Pathway to health: cluster-randomized trial to increase fruit and vegetable consumption among smokers in public housing.

OBJECTIVES: Examine the effectiveness of an intervention to increase fruits and vegetables (FV) consumption among smokers. DESIGN: Cluster-randomized trial of 20 public housing developments; 10 randomly assigned to an FV intervention and 10 to a smoking cessation intervention. MAIN OUTCOME MEASURES: Usual (past 7 days) and past 30 days change in daily FV intake at 8 weeks and 6 months postbaseline. RESULTS: Greater increases were seen in the FV group. At Week 8 and Month 6, the FV group had consumed 1.58 (p = .001) and 0.78 (p = .04), respectively, more daily FV servings in the past 7 days than the cessation group. At the same time points, the FV group had consumed 3.61 (p = .01) and 3.93 (p = .01), respectively, more FV servings in the past 30 days than the cessation group. Completing more motivational interviewing sessions (p = .02) and trying more recipes (p = .02) led to significantly greater increases at Month 6 among FV participants. CONCLUSIONS: Motivational interviewing counseling and lifestyle modification through trying out healthy recipes may be effective in helping a high-risk population increase their FV intake.     

Feasibility of a Telephone Intervention for HIV Patients and Their Informal Caregivers

Objectives: To assess the feasibility of a telephone intervention for HIV-positive patients and their caregivers. Methods: HIV-positive participants, some co-enrolled with their informal caregiver, enrolled in this randomized study. Intervention-arm participants (124 patients and 76 caregivers; dyads assigned to same arm) received up to 12 scheduled calls from an interventionist over 6 months. Results: An average of 7.6 (SD = 3.0) calls to each participant was completed; 66.5% received at least 6 calls; 43.0% received more than 75% of the intervention (defined as ‘study adherent’). Having a higher T-cell count was associated with call adherence (p = .014); cocaine use was associated with reduced call adherence for both patients (p = .019) and caregivers (p = .083). Common telephone themes included problems with mood, relationships, finances, housing, and work; interventions (e.g., referral for mental health care) were initiated in response to these. Participant satisfaction was high, and many reported benefits from the intervention. Conclusions: Using a telephone intervention with HIV-positive patients and their caregivers is a feasible and potentially beneficial intervention.     

Relationship of social cognitive theory factors to exercise maintenance in adults

Modifiable variables related to Bandura's social cognitive theory were tested for their relationship to self-reported retrospective exercise maintenance in 178 adults. Significant bivariate correlations were found between length of adherence to regular moderate-to-vigorous exercise and item clusters reflecting social support (r = .42), self-management ability (r =.39), and ability to tolerate exercise-induced discomfort (r = .60). Stepwise multiple regression analysis indicated that each item cluster significantly contributed to the overall explained variance in length of exercise maintenance over 52 weeks (R2 =.43). When responses from each of the item clusters were summed, participants defined as adherents had significantly higher scores than drop-outs. Discussion emphasized the need for replication and implications for exercise adherence intervention.     

A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women.

OBJECTIVE: To determine the efficacy of a peer-led social support intervention involving support groups and telephone contacts compared with standard clinical care to enhance antiretroviral medication adherence. DESIGN: Randomized controlled trial with follow-up. Participants were 136 HIV-positive indigent mainly African American and Puerto Rican men and women recruited from an outpatient clinic in the Bronx, New York. The 3-month intervention was delivered by other HIV-positive clinic patients trained in addressing barriers to adherence and sensitively providing appraisal, spiritual, emotional, and informational adherence-related social support. MAIN OUTCOME MEASURES: Medical chart-abstracted HIV-1 RNA viral load, antiretroviral adherence according to electronic drug monitoring and participant self-report, and social support and depressive symptomatology. All assessments conducted at baseline, 3 months, and 6 months. RESULTS: Intent-to-treat and as-treated analyses indicated no between-conditions intervention effects on the primary outcome of HIV-1 RNA viral load or any of the secondary outcomes at immediate postintervention or follow-up. Post hoc analyses within the intervention condition indicated greater intervention exposure was associated with higher self-reported adherence, higher social support, and lower depressive symptomatology at follow-up, even after controlling for baseline adherence. CONCLUSION: Null findings, consistent with the limited literature on efficacious highly active antiretroviral therapy (HAART) adherence interventions, may be due to insufficient exposure to the intervention, its low intensity, or the nature of the sample-a heterogeneous HAART-experienced group of patients with high levels of substance use and multiple other competing stressors. Overall, findings highlight the need for more comprehensive and intensive efforts to battle nonadherence.     

Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis.

Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.     

Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study

This study examined whether giving activity feedback to obese, sedentary adults with Type 2 diabetes would improve their adherence to a home-based walking program. 49 subjects were recruited. Ten failed a treadmill cardiovascular test. Another 9 dropped out before the intervention, and 4 dropped out during the intervention. The remaining 26 adults (14 women, 12 men; age M = 48.1 yr., SD = 7.1) received behavioral counseling monthly for 3 mo. regarding exercise. All subjects wore a triaxial accelerometer during these 3 months. Randomly, half of the subjects were blind to the data from the accelerometers, i.e., no feedback, and had counseling based on their self-report diaries. The other half had access to the accelerometer data, got a computerized graph of their physical activity for the period between counseling sessions, and had counseling based on these objective data, i.e., feedback. The feedback group showed an increase in exercise over the 3 mo. The nonfeedback group showed an increase in activity at 1.5 mo. but reverted to their baseline exercise levels at 3 mo. However, analysis of variance showed there was at least an 8% probability that this effect was due to chance, so the hypothesis that feedback would improve exercise adherence could not be supported. Further studies with larger sample sizes and greater control of experimental conditions are needed to determine the utility of objective activity feedback.     

555例危险行为高危青少年的心理干预：来自个体辅导和团体辅导的效果对照

对有较高风险发展为危险行为青少年的高危群体实施有针对性的心理干预是非常有价值的。本研究对青少年危险行为高危人群进行结构化的个体与团体心理干预,评估两种干预的即时效果和六个月的预后情况。采用《青少年健康相关危险行为问卷》等量表对16所中职院校的学生进行筛查,共555名学生参加本研究,被随机分为个体、团体和对照组并分别进行干预。结果发现：干预后,个体心理干预组被试的危险行为水平、心理健康以及抑郁和焦虑情绪均获得显著改善,并且6个月的预后效果依然明显,而接受团体辅导干预组仅在抑郁指标上有所改善,在危险行为评分、焦虑和心理健康水平上均没有明显的改善。研究认为,对危险行为易感青少年的心理干预应以经过良好设计的个体心理干预为主、团体干预为辅的方式进行。     

Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia

The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.     

Electronic monitoring and counseling to improve medication adherence

Electronic caps, pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication. A promising intervention to improve adherence, cue-dose training, involves reviewing patients' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day. In this preliminary study, 79 patients prescribed the antihyperglycemic medication metformin had adherence assessed during a 4-week baseline period. Adherence, defined as proportion of prescribed doses taken within a predetermined 4-h window, was measured using electronic MEMS caps. Those who had less than 80% baseline adherence (n = 33) were randomly assigned to either receive 4 months of cue-dose training (n = 16) or to a control group (n = 17). Cue-dose training was associated with significantly better adherence to metformin (mean improvement of 15%). The effects of cue-dose training on adherence to other antihyperglycemic medication did not reach statistical significance. Glycosylated hemoglobin (a measure of blood sugar control) did not differ between groups. Data from nine patients who reviewed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable.     

Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status.

