Adaptation Process Research Articles

Muscle Mass and Glucagon-Like Peptide-1 Receptor Agonists: Adaptive or Maladaptive Response to Weight Loss?

Recent studies have shown that pharmacologic weight loss with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combination therapies is approaching magnitudes achieved with surgery. However, as more weight loss is achieved, there is concern for potential adverse effects on muscle quantity, composition, and function. This primer aims to address whether muscle-related changes associated with weight loss treatments such as GLP-1 RAs may be maladaptive (ie, adversely affecting muscle health or function), adaptive (ie, a physiologic response to weight loss maintaining or minimally affecting muscle health or function), or perhaps an enhanced response to weight loss (ie, improved muscle health or function after treatment). Based on contemporary evidence with the addition of studies using magnetic resonance imaging, skeletal muscle changes with GLP-1 RA treatments appear to be adaptive: changes in muscle volume z-score indicate a change in muscle volume that is commensurate with what is expected given aging, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function. Nevertheless, factors such as older age and prefrailty may influence the selection of appropriate candidates for these therapies because of risk for sarcopenia. Several pharmacologic treatments to maintain or improve muscle mass designed in combination with GLP-1-based therapies are under development. For future development of GLP-1-based therapies (and other therapies) designed for weight loss, as well as for patient-centered treatment optimization, the introduction of more objective and comprehensive ways of assessing muscle health (including accurate and meaningful assessments of muscle quantity, composition, function, mobility, and strength) is important for the substantial numbers of patients who will likely be taking these medications well into the future.

Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation.

Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523.

Reliability and validity of the Chinese version of the family presence risk-benefit and self-confidence scales in Chinese nurses

BackgroundControversy surrounding Family Presence during Resuscitation (FPDR) continues internationally. The attitudes of medical professionals toward FPDR are particularly important for its clinical implementation. Currently, there is a lack of validated tools to evaluate medical professionals’ perceptions of FPDR in China. The study aimed to: (1) Cross-culturally adapt and validate the Family Presence Risk-Benefit Scale (FPR-BS) and the Self-Confidence Scale (FPS-CS) for use in China; and (2) investigate the nurses’ perceptions of FPDR and explore the relationships between the nurses’ perceptual variables and demographic variables.MethodsThe English version of the FPR-BS and FPS-CS underwent a rigorous process of translation, back-translation, proofreading, and cultural adaptation to create the Chinese versions. In the first stage, a sample of 200 nurses were recruited to evaluate the reliability and validity of the scales. In the second stage, a larger cohort 519 nurses were invited to assess their perceptions of FPDR and the relationships between these perceptual variables and demographic variables.ResultsExploratory factorial analysis identified a single dimension for both the FPR-BS and FPS-CS, explaining 43.84% and 48.43% of the variance, respectively. The Scale-level content validity index (S-CVI) of the FPR-BS and the FPS-CS was 0.98 and 0.97, respectively. Reliability assessments yielded Cronbach’s alpha coefficients of 0.933 for the FPR-BS and 0.930 for the FPS-CS. The split-half reliability coefficients were 0.832 for the FPR-BS and 0.835 for the FPS-CS, while the retest reliability coefficients were 0.742 and 0.927, respectively. The average scores obtained were 2.76 (SD = 0.52) for the FPR-BS and 3.43 (SD = 0.58) for the FPS-CS. Statistical analyses revealed that factors such as patient type, family members’ prior experience with resuscitation, and the number of times nurses invited family members during resuscitation significantly influenced perceptions of the benefits and risks associated with FPDR (P < 0.05). Furthermore, obtaining certification as an intensive care specialist was positively associated with nurses’ self-confidence in managing FPDR (P < 0.05).ConclusionsThe FPR-BS and FPS-CS were validated as effective instruments for measuring nurses’ perceptions of PFDR, demonstrating acceptable levels of validity and reliability. While nurses reported fewer benefits and greater risks of FPDR, they exhibited increased self-confidence in managing family presence during resuscitation.

