Self-administered Intervention Research Articles

Mood changes by self-administered acupressure in Japanese college students: a randomized controlled trial.

The aim of this 2-week study was to examine the effects of self-administered acupressure intervention onlevels of mood of 54 students (34 males and 20 females) majoring in acupuncture and moxibustion medicineat a college located in Fukuoka, Japan. Eligibility criteria were the ability to complete the intervention accurately and no history of psychiatric diseases. The students were randomly assigned to one of the two groups: an intervention group (IG, n = 28) and a control group (CG, n = 26). The IG participants completed fiveacupressure sessions three times a day (morning, noon, and night), involving the application of pressure to six acupuncture points (GB12, SI17, and LI18 according to 2008 World Health OrganizationRegional Office in the Western Pacific standard), three on the left and three on the right side of the neck for 5 s each. The CG participants were requested to spend their time as usual. Self-reported levels of tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, and confusion over the past week were measured before and after the study as the main outcomes. Side effects were not predicted and not assessed. The retention rate of this trial was 100%. Improvements in mood, defined as a change from baseline to 2 weeks later, were significantly greater in IG. Our results showed that self-administered intervention had the ability to alter mood levels in college students.

Results of a Pilot Test of a Self-Administered Smartphone-Based Treatment System for Alcohol Use Disorders: Usability and Early Outcomes

ABSTRACT. Background: This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. Methods: Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A–enabled smartphone for 6 weeks. Results: Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. Conclusions: Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer

BackgroundHope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity (“Stories of the Present”). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred.MethodsA time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data.ResultsHerth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience.ConclusionsThe Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy.Trial registrationsRegistration ClinicalTrails.gov, NCT01081301.

Development of a Smartphone-Based, Self-Administered Intervention System for Alcohol Use Disorders

Advances in mobile technology provide an opportunity to deliver in-the-moment interventions to individuals with alcohol use disorders, yet availability of effective “apps” that deliver evidence-based interventions is scarce. The authors developed an immediately available, portable, smartphone-based intervention system whose purpose is to provide stand-alone, self-administered assessment and intervention. In this article, the authors describe how theory and empirical evidence, combined with smartphone functionality, contributed to the construction of a user-friendly, engaging alcohol intervention. With translation in mind, the authors discuss how they selected appropriate intervention components including assessments, feedback and tools, that work together to produce the hypothesized outcomes.

Internet-based randomized controlled trials: a systematic review

The internet is increasingly being used to conduct randomized controlled trials (RCTs). Knowledge of the types of interventions evaluated and the methodological quality of these trials could inform decisions about whether to conduct future trials using conventional methods, fully online or a mixture of the two. To identify and describe the scope of internet-based RCTs for human health condition interventions and evaluate their methodological quality. A systematic review of RCTs of any health intervention conducted fully or primarily on the internet was carried out. 23 fully and 27 primarily internet-based RCTs were identified. The first was conducted in 2000. The majority of trials evaluated interventions that involved providing health information to participants, but a few evaluated self-administered interventions (eg, valerian, stretching). Methodological quality was variable and the methods were generally poorly reported. The risk of bias was low in only a small number of trials; most had substantial methodological shortcomings. Only one trial was identified as meeting all criteria for adequate methodological quality. A particular problem was high rates of loss to follow-up (fully online: mean 47%; primarily online: mean 36%). It is theoretically possible but perhaps difficult to test the effectiveness of health interventions rigorously with RCTs conducted fully or primarily over the internet. The use of the internet to conduct trials is more suited to pragmatic rather than explanatory trials. The main limitation of these trials is that they typically experience high rates of loss to follow-up. Methodological standards now accepted for traditional RCTs needs to be evident for online RCTs as well, especially in reporting of their methods.

