Treatment Services Research Articles

Use of a simplified grayscale essay for monitoring compact decentralized sewage treatment equipment.

The scarcity of sewage services is a great problem and of particular concern in rural and peri-urban areas, traditional communities, and small cities. A viable solution for expanding access to wastewater treatment services in these areas is the use of decentralized systems. However, an obstacle to the use of these systems is the lack of monitoring and operational management programs. The aim of this study was to evaluate compact wastewater treatment equipment (CWTE) using the grayscale proposed by von Sperling et al. (Water Science & Technology, 82(7):380-1392, 2020) and to develop prediction models for biochemical oxygen demand, chemical oxygen demand, and suspended solids using the grayscale and other parameters that are easy to obtain, such as color, turbidity, and electrical conductivity. Five CWTEs were monitored for 270days, with students acting as "citizen scientists" using the grayscale essay. Of the 705 samples monitored, 157 (22%) were classified as level 1 or 2 on the grayscale, 410 (58%) as level 3, 136 (19%) as levels 4 and 5, and only two samples as level 6. Regarding the use of the grayscale, it was observed that in this case, there was a small overestimation of the real values obtained in the laboratory analyses. With the use of the grayscale, the most expensive analyses would only be accessed if the level stabilized at values equal to or greater than 3. The predictive models developed based on the grayscale and simple parameters such as color, turbidity, and electrical conductivity demonstrated good accuracy (R2 > 0.8), offering a practical and efficient approach for estimating effluent quality indicators while reducing the need for complex laboratory analyses. The grayscale method can be a useful tool for (self) monitoring effluents in CWTEs, especially in contexts where resources are limited.

Use of a violence risk prediction tool (Oxford Mental Illness and Violence) in early intervention in psychosis services: mixed methods study of acceptability, feasibility and clinical role.

Scalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed. This study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role. A mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers. The OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support. The OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.

Functional Disability, Violence, HIV Status, and Risk Factors for HIV Among Adolescent Girls and Young Women - Eswatini, 2022.

Eswatini has made substantial progress responding to its HIV epidemic and reducing violence against children. However, adolescent girls and young women with disabilities might be at increased risk for experiencing violence and for HIV infection, compared with those without disabilities. Data from the 2022 Eswatini Violence Against Children and Youth Survey were analyzed to compare HIV infection and violence-related measures by functional disability status (e.g., difficulties in performing functional activities such as seeing, walking, or communicating) among adolescent girls and young women. In 2022, in Eswatini, 14.0% of adolescent girls and young women aged 13-24 years had a reported functional disability. Compared with those without a functional disability, adolescent girls and young women with a functional disability had higher lifetime prevalences of experiencing sexual, physical, and emotional violence. They were also more likely to know where to seek help for experiences of violence. After adjusting for sociodemographic characteristics, HIV testing and infection status, HIV risk factors, sexual risk behaviors, and HIV treatment and prevention services did not differ by functional disability status. Prioritizing accessible, disability-inclusive prevention programs and services might help reduce experiences of violence among adolescent girls and young women with disabilities. Partnering with disability-led and disability-serving organizations and directly with adolescent girls and young women with disabilities to plan and implement programs and services that are disability-inclusive could help ensure that adolescent girls and young women with disabilities are aware of and can access these resources.

Historical perspective on farm placements as a child welfare intervention in Iceland

ABSTRACT In 20th-century Iceland, the practice of urban children spending summers on farms evolved from a cultural tradition to include formal social service intervention for vulnerable youth by the early 1970s. This study examines this transformation through qualitative interviews with social workers, adults staying on farms in childhood as a social intervention, and farmers who hosted the children, supplemented by archival research. Social workers viewed farm stays as opportunities for children to broaden their horizons through farm life participation, nature immersion, and animal interaction. Adults who experienced farm placements in childhood valued the structured routine, outdoor activities, and animal care, though their experiences were not uniformly positive. Farmers noticed how the children they took care of in the 1990s presented more complex issues, e.g. behavioural issues and substance abuse. The social services in Reykjavík used the intervention extensively in the second half of the 20th century; however, its use declined after 2000, with the final farm placement occurring in 2019. This decline reflects evolving professional perspectives and practical challenges. Although farm placements may seem obsolete as a social intervention, their fundamental elements align with modern nature-based approaches. The Icelandic experience provides valuable insights for social work practice, highlighting the importance of continuously evaluating and adapting interventions to meet contemporary professional standards, societal needs, and children’s best interests.