OBJECTIVE: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. DESIGN: Prospective, cross-sectional observational design. MAIN OUTCOME MEASURES: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). RESULTS: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. CONCLUSION: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

Development and validation of the HIV Medication Readiness Scale

Excellent medication adherence (>95%) is required for optimal HIV treatment success. This study aimed to develop and validate a brief scale to assess psychological readiness for successfully starting and adhering to HIV medications. HIV-positive men and women (N = 142) from an HIV outpatient clinic completed the proposed HIV Medication Readiness Scale (HMRS) prior to starting HIV medications. The 10-item HMRS demonstrated high internal consistency (alpha = .90), test-retest reliability (r = .83), and sensitivity to change following a standardized 4-session psychoeducational intervention designed to increase readiness for successful adherence. Predictive validity was supported by higher readiness scores on the day starting HIV medications, predicting higher treatment adherence at 1-month follow-up. The HMRS is a brief, easy-to-use, clinically relevant tool that can assist in identifying people living with HIV at high risk of nonadherence, who might benefit from tailored readiness counseling prior to initiating HIV medications.     

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

Purpose

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

Results

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in “flare odds” was about 2 times greater in treatment versus controls (OR = 0.52, t(34) = 2.07, p < 0.05). Office visits, ER visits, and disease severity (all p < 0.05) were identified as moderators of flare risk.

Conclusions

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.     

Feasibility of Pairing Behavioral Activation With Exercise for Women With Type 2 Diabetes and Depression: The Get It Study Pilot Randomized Controlled Trial

Major depressive disorder is often comorbid with diabetes and associated with worse glycemic control. Exercise improves glycemic control and depression, and thus could be a parsimonious intervention for patients with comorbid diabetes and major depression. Because patients with diabetes and comorbid depression are often sedentary and lack motivation to exercise, we developed a group exercise intervention that integrates strategies from behavioral activation therapy for depression to increase motivation for and enjoyment of exercise. We conducted a 6-month pilot randomized controlled trial to test the feasibility of the behavioral activation exercise intervention (EX) for women with diabetes and depression. Of the 715 individuals who contacted us about the study, 29 participants were randomized to the EX condition or an enhanced usual care condition (EUC), which represents 4.1% of participants who initially contacted us. Inclusion criteria made recruitment challenging and limits the feasibility of recruiting women with diabetes and depression for a larger trial of the intervention. Retention was 96.5% and 86.2% at 3 and 6 months. Participants reported high treatment acceptability; use of behavioral activation strategies and exercise class attendance was acceptable. No condition differences were observed for glycemic control, depressive symptoms, and physical activity, though depressive symptoms and self-reported physical activity improved over time. Compared to participants in the EUC condition, participants in the EX condition reported greater exercise enjoyment and no increase in avoidance behavior over time. Using behavioral activation strategies to increase exercise is feasible in a group exercise setting. However, whether these strategies can be delivered in a less intensive manner to a broader population of sedentary adults, for greater initiation and maintenance of physical activity, deserves further study.     

Does Happiness Predict Medication Adherence among African Americans with Hypertension?

Poor medication adherence is a leading cause of excessive cardiovascular morbidity among African Americans. Many adherence-promoting interventions have addressed economic barriers, improved the patient-provider relationship, simplified regimens, and used reminder systems; however, the problem of low adherence remains intractable. Meanwhile, positive psychological attributes that might serve to promote medication adherence have not been fully explored. To address this gap, we examined the association between happiness and medication adherence among low-income African Americans with hypertension treated in a safety-net setting. Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2007?C2008. Happiness was measured using the 4-item scale of Lyubomirsky and Lepper; low, moderate, and high happiness were defined by tertiles because of the non-normal distribution. Medication adherence was assessed with the Morisky Medication Adherence Scale. Associations were quantified with ordinal logistic regression. Our sample of 573 African Americans was 71.6?% female and had an average age?±?SD of 53.6?±?9.7?years and a median happiness score of 5.2. Compared to participants with low happiness, the odds (OR; 95?% CI) of being in a better medication adherence category were greater for those with moderate (1.53; 1.02?C2.27) and high (2.26; 1.52-3.37) happiness, after adjusting for age, sex, income, education, and difficulty paying for medical care. Within this cohort of low-income African Americans with hypertension, participants with greater happiness exhibited better medication adherence. Although one interpretation of our study is that more adherent patients are naturally happier, our findings raise the possibility that adding happiness-boosting components may increase the effectiveness of more traditional adherence interventions.     