Self-Administered Intervention for Caregivers of Persons With Alzheimer’s Disease

The purpose of this article is to describe the development and feasibility testing of a Transition Toolkit to support caregivers of persons with Alzheimer's disease (AD) in dealing with transitions. Using the Medical Research Council (MRC; UK) guidelines for complex intervention development, Step 1 was to develop a theoretical understanding of the likely processes of change, by reviewing existing evidence and theory, and conducting new primary research. Based on Step 1, the intervention was developed with the Alzheimer's Society experts (Step 2), followed by concept mapping of the critical inputs of the intervention with the theoretical understanding (Step 3). A feasibility study was then conducted with 20 caregivers of persons with AD (Step 4) using a mixed methods concurrent design. The preliminary findings of the pilot study were positive with the participants describing the Transition Toolkit as acceptable, easy to use, and having the potential to help deal with transitions.

Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review

Aim. This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practices for stroke rehabilitation. Background. The experience of stroke can have a negative impact on both psychological and physical health and on quality of life. Yoga and relevant practices are promising therapies that have been used with patients with a variety of conditions. In order to draw conclusions on effectiveness for stroke patients, the evidence requires systematic assessment. Methods. A comprehensive search of major biomedical and complementary medicine databases was conducted. Relevant research was categorized by study type and appraised according to study design. Results. Five randomized controlled clinical trials and four single case studies were found. Additionally, one qualitative research study was identified. Studies reported positive results, including improvements in cognition, mood, and balance and reductions in stress. Modifications to different yoga practices make comparison between studies difficult, and a lack of controlled studies precludes any firm conclusions on efficacy. Conclusion. Yoga and mindfulness could be clinically valuable self-administered intervention options for stroke rehabilitation. Further research is needed to evaluate these specific practices and their suitability in stroke rehabilitation.

A Feasibility Study of Low-Cost, Self-Administered Skin Care Interventions in Patients With Head and Neck Cancer Receiving Chemoradiation

Current evidence for the management of radiation skin toxicities demonstrates equivocal outcomes using a variety of interventions, leaving substantial gaps in knowledge. Skin toxicities can lead to treatment delays, infection, pain, and increased costs for the patient. Patients with head and neck cancers receiving chemoradiation (N = 100), a population particularly vulnerable to disruptions in skin integrity, were enrolled into a prospective, descriptive study. Data collection was conducted and photographs were taken at baseline and weekly throughout treatment. Patients received skin care kits, instructions, and a diary to record adherence. Skin toxicity was measured and validated by at least three observers using serial photographs with 100% interrater agreement. Data were analyzed using descriptive statistics, graphs, and bivariate analysis. Adherence to both washing and moisturizing was consistently high. Although a correlation existed between the radiation dose and skin toxicity at week 6, no correlation existed between skin toxicity and adherence. Given the rate of grade 3 toxicities at week 6 and product costs, this proved to be an affordable regimen to which patients could easily adhere. Positive patient outcomes can be promoted through teaching and reinforcement of self-care measures to reduce skin toxicity.

Testing of a Web-Based Program to Facilitate Parental Smoking Cessation Readiness in Primary Care

To test the efficacy of a self-administered web-based computer intervention designed to facilitate readiness to alter tobacco use or secondhand smoke exposure among parents of children visiting a pediatric primary care clinic. The computer program included an assessment of the participant's smoking behavior and personalized feedback. Self-identified smoking parents of children presenting to a general pediatric outpatient clinic completed measures of motivation and readiness to cease smoking. Participants were then randomly assigned to complete the computer program or receive treatment as usual. One month after completing the intervention, participants were contacted either in person or by phone to complete measures of motivational readiness to engage in smoking cessation. Compared to treatment-as-usual parents, intervention parents reported increased readiness to change their smoking at follow-up. This effect appeared to strengthen, favoring the intervention condition, when analyses included only those participants who identified at baseline that they were contemplating quitting smoking in the next 6 months. Results of this small study supported the integration of a brief computerized tobacco intervention in the pediatric primary care setting and provided some evidence for efficacy. Brief, self-administered, and computer-based interventions such as this can be disseminated and deployed at relatively little cost or burden to existing practices, which makes small effects more meaningful and justifiable. Future investigations should investigate this intervention with larger samples and with expanded measures of parent smoking behavior.

