Implementing the Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS): a therapeutic radiographer's perspective

Introduction: Lung cancer patients often have a number of comorbidities which impacts patient mortality and morbidity rates. Lifestyle changes for this group of patients have the potential to positively impact both quality of life and longevity. The Yorkshire Cancer Research funded Prehabilitation Radiotherapy Exercise smoking Habit cessation And Balanced diet Study (PREHABS) was designed to determine if it is feasible to embed interventions promoting a healthier lifestyle into the radical lung radiotherapy pathway. Method(s): The PREHABS study was led by therapeutic radiographers trained in smoking cessation provision, motivational interviewing, informed consent and good clinical practice and a dietitian. Radiographers screened and consented study participants, delivered the exercise intervention and up to 12-weeks of smoking cessation support, whilst dietary advice was provided by the dietitian. Patients diagnosed with chronic obstructive pulmonary disease (COPD), were referred to a community based pulmonary rehabilitation service rather than the PREHABS exercise intervention. Ethical and regulatory approvals were secured in September 2021. Result(s): 61 patients were recruited between September 2021 and October 2022. The majority were female (n=42), mean age 73.1 years (SD 9.36 years). Discussion(s): In addition to the training requirements detailed above and the challenges of COVID-19, the radiographers had to become adept in a number of study-specific aspects including writing the study standard operating procedures (SOPs), creating a study organisational workflow and patient recruitment. The PREHABS study has broadened the radiographer's perspective beyond the radiotherapy department, by further understanding the complex comorbidities that lung cancer patients present with, how to motivate patients to positively change their lifestyle, and how the side effects caused by cancer treatment can affect a patient's ability to change their lifestyle. Conclusion(s): Therapeutic radiographers, after appropriate training, are capable of delivering lifestyle intervention support within a radical lung cancer radiotherapy pathway. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Anticipatory Guidance through Online Motivational Interviewing for Mothers on Early Childhood Caries among Young Children of Age 9–24 Months amidst Pandemics: A Nonrandomized Clinical Trial

Early childhood caries (ECC) is a multifactorial disease with known etiologic factors and can be very devastating to the oral and general well-being of a child, including psychological impact on a growing child. The irony is among the different factors responsible for milk that is wholesome nutrition, if fed in a wrong pattern, can be the main factor that helps this type of rampant caries spread within no time, leading to pulp exposures and complicating proceedings. Awareness is the mainstay in prevention, and creating it becomes our sole responsibility as a pediatric dentists. A multidisciplinary approach with the involvement of mothers as a main stakeholder in this front becomes a very promising move, so this project is phase two of interprofessional collaboration involving mothers in prevention;the aim of the study is to create awareness among mothers during COVID lockdown so as to prevent ECC in this COVID pandemic. Materials and methods: A total of 222 mothers with 9–24 months old children were selected and added to the e-groups. The allocated mothers were given a pretest questionnaire and collected back with a photo of their child's oral health, and anticipatory guidance and in-depth interviewing were given to them. Follow-up is done in 2, 4, and 6 months. Awareness is evaluated by pre-and posttest questionnaires. Reversal of the white spot is evaluated through indices, and progression is noted. Statistical analysis: The data was analyzed using Statistical Package for the Social Sciences 13. Result: Pretest and postquestionnaire analysis were done using the Chi-squared test. The test shows the marked raise in knowledge, attitude, and practice of mothers on their children after postintervention, which was given through motivational interviewing (MI). Conclusion: In summary, the MI intervention appeared to improve maternal knowledge but had no effect on oral health behaviors or on the progression of early childhood caries (ECC). © The Author(s). 2023 Open Access.

A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics.

