sleep apnea and to provide subjects with objective data to motivate behavioral change. Methods: Thirty-eight post-9/11 Veterans met criteria for insomnia on the Insomnia Severity Index (ISI). We assessed feasibility and usability of the HITs over a 6-week intervention with a pre-post design. The WatchPAT was used to screen for sleep apnea, and those with moderate to severe apnea were withdrawn from the trial and referred for further assessment. Participants were given a self-management guide which detailed when to use different elements of the CBT-i Coach app, including guidance to complete a sleep diary each morning. Assessments were completed at the beginning, middle, and end of the 6-week intervention. Results: Of the 38 enrolled, 18 participants were withdrawn for moderate or severe sleep apnea as measured by the WatchPAT, and 9 withdrew for personal reasons. Post-intervention qualitative interviews revealed that many participants found both the CBT-i Coach app and WatchPAT easy to use. Participants also liked tracking their daily sleep and seeing graphical results of their sleep changes over time, with only 2 of the final 11 participants completing CBT-I Coach sleep diaries less than 85% of the time. Exploratory analyses on the 11 completers also revealed significant but modest differences between baseline ISI scores (M=16.63, SD = 5.55) and post-intervention follow-up (M=12.82, SD = 3.74; t (10) = 4.14, P<.01). Conclusions: We found good usability of the combined CBT-i Coach app and WatchPAT sleep intervention and determined that feasibility was reasonable, with more than half of those not excluded due to apnea completing all assessments. The pilot demonstrated reasonable feasibility and usability of the mobile HIT tools which could provide an accessible adjunct or alternative to in-person cognitive behavioral therapy for insomnia to improve the health and wellbeing of busy individuals. [iproc 2017;3(1):e53]

HIV stigma experiences and stigmatisation before and after a HIV stigma-reduction community “hub” intervention

This study sought to explore, describe and determine whether an HIV stigma-reduction community “hub” intervention would change the HIV stigma experiences of people living with HIV (PLWH) and the stigmatisation by the community in an urban area in South Africa. A convergent parallel mixed-method design with a single case pre-test post-test design and an interpretive description approach was utilised. The sample for this study included 62 PLWH recruited through accessibility sampling and 570 community members recruited through random voluntary sampling. A sub-sample of both groups, selected using purposive voluntary sampling, was utilised for the in-depth interviews about stigma experiences of PLWH, and for perceptions and attitudes of the community toward PLWH. Both quantitative and qualitative data showed that stigma is present. Although no statistically significant changes were found, small practically significant changes were demonstrated in the experiences of PLWH and in the perceptions and attitudes of the community. The extent of changes was much more obvious in the responses of the PLWH and the community during their post-intervention qualitative interviews than the changes found with the quantitative measures. This study thus concludes that the HIV stigma-reduction community hub intervention was successful in initiating the onset of changes in a community through the PLWH and people living close to PLWH (PLC) as community mobilisers active in the community hub to mobilise their own communities towards HIV stigma reduction through social change.

Building young women's knowledge and skills in female condom use: lessons learned from a South African intervention.

Partner negotiation and insertion difficulties are key barriers to female condom (FC) use in sub-Saharan Africa. Few FC interventions have provided comprehensive training in both negotiation and insertion skills, or focused on university students. In this study we explored whether training in FC insertion and partner negotiation influenced young women's FC use. 296 female students at a South African university were randomized to a one-session didactic information-only minimal intervention (n= 149) or a two-session cognitive-behavioral enhanced intervention (n= 147), which received additional information specific to partner negotiation and FC insertion. Both groups received FCs. We report the 'experiences of' 39 randomly selected female students who participated in post-intervention qualitative interviews. Two-thirds of women reported FC use. Most women (n= 30/39) applied information learned during the interventions to negotiate with partners. Women reported that FC insertion practice increased their confidence. Twelve women failed to convince male partners to use the FC, often due to its physical attributes or partners' lack of knowledge about insertion. FC educational and skills training can help facilitate use, improve attitudes toward the device and help women to successfully negotiate safer sex with partners. Innovative strategies and tailored interventions are needed to increase widespread FC adoption.

Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial.

Objective. To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM). Design. A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n = 24) or wait control (n = 26) and postintervention qualitative interviews with participants. Main Outcome Measures. Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up. Results. At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance. Conclusions. Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.

Putting habit into practice, and practice into habit: a process evaluation and exploration of the acceptability of a habit-based dietary behaviour change intervention.

BackgroundForming ‘habit’ – defined as a learned process that generates automatic responses to contextual cues – has been suggested as a mechanism for behaviour maintenance, but few studies have applied habit theory to behaviour change. This study used process evaluation data, taken from a randomised controlled trial of a healthy child-feeding intervention for parents previously shown to be effective, to explore the applicability to dietary behaviour change of predictions and recommendations drawn from habit theory. The intervention supported parents in pursuing child-feeding habit goals in three domains (giving fruit and vegetables, water, healthy snacks), over four fortnightly home visits. We explored whether (a) the habit-formation model was acceptable to participants, (b) better-specified habit-formation goals yielded greater habit gains, and (c) habit gains were sustained (d) even when subsequent, new habit goals were pursued.MethodsQualitative and quantitative data were taken from 57 parents randomised to the intervention arm, and so analyses presented here used a pre-post intervention design. Thematic analysis of post-intervention qualitative interviews evaluated acceptability, and self-reported habit goals were content-analysed. ANOVAs explored changes in habit strength, recorded at home visits and one- and two-month follow-ups, across time and goals.ResultsParticipants understood and engaged positively with the habit-formation approach. Although many seemingly poorly-specified habit goals were set, goal characteristics had minimal impact on habit strength, which were achieved within two weeks for all behaviours (p’s < .001), and were maintained or had increased further by the final follow-up.ConclusionsThe habit-formation model appears to be an acceptable and fruitful basis for dietary behaviour change.

Evaluation of an Online Education and Support Intervention for Adolescents With Diabetes

The current study evaluated an online education and support website intervention for adolescents with Type 1 diabetes. Participants were enrolled in an 8-week, online program addressing diabetes-related issues for adolescents. The evaluation comprised an intervention trial in which participants were assigned to an intervention or control group, and pre- and post-intervention measures of social support were administered. Outcomes indicated interventional gains approaching significance in participants' quality of relationships with others external to their family. Post-intervention qualitative interviews with intervention group participants identified beneficial impacts of decreased isolation, knowledge gain, and normalization of experience. Findings suggest that online information and support is an important resource in augmenting clinical care. Implications and recommendations for clinical practice are discussed.