Self-monitoring Diaries Research Articles

Determinants of adherence among patients with hypertension

Abstract Background Poor adherence to pharmacological treatment among patients with hypertension (HTN) is common. Approximately half of HTN patients do not use their medications as prescribed. Multiple barriers can influence adherence to antihypertensive medications. HTN patients may be characterized by the presence of frailty syndrome (FS) and cognitive impairment (CI). FS and CI may adversely affect the course of the disease and adherence to therapeutic recommendations. Purpose To assess the adherence and its determinants among patients with hypertension. Methods The study included 129 patients diagnosed with hypertension (81 men, 48 women; mean age M±SD=69.98±11.67) hospitalized in the Department of Occupational Diseases and Hypertension. Medical record analysis, the author's sociodemographic questionnaire, the Tilburg Frailty Idicator (TFI) to determine the presence of frailty syndrome, the Montreal Cognitive Assesment (MoCa) questionnaire to assess cognitive function, and the Adherence to Medication Scale (ARMS) to assess adherence were used. Results The majority of respondents were male (62.79%), living in large cities (31.78%), in a relationship (61.24%), with a high school education (68.22%), and retired (67.44%). Analysis of medical records among comorbidities showed diabetes (59.69%) and other cardiovascular diseases (58.91%) to be the most common. Hospitalizations due to hypertension within the past year in the range of 1-2 were reported in 72.09% of the subjects, 3-5 hospitalizations in 17.05%, and more than 5 hospitalizations in 10.85% subjects. The surveyed patients mostly kept self-monitoring diaries (61.24%), measured their blood pressure values 2-3 times a day (58.15%) with an upper arm blood pressure monitor (64.34%). In terms of self-care behaviors, respondents most often indicated following a diet with a restriction of unhealthy fats (52.71%), following a low-sodium diet (44.19%) and being physically active (33.33%). The mean blood pressure values in the study group were M±SD=139.73±16.73 mmHg for SBP and M±SD=81.48±13.25 mmHg for DBP, respectively. On the basis of the TFI, 99.22% of patients showed the presence of FS (M±SD =10.66±2.82), the MoCa questionnaire indicated abnormal values in cognitive function in 79.07% (M±SD =18.16±8.3). The average adherence ARMS score was M±SD 17,6±6,72 pcts. (higher the ARMS score the worse adherence). Univariate analysis as determinants of adherence showed unemployment (b=9.391;p=0.001), smoking (b=6.701;p=0.001), duration of illness (b=-0.153;p=0.003), 3-5 hospitalizations in the past year (b=3.891;p=0.014). Multivariate analysis among determinants of adherence showed unemployment (b=7.556;p=0.022), duration of illness (b=-0.167;p=0.002) and 3-5 hospitalizations (b=5.011;p=0.001). Conclusion Hypertensive patients are characterized by optimal adherence. Despite expectations, cognitive impairment and frailty syndrome did not determine adherence to medications.

Adaptation of students' bodies in the fight against stress. Regulating modes for mental health balance

A healthy lifestyle has a wide range of positive effects on various aspects of the human body and personality. In the psychological aspect. The benefits of a healthy lifestyle are manifested as mental health, well-being, neuropsychological stability, the ability to successfully endure the effects of mental stress, and self-confidence. In the functional manifestation, it is possible to note a higher quality of health, improvement of adaptation processes, increase of working capacity and training, reduction of diseases and painful sensations.
 Physical self-education is understood as the process of purposeful, conscious, planned work on oneself and focused on the formation of physical culture of the individual. A personal physical self-education plan should have the following tasks: strengthening health, hardening the body, developing perseverance, training coordination abilities, training endurance, improving physical development and physical readiness in accordance with the requirements of future professional activity.
 It is necessary to use the following means and methods: morning gymnastics, physical exercises, hygienic and natural factors, exercises for the development of coordination, running, hiking, cycling. Based on the results of this plan, you should keep a self-monitoring diary. Systematic filling of the self-monitoring diary is a report on the work done. Thus, the student's ability to note even minor changes in self-improvement is important, as it reinforces his confidence in his abilities, activates, and contributes to the further improvement of the self-education program, the implementation of a healthy lifestyle.