ʻĀina as resilience: mapping community networks and collaborative care in Hawaiʻi

This article examines the growth of Indigenous grassroots community groups across Hawaiʻi, whose efforts are pivotal to place-based climate change resilience and community well-being. Instead of focusing on specific ecosystem resilience actions, it highlights the people and places that make this movement of community organizations resilient, leveraging both social and cultural strengths to adapt to climate impacts. For many Indigenous peoples, climate change is not new; adaptation has already been integral to relationships between environment and culture. These changes require culturally responsive approaches, not short-term engineering solutions such as coastal hardening or stream channelization. A collaboration between a grassroots artist mapping initiative (‘ĀINAVIS) and a university’s community-based research project (‘ĀINA KUPU), this study utilizes a novel data index compiled using publicly available information to inform a series of in-depth student interviews with community groups across Hawai‘i whose mission, vision, and work are dedicated to caring for ‘āina. We find that these “ʻĀina Organizations” articulate climate resilience in multi-faceted and culturally grounded ways, maintaining reciprocal and mutual relationships with ʻāina, the Hawaiian term for land meaning “that which feeds.” Facing various challenges and needing different systems of support, our work maps the dynamic adaptability of ‘āina expressed through community networks of collaborative care with emphasis on the importance of intergenerational knowledge and genealogical connection to place shared and passed onto future generations. The article concludes by emphasizing the importance of working on ‘āina as an exercise of Indigenous sovereignty, expanding climate resilience with cultural practice and social justice as both outcome and process of climate change adaptation.

Enhancing Flexible Assessment Through ePortfolios: A Scholarly Examination

In contemporary educational settings, the demand for flexible assessment practices has gained prominence due to students' diverse learning needs and preferences. Portfolios have emerged as a versatile tool for facilitating personalised and adaptable assessment processes. This paper investigates how ePortfolios can cater to students' flexible assessment needs. By examining the benefits, challenges, and implementation strategies associated with ePortfolios, this paper highlights their potential to enhance assessment practices, foster student engagement, and promote lifelong learning. As part of implementation strategies, we provide examples to support teaching staff and institutions in translating the underpinning principles and theory into actionable practice.

Staged suppression of main-lobe compound jamming using airborne distributed arrays

For the compound jamming scenario where noise suppression jamming and interrupted sampling repeater jamming simultaneously exist, we propose a method of staged suppression of them using distributed arrays. The basic principle is using the generalized inner product for the selection of non-uniform samples. By using the generalized inner product quadratically for the staged selection of the samples, we can obtain the statistical feature estimates of the noise suppression jamming and the interrupted sampling repeater jamming, respectively, and then complete the robust suppression of the compounded jamming using the distributed array spatial domain adaptive processing. With typical configuration of parameters, we validate and analyze the effectiveness and performance of the proposed method through numerical simulation experiments.

Cross-cultural adaptation of the Quebecois Patient-Centered Coordination by a Care Team Questionnaire for use in France

BackgroundThe prevalence of chronic disease and multimorbidity is increasing and the associated disease and treatment burden is particularly heavy. Coordinated multidisciplinary, patient-centered care is particularly important for people living with chronic disease or multimorbidity. There was no valid tool to measure the quality of coordinated patient-centered care from the patient’s perspective until the Patient-Centered Coordination by a Care Team (PCCCT) questionnaire was recently developed in Canada (Quebec/Ontario). The Quebecois version has been validated but is not directly transferable to France due to linguistic, cultural and health system differences between the two countries. To perform a cross-cultural adaptation of the Quebecois PCCCT questionnaire is therefore necessary to obtain a questionnaire’s new version adapted for use in France, ensuring item and semantic equivalence.MethodsThe adaptation process consisted of two stages, both of which were supervised by a scientific committee made up of five healthcare professionals. The first stage was a Delphi consensus involving a multidisciplinary healthcare professional panel to evaluate and harmonize the clarity and appropriateness of the questionnaire for patients in the French health system. During the second stage, adult patients with one or more chronic diseases, from various age, sex, socio-occupational categories, assessed the comprehensibility and conformity of the adapted version of the questionnaire resulting from stage 1 and improved it if necessary. This was achieved using cognitive interviews.ResultsDuring Stage 1, two rounds were undertaken with 10 professional experts resulting in consensual reformulation of 10 out of the 14 items. These newly formulated items and the 4 remaining items were submitted to patients in Stage 2. Cognitive interviews were undertaken with 14 patients, testing 3 successively adapted versions of the questionnaire, until three consecutive patients did not find any ambiguity or misunderstanding. The final version resulting from the cross-cultural adaptation process aimed at being used in France, has item and semantic equivalence to the original Quebecois version.ConclusionsMeasurement equivalence will be addressed in a future study. This French version is intended to be a useful resource for the health system reforms aimed at promoting more integrated and patient-centered care pathways.