Evaluation of differentiated service delivery models on HIV treatment retention among key populations in Nigeria: a prospective cohort analysis

IntroductionDifferentiated Service Delivery models (DSD) that cater to the needs of key populations (KP) have shown promise in providing KP-sensitive and KP-tailored care and treatment services. We evaluated the effect of two DSD models on linkage to and retention in treatment in Nigeria.MethodsBetween December 2017 and June 2018, newly-diagnosed men who have sex with men (MSM) and female sex workers (FSWs) were enrolled into treatment through two DSD models and followed prospectively for one year. Model 1 was a fully integrated one-stop-shop (OSS) while model 2 was a hybrid HIV prevention and treatment site (DIC). Retention was estimated from drug pick-up records and was defined as being on treatment within 90 days one-year post ART initiation. Cox regression was used to identify the independent effect of the DSD models on retention while probability of being retained in treatment at 1-year was estimated with Kaplan-Meier product limit.ResultsA total of 605 newly-diagnosed clients were enrolled into the study (340 in OSS and 265 in DIC; 342 were FSWs, while 263 were MSM). Median age was 26 years for MSM and 30 years for FSWs. Among those linked to treatment, retention was higher in the OSS than in DIC (63% vs. 48%; p = 0.002). Among those not retained, mean days to be lost-to-follow up (LFTU) was 60 days. Controlling for educational level, population type and age, clients who received treatment in M2 were 6 times more likely not to be retained in treatment at the end of 1 year (Hazard ratio 5.89; 95% CI: 1.04–33.16). The Kaplan Meier estimates of the probability of being retained in 6 months, 9 months and 12 months was 0.97, 0.92, 0.80 for the DIC and 1.00, 0.96, 0.91 for the OSS.ConclusionLinkage to treatment was suboptimal across both models with less than 90% of newly-diagnosed positives initiated on treatment and suggests that facilitated linkage is required to achieve at least 95%. Though retention was higher in the OSS model, both models had an alarmingly short time frame for LTFU and thus intensive monitoring during this phase of treatment is recommended irrespective of the type of DSD. Addressing these gaps will improve service delivery by one stop shops for HIV care and treatment.

Efficacy of short message service (SMS) intervention on medication adherence and knowledge of stroke prevention among clinic attendees at risk of stroke: a randomized controlled trial

BackgroundStroke remains a leading cause of long-term disability and mortality worldwide, particularly in low- and middle-income countries where suboptimal management of modifiable risk factors such as hypertension and diabetes mellitus are prevalent. Poor medication adherence, a critical barrier to effective risk management, is widespread in Nigeria, with adherence rates below 50% in patients with chronic illnesses. This study evaluates the efficacy of a 12-week short message service (SMS)-based intervention in improving medication adherence, knowledge, and prevention practices among hypertensive and diabetic patients attending the Medical Outpatient Clinic at the University College Hospital, Ibadan, Nigeria.MethodologyA single-center randomized controlled trial was conducted with 150 participants aged 18 years and above and had a documented clinical diagnosis of hypertension and/or diabetes mellitus and currently being treated with a prescribed medication. The intervention group received bi-daily SMS reminders on medication adherence, lifestyle modifications, and stroke prevention, alongside standard care. The control group received standard care only. Outcomes assessed included change in medication adherence, knowledge, stroke prevention practices, and quality of life. A p value of 0.05 was used.ResultThe prevalence of hypertension and diabetes were 90.0% and 20.7% respectively; 16 individuals (10.7%) had comorbidity of hypertension and diabetes. There was a 14.7% increase in the proportion of participants with a high medication adherence in the intervention arm whereas the control arm had a 2.7% increase. This 5 times relative increase in proportion was however not statistically significant. The study showed a significant effect of the intervention on participants knowledge of stroke prevention (t = 3.339, p = 0.001). There was no significant impact of the intervention on self-rated health scores (t = 0.132; p = 0.896).ConclusionThe SMS intervention significantly improved stroke prevention knowledge and showed a non-significant trend towards better medication adherence. Baseline motivational and cultural factors likely influenced outcomes, underscoring the need to address behavioral, cultural and economic barriers. This scalable telehealth model warrants further exploration to optimize adherence in resource-limited settings.Clinical trial registrationThis study was registered on the 25th July and approved on 25th of August 2023 by the Pan African Clinical Trials Registry (PACTR) with unique identification number: PACTR202308767234235. The findings from this study are presented in accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement.