A Randomized Controlled Pilot Study of Motivational Interviewing to Change Attitudes about Adherence to Medications for Asthma

The day-to-day management of asthma relies on patient self-care practices; in particular, adherent use of asthma medications is fundamental for asthma management. However, most persons with asthma do not use their medications to clinically acceptable standards. The purpose of this study was to test the efficacy of a brief educational intervention to enhance knowledge and skills relevant to asthma self-care, and the efficacy of motivational interviewing to improve attitudes toward taking medications as prescribed. Twenty-five adults with asthma were randomly assigned to receive a brief educational intervention alone, or education plus motivational interviewing. Over time, all participants improved their knowledge of asthma and skills using a metered dose inhaler. Participants who received education alone showed a decreased level of readiness to adhere with their medications over time, whereas participants who received motivational interviewing were more likely to show a stable or increased level of readiness to adhere over time. Among participants who described themselves as not consistently adhering with their medications at the first evaluation, those who received motivational interviewing endorsed more positive attitudes toward taking medications over time. The results are supportive of the utility of motivational interviewing in enhancing participants' attitudes toward adherent medication use. Future research should test if attitude change is reflected in change in medication use.     

“Sometimes cathartic. Sometimes quite raw”: Benefit and harm in an intimate partner violence trial

Research on intimate partner violence (IPV) has increased over the past two decades, however empirical research on potential harm to participants is limited. The aim of this study was to assess whether 272 women involved in a general practice based IPV intervention trial (weave) reported more benefit or harm, whether this differed by intervention or comparison group, and what types of benefit and harm were reported. Feedback was obtained via adapted Consequences of Screening Tool, visual analogue scale and open-ended question in baseline, 6-month, 12-month and 24-month surveys (all participants), and semi-structured interviews (subset of 28 participants). Participants in both the intervention and comparison groups tended to respond positively on all quantitative items, although on a number of items, the intervention group responded even more positively. At 6 and 12 months, 51.1% and 54.7% of all participants, respectively, reported their quality of life as becoming better and over 40% of women at each time-point, indicated they felt more positive about themselves as a result of some aspect of their involvement in weave. 42% of all participants reported their home lives becoming less difficult. In qualitative analyses, positive themes identified were altruism, value, evaluation of relationship, validation, self-awareness, empowerment, positive reinforcement, catharsis, motivation to seek help, and response to the research process. Negative themes identified were short-term emotional reactions, long-term emotional reactions, recall, retraumatization and minimization. Many participants indicated short-term negative emotions had been balanced by longer-term positive benefits. Further research is needed regarding characteristics and experiences of the small minority of participants who did not report positive benefit.     

Contracting, prompting, and reinforcing substance use disorder continuing care: a randomized clinical trial.

Although continuing care is strongly related to positive treatment outcomes for substance use disorder (SUD), participation rates are low and few effective interventions are available. In a randomized clinical trial with 150 participants (97% men), 75 graduates of a residential Veterans Affairs Medical Center SUD program who received an aftercare contract, attendance prompts, and reinforcers (CPR) were compared to 75 graduates who received standard treatment (STX). Among CPR participants, 55% completed at least 3 months of aftercare, compared to 36% in STX. Similarly, CPR participants remained in treatment longer than those in STX (5.5 vs. 4.4 months). Additionally, CPR participants were more likely to be abstinent compared to STX (57% vs. 37%) after 1 year. The CPR intervention offers a practical means to improve adherence among individuals in SUD treatment.     

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.