Introduction: Virtual and low-touch behavioral interventions are needed for African American/Black and Latino persons living with HIV (PLWH) with barriers to HIV viral suppression, particularly during COVID-19. Guided by the multiphase optimization strategy, we explored three components for PLWH without viral suppression, grounded in motivational interviewing and behavioral economics: (1) motivational interviewing counseling, (2) 21-weeks of automated text messages and quiz questions about HIV management, and (3) financial rewards for viral suppression (lottery prize vs. fixed compensation). Methods: This pilot optimization trial used sequential explanatory mixed methods to explore the components' feasibility, acceptability, and preliminary evidence of effects using an efficient factorial design. The primary outcome was viral suppression. Participants engaged in baseline and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. A subset engaged in qualitative interviews. We carried out descriptive quantitative analyses. Then, qualitative data were analyzed using directed content analysis. Data integration used the joint display method. Results: Participants (N = 80) were 49 years old, on average (SD = 9), and 75% were assigned male sex at birth. Most (79%) were African American/Black, and the remainder were Latino. Participants were diagnosed with HIV 20 years previously on average (SD = 9). Overall, components were feasible (>80% attended) and acceptability was satisfactory. A total of 39% (26/66) who provided laboratory reports at follow-up evidenced viral suppression. Findings suggested no components were entirely unsuccessful. The lottery prize compared to fixed compensation was the most promising component level. In qualitative analyses, all components were seen as beneficial to individual wellbeing. The lottery prize appeared more interesting and engaging than fixed compensation. However, structural barriers including financial hardship interfered with abilities to reach viral suppression. The integrated analyses yielded areas of convergence and discrepancy and qualitative findings added depth and context to the quantitative results. Conclusions: The virtual and/or low-touch behavioral intervention components tested are acceptable and feasible and show enough potential to warrant refinement and testing in future research, particularly the lottery prize. Results must be interpreted in the context of the COVID-19 pandemic. Trial registration: NCT04518241 (https://clinicaltrials.gov/ct2/show/NCT04518241).

Intervention Efficacy on Covid-19 Testing and Vaccination in People Who Inject Drugs

Background: People who inject drugs (PWID) are vulnerable to SARS-CoV-2 and severe disease but have low rates of COVID-19 testing and vaccination due to multilevel barriers. We partnered with a mobile syringe service program (SSP) in San Diego County, CA, to develop the theory-informed LinkUP intervention to increase COVID-19 testing and vaccination among PWID. Method(s): From March-June 2022, we conducted a pilot randomized controlled trial (RCT;ClinicalTrials.gov #NCT05181657) to assess efficacy of LinkUP vs. a didactic attention-matched control condition in increasing COVID-19 testing uptake and acceptance of vaccination referrals. Based on Social Cognitive Theory, trained, SSP-hired peer counsellors delivered tailored education, motivational interviewing, and problem-solving and planning to the active LinkUP intervention arm. We referred eligible participants (PWID, >=18 years old, San Diego County residents without recent voluntary COVID-19 testing or fully vaccinated status) to mobile SSP sites that had been randomized by week to offer LinkUP or the control condition;all participants were then offered on-site rapid COVID-19 antigen testing and vaccination referrals. Our intent-to-treat analysis used Chi-square tests to compare intervention groups' outcomes and log-binomial regression to estimate preliminary intervention efficacy and explore potential moderation. Result(s): Among 150 participants, median age was 41 years, 33% identified as Latinx and 65% as male, 73% were experiencing homelessness, and 45% had prior mandatory COVID-19 testing. Overall, we only detected one SARS-CoV-2 case. However, more active intervention vs. control participants agreed to COVID-19 testing (77.3% vs. 22.7%;p< .001) and vaccine referrals (32.4% vs. 13.3%;p=0.006). Homelessness moderated intervention effects: LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.64;95% CI: 1.27-2.12) than those not experiencing homelessness (aRR: 1.25;95% CI: 0.99-1.56). Conclusion(s): Findings from this RCT support the efficacy of LinkUP in increasing COVID-19 testing and acceptance of vaccination referrals among PWID presenting at mobile SSP sites, particularly for those experiencing homelessness. This research underscores the significance of communityacademic partnerships when working with PWID and identifies a promising model that could be adapted to increase access to other underutilized vaccines in this vulnerable population.

Vaccine Hesitancy: Obstacles and Challenges.

Purpose of Review: In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions. Recent Findings: There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions. Summary: Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.