Application of Internet Hospitals in the Disease Management of Patients With Ulcerative Colitis: Retrospective Study.

Ulcerative colitis (UC) is a chronic disease characterized by frequent relapses, requiring long-term management and consuming substantial medical and social resources. Effective management of UC remains challenging due to the need for sustainable remission strategies, continuity of care, and access to medical services. Intelligent diagnosis refers to the use of artificial intelligence-driven algorithms to analyze patient-reported symptoms, generate diagnostic probabilities, and provide treatment recommendations through interactive tools. This approach could potentially function as a method for UC management. This study aimed to analyze the diagnosis and treatment data of UC from both physical hospitals and internet hospitals, highlighting the potential benefits of the intelligent diagnosis and treatment service model offered by internet hospitals. We collected data on the visits of patients with UC to the Department of Gastroenterology at Tianjin Medical University General Hospital. A total of 852 patients with UC were included between July 1, 2020, and June 31, 2023. Statistical methods, including chi-square tests for categorical variables, t tests for continuous variables, and rank-sum tests for visit numbers, were used to evaluate the medical preferences and expenses of patients with UC. We found that internet hospitals and physical hospitals presented different medical service models due to the different distribution of medical needs and patient groups. Patients who chose internet hospitals focused on disease consultation and prescription medication (3295/3528, 93.40%). Patients' medical preferences gradually shifted to web-based services provided by internet hospitals. Over time, 58.57% (270/461) of patients chose either web-based services or a combination of web-based and offline services for UC diagnosis and treatment. The number of visits in the combination of web-based and offline service modes was the highest (mean 13.83, SD 11.07), and younger patients were inclined to visit internet hospitals (49.66%>34.71%). In addition, compared with physical hospitals, there was no difference in testing fees and examination fees for patients with UC in internet hospitals, but medicine fees were lower. The intelligent diagnosis and treatment model provided by internet hospitals demonstrates the potential benefits in managing UC, including feasibility, accessibility, convenience, and economics.

The feasibility of culturally adapted computerised cognitive remediation for first-episode psychosis.

British South Asians have a greater incidence of psychotic illness, which is associated with cognitive deficits. Computerised cognitive remediation aims to improve cognition. We aimed to culturally adapt computerised cognitive remediation for British South Asians with first-episode psychosis, and assess its feasibility. Qualitative interviews were analysed using thematic analysis to guide cultural adaptation of cognitive remediation, followed by a case series to determine feasibility. Our sample comprised 20 participants: ten in the qualitative interviews and ten in the feasibility evaluation. The sample was generated via purposive sampling from early intervention services in England, and was an entirely Muslim cohort, who were mainly Pakistani and born in the UK. Our intervention was computerised interactive remediation of cognition training for schizophrenia (CIRCuiTS), which was culturally adapted based on formative qualitative interviews and using an established framework. Participants engaged with 40 h of tasks over 12 weeks, with the aim of improving attention, memory and executive functioning. Feasibility was explored by assessing acceptability, engagement and retention in the study, and a range of measures were used to assess impact on cognition and mental state. The cultural adaptation of CIRCuiTS was found to be acceptable, with high levels of engagement and satisfaction. Despite the small sample, the intervention led to improved cognition and mental state. This is the first study to culturally adapt computerised cognitive remediation for British South Asians who are Muslim, and it had high acceptability with good retention, engagement and satisfaction. Future effectiveness testing is recommended.