КОНТРОЛЬ НАЗНАЧЕНИЙ ВРАЧА И ПОВЫШЕНИЕ ПРИВЕРЖЕННОСТИ ПАЦИЕНТА К ЛЕЧЕНИЮ ЗАБОЛЕВАНИЙ ПАРОДОНТА. ОЦЕНКА ЭФФЕКТИВНОСТИ

Object. Periodontitis, as a chronic disease, must be treated comprehensively, in stages, with subsequent preventive medical examination. Periodontal treatment being a time-consuming process, requires special cooperation from both the doctor and for the patient. The results of the treatment largely depend on the patient's involvement in the process of treatment. It depends on how efficiently and timely patients fulfill all the recommendations. The task of a dentist is to assess and increase the level of patients’ compliance to treatment.
 Objective. To study the effect of the use of doctor's appointment monitoring using the patient's self-monitoring diary on the effectiveness of periodontitis treatment.
 Materials and methods. The object of the study was 63 patients diagnosed with chronic generalized periodontitis aged 32 to 63 years, who were 44.6 ± 5.8 years old in average. The patients were divided into two groups (No. 1 and No. 2). Group No. 1, after diagnosis, a conversation was conducted about the importance of compliance with doctor’s recommendations and sequence of prescribed treatment. Also, every patient was given a step-by-step list of appointments with the patient's diary, which they were to fill out. Group No. 2 received only medical appointments and recommendations. Diagnosis and treatment were carried out in accordance with the protocol for the management of patients with periodontal diseases developed by Federal State Budgetary Educational Institution of Higher Education "Moscow State Medical and Dental University named after A. I. Evdokimov" of the Ministry of Health and Social Development of the Russian Federation, 2012. On the 7th day and after 1 month of the study, the effectiveness of the prescribed therapy was evaluated.
 Conclusions. The results of our study show that the appointment list and self-monitoring diary issued to patient are good ways to increase the patient's adherence to treatment, evaluation of medication intake, compliance with doctor's recommendations. This method undoubtedly increases the effectiveness of the prescribed treatment.

Медико-социальная характеристика медицинской активности пациентов с болезнями системы кровообращения

INTRODUCTION: The course and outcomes of the disease, including diseases of the circulatory system, are greatly influenced not only by the quality of medical care, but also by the attitude of patients to their health, as well as their medical activity. AIM: To study the age characteristics of the medical activity of patients with diseases of the circulatory system, taking into account gender and marital status. MATERIALS AND METHODS: On the basis of the Vinogradov City Clinical Hospital, Moscow, using a specially designed questionnaire, 582 patients hospitalized in the cardiological and neurological departments of the hospital for diseases of the circulatory system were interviewed. In the mathematical processing of the obtained data, the methods of variation statistics were used. RESULTS: Only 28.9% of the respondents answered that they regularly see a doctor for diseases of the circulatory system. Women were more active than men in terms of compliance with the dispensary observation schedule and the frequency of consultations with doctors of other specialties. According to the data obtained, 62.4% of the respondents considered it necessary to establish schools for the chronically ill and their family members, but only 17.4% of the respondents attended a school for a patient with diseases of the circulatory system. It was found that 86.1% of the surveyed patients with diseases of the circulatory system kept self-monitoring diaries: 68.7 per 100 respondents monitored blood pressure, 46 — blood sugar level and 33.6 — body weight. At the same time, married men are more likely to keep self-monitoring diaries for blood pressure, blood sugar levels and body weight. The timeliness of seeking medical care is the most important criterion that characterizes the medical activity of patients and largely determines the outcome of treatment and the cost of it. The conducted sociological study revealed a rather high medical activity of patients with diseases of the circulatory system, as well as its significant differences in a number of positions in age, gender, and marriage and family aspects. CONCLUSION: The identified features of the self-preserving behavior of patients with diseases of the circulatory system should be taken into account when providing them with therapeutic and preventive care.