The role of motivational interviewing training in supporting the practice of COVID-19 contact tracers

Purpose: To explore how motivational interviewing (MI) training might benefit the practice of COVID-19 contact tracers. Design/methodology/approach: Following co-production of a MI training package, with a United Kingdom (UK) track and trace organisation, training was delivered virtually to 101 volunteer participants involved in contact tracing. Data were captured via an online survey, incorporating questions from recognised measures of occupational self-efficacy and workplace wellbeing, prior to the training. Open data fields were used to gather feedback about participants' reasons for attending, and views about the training afterwards. Finding(s): Although the contact tracers reported high occupational self-efficacy and workplace wellbeing, both quantitative and qualitative data suggested participants saw practitioner value and utility in MI. Research limitations/implications: The sample was self-selecting and typically involved contact tracers from UK local authorities. The study did not measure impact on compliance with self-isolation guidance and/or providing details of contacts, and larger-scale research would be needed to establish this. This was not a pre-post-test evaluation study, and measures of occupational self-efficacy and workplace wellbeing were gathered to give insight into the sample and to test the feasibility of using this survey for a future large-scale study. The research was conducted during the height of the pandemic. While UK COVID-19 contact tracing services have since been reduced, there are potential implications for infection control more generally. Practical implications: MI is potentially a useful approach for enhancing contact tracing practice. However, implementation factors should be carefully considered, to ensure effective and sustainable practice. Social implications: Improved practice in contact tracing could have potential benefits in infection control, through improving compliance with central guidance, although this requires more widespread investigation. Originality/value: This is the first empirical study to investigate how MI training could benefit COVID-19 contact tracing practice.Copyright © 2023, Emerald Publishing Limited.

Vaccinator communication interventions to address HPV vaccine hesitancy

Human papillomavirus (HPV) vaccination is an effective public health tool to decrease the rates of HPV-related cancers in our communities. Vaccine hesitancy can undermine this effort, and interventions are needed to inform and assist individuals/parents in decision-making to receive vaccines. The COVID-19 pandemic and newly developed vaccines have increased attention and made families hesitant about vaccines. Receiving a provider's strong recommendation for the vaccine is one of the strongest predictors of HPV vaccine uptake. However, not all providers have the knowledge and skills to provide the best approach for families and patients. The primary communication method has been the presumptive approach. However, this may not work well with vaccine-hesitant individuals. Would another evidence-based approach, such as motivational interviewing (MI), improve vaccine uptake? A study analysis showed that the presumptive strategy remains proven;however, the MI communication strategy was less proven. However, an evidence-based intervention, DOSE HPV, endorsed by the National Cancer Institute showed promise. This DNP project implemented a quality improvement project in a public immunization clinic using the DOSE HPV model as a framework. The project purpose aimed to improve HPV vaccination rates in individuals aged 11-24 years. Staff participants received education on HPV 101 and two communication strategies, presumptive and MI approaches. The project data demonstrated a 5% increase in vaccine uptake for those aged 11-12 years and staff participants rated the educational presentation favorably. This DNP project potentially may be duplicated to include other vaccines, especially the COVID vaccine or other applications changing health behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Nutritional care approaches and outcomes of health care professionals managing alcohol withdrawal patients post hospital discharge: a scoping review

Alcohol use disorder (AUD) is highly prevalent in Australia.(1) However, best practice management of AUD in the community post discharge from hospital is not well articulated in the literature. In particular, given the harmful effects excessive alcohol consumption has on nutritional status there is a need to identify what approaches are being utilised in managing this vulnerable group.(2) Hence the aim of this scoping review was to identify the current approaches and outcomes with respect to nutritional care as identified by the Nutrition Care Process Model (NCPM) for patients discharged from hospital post alcohol withdrawal. This scoping review was registered with OpenScience Framework (words: PubMed, CINAHL, Web of Science and Scopus. Articles included were published between January 1995 and April 2022 Eligible articles were screened independently by pairs of reviewers, and consensus was reached across pairs to provide inter-rater and inter-consensus reliability. Screening and data extraction was conducted using Covidence by reviewers HM, ATM, CM, SG Fourteen articles were eligible for inclusion. Approaches to nutritional care was identified based on the intervention utilised and in comparison to the NCPM.(3) Key findings were screening for nutrition related problems and anthropometry measures were the most evaluated (n = 10), whereas practices of referral providing continuum of care were highlighted in only a minority of studies (n = 3). Education interventions included Motivational Interviewing and cognitive behavioural therapy sessions (4) (n = 7). Few studies (n = 4) which combined harm-reduction counselling with nutritional approaches and education interventions showed significant improvement (p < 0.05) in outcome measures of nutritional care. This was measured through the improvement in nutritional status (positive eating habits, decrease in nutrition-related impact symptoms, and WHO Quality of Life (QoL) health and physical domains) Limitations include varying aims of analysis and a paucity of information in this area. There is a need for further studies to be completed in this area to understand the nature of this complex issue and recommend effective strategies to improve health outcomes for individuals and populations.