How theories, models, and frameworks have been used to implement digital health interventions in services for people with severe mental health problems: a scoping review

BackgroundDigital health interventions have the potential to improve the efficacy and accessibility of mental health services for people with severe mental health problems, but their integration into routine practice is a challenge. The real-world implementation of digital health interventions should be considered alongside digital intervention development. However, little is known about the quality of implementation research in this area, including the extent to which implementation science theories, models and frameworks are used. The aim of this review was to synthesise evidence regarding the application of theories, models and frameworks in research investigating the implementation of digital health interventions in services for people with severe mental health problems. Secondary aims were to consider the contexts within which studies had been undertaken and the degree of service user involvement in this research.MethodsA scoping review method was employed. Electronic databases were systematically searched for published papers in English and reference lists of included studies were hand searched. Included studies used an implementation science theory, model, or framework to understand, guide or evaluate the implementation of digital health interventions in services for people with severe mental health problems.ResultsTwelve eligible studies were identified. Studies were primarily undertaken in community mental health services with staff participants and there was variation in the types of digital interventions that were investigated. Eight different implementation science theories, models, and frameworks were used and were mainly employed to guide qualitative analysis. Most studies were undertaken in the early exploratory stages of implementation projects and there was little evidence regarding factors affecting the longer-term sustainment of digital health interventions in practice. Only one study reported the inclusion of service users in the design of the implementation study.ConclusionsThe use of implementation theories, models, and frameworks in efforts to implement digital health interventions in routine care for people with severe mental health problems is limited. Researchers should consider integrating such approaches throughout the research process and ensure service users are involved in this work. Further research regarding implementation processes, and the reach and sustainment of digital health interventions in routine practice, is required.

Perceptions and Experiences of Antipsychotic Use and Discontinuation Among Young Adults Who Completed a First-Episode Psychosis Program

Antipsychotic medications (APMs) are one of the frontline treatments in First Episode Psychosis (FEP) programs. However, in recent years, debates have emerged regarding the risk-benefit ratio of APMs, leading to more open and frequent discussions about discontinuation. The purpose of this study was to explore the lived experiences of APM use and decision-making among young adults with FEP participating in NAVIGATE, an FEP program. Semi-structured interviews were conducted with 23 individuals with FEP who graduated from NAVIGATE to understand their perceptions and experiences of APMs—treatment they received as part of the program. Thematic analysis identified three themes: (a) Pre-NAVIGATE experience of APMs—participants reported that APMs led to weight gain, negative impact on their body image, emotional emptiness, and altered sense of self; (b) Facilitators to reduction in APMs dose during NAVIGATE—the majority of participants acknowledged the program’s professional staff approach as the main facilitator to mutually make decisions about APMs reduction; (c) Barriers to reduction of APMs dose during NAVIGATE was most often attributed to family members’ reluctance. Considering the challenges in APM reduction, it is essential to engage early intervention services caregivers and significant others in the process.

Latine Caregivers' Perspectives of Autism-Related Services: A Scoping Review.

Minoritized cultural groups in the United States experience disparities in diagnostic and intervention services for autistic children. Listening to the experiences of minoritized caregivers when accessing these services can identify areas for structural and individual improvement in cultural responsiveness. We conducted a scoping review to map the experiences of Latine caregivers of autistic children in navigating autism-related services. Included studies were published between 2015 and 2024 and employed a qualitative design. Twenty-six studies were included in the review. The caregivers interviewed in these studies were primarily mothers; few studies included fathers or extended family members. Services reviewed included both assessment and intervention. Factors related to assessment and intervention uptake included communication, provider support, logistics, immigration, cultural beliefs, caregivers' knowledge about autism, and social systems. Public education on the signs of autism and how to access services may address some of the barriers identified by caregivers in this review. Clinicians can provide education and support to empower caregivers to advocate for their children.