Effect of a Four-Week Self-Administered Acupressure Intervention on Perceived Stress over the Past Month

The use of relaxation techniques in daily life is an effective means for the self-management of stress. Acupressure is a traditional technique where pressure is applied to acupuncture points instead of puncturing the skin. Self-administered acupressure is a potential method for dealing with stress. The effect of self-administered acupressure on anxiety has been examined but whether it can reduce perceived stress over longer periods is unknown. This study aimed to examine whether a self-administered, four-week acupressure intervention would reduce perceived stress over the past month. Fifteen male and nine female college students (age, 28.9 ± 8.51 yr) majoring in acupuncture and moxibustion medicine were randomly assigned to self-acupressure (AG) and control groups (CG). AG participants were instructed to conduct five sessions of acupressure in the morning, midday, and night. Each session included pressing six acupressure points on the neck (three points on the left and right side each) for five seconds. CG participants were asked to spend their daily life as usual. The outcome was the perceived stress level during the past month, which was assessed using a reliable and valid four-item scale. Perceived stress was measured at baseline, two weeks later, and after intervention. The stress level did not significantly differ between the two groups at baseline. In the AG, the stress level decreased from baseline to two weeks later and remained constant until the end of intervention. The stress level was significantly lower in the AG than in the CG only after intervention. These results provided initial evidence that self-administered acupressure reduces perceived stress over the past month.

A simple and promising tool to improve self-monitoring of blood glucose in patients with diabetes

Aim To examine patient formation of implementation plans, a volitional strategy, and its influence on self-monitoring of blood glucose (SMBG). Methods A randomized experimental-control design over a 2-week time period was used. The study population was diabetes patients with HbA1c >7% and requiring insulin therapy. Patients were recruited from a southeastern Michigan healthcare system. A self-administered intervention was designed to assist patients to formulate plans to perform SMBG. The primary outcome measure was SMBG rates. Three control groups were used to control for testing effects. Hypotheses were tested using ANOVA at a significance level of 0.05. SMBG was measured using a 2-week diary and two recall measures. Results There were 402 patients with diabetes recruited for the study. Analyses indicated that making implementation plans increased SMBG rates as assessed by a diary and two recall measures. The patients in the experimental group checked their blood sugar up to 7.77 times more than the control groups (sig < 0.05) over a 2-week time period as measured by the diary. Conclusions Patient behavior can be impacted by using an implementation planning tool. This technique can help improve patient self-monitoring behavior.

Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between-group differences. Treatment and public health implications are discussed.

Army women's evaluations of a self-administered intervention to prevent sexually transmitted diseases during travel

Military personnel experience seven times the sexually transmitted infections of civilians. Military women are especially vulnerable. No self-administered interventions to promote safer sexual behaviors are available for use by military personnel while on duty in austere locations. The purpose of this study was to ascertain Army women's evaluations of a new theory-based, self-administered, and portable intervention designed to promote safer sexual practices during duty abroad. Two focus groups were conducted at a large military installation in the Pacific Northwest. Army women (N=20) ages 18-49 years participated in the groups. Women first examined the intervention and then their reactions to the intervention were elicited with open-ended questions. The qualitative data then were content analyzed. All participants would either recommend or personally use the intervention. Positive features of the intervention included the type of information, a user-friendly and self-explanatory format, and that it was an aid to decision making about safer sex. Concerns included a tendency toward too much information and fears of non-acceptance by peers or sexual partners. Minor changes have been made based upon these results. The intervention will be reviewed again and proceed to clinical trials with female military personnel and other travelers.