Adaptive nonlinear filtering algorithms for removal of non-stationary noise in electronystagmographic signals

Non-stationary physiological noise poses significant difficulties due to its time-varying and previously unknown characteristics. When processing electronystagmographic signals, linear filtering can distort diagnostically significant rapid changes caused by saccadic eye movements. In such cases, nonlinear filters based on robust estimators are more appropriate, whereas linear filtering effectively reduces white noise in parts of a signal with linear behaviour. Therefore, an adaptive signal processing approach that varies in nonlinearity from highly nonlinear robust estimation to linear averaging and combines their benefits appears promising. We have proposed a low-complexity adaptive method for switching filter sets and relevant filter parameter settings based on the estimated noise level and local signal behaviour. This method does not require time for filter parameter modification and does not need prior information on the signal model and noise variance. Based on this method, we have designed adaptive nonlinear filtering algorithms to exploit the advantages of both the nonlinear robust and linear averaging estimators. We have evaluated the filtering quality statistically using the minimum mean square error criteria and the maximum signal-to-noise ratio for a model signal with different levels of additive Gaussian noise. The proposed real-time adaptive filtering algorithms demonstrate a significant efficiency improvement compared to the commonly used filters. The proposed adaptive myriad algorithm achieves the highest efficiency by adjusting a sample myriad linearity parameter depending on the local estimate of a signal scale and changing the sliding window length and the coefficient affecting the linearity parameter.

Adaptive threshold wavefront sensing for portable adaptive optics system driven by hybrid parallel technique

Abstract Our Portable Adaptive Optics (PAO) system designed for high-contrast imaging of exoplanets with current 2-4 meter class telescopes achieves a correction speed of nearly 1000Hz, utilizing a Shark-Hartmann Wavefront Sensor (S-H WFS) in a $9\times9$ sub-aperture configuration. As we look towards adapting the PAO system for larger telescopes, an increase in the number of sub-apertures in the WFS and enhanced precision in wavefront detection are imperative. Originally programmed in LabVIEW, our initial PAO software is based on a traditional centroid calculation module for nighttime wavefront sensing and lacks adaptive processing of background noise. To address these limitations and to boost the PAO system’s performance and accuracy in wavefront detection, we propose a compressive neural network(Th-Net) combined with a specialized hybrid parallel programming approach for wavefront detection. Our experimental results indicate that this hybrid parallel technique and Th-Net significantly enhance the PAO system’s operational speed and wavefront detection precision under uneven background noise. This work paves the way that a duplicable and low-cost PAO system can be used for direct imaging of exoplanet with large telescopes.

Translation and cultural adaptation of evidence-informed leaflets on the work-health interface: a pragmatic approach to cultural adaptation.

Our aim was to translate and culturally adapt three evidence-informed leaflets on the work-health interface from English into Norwegian. Integral to this aim was the exploration of the quality and acceptability of each of the adapted leaflets to Norwegian-speaking stakeholders; general practitioners, people who deal with health issues in the workplace, and the general population. Common health problems, such as musculoskeletal pain, account for most workdays lost and disability benefits in Norway. To facilitate return to work, it may be important to have access to evidence-informed information on the work-health interface for stakeholders involved in sickness absence processes. However, there is limited information material available in Norwegian that is tailored for the different stakeholders. Cultural adaptation is an emerging strategy for implementing health information across different populations and regions. Guidelines on cultural adaptation are not well-suited for translating and adapting evidence-informed health information material. We conducted a pragmatic cultural adaptation process informed by existing guidelines. Our conceptual framework for adaptation is situated between adaptation and translation and comprises appraisal, forward- and back-translation, review in multiple steps, sense checking, and re-designing using a transcreation approach. Using an online survey, we aimed to evaluate the overall quality, value, acceptability, and clarity of each of the adapted leaflets to a total of 30 end-users. We translated and culturally adapted three leaflets from English to Norwegian. Adapted leaflets were found to be clearly presented, acceptable, and valued by 45 Norwegian end-users. No differences in key concepts between original and back-translated leaflets emerged through the review process by the original author and forward translators. We used a pragmatic approach in this study that might be useful to others culturally adapting evidence-informed health information material.

Family Farm Resilience during the COVID-19 Pandemic in Indonesia: Case Studies on Organic and Conventional Farming

The COVID-19 pandemic has brought additional stressors to Indonesian family farms, which are already subject to drought, flood, landslide, pest attack, and market price fluctuations. This study aims to analyse family farms’ resilience to the stressors caused by the COVID-19 pandemic using Henry’s family resilience model. Applying a qualitative approach, this study collected data using focus group discussions in two villages in East Java and a village in Center Java. The data was analysed using thematic analysis. We discovered that stressors related to the COVID-19 pandemic are lower demand on agricultural products and lower income among farmers. Organic and conventional farmers have different protection and vulnerability factors. Organic farmers are able to reach buyers directly using social media amid COVID-19 restrictions while conventional farmers still rely on sales through middlemen. The adaptive process of farming families is influenced by social psychological factors within the family such as meaning, emotion, control, and maintenance systems. This study suggests that family farmers have to be empowered in terms of their innovative production in current stressors and increase their access to the market as a priority for agricultural extension programmes.