Impact of COVID-19 on Subjective Well-being and Community Im-portance-Performance in Sanitation Programs in Jakarta, Indonesia

This research investigates the critical impacts of the COVID-19 pandemic on subjective well-being and evaluates community responses to sanitation programs within three urban villages in Koja, Jakarta. Utilizing Importance-Performance Analysis (IPA), the study comprehensively assesses community perceptions and engagement levels with key sanitation aspects including access to defecation and treatment, treatment quality, aesthetic quality, monitoring practices, and socialization efforts in drainage and treatment. Advanced statistical models, such as probit and logit regressions, are employed to explore how demographic variables like housing stability, gender, and active involvement in community-based sanitation programs influence these perceptions and actions toward sanitation. The findings reveal significant disparities in satisfaction levels with existing sanitation services, pinpointing areas such as monitoring and treatment services that are critically underperforming and require immediate improvement. This study highlights the urgency of addressing these issues in the face of the ongoing pandemic, reflecting on the novel insights into the complex dynamics between demographic factors and the effectiveness of sanitation programs. Our approach aims to elevate the standard of sanitation services to enhance the resilience and well-being of urban communities against the multifaceted impacts of COVID-19. These strategic improvements are vital for sustaining public health and promoting a safer, healthier living environment in densely populated urban areas, where effective sanitation is crucial for mitigating health risks and enhancing public safety.

Implementing a rapid-learning health system in early intervention services for psychosis: qualitative evaluation of its feasibility and acceptability

BackgroundHeterogeneity in implementing essential evidence-based early intervention for psychosis services (EIS) components persists despite existing fidelity standards/guidelines in many countries. Rapid-learning health systems (RLHS) may remedy these challenges, improving service delivery through systematic data collection, analysis, feedback and capacity-building activities. SARPEP (Système Apprenant Rapide pour les Programmes de Premiers Épisodes Psychotiques) is the first Canadian RLHS for EIS. This paper presents qualitative findings from the mixed-method study that evaluated the feasibility and acceptability of SARPEP.MethodsWe conducted six focus groups on the implementation of SARPEP with 25 participants from all SARPEP stakeholder groups; most were involved from project inception and throughout the 3-year implementation. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework (Glasgow, et al., 2019) and Lessard’s dimensions for learning health systems guided data collection and deductive analysis.ResultsReach: focus group participants reflected SARPEP reach and included all stakeholders involved (six service users, two family members, four psychiatrists, six managers, seven team leaders) who shared their experiences. Effectiveness: participants confirmed that SARPEP improved program capacity for data collection on core indicators and promoted evidence-based practices. Adoption: participants supported the selection of specific indicators and need to improve data-gathering technologies in the RLHS, even while challenges persisted regarding the integration of digital platform use by service users into routine care. Implementation and maintenance: all participants credited the RLHS with enabling mutual learning, self-reflection of programs and shared improvement of practices.ConclusionsSARPEP contributes to promote evidence-based care and a sense of belonging within the Quebec EIS network.

Trends in breast cancer mortality in Peru and its geographical areas from 2013 to 2022 and prediction until 2027

BackgroundIn 2022, breast cancer was one of the most commonly diagnosed neoplasms and the leading cause of cancer death among women worldwide. In Peru, reports on mortality due to this neoplasm are scarce, especially after implementing strategies to reduce its impact. This study aimed to estimate mortality rates for breast cancer in Peru and its geographic regions from 2013 to 2022 and to project its evolution to 2027.MethodsAn observational ecological study of multiple time series was conducted. Data were obtained from the Ministry of Health’s death database via SINADEF. Mortality rates per 100,000 women were calculated using the direct method and Segi’s world standard population. Mortality trends were analyzed using the Annual Percent Change (APC) calculated with Joinpoint regression software. Predictions for 2027 were also made using the Nordpred package in R Studio.ResultsIn 2013, the departments with the highest breast cancer mortality rates in Peru were Ica, Callao, Lambayeque and La Libertad. In 2022, Ancash and Tumbes were added, with Tumbes having the highest rates. For women under 50, Lambayeque and Madre de Dios led in 2013, while for women over 50, Tumbes had the highest mortality rate in 2022. Peru reported a significant increase of 3.97% on an annual basis for the entire period. According to regions, Rainforest region (APC = + 8.37) and the Rainforest region (APC = + 11.55) showed significant increases in mortality rates, while no significant changes were observed in the Coastal region. Moreover, an increase in breast cancer mortality in Peru is projected for the year 2027.ConclusionBreast cancer mortality in Peru has shown a constant increase, with significant regional disparities. The highest rates were recorded in the coastal region, although the Andean and jungle regions experienced the most pronounced increases. These disparities may be attributed to data underreporting during the COVID-19 pandemic and unequal access to diagnostic and treatment services. The findings highlight the urgent need for focused public health interventions to reduce these regional gaps and improve breast cancer management outcomes.