A Randomized Trial of Parents Who Care: Effects on Key Outcomes at 24-month Follow-up

This study was designed to test the efficacy of Parents Who Care (PWC), a seven-session universal prevention program which includes parenting, youth, and family components designed to prevent substance use and other problem behaviors. Using an intent-to-treat experimental design, this study tests the program efficacy across race within a balanced sample of European American (EA) and African American (AA) youth and their parents (n = 331 n AA = 163; n EA = 168). Families were recruited, randomly assigned to three conditions (group-administered [PA], self-administered with telephone support [SA], and no-treatment control) and the intervention was administered when the adolescents were in the eighth grade. Analyses on key teen outcomes of the Parent's Who Care program at 24-month follow-up are reported here and include perceptions of drug use harm; favorable attitudes about drug use; delinquent and violent behavior; and initiation into cigarette, alcohol, other drug use, or sexual activity. Repeated measures mixed model regressions found no effect of the intervention on rate of change in attitudes about drug use or frequency of delinquent or violent behavior. Regression analyses with multiple imputations for missing data detected group differences in means at 24-month follow-up. Both program formats reduced favorable attitudes toward drug use among youth (SA d = 0.39, PA d = 0.22); and AA youth in the self-administered intervention reported significantly less violent behavior than their control counterparts (d = 0.45). No effects were found for drug use harm or delinquency. Finally, logistic regression predicting a combined outcome measure of initiation of alcohol, tobacco, drug use, and/or sexual activity found AA youth in both the group- and self-administered intervention conditions significantly less likely to initiate substance use and/or sexual activity than those in the control condition. Odds ratios indicated the chances of initiating sex or substance use were reduced by almost 70% (OR = 0.31) for AA teens in the SA condition compared to controls, and 75% (OR = 0.25) for the AA teens in the PA compared to controls.

Effects of laterally wedged insoles on symptoms and disease progression in medial knee osteoarthritis: a protocol for a randomised, double-blind, placebo controlled trial.

BackgroundWhilst laterally wedged insoles, worn inside the shoes, are advocated as a simple, inexpensive, non-toxic self-administered intervention for knee osteoarthritis (OA), there is currently limited evidence to support their use. The aim of this randomised, double-blind controlled trial is to determine whether laterally wedges insoles lead to greater improvements in knee pain, physical function and health-related quality of life, and slower structural disease progression as well as being more cost-effective, than control flat insoles in people with medial knee OA.Methods/DesignTwo hundred participants with painful radiographic medial knee OA and varus malalignment will be recruited from the community and randomly allocated to lateral wedge or control insole groups using concealed allocation. Participants will be blinded as to which insole is considered therapeutic. Blinded follow up assessment will be conducted at 12 months after randomisation. The outcome measures are valid and reliable measures recommended for OA clinical trials. Questionnaires will assess changes in pain, physical function and health-related quality-of-life. Magnetic resonance imaging will measure changes in tibial cartilage volume. To evaluate cost-effectiveness, participants will record the use of all health-related treatments in a log-book returned to the assessor on a monthly basis. To test the effect of the intervention using an intention-to-treat analysis, linear regression modelling will be applied adjusting for baseline outcome values and other demographic characteristics.DiscussionResults from this trial will contribute to the evidence regarding the effectiveness of laterally wedged insoles for the management of medial knee OA.Trial registrationACTR12605000503628; NCT00415259.

Army Women’s Sexual Health Information Needs

To ascertain Army women's specific sexual health information needs prior to developing a theoretically based, self-administered intervention to promote safer sexual practices during deployment. An exploratory design was employed to address the research questions. Participants (N= 131) were Army women recruited from Army posts around the United States. The women ranged in age from 18 to 68 years (M= 30.8, SD= 10.5), were of varied ethnicity, and had an average time in service of 8.0 years (SD= 6.6). Desire for knowledge about sexual health and safer sexual practices were measured with forced-choice responses based upon DiIorio's Safer Sex Questionnaire (DiIorio, Parsons, Lehr, Adame, & Carlone, 1992) and open-ended questions to assess past information received, quality of that information, and information desired. Participants had moderate levels of sexual risk behaviors. Forced-choice responses yielded little desire for information regarding safer sexual practices. Women identified different sexual health and safer sexual information needs based upon whether they were at a normal duty station or during deployment. Participants did not identify many information needs; however, their sexual behaviors indicate the need for interventions.

