Technology-assisted Intervention Research Articles

Addressing Water Contamination and Associated Health Issues through Community-Based Interventions: A Case Study in Khon Kaen Province.

A recent study conducted in Khon Kaen Province, Thailand, evaluated the effectiveness of a technology-assisted intervention aimed at improving water quality and addressing related health issues in communities around key water bodies. The intervention targeted health concerns associated with water contamination, including chronic kidney diseases, skin conditions, hypertension, and neurological symptoms. The study included water quality assessments and health evaluations of 586 residents and implemented a Learning Innovation Platform (LIP) across 13 communities. Results showed significant improvements in the community, including a decrease in hypertension and skin-related health issues, as well as enhanced community awareness and proficiency in implementing simple water quality assessments and treatment. The study demonstrated the value of a comprehensive, technology-driven community approach, effectively enhancing water quality and health outcomes, and promoting greater community awareness and self-sufficiency in managing environmental health risks.

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization

IntroductionScant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART – a technology-assisted intervention for parents of adolescents in residential treatment – was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization. MethodThe study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization. ResultsBoth the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization. ConclusionResidential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

FREE: A randomized controlled feasibility trial of a cognitive behavioral therapy and technology-assisted intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes

ObjectiveThe purpose of this study was to test the preliminary effectiveness of a cognitive behavioral therapy intervention (Fear Reduction Efficacy Evaluation [FREE]) designed to reduce fear of hypoglycemia in young adults with type 1 diabetes. The primary outcome was fear of hypoglycemia, secondary outcomes were A1C, and glycemic variability. MethodsA randomized clinical trial was used to test an 8-week intervention (FREE) compared to an attention control (diabetes education) in 50 young adults with type 1 diabetes who experienced fear of hypoglycemia at baseline. All participants wore a continuous glucose monitor for the 8-week study period. Self-reported fear of hypoglycemia point-of-care A1C testing, continuous glucose monitor-derived glucose variability were measured at baseline, Week 8, and Week 12 (post-program). ResultsCompared to controls, those participating in the FREE intervention experienced a reduction in fear of hypoglycemia (SMD B = −8.52, p = 0.021), change in A1C (SMD B = 0.04, p = 0.841) and glycemic variability (glucose standard deviation SMD B = −2.5, p = 0.545) by the end of the intervention. This represented an 8.52% greater reduction in fear of hypoglycemia. ConclusionA cognitive behavioral therapy intervention (FREE) resulted in improvements in fear of hypoglycemia.Clinicaltrials.govNCT03549104

Multimodal, Technology-Assisted Intervention for the Management of Menopause after Cancer Improves Cancer-Related Quality of Life-Results from the Menopause after Cancer (Mac) Study.

Vasomotor symptoms (VMSs) associated with menopause represent a significant challenge for many patients after cancer treatment, particularly if conventional menopausal hormone therapy (MHT) is contraindicated. The Menopause after Cancer (MAC) Study (NCT04766229) was a single-arm phase II trial examining the impact of a composite intervention consisting of (1) the use of non-hormonal pharmacotherapy to manage VMS, (2) digital cognitive behavioral therapy for insomnia (dCBT-I) using Sleepio (Big Health), (3) self-management strategies for VMS delivered via the myPatientSpace mobile application and (4) nomination of an additional support person/partner on quality of life (QoL) in women with moderate-to-severe VMS after cancer. The primary outcome was a change in cancer-specific global QoL assessed by the EORTC QLC C-30 v3 at 6 months. Secondary outcomes included the frequency of VMS, the bother/interference of VMS and insomnia symptoms. In total, 204 women (82% previous breast cancer) with a median age of 49 years (range 28-66) were recruited. A total of 120 women completed the protocol. Global QoL scores increased from 62.2 (95%CI 58.6-65.4) to 70.4 (95%CI 67.1-73.8) at 6 months (p < 0.001) in the intention to treatment (ITT) cohort (n = 204) and from 62 (95%CI 58.6-65.4) to 70.4 (95%CI 67.1-73.8) at 6 months (p < 0.001) in the per-protocol (PP) cohort (n = 120). At least 50% reductions were noticed in the frequency of VMS as well as the degree of bother/interference of VMS at six months. The prevalence of insomnia reduced from 93.1% at the baseline to 45.2% at 6 months (p < 0.001). The Sleep Condition Indicator increased from 8.5 (SEM 0.4) to 17.3 (SEM 0.5) (p < 0.0005) in the ITT cohort and 7.9 (SEM 0.4) to 17.3 (SEM 0.5) (p < 0.001) in the PP cohort. A targeted composite intervention improves the quality of life for cancer patients with frequent and bothersome vasomotor symptoms with additional benefits on frequency, the bother/interference of VMS and insomnia symptoms.

