Successful Behavioral Interventions Research Articles

Experiences and lessons from structural interventions against COVID-19 in Addis Ababa, Ethiopia.

Fighting pandemics like COVID-19 requires implementing successful structural and behavioral interventions that attempt to change the social and political environments to increase adherence to preventive behavior among community members. However, studying structural interventions implemented during pandemics and their challenges remains to be uncharted territory in developing implemented countries. Given this, we documented the experiences of implementing such interventions in Ethiopia with the aim of drawing lessons for future efforts to fight similar outbreaks in resource limited and low-income settings. We conducted a qualitative study between September and October 2021. Data were collected through face to face and telephone interviews from purposefully selected stakeholders from government and private sectors engaged in social interventions to prevent COVID-19. The systematization and the analysis of the data were conducted with MAXQDA 2020 software. Ethiopia implemented structural and social interventions to respond to the COVID-19 pandemic. This included: developing national policy and guidelines, mainstreaming COVID-19 interventions to local organizations, implementing capacity development programs, and developing strategies to engage the community, through traditional institutions, in intervention activities. In addition, a mass communication approach was used to deliver risk messages. This yielded a promising result in slowing down the spread of COVID-19 in the capital of Ethiopia-Addis Ababa. On the other hand, competing interests, misconceptions, capacity constraints among professionals and organizations, limited capacity to enforce legislation and lack of motivation for change from the community side affected the implementation and the outcomes of interventions. Going forward, these challenges need to be taken into consideration when designing and implementing structural interventions to contain disease outbreaks effectively. The study highlighted that attempts to withstand pandemic in low- and middle-income settings shall successfully utilize local resources, act swiftly when pandemics outbreak and adjust themselves to the dynamic challenges and limitations of structural interventions.

Influencing patient behaviors in coordinated care based on behavioral patterns.

Healthcare providers on primary healthcare teams have to know how to effectively encourage patients to change their health behavior to achieve therapeutic goals. When influencing patients’ lifestyle and health behaviors, patient’s perspective should be at the heart of the discussion so that lifestyle promotion services support better outcomes and experiences. Understanding behavioral patterns and psychological background of implementing change, can help healthcare professionals in delivering interventions with higher success rate. In fact, thanks to enhanced patient engagement, theory-based interventions tend to be more effective in changing behaviors compared to non-theory based interventions. In coordinated care, lifestyle promotion can consist of screening, lifestyle advice and referral to another healthcare professional.
 The aim of the study was to evaluate the importance of behavioral patterns in influencing the patient’s attitudes and health behaviors.
 Changing habits in the context of health promotion could be accomplished by influencing patients’ perception. This could be achieved by TRA (Theory of Reasoned Action) and HBM (Health Belief Model) models by convincing the public of susceptibility to a particular disease, disseminating knowledge about effective prevention methods and generating persuasion, support, admiration or recognition in society after positive behaviors such as smoking cessation or regular physical activity.
 A more effective technique is cognitive behavioral technique based on the theory of learning. These techniques rely on the assumption that behavior and cognition must be considered together if they are to be effective in causing change. Our thoughts, feelings and behaviors are often connected in cause and effect sequences. Therefore, in order to understand the causes of, for example, self-destructive behaviors, attention should be paid not only to the behavior itself, but also to the cognitive processes related to it.
 Successful behavioral interventions must be based on changing the approach of medical personnel to the interpersonal process with the patient. This approach should be patient - centered and collaborative. It is therefore important to establish a relationship that shows genuine interest in the patient. Medical staff should assess the importance that the patient attributes to their health and the treatment process, and thus also their willingness and motivation to comply with the recommendations. Mere provision of information will not guarantee a change in their behavior. Effective ways to reduce patient’s resistance include emphasizing their personal choice and control, making sure the patient is ready for treatment, convincing the patient of the importance of the treatment process and involving the patient in the decision-making process. Medical staff should use active listening techniques (use of open-ended questions, clarifications, reflective statements and summary statements), should encourage patients to express their concerns and should be able to weigh the pros and cons of different therapeutic approaches.