Virtual training of rheumatoid arthritis peer coaches in motivational interviewing skills and concepts of cardiovascular disease.

Background: Peer coaching interventions are effective in helping individuals with chronic conditions understand their disease. Most peer coach training programs occur in person, which has become an obstacle during the COVID pandemic. We describe our experiences with virtual training for future peer coach interventions. Methods: Individuals with rheumatoid arthritis (RA) between 40 and 75 years of age were recruited and interviewed by the research team. We conducted seven virtual training sessions focused on four main points: Listen, Discuss, Practice, and Certify. The peer coaches provided feedback throughout the program, which was used to refine the training and intervention. A post-training focus group assessed satisfaction with the training program and intervention development process. Results: Four peer coaches (3 women, 1 man) were trained, including 2 Black and 2 White individuals with advanced degrees. Their ages ranged from 52 to 57, and their RA duration ranged from 5 to 15 years. An iterative process with the coaches and researchers resulted in a nine-week training program. Peer coaches reported satisfaction, confidence, and a preference for the virtual training format. Conclusion: This virtual peer coach training program was feasible and acceptable for coaches with advanced degrees during the global COVID-19 pandemic. Our approach represents an opportunity to adapt training that has been traditionally done in person. By doing so, our approach facilitates the recruitment and training of a diverse group of coaches and promotes sustainability.

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial.

BACKGROUND: People who inject drugs (PWID) have low rates of COVID-19 testing yet are vulnerable to severe disease. In partnership with a mobile syringe service program (SSP) in San Diego County, CA, we developed the evidence-, community-, and Social Cognitive Theory-informed "LinkUP" intervention (tailored education, motivational interviewing, problem-solving, and planning) to increase COVID-19 testing uptake among PWID. PURPOSE: To assess preliminary efficacy of LinkUP in increasing PWID COVID-19 testing in a pilot randomized controlled trial (RCT). METHODS: We referred participants (PWID, ≥18 years old, San Diego County residents who had not recently undergone voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week) to offer the active LinkUP intervention or didactic attention-control conditions delivered by trained peer counselors. Following either condition, counselors offered on-site rapid COVID-19 antigen testing. Analyses estimated preliminary intervention efficacy and explored potential moderation. RESULTS: Among 150 participants, median age was 40.5 years, 33.3% identified as Hispanic/Latinx, 64.7% were male, 73.3% were experiencing homelessness, and 44.7% had prior mandatory COVID-19 testing. The LinkUP intervention was significantly associated with higher COVID-19 testing uptake (p < .0001). Homelessness moderated intervention effects; LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.80; 95% CI: 1.56-2.09; p < .0001) than those not experiencing homelessness (aRR: 1.20; 95% CI: 1.01-1.43; p = .04). CONCLUSIONS: Findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention to increase COVID-19 testing among PWID and underscore the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.

People who inject drugs (PWID) are vulnerable to severe COVID-19 disease yet have low rates of COVID-19 testing. We partnered with a syringe service program (SSP) in San Diego County, CA, to develop "LinkUP," an evidence- and community-informed intervention. Specifically, LinkUP used tailored education, motivational interviewing, and problem-solving and planning strategies to increase COVID-19 testing uptake among PWID. This study was a pilot randomized controlled trial (RCT) designed to assess the preliminary efficacy of LinkUP in increasing PWID COVID-19 testing. We referred participants (PWID, ≥18 years old, San Diego residents without recent voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week). Trained peer counselors then offered LinkUP or an educational control condition lasting the same length (~30 minutes). After either condition, counselors offered on-site rapid COVID-19 antigen testing. Among 150 participants, our analyses found that the LinkUP intervention was associated with higher COVID-19 testing uptake, especially for participants experiencing homelessness. In summary, our findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention in increasing COVID-19 testing among PWID. This study also underscores the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.

Development of PIVOT with MI: A motivational Interviewing-Based vaccine communication training for pediatric clinicians.

Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial.

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Challenges of virtual talking therapies for substance misuse in New Zealand during the COVID-19 pandemic: An opinion piece

The COVID-19 pandemic requires us to rethink how virtual approaches might work for people who use alcohol and other drugs. Are virtual clinics only suitable for clients with whom clinicians have already formed a therapeutic relationship? How well would virtual clinics work for new clients presenting to services, for clients in acute distress, and for those with complex problems? Addressing the sustained change required to maintain substance-free lives or a safe substance-use life requires robust psychotherapeutic approaches, which have traditionally been delivered through physical contact, whether they are one-to-one or group-based interventions. The challenge during this time of the COVID-19 pandemic is to deliver effective talking therapies while avoiding physical contact. How then should services continue to offer counselling and support in such an environment? How can we learn from the COVID-19 situation to deliver treatment to individuals who may have difficulties attending traditional clinic-based care, such as those in more rural areas with transport difficulties? This article focuses on identifying practical issues and providing some solutions. Copyright © 2020 New Zealand Medical Association. All rights reserved.

A Telepsychiatry Simulation for Suicide Assessment: Increasing Virtual Mental Health Competency in Health Professional Students

Objectives: Suicide is a global epidemic that claims up to 800,000 lives each year and is the second leading cause of death in young people aged 15-29 years. With the COVID-19 pandemic came increased rates of stress, helplessness, and suicide among adolescents. The increasing popularity of telemedicine opens new doors for identifying patients in distress, decreasing suicide rates, and increasing access to mental health services. Youth and adolescents grew up with electronics and will likely be open to the use of telemedicine in the future. However, it is unknown how prepared learners are for the unique challenges of these new modes of patient interaction. Method(s): We designed a telemedicine simulation for medical and physician assistant students to identify, assess, and appropriately escalate care for a standardized patient (SP) with suicidal ideation. We incorporated didactics on telepsychiatry, a motivational interviewing exercise, and a simulated telemedicine objective structured clinical exam (OSCE). Students completed a participant survey and were evaluated by SPs on their medical knowledge, interpersonal/communication skills, and 8 key telemedicine competencies. Result(s): Forty-four students completed the workshop, and 30 students completed the participant survey. Students were strongest in interpersonal/communication skills and weakest in telemedicine competencies. SPs evaluated telemedicine performance by deeming students "not yet entrustable," "approaching entrustment," or "entrustable" based on their ability to perform a described behavior or task unsupervised. Only 20% of students were entrustable to describe when patient safety was at risk, including when and how to escalate care. Fifty percent correctly interpreted the Patient Health Questionnaire, 59% completed the Columbia Suicide Risk Assessment, and 41% completed a suicide safety plan. Ninety-seven percent of students said that they expect to use telemedicine in their future practice. Conclusion(s): The telepsychiatry OSCE revealed gaps in students' telepsychiatry knowledge, particularly in telemedicine-specific competencies. Future studies are needed to assess the generalizability of our findings, including incorporating adolescent SPs to prepare students for the mental health needs of all ages given increasing rates of suicide in adolescent populations. TVM, S, AC Copyright © 2022

Community-oriented Motivational Interviewing (MI): A novel framework extending MI to address COVID-19 vaccine misinformation in online social media platforms.

Researchers have linked circulating misinformation in online platforms to low COVID-19 vaccine uptake. Two disparate literatures provide relevant initial guidance to address the problem. Motivational Interviewing (MI) effectively reduces vaccine hesitancy in clinical environments; meanwhile, social scientists note inoculation, rebuttal, and appeals to accuracy are persuasive in digital contexts. A tension is inherent in these approaches. MI in digital forums may induce an 'illusory truth effect,' wherein falsehoods appear more accurate through repetition. Yet, rebutting misinformation directly may elicit backfire or reactance effects, motivating some to amplify their presentation of misinformation. Building on Identity Process Theory, we propose a theoretical framework for conducting MI-based infodemiology interventions among digital communities that conceptualizes the community in toto (rather than one specific person) as the unit of focus. Case examples from interventions on public Facebook posts illustrate three processes unique to such interventions: 1) Navigating tension between addressing commenters and "bystanders"; 2) Activating pro-vaccine bystanders; and 3) Reframing uncertainty or information individuals might find concerning or threatening according to implied collective values. This paper suggests community-oriented MI can maximize persuasive effects on bystanders while minimizing potential reactance from those with committed beliefs, thereby guiding community-oriented public health messaging interventions enacted in digital environments.