A Theory-Based, Technology-Assisted Intervention in a Hybrid Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Feasibility Study

To assess the feasibility of a technology-assisted intervention in a hybrid cardiac rehabilitation program among patients with coronary heart disease. This study was a two-armparallel randomized controlled trial. Twenty-eight patients with coronary heart disease were randomly assigned to either the intervention group, receiving a 12-week technology-assisted intervention (n=14), or the control group (n=14), receiving usual care. Guided by the Health Belief Model, the intervention group received three center-based, supervised exercise training sessions, a fitness watch that served as a cue to action, six educational videos, and a weekly video call. The Self-efficacy for Exercise, exercise capacity, and Health Promoting Lifestyle Profile II were assessed at baseline and immediately post-intervention (12-weeks). Among the 28 patients who participated in this study, 85.7% completed the program, with a relatively low attrition rate (14.3%). The number of exercise training sessions accomplished by the participants in the intervention group was 51.27±19.41 out of 60 sessions (85.5%) compared to 36.46±23.05 (60.8%) in the control group. No cardiac adverse events or hospitalizations were reported throughout the study. Participants in the intervention group showed greater improvement in health-promoting behaviors when compared with the control group at 12weeks. Within-group effects demonstrated improvement in exercise self-efficacy and exercise capacity among participants in the intervention group. A participant satisfaction survey conducted immediately post-intervention revealed that participants were "very satisfied" (23.1%) and "satisfied" (76.9%) with the technology-assisted intervention. The findings demonstrated that technology-assisted intervention in a hybrid cardiac rehabilitation program was feasible and suggested to be beneficial in improvingexercise self-efficacy, exercise capacity, and health promoting behavior among patients with coronary heart disease. A full-scale study is needed to determine its effectiveness in the long term. ClinicalTrials.gov NCT04862351. https://clinicaltrials.gov/ct2/show/NCT04862351.

A legal dispute resolution intervention for patients with substance use disorders: a study protocol for a randomized controlled trial

BackgroundSubstance use disorders (SUDs) represent major public health concerns and are linked to enhanced risk of legal consequences. Unresolved legal issues may prevent individuals with SUD from completing treatment. Interventions aimed at improving SUD treatment outcomes are limited. Filling that gap, this randomized controlled trial (RCT) tests the ability of a technology-assisted intervention to increase SUD treatment completion rates and improve post-treatment health, economic, justice-system, and housing outcomes.MethodsA randomized controlled trial with a two-year administrative follow-up period will be conducted. Eight hundred Medicaid eligible and uninsured adults receiving SUD treatment will be recruited at community-based non-profit health care clinics in Southeast, Michigan, USA. Using an algorithm embedded in a community-based case management system, we randomly assign all eligible adults to one of two groups. The treatment/intervention group will receive hands-on assistance with a technology aimed at resolving unaddressed legal issues and the control group receives no treatment. Upon enrollment into the intervention, both treatment (n = 400) and control groups (n = 400) retain traditional options to resolve unaddressed legal issues, such as hiring an attorney, but only the treatment group is targeted the technology and offered personalized assistance in navigating the online legal platform. To develop baseline and historical contexts for participants, we collect life course history reports from all participants and intend to link those in each group to administrative data sources. In addition to the randomized controlled trial (RCT), we used an exploratory sequential mixed methods and participatory-based design to develop, test, and administer our life course history instruments to all participants. The primary objective is to test whether targeting no-cost online legal resources to those experiencing SUD improves their long-term recovery and decreases negative health, economic, justice-system, and housing outcomes.DiscussionFindings from this RCT will improve our understanding of the acute socio-legal needs faced by those experiencing SUD and provide recommendations to help target resources toward the areas that best support long-term recovery. The public health impact includes making publicly available a deidentified, longitudinal dataset of uninsured and Medicaid eligible clients in treatment for SUD. Data include an overrepresentation of understudied groups including African American and American Indian Alaska Native persons documented to experience heightened risk for SUD-related premature mortality and justice-system involvement. Within these data, several intended outcome measures can inform the health policy landscape: (1) health, including substance use, disability, mental health diagnosis, and mortality; (2) financial health, including employment, earnings, public assistance receipt, and financial obligations to the state; (3) justice-system involvement, including civil and criminal legal system encounters; (4) housing, including homelessness, household composition, and homeownership.Trial registrationRetrospectively registered # NCT05665179 on December 27, 2022.