Влияние самоконтроля на течение и исходы гестационного сахарного диабета

Gestational diabetes mellitus is characterized by an increased risk of fetal macrosomia and obstetric complications during childbirth, as well as the development of type 2 diabetes in the mother after pregnancy. Timely diagnosis and treatment of hyperglycemia during pregnancy reduces adverse pregnancy outcomes. The first step towards tight glucose control during pregnancy is self-monitoring of glycemia. Aim: to evaluate the effectiveness of regular glycemic control using a Satellite express glucometer calibrated on capillary whole blood in patients with gestational diabetes mellitus (GDM) in outpatient practice. Material and methods. The 96-week prospective observational non-interventional study included 150 patients with GDM. In women with confirmed GDM, blood glucose was measured using a satellite express glucometer. At each visit, further tactics for the treatment of GDM were determined based on the results of glycemia (data from the self-monitoring diary). Until the 34th week of pregnancy, an endocrinologist was consulted with a frequency of 1 time in 2 weeks in the form of a medical appointment and telephone contact. After 34 weeks of pregnancy, consultation of an endocrinologist with a frequency of 1 time per week. 6–12 weeks after delivery, an oral glucose tolerance test and consultation with an endocrinologist were performed to assess the degree of carbohydrate metabolism disorder. Results. The participation of 138 (92%) patients in the study ended in childbirth, 12 (8%) patients dropped out of the study ahead of schedule. Spontaneous abortions were noted in patients who performed self-monitoring of glycemia 0–1 times a day, independent births were more often observed in patients who performed self-monitoring 3–4 times a day, and these patients also had more stable glycemic indices. 9 patients out of 138 gave birth to children weighing 4000 g or more. The weight of the rest of the children at birth did not exceed 3500 g. Conclusion. A well-controlled course of GDM, adequate self-monitoring and dynamic observation of women allows delivery to be carried out within the generally accepted terms without worsening its outcomes.

Personalized Digital Health Information to Substantiate Human-Delivered Exercise Support for Adults With Type 1 Diabetes.

Pilot-test personalized digital health information to substantiate human-delivered exercise support for adults with type 1 diabetes (T1D). Single-group, 2-week baseline observation, then 10-week intervention with follow-up observation. Community-based sample participating remotely with physician oversight. Volunteers aged 18 to 65 years with T1D screened for medical readiness for exercise intervention offerings. N = 20 enrolled, and N = 17 completed all outcomes with 88% to 91% biosensor adherence. Feedback on personalized data from continuous glucose monitoring (CGM), its intersection with other ecological data sets (exercise, mood, and sleep), and other informational and motivational elements (exercise videos, text-based exercise coach, and self-monitoring diary). Feasibility (use metrics and assessment completion), safety (mild and severe hypoglycemia, and diabetic ketoacidosis), acceptability (system usability scale, single items, and interview themes), and standard clinical and psychosocial assessments. Participants increased exercise from a median of 0 (Interquartile range, 0-21) to 64 (20-129) minutes per week ( P = 0.001, d = 0.71) with no severe hypoglycemia or ketoacidosis. Body mass index increased (29.5 ± 5.1 to 29.8 ± 5.4 kg/m 2 , P = 0.02, d = 0.57). Highest satisfaction ratings were for CGM use (89%) and data on exercise and its intersection with CGM and sleep (94%). Satisfaction was primarily because of improved exercise management behavioral skills, although derived motivation was transient. The intervention was feasible, safe, and acceptable. However, there is a need for more intensive, sustained support. Future interventions should perform analytics upon the digital health information and molecular biomarkers (eg, genomics) to make exercise support tools that are more personalized, automated, and intensive than our present offerings.

Main Aspects of Preparing Diabetic Patients in Poland for Self-Care.

Diabetes is a lifestyle disease which can cause many complications and organ-related disorders. The aim of the study was to analyze selected aspects of preparing patients with diabetes for self-care. The study group consisted of 190 people diagnosed with type 1 and type 2 diabetes, including 101 women and 89 men. The mean age of the respondents was 42.2 ± 13.4 years. The study was conducted using an anonymous self-designed questionnaire containing 50 questions. Among the respondents, 23.2% did not control their glucose levels at home. The respondents most often measured glucose once a day (33.6%) or three times a day (26.7%). A total of 64.7% of the respondents declared that they kept a self-monitoring diary. The knowledge of the symptoms of hypoglycemia and the ability to properly manage it was declared by 64.8% of the respondents. A total of 52.1% of the patients did not undertake any activity lasting more than 30 min at least 3 times a week, and 75.2% described their condition as very good and good. Independent participation in therapy, i.e., taking hypoglycemic drugs or insulin, was declared by 63.7% of the respondents. Despite undergoing therapeutic education, the study population diagnosed with diabetes still shows deficiencies in terms of awareness of proper health behaviors. Objective results showed that the patients had insufficient knowledge and skills in terms of self-care and self-observation, blood glucose and blood pressure measurements, physical activity, diet therapy as well as adherence to pharmacotherapy recommendations. Despite the good general preparation for self-care as declared by the respondents, these patients require further systematic, individual educational activities. The results of the present study have implications for nursing practice, patient therapeutic education, and the functioning of the public health and healthcare systems. The number of diabetic patients is constantly increasing. Patients require coordinated care and individualized therapeutic education in order to be prepared for self-care and self-management, thus reducing the risk of complications. Delaying the occurrence of potential complications provides patients with a chance to live an active private and professional life, and protects the health care system from carrying the cost burden of expensive highly specialized services.