A theory of change for patient-initiated follow-up care in rheumatoid arthritis

BackgroundTimely, high-quality care is critical to rheumatoid arthritis (RA) management. In Alberta, thousands of individuals with RA are waiting for care due to the resource-intensive nature of lifelong follow-ups and rheumatologist shortages. With 20–50% of routine follow-ups not leading to treatment changes or raising new concerns, many appointments may be avoidable if care were restructured. Patient-initiated models extend rheumatologist follow-up intervals beyond 12 months where appropriate, which can reduce inefficiencies and improve care access. To address provincial RA care challenges, we co-developed a theory of change (TOC) for patient-initiated follow-up care.MethodsA TOC serves to define health services interventions and their intended impact prior to implementation testing. We worked with 35 healthcare leaders, implementation experts, and patient partners to co-develop a TOC for patient-initiated RA follow-up care. During the scoping phase, we held discussions with healthcare leaders and reviewed evidence on patient-initiated follow-up models to assess their implementation potential. During the development phase, we drafted a TOC map using scoping phase findings and clinical and patient expertise. During the refinement phase, feedback was collected to optimize the TOC. Meetings were recorded, transcribed, and analyzed using deductive qualitative content analysis alongside anonymous poll results and informal feedback to guide TOC refinement.ResultsThe scoping phase identified challenges in RA care, including long waitlists and unnecessary appointments, which patient-initiated follow-up models have the potential to address. TOC discussions highlighted two intended impacts: (1) efficient and effective care for patients when needed, and (2) a sustainable model for RA care. Feedback in the refinement phase covered 4 topics: (1) preference for an interdisciplinary flare clinic, (2) patient selection, (3) patient education, and (4) patient monitoring. Tools and strategies were co-developed with partners to support patients (e.g., decision tool for patient-provider discussions) and the health system (e.g., monthly meetings to monitor burden). The final TOC for patient-initiated follow-up in RA details the care pathway, key resources and considerations, and evaluation outcomes.ConclusionsA patient-centered, context-specific patient-initiated RA follow-up care model was co-developed with patient and healthcare partners. An implementation pilot will test its ability to address RA care challenges.Clinical trial registrationNot applicable.

IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods.

There is evidence that smoking cessation may improve depression and anxiety symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness. This study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or anxiety [mean age 35.6years, standard deviation (SD) = 12.7, 89.6% white] who smoked 14.3 (SD = 8.2) cigarettes/day with mean Generalised Anxiety Disorder Questionnaire-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores of 13.1 (SD = 4.9) and 14.5 (SD = 6.0). Sixty-eight participants were allocated to the treatment group and 67 to control. Both groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking cessation services post-treatment. Follow-up was at 3 and 6months. The primary outcome was 'study completion' by 3months. Other outcomes included acceptability, satisfaction, feasibility, data completeness and mental health. At 3months, treatment did not affect study completion [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.31 to 2.09], did not harm mental health (PHQ-9 difference: coefficient 0.01, 95% CI = -2.19 to 2.22); GAD-7: coefficient 0.65, 95% CI = -1.59 to 2.90), but increased abstinence rates (OR = 8.69, 95% CI = 1.11 to 396.26). Recruitment was acceptable and key stakeholders were satisfied with the intervention. Among UK adult smokers receiving CBT treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals and increased smoking cessation.

Facilitating equitable access to genomic testing for advanced cancer: A combined intuition and theory informed approach to intervention development and deployment.