Self-creation of Older People in the Perspective of Developing Wisdom and Adaptation to Changing Roles in the Family and Society

Old age is a stage of life during which a person must confront the changes that occur both in the reality around them and in themself. Those are changes at the biological, psychological and social levels. Adapting to old age and the roles it brings becomes a difficult and demanding task. One of the most important developmental tasks of an elderly person is developing wisdom that can support and facilitate the process of adaptation to old age. Entering the period of late adulthood is therefore a special opportunity for further development and self-creative action of the individual leading to the creation of a mature identity of an old person. The aim of this text is to provide insight into the meaning and manifestations of this self-creative involvement, with particular emphasis on its importance in the process of adaptation to changing roles in old age and building wisdom.

Overgeneralization of autonomic defensive reactions in obesity

Generalizing defensive responses to new stimuli resembling learned threats is an adaptive process within an ever-changing environment. However, evaluation mechanisms excessively biased toward generalization (i.e., overgeneralization) may underlie anxiety-related symptoms. In the context of obesity, fear memory and fear generalization processes have never been investigated. In this study, participants with obesity and healthy participants as controls underwent a single-cue auditory fear conditioning paradigm and recognition memory tasks. We analyzed the autonomic reactions evoked by threat-predictive and new stimuli, as well as the recognition performance towards the same cues. We found that participants with obesity displayed similar autonomic defensive responses to a learned fearful stimulus, but enhanced reactions to new stimuli, when compared with the controls. We detected no significant differences between groups in recognition abilities. Our results provided the first evidence that obesity may widen fear generalization patterns. This alteration may encourage future research in investigating the link between emotional dysregulation and clinical anxiety-related symptoms in obesity.

Reveal mechanical and optical properties changes during prolonged skin stretching via in vivo continuous investigation

Skin expansion is a well-established technique in plastic surgery, and recent studies have highlighted its potential in promoting hair regeneration. This study aimed to explore how the mechanical and optical properties of skin change during a prolonged stretching process. A hybrid method was developed to assess, in vivo, the effects of an 8-day skin stretching protocol—previously used in hair regeneration research—on the dorsal skin of mice. This method combined mechanical and optical measurement systems. Tensile stress–strain curves were generated using a spring-based setup, while optical properties such as scattering and birefringence were analyzed with a polarimetry imaging system that incorporated the Mueller matrix (MM) and Mueller matrix polar decomposition (MMPD) methods. The results showed that Young's modulus increased from approximately 5 kPa on day 1 to 60–100 kPa by days 6–8, indicating collagen fiber straightening and increased stiffness. Optical analysis revealed greater anisotropy in both scattering and birefringence, as reflected by changes in MM elements and MMPD results. These changes suggest skin adaptation and regeneration, particularly within the first 24 h of stretching. Interestingly, alterations in optical properties closely mirrored changes in mechanical properties, pointing to a coordinated process of structural remodeling and functional adaptation in the skin. These findings offer valuable insights into skin remodeling and adaptation, which could guide future tissue engineering strategies.

Sharp habitat shifts, evolutionary tipping points and rescue: Quantifying the perilous path of a specialist species towards a refugium in a changing environment

Specialist species thriving under specific environmental conditions in narrow geographic ranges are widely recognized as heavily threatened by climate deregulation. Many might rely on both their potential to adapt and to disperse towards a refugium to avoid extinction. It is thus crucial to understand the influence of environmental conditions on the unfolding process of adaptation. Here, I study the eco-evolutionary dynamics of a sexually reproducing specialist species in a two-patch quantitative genetic model with moving optima. Thanks to a separation of ecological and evolutionary time scales and the phase-line study of the selection gradient, I derive the critical environmental speed for persistence, which reflects how the existence of a refugium impacts extinction patterns and how it relates to the cost of dispersal. Moreover, the analysis provides key insights about the dynamics that arise on the path towards this refugium. I show that after an initial increase of population size, there exists a critical environmental speed above which the species crosses a tipping point, resulting into an abrupt habitat switch. In addition, when selection for local adaptation is strong, this habitat switch passes through an evolutionary “death valley”, leading to a phenomenon related to evolutionary rescue, which can promote extinction for lower environmental speeds than the critical one.