АНАЛИЗ ДВИГАТЕЛЬНОЙ АКТИВНОСТИ И ФИЗИЧЕСКОЙ ПОДГОТОВЛЕННОСТИ ЮНЫХ ФУТБОЛИСТОВ ПРИ ДИСТАНЦИОННОМ РЕЖИМЕ ТРЕНИРОВОЧНЫХ ЗАНЯТИЙ В УСЛОВИЯХ ПАНДЕМИИ

This article deals with the problems of performing physical exercises by young footballers under pandemic conditions. The restrictions imposed due to COVID-19 led to a decrease in all forms of motor activity, which negatively affected physical conditions and required search for new means, methods and forms of the training process organization under a self-isolation regime. To determine the impact of independent forms of performing physical exercises on motor activity and physical fitness, a study was carried out, in which 18 boys aged 9 and 10, members of a football club, took part. For independent forms of young footballers' exercising, sets of exercises were designed to improve flexibility, strength and coordination abilities; accompanying video footage with methodological guidelines was prepared. An analysis of scientific papers, a questionnaire, a review of self-monitoring diaries, methods of mathematical statistics were used as research methods. Based on the research findings, it was established that the introduction of the self-isolation regime caused a 20.5% (p<0.01) drop in the general level of motor activity; duration of children's stay in motionless position throughout the day rose by 12.3%; specific indicators of motor activity characterizing its amount and intensity declined on average by 32.2%. The analysis of the test subjects' physical fitness at research stages identified an increase in physical strength and flexibility indicators. The result of the flexibility test improved by 20% (p>0.05); the growth in the test of muscular endurance and strength of the arms was 22.6% (p<0.01); of sit-ups and standing jumps 2.6% and 1.3% (p>0.05) respectively. Negative trends of indicators on average by 3% (p>0.05) were found in the tests of general endurance, speed and coordination abilities. To eliminate the imbalance in the level of physical skills development with independent exercising under a self-isolation regime, means of physical fitness should include exercises performed with the use of exercise devices (cardiovascular equipment, bicycle ergometers and other similar technical devices) that promote the development of general endurance and speed abilities. The design of sets of strength training exercises in various forms and the use of tasks based on competitive gaming method in the mode of remote contact with team members can encourage an increase in motivation for independent physical exercising.

Development of an app for lung cancer survivors (iEXHALE) to increase exercise activity and improve symptoms of fatigue, breathlessness and depression.

Exercise-based self-management interventions are recommended for lung cancer survivors and can provide physical, psychosocial and emotional relief. Mobile health technologies can encourage self-management; however, currently, no cancer-related app addresses exercise-specific needs of lung cancer survivors. This paper details the design, development and testing of an exercise app for lung cancer survivors (iEXHALE), which aims to increase exercise activity and improve symptoms. The research had two stages: (1) focus groups with healthcare professionals, patients and family members (n=21) and (2) app development and usability study with lung cancer survivors (n=6). The Capability, Opportunity, Motivation-Behaviour model was used as a theoretical framework; data were thematically analysed. Focus group findings identified many helpful exercises for managing lung cancer survivors' symptoms. These findings, alongside relevant literature, informed iEXHALE's content and design. The usability study found that lung cancer survivors valued iEXHALE's self-management capabilities but identified potential modifications including improved self-monitoring diaries and navigation. iEXHALE's development has been theoretically and empirically informed, showing value as a self-management tool. Next, we will test its effectiveness, acceptability and cost-effectiveness.

The impact of the interventionist-participant relationship on treatment adherence and weight loss.

