The Links Among Perceived Adherence to the System of Care Philosophy,Consumer Satisfaction,and Improvements in Child Functioning

The present study investigated the associations among perceived adherence to the system of care philosophy, changes in internalizing and externalizing behaviors, and consumer satisfaction with services. Participants included 98 families, interviewed at two time points across a one-year period. Hierarchical multiple regressions indicated that the more a child and family perceived services to be consistent with the system of care philosophy, the greater their level of satisfaction with services and the fewer internalizing and externalizing behaviors they reported one year after receiving services (controlling for initial levels of problem behaviors). Implications for children’s mental health service delivery are offered.     

Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = −2.06, p = .046, d = −0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement’s effects on physical and mental health.     

IMPROVING THE ACCURACY OF SELF-REPORTS OF ADHERENCE

Behavioral scientists who study socially important but difficult-to-measure behaviors often rely on self-reports. We evaluated the influence of three experimenter demands—demand for adherence, demand for accurate reports, and demand for accurate reports combined with a prompted recall strategy—on the accuracy of self-reports of adherence to a week-long prescribed regimen of twice-daily telephone calls. Self-reports of adherence were significantly more accurate in the accuracy demand/prompted recall group (p < .05). The analogue study should be replicated with other regimens and populations to determine the most effective strategies for enhancing the accuracy of self-reports.     

The relationship among the transtheoretical model of behavioral change,psychological distress,and diet attitudes in obesity: Implications for primary care intervention

Obesity is prevalent but undertreated in primary care. Family practice volunteer outpatients (N=454) were administered the Stage of Change for Weight (URICA), the Brief Symptom Inventory (BSI), and the Diet Readiness Test (DRT) to assess the relationship between these variables and obesity. The body mass index (BMI) was used to classify obesity revealing 197 patients with elevated BMI's. There was no significant difference between the obese and the nonobese on any of the psychological measures. The obese reported significantly more difficulty setting diet goals and less control over their eating, ate more to emotional situations, and exercised less than the nonobese. The obese sample (46.7%) reported being in the Action stage of change for weight management. Implications for intervention in primary care include targeting attitudes (DRT) and dispelling physician attitudes that obese individuals have increased levels of psychological distress. Addressing Stage of Change for weight management can facilitate tailoring the appropriate intervention when used in concert with the DRT variables.     

Target-related autobiographical memories affect dietary intake intentions*

ABSTRACT

Although there is evidence that autobiographical memory (AM) recall impacts behaviour in multiple domains, the mechanisms for this effect are unclear. Two experiments examined how AM Frame and Relatedness to target behaviour affect intention to control future dietary intake. Participants completed an AM task where they recalled success or fail-framed memories of behaviour in the target domain (dietary intake), a related domain (exercise), and an unrelated domain (work). Next they completed questionnaires about attitudes, self-efficacy, and behavioural intention for controlling dietary intake. In Experiment 1, Frame and Relatedness of AMs recalled did not affect attitudes or self-efficacy ratings of controlling dietary intake. However, Related AMs resulted in higher intention ratings to control future dietary intake compared to Unrelated AMs. Experiment 2 replicated these results for attitude and self-efficacy, but showed no effect on behavioural intention. A mini-meta analysis was conducted to clarify the effect of AM recall on intention. This analysis confirmed a significant effect of AM Relatedness on intention ratings (meta-analysis Cohen’s d?=?.25, Z?=?2.54, p?=?.011). These results provide evidence that recalling related AM can affect dietary behaviour intentions directly, without changes attitudes or ratings of personal control regarding dietary intake.     

Spouse marital adjustment and patient dietary adherence in chronic hemodialysis: A Comparison of Afro-Americans and Caucasians

Abstract

This study investigated racial differences in the relationship between spouse marital adjustment and dietary adherence of chronic hemodialysis patients. Sixty-eight adult patients and their spouse were subjects. Fifty-two percent of the patients were Caucasians while 48% were Afro-Americans. Spouses completed the Locke-Marital-Questionnaire (LMQ) and provided demographic data pertaining to their patient spouses. The patients' predialysis potassium levels (indices of food intake compliance) for the previous three months were matched with the respective questionnaires. Afro-American spouses, especially males, evidenced significantly lower marital satisfaction than Caucasian spouses. Afro-American female patients seemed to be most compliant as far as food intake wasconcemed. Although the spouse LMQ score was negatively correlated with interdialysis weight gain. Afro-Americans who generally scored lower on the LMQ did not differ from Caucasians in so far as their adherence to the dietary regimen was concerned. Implications for improving quality of life of hemodialysis couples in general, and Afro-Americans in particular are discussed.     

The Hepatitis C treatment experience: Patients’ perceptions of the facilitators of and barriers to uptake,adherence and completion

Objective: This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program.

Design: Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC).

Main outcome measures: To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion.

Results: Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system.

Conclusion: To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies.     

Prediction of dietary adherence in cholesterol reduction: Relative contribution of personality variables and health attitudes

Abstract

The purpose of this study was to identify personality and health attitude variables that might predict adherence to a cholesterol-reducing diet.

After taking a battery of psychological inventories, 66 subjects entered a 26 week diet program. Adherence indices included attendance rate at scheduled appointments, changes in diet, and changes in serum cholesterol levels.

Of the 55 subjects with complete data, 7 dropped out, 7 attended inconsistently, and 41 completed the program. Drop-outs scored significantly lower on the Health Belief measures of seriousness, susceptibility, and benefits. Improvement in serum cholesterol was positively correlated with the Health Belief Benefits Scale and negatively correlated with the Health Locus of Control chance scale. Dietary reduction in saturated fat was positively associated with the Health Belief Seriousness and Benefits Scales.

Health attitudes and beliefs were better predictors of adherence than personality trait measures.     

Transitioning from a hospital rehabilitation programme to home: Exploring the experiences of people with complex regional pain syndrome

Complex regional pain syndrome (CRPS) is difficult to diagnose and is characterised by burning pain in one or more limbs. Treatment is palliative not curative and focuses on improving function. This requires patients to make long-term changes to their behaviour. As with all such regimens, adherence is often poor. This study explored the lived experience of 10 patients who had returned home after completing a two-week in-patient treatment programme. The interviews focused on how they coped with the transition from hospital to home, and on the things that they considered had facilitated or hindered this transition. Battling for Control was an overarching theme that connected the four superordinate themes: ‘Gaining Momentum’ that facilitated the implementation of treatment advice, ‘Distance from the pool of expertise’ that detailed the barriers to adherence experienced; ‘It helped me realise it was not all in my head’ that detailed a facilitative process, and the ‘nag list’ that was a technique patients’ used to garner support. This article offers insights into the transition experience. A key outcome is the recognition of the need to better prepare patients for their transition back home.     

Clinical commentary by David Trevatt,Clinical Manager of ‘Hear and Now’ Adolescent Counselling Service,Redbridge and Manager of Open Door's Parenting Teenagers Project,Haringey

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.