Model-based portrait video compression with spatial constraint and adaptive pose processing

Model-based portrait video compression with spatial constraint and adaptive pose processing

Adaptation and Validation of the Moral Distress Scale-Healthcare Professionals in Latvia

Moral distress occurs when an individual recognizes the ethically appropriate action in a given situation but is prevented from acting on it due to external factors. The MMD-HP represents a major update to the previously revised Moral Distress Scale (MDS-R). This tool was designed and refined to measure the extent of moral distress experienced by healthcare professionals when encountering ethical challenges. The adaptation and validation process was conducted in four phases, employing various psychometric measures to ensure the scale's consistency with the original study. Psychometric indicators used include Cronbach’s alpha, Pearson correlation, and confirmatory factor analysis, among others. The MMD-HP total score ranged from 4 to 207, with a mean score of 95.3 (SD 53.8) for n=12, 79 19 (SD 46.4) for n=48, and 115.7 (SD 75.1) for n=201. The overall Cronbach's alpha in each phase of our study ranged from 0.907 to 0.965 The Chi-square of the scale was 315.49 and χ²/df = 0.9. The CFI was 0.934, TLI 0.913, and NFI was 0.891. The RMSEA was 0.059 and SRMR 0.08. We determined that the Latvian version of the MMD-HP is valid and reliable for assessing moral distress among nurses in Latvia.

Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions

Breast cancer poses a significant global health challenge, with Iran experiencing particularly high incidence and mortality rates. Understanding the adaptation process of Iranian breast cancer survivors’ post-treatment is crucial. This study explores the health perceptions, barriers, and coping mechanisms of Iranian survivors by integrating Stress-Coping Theory (SCT) and the Health Belief Model (HBM). Semi-structured interviews were conducted with 17 survivors, and a grounded theory approach guided the deductive content analysis of the data. The findings reveal key themes, including perceived susceptibility, benefits, barriers to care, cues to action, self-efficacy, and appraisal of action. Perceived susceptibility highlights diagnostic challenges stemming from practitioner errors and symptom misconceptions. Perceived benefits underscore the importance of early detection and support from healthcare providers and families. Barriers include cultural and financial obstacles, while cues to action reflect the influence of media, family, and personal experiences on healthcare-seeking behavior. The study also examines coping strategies, such as problem-focused and emotion-focused approaches, along with family support and external stressors. To address these barriers and enhance support systems, the study suggests specific strategies for healthcare providers, including targeted training to improve diagnostic accuracy and patient communication. Culturally sensitive awareness campaigns can correct symptom misconceptions, while financial counseling can mitigate economic barriers. Establishing community-based support groups and involving family members in care plans can enhance emotional and psychological support. These strategies aim to overcome the identified barriers and improve support systems for Iranian breast cancer survivors, ultimately fostering better recovery outcomes.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Smart Tools Proneness Questionnaire (STP-Q).

This study elucidates the cross-cultural adaptation, reliability, and validity of the Turkish version of the Smart Tools Proneness Questionnaire (STP-Q), designed to probe into individuals' engagement with smart tools within the Turkish cultural milieu. Undertaking a rigorous adaptation process, this investigation aimed to ensure the questionnaire's relevance and intelligibility, subsequently, assessing its psychometric properties within a cohort of 387 participants. The exploratory factor analysis revealed a tripartite structure that reflects the original instrument, covering utilitarian use, hedonic and social use, and the inclination to delegate tasks. This congruity underscores the STP-Q's adeptness in capturing the complex dimensions of smart tool interaction across various contexts. Demonstrated by a Cronbach's alpha of 0.954 and a test-retest reliability index of 0.851, the results affirm the questionnaire's exceptional internal consistency and significant temporal stability. Further, the execution of convergent validity assessments alongside the E-Learning Readiness Scale and the Nomophobia Questionnaire augmented the STP-Q's validity, unveiling correlations that delineate the intricate interrelations among smart tool proneness, e-learning readiness, and nomophobia. Conclusively, the STP-Q distinguishes itself as a reliable and valid instrument for gauging tendencies towards smart tool use among the Turkish populace, providing profound insights into digital behavior across different cultural backgrounds. Its confirmed three-factor structure and robust psychometric attributes render it an indispensable resource for both individual assessments and expansive digital behavior investigations, enabling cross-cultural comparisons and enhancing our understanding of technology engagement dynamics.

United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study.

People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.