Little is known about the impact of the relationship built between interventionists and their participants on weight loss. Our objective is to determine whether stronger early (i.e., 4 weeks) participant-interventionist bond is associated with significantly greater weight loss success and treatment adherence. Three hundred and ninety-eight participants received an online group behavioral weight control program over 18 months. Weight was measured objectively at baseline and at 6 and 18 months. At 4 weeks, participants completed the Working Alliance Inventory (WAI) bonding subscale, which measures the collaborative bond with the interventionist. Adherence (i.e., session attendance and online self-monitoring diary completion) was recorded by the interventionists. Participant-interventionist bond at 4 weeks was significantly associated with weight loss at 6 months (t(322) = -2.14, p = .03) but not at 18 months (t(290) = 0.53, p = .60). The model indicated that participant-interventionist bond at 4 weeks was a significant predictor of adherence at 6 months (b = .063, standard error [SE] = .30, p = .04), and 6 month adherence was a significant predictor of weight loss at 6 months (b = -.594, SE = .049, p < .0001). The indirect effect of the WAI-Bond subscale was significant (b = -.037, p = .03, 95% confidence interval: -.074, -.002) and accounted for 54% of the total effect of participant-interventionist bond on weight loss. However, the total weight loss explained by WAI-Bond subscale was small (0.04 kg). Participant-interventionist bond between participant and interventionist is an early predictor of treatment adherence and weight loss success at 6 months; however, the degree of weight loss explained by participant-interventionist bond is small and was not maintained at 18 months.

Direct Oral Anticoagulants in the Real World: Insights into Canadian Health Care Providers’ Understanding of Medication Dosing and Use

Direct Oral Anticoagulants in the Real World: Insights into Canadian Health Care Providers’ Understanding of Medication Dosing and Use

The role of local immunotherapy in the treatment of the patients presenting with virus-associated allergic rhinitis

The objective of the present study was to evaluate the clinical effectiveness of intranasal immunotherapy with the use of сycloferon in the patients presenting with seasonal virus-associated allergic rhinitis during the period of pollination. The results of the treatment of 50 patients with virus-associated allergic rhinitis (i.e. those allergic to the sagebrush pollen) were analyzed. The patients were divided into two groups depending on the therapeutic modality being used. Those comprising the main group (21 patients) received immunotherapy with сycloferon in addition to allergen-specific immunotherapy (by sublingual administration). A cycloferon solution in the physiological saline (2:1) at a concentration of 125 mg/ml was applied to the intranasal mucous membrane with the use of a nebulizer. The inhalation was performed every other day as a course of 10 procedures at a total cycloferon dose of 1250 mg. The control group was composed of 29 patients given sublingual allergen-specific immunotherapy alone. The study included the evaluation of the patients' quality of life in accordance with the adapted and modified RQLQ questionnaire. In addition, the demand for other relevant medications following the course of intranasal immunotherapy was determined by analyzing the data extracted from the self-monitoring diaries and questionnaires. The study has shown that the inclusion of сycloferon therapy in the scheme for the management of the patients presenting with virus-associated allergic rhinitis during the period of pollination enhanced the effectiveness of the treatment as assessed from the improvement of the patients' quality of life that correlated with the reduction in the severity of rhino-conjunctival manifestations of the disease (r= -0.4, p<0.05). It is concluded that the intranasal administration of the immunomodulator сycloferon has resulted in a significant decrease of requirements for chromones (p<0.001) and antihistamines (p<0.05) among the patients suffering from allergic rhinitis.

The Gestational Diabetes Management System (GooDMomS): development, feasibility and lessons learned from a patient-informed, web-based pregnancy and postpartum lifestyle intervention.

BackgroundGestational diabetes mellitus (GDM) contributes to the epidemic of diabetes and obesity in mothers and their offspring. The primary objective of this pilot study was to: 1) refine the GDM Management System (GooDMomS), a web-based pregnancy and postpartum behavioral intervention and 2) assess the feasibility of the intervention.MethodsIn phase 1, ten semi-structured interviews were conducted with women experiencing current or recent GDM mellitus GDM to garner pilot data on the web based intervention interface, content, and to solicit recommendations from women about refinements to enhance the GooDMomS intervention site. Interviews were audiotaped, transcribed and independently reviewed to identify major themes with Atlas.ti v7.0. In phase 2, a single-arm feasibility study was conducted and 23 participants were enrolled in the GooDMomS program. Participants received web lessons, self-tracking of weight and glucose, automated feedback and access to a message board for peer support. The primary outcome was feasibility, including recruitment and retention and acceptability. Secondary outcomes included the proportion of women whose gestational weight gain (GWG) was within the Institute of Medicine (IOM) guidelines and who were able to return to their pre-pregnancy weight after delivery.ResultsComments from semi-structured interviews focused on: 1) usability of the on-line self-monitoring diary and tracking system, 2) access to a safe, reliable social network for peer support and 3) ability of prenatal clinicians to access the on-line diary for clinical management. Overall, 21 (91 %) completed the pregnancy phase. 15/21 (71 %) of participants were within the Institute of Medicine (IOM) guidelines for GWG. Sixteen (70 %) completed the postpartum phase. 7/16 (43 %) and 9/16 (56 %) of participants returned to their pre-pregnancy weight at 6 and 30 weeks postpartum, respectively.ConclusionsThis study documents the feasibility of the GooDMomS program. The results can have implications for web technology in perinatal care and inform the current care paradigm for women with GDM. Findings are supportive of further research with recruitment of a larger sample of participants and comparison of the outcomes with the intervention and standard care.Trial registrationThe study was registered at ClinicalTrials.gov on May 15, 2012 under protocol no. NCT01600534.