Translation of a Successful Behavioral Intervention to a Digital Therapeutic Self-Management System for Older Adults.

Feature at a Glance: Nonadherence to hypertension medications is associated with negative health outcomes, which is of particular importance for older adults because of the high prevalence of hypertension in this population. To promote medication adherence among this group, we translated a behavioral intervention that improved adherence by 36% into a digital therapeutic self-management system. Design strategies included interviewing older adults, conducting usability evaluations after each iteration, and engaging a team of experts from nursing, cognitive psychology, pharmacy, human factors in aging, and software development. We outline our design process that can guide translation of other behavioral interventions into digital therapeutic platforms.

Supporting Families with Children Who Display Severe Challenging Behavior

Over the past several decades, we have developed quality behavioral assessments and interventions for challenging behaviors among individuals with a variety of severe developmental and cognitive disorders. These assessments and interventions have been used to educate family members on how to understand and intervene with these behaviors at home and in community settings. However, it has become clear that many families are not able to carry out these procedures adequately. This case describes recent work that is designed to support families so that they can assist their challenging children. Fortunately, we have been able to demonstrate a way of looking at parental difficulties and have designed interventions for families so that they are better able to implement successful behavioral assessments and interventions. We will describe a concession process that can help explain these parental obstacles and can aid with creating specific supports to assist families struggling with these difficulties. We also discuss future directions for follow-up research.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Employing telehealth within HIV care: advantages, challenges, and recommendations.

Behavioral Interventions for Choice Decision: Convenience and Visibility Interventions Versus Taste Preference

Successful behavioral interventions to reduce the consumption of unhealthy food will ease burden of NCDs and its economic cost. In prior research, conventional approach such as nutrition information could not overcome the impact of tasty but unhealthy food. Thus, this study is designed a field experiment at a casual restaurant to assess the effects of taste and behavioral approach, particularly the combination of convenience and visibility enhancements on healthier meal choices. The results of this study show that adding difficulty in ordering high-calorie food along with visibility can reduce calorie intake and compensate for the calorie increase caused by ordering according to taste. However, there are differences in effectiveness of interventions across each type of participant.

Sustained Positive Behavioral Interventions and Supports Implementation: School Leaders Discuss Their Processes and Practices

The purpose of the study was to investigate the leadership practices that elementary school administrators and leadership teams utilize to promote effective, successful, and sustainable schoolwide positive behavioral interventions and supports (SWPBIS). The study focused on the practices, processes, and challenges that administrators and school leaders indicated led to the successful implementation of the SWPBIS framework. Twenty-four school leaders (six administrators; 18 leadership team members) from five elementary schools with platinum recognition for their high-quality SWPBIS implementation participated. School administrators participated in an in-person interview, and leadership team members participated in focus group interviews. Results revealed that successful SWPBIS framework implementation was promoted by establishing a distributed leadership approach that leveraged teachers as leaders while shaping their buildings’ systems of practices and processes, providing training and professional development to staff, establishing buy-in by stakeholders, and engaging stakeholders in their PBIS efforts.

Solution-based science to prevent and control diabetes in underserved communities around the world (commentary, for Diabetes special section).

Despite the numerous successful behavioral interventions that have been published in the behavioral medicine field over a number of decades, surprisingly few have been translated and adapted for real-world settings using participatory research methods. The purpose of this commentary is to highlight the advances in participatory behavioral medicine reflected in the articles contained in the Diabetes special section. The articles contained in the Diabetes special section were reviewed, with a focus on the advances made with this type of research and the challenges that came to light. Numerous strengths of the large-scale translational studies were identified. The studies also highlighted important areas meriting further attention, including exploration of additional dissemination pathways, and further piloting and refinement of program components for different population segments. The articles in this special section represent major advances in implementing successful, impactful programs for diabetes prevention and control in low- and middle-income countries.