From parenting skills to adolescent treatment needs: Questions elicited by parents of adolescents discharged from residential treatment

BackgroundDespite the utility of parent involvement in continuing care following adolescent residential treatment, parent engagement in traditional office-based treatment is low. In our prior work, we found that parents who had access to a continuing care forum directed questions to a clinical expert and to other parents around five topics: parenting skills; parent support; managing the post-discharge transition; adolescent substance use; family functioning. The current qualitative study elicited questions from parents without access to a continuing care support forum to explore overlapping and new themes MethodsThis study was embedded within the pilot trial of a technology-assisted intervention for parents of adolescents in residential treatment for substance use. Thirty-one parents randomized to residential treatment as usual were asked two prompts at follow-up assessments: what questions they would like to ask a clinical expert and what questions they would like to ask other parents of adolescents discharged from residential care. Thematic analysis identified major themes and subthemes ResultsTwenty-nine parents generated 208 questions. Analyses revealed three themes identified in prior work: parenting skills; parent support; adolescent substance use. Three new themes emerged: adolescent mental health; treatment needs; socialization ConclusionsThe current study identified several distinct needs among parents who did not receive access to a continuing care support forum. Needs identified in this study can inform resources to support parents of adolescents during the post-discharge period. Parents may benefit from convenient access to an experienced clinician for advice on skills and adolescent symptoms, paired with access to parental peer support.

Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework.

Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework.

Clinical- and cost-effectiveness of a technology-supported and solution-focused intervention (DIALOG+) in treatment of patients with chronic depression\u2014study protocol for a multi-site, cluster randomised controlled trial [TACK

BackgroundMany with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression.MethodsPatients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months.DiscussionThis definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit.Trial registrationISRCTN11301686. Registered on 13 Jun 2019.

Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention.

BackgroundAdolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)—a technology-assisted parenting intervention informed by extensive formative research—as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication.ObjectiveThis protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills.MethodsAdolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling.ResultsThe trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022.ConclusionsThe proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model.Trial RegistrationClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385International Registered Report Identifier (IRRID)PRR1-10.2196/35934

Parent Smart: Effects of a Technology-Assisted Intervention for Parents of Adolescents in Residential Substance Use Treatment on Parental Monitoring and Communication

ABSTRACT Promoting parent involvement in adolescent residential substance use treatment is an evidence-based principle, yet engaging parents is challenging. Parent SMART (Substance Misuse among Adolescents in Residential Treatment) is a technology-assisted intervention that was designed to engage parents of adolescents in residential SU treatment during the post-discharge transition period. A prior pilot randomized controlled trial (n = 61 parent-adolescent dyads) established Parent SMART’s feasibility, acceptability, and preliminary effectiveness in reducing adolescent substance use and substance-related problems across both a short- (i.e., short-term) and long- (i.e., long-term residential) term care facility. The current secondary analysis extends this prior work by examining whether Parent SMART was associated with improvements in putative mediators of change: parental monitoring and parent-adolescent communication. Multi-modal assessment consisting of participant-report questionnaires and a behavioral interaction task evaluated parenting processes over the 24 weeks following discharge. Generalized linear mixed models showed no significant time by condition interactions on the participant-report questionnaires, but found significant interactions on all five scales of the behavioral interaction task. Supplemental analyses by long-term residential facility detected additional interaction effects favoring Parent SMART on the participant-report questionnaires. Plotting of the interaction effects indicated that Parent SMART was associated with improvements in parenting processes, whereas TAU was associated with relatively stable or worsening parenting scores. Parent SMART demonstrated preliminary effectiveness in improving key parenting processes among adolescents discharged from long-term residential substance use treatment. Parent SMART warrants further testing in a fully powered trial that evaluates parental monitoring and parent-adolescent communication as mediators of change.