A Pilot Study of APN-led Self-management Program to Improve Cardiovascular Health Status among Korean Women with Risk Factors

Purpose: The aim of this study was to examine the effects of an Advanced Practice Nurse (APN)-led self-management program on cardiovascular health status among Korean women at risk of developing or progressing cardiovascular disease. Methods: This pilot study used one-group pre- and post- test experimental design. At health fairs in a community, 30 women who had one or more risk factors for metabolic syndrome were recruited and agreed to participate in the study. A total of 25 women completed the study. The intervention consisted of weekly follow-up calls and self-monitoring diary after an hour of individual counseling regarding risk factors, fast walking, and healthy diet tailored to the participants’ needs. Physical activity was assessed with the World Health Organization International Physical Activity Questionnaire and a pedometer. Results: Participants showed statistically significant improvements in blood pressure, body mass index, levels of triglyceride, total cholesterol and low density lipoprotein, numbers of metabolic syndrome factors, and the 10-year CV risk estimate after one month of concentrated intervention. In addition, their physical activity behavior significantly improved after the intervention. Conclusion: This APN-led self-management program targeting modifiable risk factors by offering tailored counseling and concentrated support during the transition might be effective in preventing progression to the cardiovascular disease.

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy.

Background. Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. Methods. Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements. Results. Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women. Conclusions. MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

Efficacy of a cognitive-behavioural therapy administered by videoconference for generalized anxiety disorder

IntroductionDelivering psychotherapy by videoconference could considerably extend the accessibility of empirically validated treatments. ObjectiveThe aim of this study was to evaluate the efficacy of a cognitive-behavioural therapy (CBT) for generalized anxiety disorder (GAD), administered via videoconference. MethodFive participants with a primary diagnosis of GAD took part in an experimental multiple baseline case study protocol. The efficacy of the treatment was evaluated using a semi-structured interview, self-report questionnaires, and daily self-monitoring diaries. ResultsThe results demonstrate that overall, participants’ conditions were improved following treatment and they no longer met the diagnostic criteria for GAD in the short-term. Participants’ conditions improved clinically and statistically at each follow-up point, achieving a greater global level of functioning at post-test, as well as at 3-month and 12-month follow-up. ConclusionClinical implications of this new treatment modality and directions for future research are discussed.

Diaries for observation or intervention of health behaviors: factors that predict reactivity in a sexual diary study of men who have sex with men.

Behavioral diaries for observation of health-related behaviors assume absence of reactivity (i.e., change in behavior resulting from observation), while self-monitoring diaries maximize reactivity for behavior change. Little is known about when and for whom behavioral diary studies become self-monitoring interventions. This study evaluated the moderating effects of social cognitive variables on reactivity in sexual risk behavior and risk appraisals in a diary study of men who have sex with men (MSM). One hundred forty-three MSM completed weekly online sexual diaries for 3months. Analyses were conducted with hierarchical linear modeling. There was no evidence of reactivity for the sample as a whole. Social cognitive variables (e.g., risk reduction motivation, condom use intentions, and social norms) moderated reactivity in study outcomes. For example, more highly motivated MSM experienced declines in serodiscordant unprotected anal intercourse over time. Effectiveness of behavioral self-monitoring strategies may vary depending on social cognitive domains.