Parental perspectives on successful parent education and behavioral intervention

Introduction: Literature suggests that although behavioral therapy is an effective means of intervention for children with disabilities, family participation in these programs is often lacking. Several barriers exist to meaningful parent education and parent-professional partnerships, which can lead to lower quality outcomes for both the individual with a disability and their families. These barriers should be identified and addressed. This study used a survey measure to gather quantitative and qualitative information on parental perceptions of barriers to behavioral parent education and training as well as suggestions for creating a stronger family-professional partnership. Common themes that emerged from the analysis include: a need for open and honest communication, the importance of a professional’s training and experience in the field, and the availability of services. Knowledge of the barriers which exist in behavior parent training will allow providers to better serve families and ensure a stronger outcome of service. Implications for both research and practice are discussed.

Can Making Family Salient Increase Financial Savings? Quantifying Heterogeneous Treatment Effects in Voluntary Retirement Contributions Using a Field Experiment in Mexico

Many people fail to save for retirement, opting to spend money and consume in the present. Previous work has largely focused on highlighting the long-term benefits that savings can have for the individual. Instead, we test a novel intervention that that frames retirement savings as a way to ‘secure your family’s financial future.’ Using a large-scale field experiment (N=97,149), we find that sending SMS reminders with a family security framing improves contribution rates relative to those in the control group who do not receive an SMS message and other treatment groups who receive SMS reminders based on previously successful behavioral interventions (e.g., basic alerts, pennies-a-day, individual goals, fresh start). Promisingly, contribution rates continue to be higher for those who received the family security SMS even two months following the experiment, despite no other SMS reminders being sent. We combine our analyses with two machine-learning approaches and identify significant heterogeneity in the effectiveness of our treatment. While the family security SMS improves contribution rates by 89% for those over the age of 28, it significantly backfires for younger individuals decreasing contributions by 53%. If the goal is to optimally increase retirement contributions, then accounting for heterogeneity can have clear policy and firm implications. Sending the family security intervention to the entire customer base would decrease the number of contributors, total contribution amounts, and overall firm profits, relative to a segmented approach that sends the intervention only to customers above the age of 28.

Psychosocial Factors of Diet and Physical Activity among Rural, Hispanic Children: Findings from a Multilevel Health Intervention Study.

To examine the relationship of psychosocial factors, such as self-efficacy, family role modeling, and perceptions of the environment, on diet, physical activity, and sedentary behavior in Hispanic children living in rural Washington State. Gender, heights, and weights were obtained from Hispanic 8-12year olds (n = 553) from two rural communities in Lower Yakima, Washington. A subsample of 179 children provided psychosocial measures, diet, and screen time via questionnaire and physical activity via accelerometer. Body mass index percentiles were used to calculate the prevalence of obesity. The association of demographic and psychosocial measures on the mean difference (95% confidence interval (CI)) of fruit, vegetable, and sugar consumption and minutes spent active was estimated using linear regression models. Prevalence of obesity was 35%. Children with obesity consumed one-fifth (- 0.3, - 0.02) fewer cups of fruits, 2.2 (0.1, 4.2) more teaspoons of total added sugars, and spent 16.1 (- 22.0, - 10.2) fewer minutes in moderate-to-vigorous physical activity per day compared with children with healthy weights. Males consumed more added sugars and reported more screen time than females, but spent more daily minutes in moderate-to-vigorous physical activity. Higher fruit and vegetable self-efficacy scores were associated with more consumption of fruits and vegetables, more engagement in light physical activity, and less time spent sedentary per day. Male gender and some psychosocial measures were associated with obesogenic behaviors. Insight about factors associated with obesity-related behaviors in rural, Hispanic children may help the development of successful and effective behavioral health interventions for this understudied population.