Study protocol for a pilot randomized controlled trial to increase COVID-19 testing and vaccination among people who inject drugs in San Diego County.

BACKGROUND: People who inject drugs (PWID) have low rates of COVID-19 testing and vaccination and are vulnerable to severe disease. We partnered with a local, community-based syringe service program (SSP) in San Diego County, CA, to develop the single-session theory- and evidence-informed "LinkUP" intervention to increase COVID-19 testing and vaccination. This paper details the protocol for a pilot randomized controlled trial (RCT) of the LinkUP intervention. METHODS: With significant community input into study design considerations, including through our Community and Scientific Advisory Board, the LinkUP pilot RCT leverages an ongoing cohort study with adult (≥ 18 years) PWID in San Diego County to recruit participants who have not recently undergone voluntary COVID-19 testing and are unvaccinated. Eligible participants are referred to SSP locations randomized to offer the active intervention (involving tailored education, motivational interviewing, and problem-solving strategies) or a didactic attention-control condition (information sharing only). Both conditions are delivered by trained peer counselors hired by the SSP and were designed to be delivered at mobile (outdoor) SSP sites in ~ 30 min. Intake data assesses COVID-19 testing and vaccination history, health status, and harm reduction needs (to facilitate SSP referrals). At the end of either intervention condition, peer counselors offer onsite rapid COVID-19 antigen testing and COVID-19 vaccination referrals. Out-take and follow-up data (via SSP and state health department record linkages) confirms whether participants received the intervention, COVID-19 testing (and results) onsite or within six months, and vaccination referrals (and uptake) within six months. Planned analyses, which are not powered to assess efficacy, will provide adequate precision for effect size estimates for primary (COVID-19 testing) and secondary (vaccination) intervention outcomes. Findings will be disseminated widely including to local health authorities, collaborating agencies, and community members. DISCUSSION: Lessons from this community-based pilot study include the importance of gathering community input into study design, cultivating research-community partnerships based on mutual respect and trust, and maintaining frequent communication regarding unexpected events (e.g., police sweeps, neighborhood opposition). Findings may support the adoption of COVID-19 testing and vaccination initiatives implemented through SSPs and other community-based organizations serving vulnerable populations of people impacted by substance use and addiction. Trial registration This trial was registered prospectively at ClinicalTrials.gov (identifier NCT05181657).

Brief Motivational Interviewing: Evaluation of a skills-based education program

Purpose: Oral health care providers have been charged with recommending the human papillomavirus (HPV) vaccine for the prevention of HPV oropharyngeal cancers (OPC). The purpose of this study was to determine dental hygiene student competency of the application of brief motivational interviewing (BMI) and the accuracy of HPV vaccine information for the prevention of HPV OPC. Methods: A convenience sample of 59 senior dental hygiene (DH) students from the class of 2020 (n=31) and the class of 2021 (n=28) participated in the HPV OPC curriculum and skills-based BMI training at the University of Minnesota School of Dentistry. Students completed two audio-recorded patient interactions and one Objective Structured Clinical Examination (OSCE). Student self-assessment and faculty evaluation scores were determined by a standardized BMI HPV rubric. Descriptive statistics were used to analyze the data. Results: Class of 2021 self-assessment ratings were higher than the class of 2020 in all components of the BMI HPV rubric at all three time points. Faculty evaluation achieved statistically significant improvement for the class of 2021 from patient Interaction 1 (evocation p<0.01;summary p<0.01) to the OSCE (evocation p<0.05;summary p<0.01). Both classes rated themselves as competent (≥70%) for most BMI subcategories. Conclusion: Dental hygiene student competence in demonstrating the components of the Spirit of MI to the accuracy of HPV and HPV vaccine information was achieved through the implementation of the skills-based BMI HPV training. Outcomes of student self-assessment and faculty evaluation highlighted the Kirkpatrick Model as a framework to evaluate BMI skills-based training.