Development and Preliminary Results of a Self-Administered Intervention for Individuals With Fibromyalgia Syndrome: A Multiple Case Control Report

Development and Preliminary Results of a Self-Administered Intervention for Individuals With Fibromyalgia Syndrome: A Multiple Case Control Report

Pilot study of a self-administered stress management and exercise intervention during chemotherapy for cancer

This pilot project explored the feasibility, safety, and effectiveness of a self-administered exercise and stress management intervention for cancer patients receiving chemotherapy. Thirty-nine of 56 eligible patients (acceptance =69%) with a variety of solid tumors volunteered for the study. Participants were advised to exercise 20-40 min at 50-75% estimated heart rate reserve 3-5 times per week. In addition, patients were provided with instruction and written materials regarding stress management techniques. Follow-up data were collected during regularly scheduled outpatient visits at the start of the second, third, and fourth chemotherapy cycles using diary entries and the same questionnaires previously administered at baseline. Twenty-four of 39 patients (62%) completed all study requirements. These participants completed 438 of the 678 exercise sessions assigned (adherence =62%). Of the stress management techniques, positive thinking most practiced most frequently (48%), followed by deep breathing (38%) and active relaxation (37%). Paired t tests, comparing baseline values with final recorded values, indicated a significant improvement over time in bodily pain (p<0.03) and mental health (p<0.04) subscale scores. Participants' evaluations of the combined intervention were favorable: 90% felt it was helpful to them and 100% would recommend it to another patient. A self-administered intervention combining aerobic exercise and stress management was acceptable and safe for cancer patients receiving chemotherapy. Preliminary data demonstrating intervention efficacy should be confirmed in subsequent randomized clinical trials.

Self-administered behavioral family intervention for parents of toddlers: Part I. Efficacy.

This study examined the efficacy of a self-administered behavioral family intervention for 126 parents of toddlers. The effects of 2 different levels of intensity of the self-administered intervention were contrasted (self-administered alone or self-administered plus brief therapist telephone assistance). The results provide support for the efficacy of the self-administered form of behavioral family intervention. There were significant short-term reductions in reported child behavior problems and improvements in maternal parenting style, parenting confidence, and anger. Families who received minimal therapist assistance made more clinically significant gains compared with families who completed the program with no therapist assistance. The intervention effects were maintained at 6-month follow-up. The implications of the findings for the population-level delivery of behavioral family interventions are discussed.

Mindfulness‐Based Stress Reduction as supportive therapy in cancer care: systematic review

This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of Mindfulness-Based Stress Reduction for cancer supportive care. The experience of cancer can have a negative impact on both psychological and physical health and on quality of life. Mindfulness-Based Stress Reduction is a therapy package that has been used with patients with a variety of conditions. In order to draw conclusions on its effectiveness for cancer patients, the evidence requires systematic assessment. A comprehensive search of major biomedical and specialist complementary medicine databases was conducted. Additionally, efforts were made to identify unpublished and ongoing research. Relevant research was categorized by study type and appraised according to study design. Clinical commentaries were obtained for each study and included in the review. Three randomized controlled clinical trials and seven uncontrolled clinical trials were found. A lack of relevant qualitative research studies was identified. Studies report positive results, including improvements in mood, sleep quality and reductions in stress. A dose-response effect has been observed between practice of Mindfulness-Based Stress Reduction and improved outcome. A number of methodological limitations were identified. Modifications to the traditional Mindfulness-Based Stress Reduction programme make comparison between studies difficult and a lack of controlled studies precludes any firm conclusion on efficacy. Mindfulness-Based Stress Reduction has potential as a clinically valuable self-administered intervention for cancer patients. Further research into its efficacy, feasibility and safety for cancer patients in the nursing context is recommended.