Psychomotor Performance Decrements following a Successful Physical Activity Intervention for Insomnia

ABSTRACTObjectives: Evidence supports the view that reductions in cognitive hyperarousal contribute substantially to improved sleep outcomes following cognitive and behavioral interventions for insomnia disorder. Assuming an inverted-u relationship between arousal and performance, a theoretical possibility, supported by limited empirical data, is that the same mediating processes could negatively impact aspects of psychomotor performance, reducing speed on tests of reaction time. Participants: Sedentary participants (mean age = 59.8; SD = 9.46) meeting research diagnostic criteria for insomnia were randomized to either an exercise intervention of ≥150 min of moderate-intensity activity per week (n = 20), or a wait-list control group (n = 21). Of these, n = 17 intervention and n = 18 control participants completed 6-month follow-up assessments. Methods: Digit span, and simple and complex vigilance task performance was assessed using a computerized protocol at baseline and 6-month follow-up. Dependent variables included digit span, simple reaction time (SRT), complex reaction time (CRT), false positive responses, number of lapses, and SRT/CRT ratio (indicative of the magnitude of difference between simple and complex RT performance). The primary clinical outcome was Insomnia Severity Index (ISI) score. Results: In comparisons of baseline to follow-up change, ISI scores showed clinically significant improvement in the intervention group at 6-month follow-up (F (8,26) = 5.16; P = 0.03). Baseline vigilance performance was equivalent in both groups. At 6-month follow-up, however, the intervention group showed significantly slower simple reaction time F(4,30) = 10.25, p < 0.01, and a significantly decreased SRT/CRT ratio (F(4,30) = 13.22, p < 0.01). Conclusions: Among people meeting diagnostic criteria for insomnia, beneficial sleep outcomes following successful behavioral interventions may, under some circumstances, come at the cost of slower psychomotor performance.

Parent perspectives and preferences for strategies regarding nonsedated MRI scans in a pediatric oncology population.

Children with cancer frequently require MRI scans for clinical purposes. Sedation with general anesthesia (GA) is often used to promote compliance, reduce motion, and alleviate anxiety. The use of GA for MRI scans is costly in terms of time, personnel, and medications. In addition, prominent risks are associated with anesthesia exposure in patients with complex medical conditions. Successful behavioral interventions have been implemented in clinical research settings to promote scan success and compliance. To our knowledge, parent/caregiver acceptability of behavioral interventions to promote nonsedated MRI has not been systematically investigated in a medically complex population. As a first step toward developing a protocol-based intervention to promote nonsedated scanning, we conducted a survey to explore parental perspectives regarding acceptability of nonsedated scanning and to gain information regarding preference for specific behavioral interventions to facilitate nonsedated MRI exams. Parents or guardians of 101 patients diagnosed with childhood cancer participated in a semi-structured survey via telephone. The sample was stratified by age group (8-12 years; 13-18 years), gender, and diagnosis (solid tumor (ST), brain tumor (BT), and acute lymphoblastic leukemia (ALL)). The majority of parents indicated that nonsedated MRI scans would be acceptable. Reduced anesthesia exposure was the most frequently identified benefit, followed by decreased irritability post-MRI scan, and shorter appointment time. Challenges included fear of movement and noise during scans and change in routine, with parents of younger children and those with a history of sedated exams identifying more challenges. Behavioral intervention preference differed by patient age and gender; however, education was ranked as most preferred overall. Parents of children treated for cancer consider behavior interventions to promote nonsedated scanning as acceptable. Patient characteristics should be considered when tailoring behavioral interventions. Results can inform future studies of behavioral interventions to promote nonsedated MRI scans. Future research should also investigate the risks associated with failed exams, both in terms of patient medical care and cost effectiveness.

Strategies for Increasing Physical Activity and Healthy Lifestyles for the Individual With Human Immunodeficiency Virus

Strategies for Increasing Physical Activity and Healthy Lifestyles for the Individual With Human Immunodeficiency Virus

Behavioral Change Strategies for Improving Complementary Feeding and Breastfeeding.