Achieving Weight Loss Goals at Lower Cost

Jakicic JM, Tate DF, Lang W, Davis KK, Polzien K, Rickman AD, Erickson K, Neiberg RH, Finkelstein EA: Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial. JAMA 307:2617–2626, 2012 Objective. To determine whether a stepped-care weight loss intervention would result in greater weight loss than a standard behavioral weight loss intervention. Design. A total of 363 overweight and obese adults were randomized to either a standard- or stepped-care weight loss intervention. During the 18-month trial period, all participants were placed on low-calorie diets, were prescribed increases in physical activity, kept self-monitoring diaries, and attended group counseling sessions. The standard-care group was assigned to a fixed counseling program consisting entirely of group sessions: weekly for months 1–6, twice per month for months 7–12, and once per month for months 13–18. For the stepped-care group, counseling frequency, type, and weight loss strategies could be modified every 3 months in response to observed weight loss. Six steps of increasingly intensive contact were used, ranging from monthly group counseling alone to a multifaceted program that included group counseling, individual counseling, telephone contacts, and meal replacements (Table 1). The primary endpoint was mean change in weight at the 18-month time point. Secondary endpoints included resting heart rate and blood pressure, waist circumference, body composition, fitness, physical activity, dietary intake, and cost of the program. The authors also reported the results of a regression analysis taking into account the changes in weight at all six of the 3-month time points. Subjects. Most (82.6%) of the participants were female, with an average age of ~ 42 years. About 88% had at least some college education. About 28% were African American, and 67% were white. The average BMI was 32.95 kg/m2. View this table: Table 1. Stages of Stepped-Care Intervention* Results. The study …

The Efficacy of Using Self-Monitoring Diaries in a Weight Loss Program for Chronically Ill Obese Adults in a Rural Area

Self-monitoring is part of many weight-loss programs and is widely accepted as effective. However, there is a lack of research related to the efficacy of various self-monitoring instruments in meeting the needs of individuals with limited mobility or access to healthcare providers, especially those with limited education living in rural settings. This study examined the efficacy of using self-monitoring diaries in a weight loss program targeting chronically ill and obese rural-dwelling adults. A community-based intervention program using a pretest and posttest design examined the effect of using self-monitoring diaries on weight loss. Fifty participants were enrolled from the chronic disease clinic of a district health center with limited medical resources in a remote village in southwestern Taiwan. All participants were diagnosed with diabetes and/or hypertension, had body mass indices between 27 and 32 kg/m, and had a minimum educational level of junior high school. Mean participant age was 43.7 years. Participants were randomly assigned to the intervention or control group. All attended a mandatory 12-week weight loss program. The intervention group received instructions on how to record diet and exercise details in a structured, graphics-based diary provided by the researchers. Body weight and percentage of body fat were measured before and after the program, and data were analyzed by chi-square and ANCOVA. The intervention group significantly lost more weight than the control group (5.7 kg vs. 2.1 kg; p < .05). The participants of 88% in the intervention group lost 5% or more of their baseline weight greater than the 23% in the control group. Both groups achieved the mean of body fat reductions by comparing pretest and posttest. Self-monitoring diaries can have a significant impact on weight loss in individuals living in rural communities. Healthcare providers and health promotion agencies can use the suggested checklist method to improve weight loss promotion programs in isolated rural communities with limited medical resources.

Pretreatment weight change is associated with obesity treatment outcomes.

Clinical experience suggests some individuals begin obesity treatment weighing more than they did at pretreatment assessment. Weight fluctuations between baseline screening and the first treatment session were examined among individuals enrolling in a group behavioral obesity treatment outcome study. Participants (N = 480, 94% female; 28% African American; M BMI = 35.7) were classified into those who started treatment having gained weight (≥ +1.15% above screening weight), lost weight (≤ -1.15% below screening weight) or remained weight stable. The majority of participants were weight-stable (61%) during the waiting period, but 23% lost weight (-2.36 ± 1.26 kg) and 16% gained weight (+2.11 ± 1.04 kg) between baseline screening and initiating treatment. Those who lost during the pretreatment period went on to have the greatest losses at 6-months (-8.9 ± 4.9 kg), with significantly greater weight losses than either the weight-stable (-6.1 ± 5.8 kg) or the weight-gain (-5.7 ± 5.8 kg) groups. Further, those who lost weight during the waiting period went on to attend a significantly higher proportion of treatment sessions and submitted more self-monitoring diaries than those who gained weight and those who stayed weight stable while waiting. Thus, pretreatment weight change was associated with treatment outcomes and may be relevant for research screening. Further, pretreatment weight change may be a clinical marker for likely success in behavioral weight control and as such warrants additional investigation to inform potential methods for enhancing outcomes for individuals in obesity treatment.