Editor's Spotlight/Take 5: How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

Editor's Spotlight/Take 5: How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

BackgroundSevere mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient’s psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness.MethodsThis randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36).ResultsPreliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures.ConclusionIt is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources.Trial registrationISRCTN34124141; retrospectively registered, date of registration 05/11/2019.

Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Pilot randomized trial of a technology-assisted parenting intervention

Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.

Psychological Support and Telehealth Options for Patients with Cancer during the Covid-19 Pandemic in Saudi Arabia

Background: COVID-19 concerns are associated with an increase in symptoms of depression and anxiety among cancer patients. Telehealth services hold incredible potential for providing psychological support to cancer patients. In a technology-assisted intervention for telehealth, hotline services are a valuable tool to provide psychosocial care. This paper examines the use of hotline services to offer psychological support to cancer patients.Methods: A retrospective analysis of hotline calls patient registry data was conducted. Data were collected from a single cancer center in Riyadh, from May 2020 to March 2021, with a random sample of 877 callers to cancer hotline services. Responses of a satisfaction questionnaire were linked to call-related concerns of registry data. Results: A total of 877 calls were received, the majority of which came from Riyadh locals. Patient disease complaints accounted for 210 calls (24%), while retake medicine requests accounted for 251 calls (28.62%). 143 (16.31%) calls were about scheduled new appointments, 261 calls (29.76%) were about psychological issues induced by Covid-19, such as worry, fear, and anxiety symptoms, and 12 calls (1.37%) having to do with Covid-19. Seven hundred seventy-two callers (88 %) indicated satisfaction with the services call attended.Discussion: Hotline services in cancer care have been identified as a key resource telehealth service that positively influences patient satisfaction and meets cancer patient needs in the face of the pandemic. This study also highlighted the need for other telehealth services, such as mental health mobile applications, virtual multidisciplinary care, and online support groups, which can provide an excellent option for providing psychological support to cancer patients.Conclusion: This study found that providing Cancer Care Hotline services during a pandemic improves patient-centered care and a more efficient healthcare delivery system.

Facilitating pathways to care: A qualitative study of the self-reported needs and coping skills of caregivers of young adults diagnosed with early psychosis.

WHAT IS KNOWN ON THE SUBJECT?: In clinical psychiatry and mental health nursing practice, family caregivers are known to provide the bulk of care and play an important role in facilitating recovery outcomes for their loved ones diagnosed with psychosis. Providing services and interventions to family caregivers is as important as to patients in the early stage of psychotic experience for having a beneficial impact on the patients' clinical and social outcomes. Limited qualitative research has focused on family caregivers' subjective views of what they need during the critical period to identify early warning signs and connect their loved ones to professional help as they have no prior experience in caring for persons with psychosis. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Using qualitative analysis of family caregiver focus groups, this manuscript provides readers in clinical nursing practice with an understanding of family caregivers' lived experiences of supporting their loved one diagnosed with early psychosis. Understanding family caregivers' caregiving unmet needs in supporting their loved one diagnosed with early psychosis could inform both the technology-assisted intervention development and nursing practice in improving family-centred care and facilitate self-management practice. IMPLICATIONS FOR MENTAL HEALTH NURSING: Psychiatry and mental health nursing has long been engaged with the health and well-being of individuals with psychosis and supporting their families in the development, evaluation and implementation of innovative approaches to patient and family education. Digital technologies designed to deliver tailored intervention for family caregivers are underdeveloped, and the present study identifies a number of potential features that could comprise technology to meet the needs of this population. ABSTRACT: Introduction Caregivers play a critical role in detecting and managing psychotic symptoms before young people diagnosed with early psychosis present to care. Little is known about the specific needs of caregivers in navigating pathways to care for their loved one. Aim The purpose of this study was to understand the needs of family caregivers and their ways of coping on the pathway to care for early psychosis. Method Twenty family caregivers of individuals diagnosed with early psychosis participated in three focus groups that explored caregiving needs provision for early psychosis. Thematic analysis was conducted. Results We identified four major themes: education and skill training; raising wider awareness, such as police offers and teachers; adopting technologies for coping; and effective coping strategies. Implications for practice These findings provide important insights into caregiving needs and the ways for nurses to address those needs and better equip carers to recognize early symptoms, monitor behaviour changes and navigate care to support people with first-episode psychosis. Nursing researchers can use the information to develop on-demand and tailored family-centred intervention in addressing caregivers' needs in education, increasing awareness of early psychosis and fostering effective coping strategies.