Improving infant and young child feeding (IYCF) practices, including breastfeeding and complementary feeding, has been identified as one of the most effective interventions to improve child survival, stunting and wasting. Evidence from randomized controlled trials suggests that effective promotion of breastfeeding and complementary feeding, with or without food provision, has the potential to improve IYCF practices and child nutrition. However, in many countries, breastfeeding practices and complementary feeding practices are still far from optimal. The lack of implementation of available, effective, affordable interventions in scale-up programs is in part attributed to a lack of innovative, creative and effective behavioral change strategies that enable and encourage caregivers. Successful behavioral change strategies should be based on a rigorous situational analysis and formative research, and the findings and insights of formative research should be used to further design interventions that address the identified barriers and enablers, to select delivery channels, and to formulate appropriate and effective messages. In addition, successful behavioral change interventions should a priori define and investigate the program impact pathway to target behavioral change and should assess intermediary behavioral changes and indicators to learn why the expected outcome was achieved or not achieved by testing the program theory. The design of behavioral change communication must be flexible and responsive to shifts in societies and contexts. Performance of adequate IYCF also requires investments to generate community demand through social mobilization, relevant media and existing support systems. Applying these principles has been shown to be effective in improving IYCF practices in Vietnam, Bangladesh and Ethiopia and is recommended to be adopted by other programs and countries in order to accelerate progress in improving child nutrition.

Theory-based psychosocial factors that discriminate between weight-loss success and failure over 6months in women with morbid obesity receiving behavioral treatments.

To improve success rates of behavioral weight-loss treatments, a better understanding of psychosocial factors that discriminate between weight-loss success and failure is required. The inclusion of cognitive-behavioral methods and manageable amounts of exercise might induce greater improvements than traditional methods of education in healthy eating practices. Women with morbid obesity [body mass index (BMI) ≥40 kg/m(2)] were recruited for a treatment of supported exercise paired with either a cognitive-behavioral or an educational approach to eating change over 6 months. They were classified as either successful with (i.e., at least 5 % loss; n = 40) or failed at (no loss, or weight gain; n = 43) weight loss. Discriminate function analysis incorporated theory-based models of 1 (self-efficacy), 5 (self-efficacy, self-regulation, mood, physical self-concept, body satisfaction), and 3 (self-efficacy, self-regulation, mood) psychosocial predictors at both month 6, and change from baseline-month 6. All three models significantly discriminated weight-loss success/failure (66, 88, and 87 % for success; and 81, 87, and 88 % for failure, respectively). Self-regulation had the strongest correlations within the multi-predictor models (0.90-0.96), and all variables entered were above the standard of 0.30 set for relevance. Participants in the cognitive-behavioral nutrition group demonstrated significantly greater improvements in all psychosocial variables and success with weight loss. Completing at least two sessions of exercise per week predicted success/failure with weight loss better than overall volume of exercise. New and relevant findings regarding treatment-induced psychosocial changes might be useful in the architecture of more successful behavioral weight-loss interventions.

On the resilience of remote traumatic memories against exposure therapy-mediated attenuation.

How to attenuate traumatic memories has long been the focus of intensive research efforts, as traumatic memories are extremely persistent and heavily impinge on the quality of life. Despite the fact that traumatic memories are often not readily amenable to immediate intervention, surprisingly few studies have investigated treatment options for remote traumata in animal models. The few that have unanimously concluded that exposure therapy-based approaches, the most successful behavioral intervention for the attenuation of recent forms of traumata in humans, fail to effectively reduce remote fear memories. Here, we provide an overview of these animal studies with an emphasis on why remote traumatic memories might be refractory to behavioral interventions: A lack of neuroplasticity in brain areas relevant for learning and memory emerges as a common denominator of such resilience. We then outline the findings of a recent study in mice showing that by combining exposure therapy-like approaches with small molecule inhibitors of histone deacetylases (HDACis), even remote memories can be persistently attenuated. This pharmacological intervention reinstated neuroplasticity to levels comparable to those found upon successful attenuation of recent memories. Thus, HDACis-or any other agent capable of heightening neuroplasticity-in conjunction with exposure therapy-based treatments might constitute a promising approach to overcome remote traumata.