Advancing adolescent bedtime by using motivational interviewing and text reminders – a randomized controlled trial

Introduction: Chronic sleep deprivation is a prevalent sleep prbolem in school-aged adolescents. The natural delay of circadian rhythm combined with early school schedule leading to significant sleep loss during school days. In particular, adolescents in Hong Kong not only sleeping less than their Shanghai counterparts but also having later bedtime. Delaying school start time is an effective strategy but has met numerous constraints. While previous sleep education programs have successfully improved sleep knowledge but failed to increase sleep practice. Intervention with specific focus on late bedtime might be an potential approach to improve adolescent sleep. Current study explores the possibility of advancing adolescent bedtime by group-based motivational enhancement approach and text message reminders. Materials and Methods: Healthy adolescents (12-18 yrs old) with schoolday sleep duration <7 hours and without other sleep disorders such as insomnia and delay sleep phase disorder were randomly allocated to intervention or non-active control group. The intervention consists of four weekly, group-based therapy delivered using motivational interviewing approach and 3 week daily text reminders. Assessments were conducted at baseline, post-intervention, 3-month and 6 -month follow up. The primary outcomes were sleep-wake pattern captured by 7-day sleep dairy. The intervention effect was evaluated by linear mixed model. The trial was registered with the Clinical Trial Registry (NCT03614572). Results: A total of 212 adolescents (mean age: 15.8±0.98;female:60.1%) were recruited from Aug 2018 to Apr 2021. Approxiamtely 80% of the adolescents attended all the follow up assessments. Adolescents in the intervention group have significantly earlier schoolday bedtime at post-intervention (intervention vs. control:(-14 mins vs +19 mins) and 6-month follow up(-14 mins vs + 21 mins) compared to the control group(F=4.6, P = 0.004). They also had a tendency of increased sleep duration throughout the follow up period, but the difference was not significant(F=2.22, P = 0.089). This is explained by the difference in schoolday wakeup time as control group had a significant later wakeup time at post-intervention (intervention vs. control: -2 mins vs +23 mins) in relative to the intervention group. It is not common to observe a change in schoolday wakeup time as wakeup time is largely determined by early school schedule. The outbreak of Coronavirus in 2020 has forced schools to close and adopted an online study mode. The online class schedule varied significantly between schools, which might explain the difference in wakeup time at follow up assessment. Despite there is no significant difference in schoolday sleep duration, adolescents in the intervention group reported greater intention to behavioral changes(P=0.043), and lower level of daytime sleepiness(P=0.001). However, there is no difference observed in sleep knowledge, mood symptoms and quality of life. Conclusions: This study supports that motivational interviewing in combined with text reminders are effective approach in advancing adolescent bedtime, improving their motivation and daytime functioning. Adolescents were able to maintain earlier bedtime regardless of the school schedule. We suggest that advancing bedtime protocol should be incorporated at school-level to benefit more adolescents. Acknowledgements:Supported by Health Medical Research Fund (#15163071), Hong Kong SAR, China.

Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians.

Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.

A description of virtual skills workshops for supporters of loved ones with eating disorders: Indicators of benefit and acceptability, clinical reflections and consideration of neurodiversity.

OBJECTIVE: Providing information and support to those supporting a loved one with an eating disorder is a key part of evidence-based service provision. We report on how we took our workshops for supporters online during the Covid-19 Pandemic when country-side physical distancing restrictions meant we were unable to work face to face. METHODS: We outline the structure of an eight-session 2-h workshop series delivered fortnightly facilitated by a multidisciplinary team of clinicians, researchers and experts by experience. We use a repeated-measures design to understand the possible benefits of the workshops on supporter skills (n = 76). RESULTS: Measured using the Caregiver Skills Scale, we observed small-sized improvements in the overall skills (D = 0.43) of n = 17 supporters who provided data at the end of the intervention. Supporters gave largely positive feedback on the virtual format. They particularly liked the opportunity to interact with other supporters. As facilitators, we overcome our initial anxiety around workshop delivery using a new platform and reflected that having more time to cover key information and for skills practice over a period of 16 weeks offered opportunities to develop and reflect on new skill together as a group. We were also able to work with larger groups of supporters, as several barriers to access were removed. CONCLUSIONS: As the workshops reached a larger number of supporters than through face to face delivery and were of benefit to those who reported on their skills, we plan to continue offering workshops to supporters online in future.