Technology-Assisted Intervention for Children with Autism Spectrum Disorder using Augmented Reality

Technology-assisted intervention has potentials in improving the social, communication and behavior impairments in of children with autism spectrum disorder (ASD). Augmented reality (AR) offers multitude of possibilities and opportunities for the intervention of children with ASD. Therefore, this study identifies 13 researches from 2012 to 2018 that documented the efficacy of augmented reality applications in supporting the intervention of children with ASD. This study reviews the applications of augmented reality that nhanced the intervention for children with autism in (i) social skills, (ii) communication skills, and (iii) behavior skills. The conclusion reports the significant roles of augmented reality as technology-assisted intervention for children with ASD.

Development of a 5As-based technology-assisted weight management intervention for veterans in primary care

BackgroundObesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams.MethodsThematic analyses of prior formative work (focus groups with patients [n = 54] and key informant interviews with staff [n = 25]) helped to create a technology-assisted, health coaching intervention called Goals for Eating and Moving (GEM). To further develop the intervention, we then conducted two rounds of testing with previous formative study participants (n = 5 for Round 1, n = 5 for Round 2). Each session included usability testing of prototypes of the online GEM tool, pilot testing of 5As counseling by a Health Coach, and a post-session open-ended interview.ResultsThree main themes emerged from usability data analyses: participants’ emotional responses, tool language, and health literacy. Findings from both rounds of usability testing, pilot testing, as well as the open-ended interview data, were used to finalize protocols for the full intervention in the clinic setting to be conducted with Version 3 of the GEM tool.ConclusionsThe use of qualitative research methods and user-centered design approaches enabled timely detection of salient issues to make iterative improvements to the intervention. Future studies will determine whether this intervention can increase enrollment in intensive weight management programs and promote clinically meaningful weight loss in both Veterans and in other patient populations and health systems.

Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) trial: Study design and sample characteristics

BackgroundPain is the most common presenting somatic symptom in medical outpatients, and depression and anxiety are the two most common mental disorders. They frequently co-occur, are under-treated, and result in substantial disability and reduced health-related quality of life. ObjectivesThe Comprehensive vs. Assisted Management of Mood and Pain Symptoms (CAMMPS) study is a randomized comparative effectiveness trial designed to test the relative effectiveness of a lower-resource vs. a higher-resource technology-assisted intervention for the management of patients suffering from pain plus anxiety and/or depression. Methods/designCAMMPS has enrolled 294 primary care patients with chronic pain plus comorbid anxiety and/or depression and randomized them to either: 1) Assisted Symptom Management (ASM) consisting of automated symptom monitoring by interactive voice recording or Internet and prompted pain and mood self-management; or 2) Comprehensive Symptom Management (CSM) which combines ASM with optimized medication management delivered by a nurse-physician specialist team and facilitated mental health care. Outcomes are assessed at baseline, 1, 3, 6, and 12months. The primary outcome is a composite pain-anxiety-depression (PAD) severity score. Secondary outcomes include individual pain, anxiety, and depression scores, health-related quality of life, disability, healthcare utilization, and treatment satisfaction. DiscussionCAMMPS provides an integrated approach to PAD symptoms rather than fragmented care of single symptoms; coordinated symptom management in partnership with primary care clinicians and psychologists embedded in primary care; efficient use of health information technology; attention to physical and psychological symptom comorbidity; and the coupling of self-management with optimized medication management and facilitated mental health care. Trial registrationclinicaltrials.gov Identifier: NCT01757301.

Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial

BackgroundAdolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only.Methods/designA two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12–17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change.DiscussionThis study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.