Authors' response to commentary by Twisk.

We respond here to commentary by Twisk [1] on our article entitled ‘‘Defining recovery in chronic fatigue syndrome: A critical review’’ [2]. Our colleague presents a biomedical model of diagnosis and recovery that is interesting, but more hypothetical than practical given the current state of knowledge in CFS and ME. We acknowledge that the use of objective assessments to ensure accurate diagnosis and document recovery is highly desirable; however, there is no such gold standard for CFS or ME. The Cardiopulmonary Exercise Test (CPET), as argued, may show promise as an objective measure of illness or perhaps recovery from illness; however, it is time-consuming, expensive, and burdensome to patients, many of whom will understandably refuse to undergo the rigors of 1–2 exhaustive treadmill tests. Also, it is simply not an established diagnostic test with all of the validation studies (e.g., sensitivity, specificity) that would be required. Thus, the evidence for the CPET as an illness marker is not sufficient to recommend it as a measure of recovery in any clinical or research context. With regard to successful behavioral interventions in CFS, we agree that outcomes are rarely confirmed with more objective measures, such as actigraphy (which does not improve with the treatment) [3] or the 6-min walk test which sometimes shows increased fitness [4] and sometimes not. The recovery assessment that we suggest is based on a transdiagnostic model; it is intended to document what is commonly understood as indicating recovery, i.e., a sustained reduction of symptoms to normative levels and restoration of premorbid functioning. It does not depend on objective tests which in the case of CFS and ME are not available anyway. Finally, symptoms should not be dismissed as unimportant to a recovery assessment because they are ‘‘subjective.’’ Patient-reported symptoms, including both fatigue and post-exertional malaise, convey critical information about illness severity and impact as well as potential recovery from illness. Without a full assessment of symptoms to inform the researcher’s characterization of illness, we are left with a biased, incomplete picture. Our recommendations for documenting recovery are applicable to whichever illness definition, CFS or ME, is used, because it is based on broadly shared characteristics of health restoration: symptom relief, normative functioning, and importantly patients’ perceptions of their recovery status.

Impact of a diabetes control and management intervention on health care utilization in American Samoa

To examine the impact of a successful 12-month behavioral intervention to improve diabetes control on health care utilization in American Samoa. A cluster-randomized design was used to assign 268 diabetes patients to a nurse-community health worker intervention or usual care. Hospitalizations, emergency department, and primary care physician visits were collected retrospectively for 1 year prior to, and during, the intervention to assess changes in health care utilization. The association of utilization changes with change in HbA1c during the intervention was assessed. Adjusted incidence rate ratios (RR) for primary care physician visits were significantly higher in the community health worker relative to the usual care group (RR = 1.71; 95% CI, 1.25-2.33). There was no main intervention effect on emergency department utilization, but visits in the prior year modified the intervention effect on emergency department visits. Increased primary care physician utilization was associated with greater decreases in HbA1c (b = -0.10, SE = 0.04, p = 0.01). A culturally adapted community health worker diabetes intervention in American Samoa significantly increased primary care physician visits, and decreased emergency department visits among those with high emergency department usage in the prior year. These changes suggest important and beneficial impacts on health system utilization from the diabetes intervention in a low resource and high-risk population.

Successful Behavioral Interventions, International Comparisons, and a Wonderful Variety of Topics for Clinical Practice

This is the issue of successful behavioral interventions and international comparisons that support the need for better primary health care in the United States. Men's preconception care is considered, and the issue rounds out with articles about the radiologic findings of fluid in the mastoid bone, sex of physicians and mortality rates, a diabetes drug review, and, as usual, some informative brief case reports.