Rapid advancements in genomic testing have revolutionised cancer care diagnostics and treatment. However, keeping pace with the evolving genomics knowledge is a challenge for oncologists who are not genomic experts. This detrimentally impacts on equitable patient access to related services and benefits which require training in genomics. In Australia, cancer incidence, survival, and mortality rates are significantly worse in the most socioeconomically disadvantaged areas compared to the least disadvantaged areas. Guided by implementation science methods, the research aimed to determine how to support oncologists with varying levels of genomic expertise to tailor optimal treatment decisions and deliver a high-quality service, across diverse locations. We used a novel approach combining clinician intuition and implementation science theory to co-design service interventions (i.e. service models) and associated implementation strategies to inform operationalisation. Phenomenology and principles of co-design guided two phases of data collection with two separate cohorts of oncologists delivering care to advanced cancer patients. Phase 1 interview data was coded thematically to develop the service models, while phase 2 focus group data was used to identify implementation strategies to support service model operationalisation. The Consolidated Framework for Implementation Research (CFIR) informed phase 1 and 2 data analysis. Phase 1 established three overarching themes and nine subthemes: (1) access - potential for inequitable patient access by centralising genomic expertise, (2) indicators for test use - identifying suitable patients for Comprehensive Genomic Profile (CGP) testing, and (3) supporting use of results - confidence to discuss results, particularly from germline and somatic testing. Five challenges were prioritised, mapped to the CGP clinical pathway, and coded to 11 unique CFIR constructs. Across all five prioritised challenges, we recorded 19 intuitive and generated 21 theory-informed strategies. The development of three service models (i.e., centralised expert, local super user and point of care resources) arose through considering these strategies in combination with the study teams broader experiences with the iPREDICT trial. In Phase 2, we identified 11 implementation challenges, mapped to 7 CFIR constructs, and 11 intuitive and 20 theory-informed strategies for service model operationalisation. The service models generated from our study are currently being tested in a multi-centre implementation study to evaluate feasibility, effectiveness, acceptability, sustainability, and scalability in 2025.

Understanding the reasons to avoid seeking mental health professionals: Validation of the MITOS-MENTAL questionnaire in Peru population.

Understanding the reasons to avoid seeking mental health professionals: Validation of the MITOS-MENTAL questionnaire in Peru population.

A Practical Guide to Assessing and Addressing Context in Quality Improvement.

This article highlights the often underestimated influence of context in improving the quality of inpatient pediatric care. Context includes environmental, social, cultural, and systemic factors that surround and influence health care service delivery and intervention outcomes. Underappreciation for context can be responsible for the lack of intervention success in improving patient outcomes and can lead to differences in outcomes when initiatives are replicated or spread across health care settings. We draw from the field of implementation science (IS) to highlight essential concepts for measuring context, emphasizing the need for a comprehensive, multifaceted approach to address context effectively. Quality improvement (QI) and IS are complementary disciplines that share a common goal of improving health outcomes. They often engage the same stakeholders in similar environments, addressing overlapping challenges. Whereas QI is usually an "inside job" with practitioners deeply embedded in the context they seek to improve, IS seeks to understand how to implement evidence-based practices across varied contexts unfamiliar to those leading the implementation. This lack of familiarity with the context makes measuring and adapting to context a primary focus in IS. Recognizing that context influences how well interventions work, implementation scientists use frameworks to conceptualize, measure, and adapt to diverse contexts effectively. These frameworks help ensure interventions are appropriately tailored to the specific environments to achieve the desired outcomes. In this article, we introduce one such framework, the Practical Robust Implementation and Sustainability Model (PRISM). Organized by PRISM domain, we outline a multifaceted approach for improvers to address context comprehensively, which, at a minimum, includes clinical and community partner engagement, diverse QI team composition, and iterative data-driven adaptations to dynamic contextual factors. Addressing context should improve QI success, patient outcomes, and the replication of initiatives.

Psychosocial outcomes associated with mobile health app use among medicaid recipients who use substances

ABSTRACT Mobile health (mHealth) applications (apps) are increasingly applied to address substance misuse and related concerns. We explored mHealth app use and usability among Medicaid recipients with substance misuse who receive recovery support and treatment services (N = 163). At one-month, compared to those who did not utilize the app at all, app use was associated with reduced barriers to treatment. Logging into the app but not using the e-coach feature was associated with reduced anxiety and decreased likelihood of opioid use, while use of the app’s e-coach feature was associated with reduced stimulant and other illicit substances. For Medicaid-insured individuals with substance misuse, mHealth apps may reduce treatment barriers and supplement safety net treatment services.