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1.
Int J Environ Res Public Health ; 19(4)2022 02 15.
Article in English | MEDLINE | ID: covidwho-1715312

ABSTRACT

Functional analyses (FA) and functional communication training (FCT) are the most commonly used behavioral assessment and treatment approaches via telehealth for children with autism spectrum disorder (ASD) who display challenging behavior. The FA + FCT telehealth model has been shown to maintain treatment effectiveness (i.e., child behavioral outcomes and parent acceptability), as well as demonstrate treatment efficiency (i.e., cost savings). However, the majority of these studies have been conducted in the United States. Therefore, the purpose of this study was to evaluate the outcomes obtained with the telehealth FA + FCT model that included global applications. Descriptive statistics were used to analyze the results of the 199 participants who enrolled in the telehealth project across all project sites. The results showed that behavioral outcomes and parent acceptability maintained at similar levels to previous studies across all sites. Additionally, very few differences were found across project sites in relation to drop-out rates, visit cancellations, and technology issues. These results demonstrate the effectiveness of the FA + FCT telehealth model for addressing the challenging behavior needs of children with ASD globally and highlight areas in need of additional evaluation (e.g., drop-outs, cancellations) to determine the conditions under which telehealth could be best used.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , Problem Behavior , Telemedicine , Autism Spectrum Disorder/therapy , Behavior Therapy/methods , Child , Humans , Telemedicine/methods
2.
JMIR Mhealth Uhealth ; 10(2): e31537, 2022 02 16.
Article in English | MEDLINE | ID: covidwho-1714901

ABSTRACT

BACKGROUND: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. OBJECTIVE: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). METHODS: This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). RESULTS: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (ß=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. CONCLUSIONS: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT.


Subject(s)
Mobile Applications , Behavior Therapy/methods , Child , Delivery of Health Care , Humans , Nutrition Policy , Nutritional Status
3.
Int J Ment Health Nurs ; 31(4): 843-856, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1634395

ABSTRACT

Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID-19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face-to-face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face-to-face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face-to-face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation.


Subject(s)
Borderline Personality Disorder , COVID-19 , Dialectical Behavior Therapy , Behavior Therapy/methods , Borderline Personality Disorder/therapy , Dialectical Behavior Therapy/methods , Humans , Pandemics , Treatment Outcome
4.
J Med Internet Res ; 23(2): e24893, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1574527

ABSTRACT

BACKGROUND: Suboptimal adherence to 6-mercaptopurine (6-MP) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and associated with increased risk of relapse. Rapid uptake of personal technology makes mobile health (mHealth) an attractive platform to promote adherence. OBJECTIVE: Study objectives were to examine access to mobile technology and preferences for an mHealth intervention to improve medication adherence in pediatric ALL. METHODS: A cross-sectional survey was administered in oncology clinic to parents of children with ALL as well as adolescents and young adults (AYAs) with ALL receiving maintenance chemotherapy. RESULTS: A total of 49 parents (median age [IQR] 39 [33-42] years; female 76% [37/49]) and 15 patients (median age [IQR] 17 [16-19]; male 80% [12/15]) participated. All parents and AYAs owned electronic tablets, smartphones, or both. Parents' most endorsed mHealth app features included a list of medications (71%, 35/49), information about 6-MP (71%, 35/49), refill reminders (71%, 35/49), and reminders to take 6-MP (71%, 35/49). AYAs' most endorsed features included refill reminders (73%, 11/15), reminders to take 6-MP (73%, 11/15), and tracking 6-MP (73%, 11/15). CONCLUSIONS: Parents and AYAs reported ubiquitous access to mobile technology and strong interest in multiple adherence-specific mHealth app features. Parents and AYAs provided valuable insight into preferred features for a multifunctional behavioral intervention (mHealth app) to promote medication adherence in pediatric ALL.


Subject(s)
Behavior Therapy/methods , Medication Adherence/statistics & numerical data , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Technology/methods , Telemedicine/methods , Adolescent , Adult , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Mobile Applications/statistics & numerical data , Smartphone , Surveys and Questionnaires , Young Adult
5.
Ghana Med J ; 54(4 Suppl): 86-96, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436199

ABSTRACT

Since March 2020, Ghana's creative arts communities have tracked the complex facets of the COVID-19 pandemic through various art forms. This paper reports a study that analysed selected 'COVID art forms' through arts and health and critical health psychology frameworks. Art forms produced between March and July 2020, and available in the public sphere - traditional media, social media and public spaces - were collated. The data consisted of comedy, cartoons, songs, murals and textile designs. Three key functions emerged from analysis: health promotion (comedy, cartoons, songs); disease prevention (masks); and improving the aesthetics of the healthcare environment (murals). Textile designs performed broader socio-cultural functions of memorialising and political advocacy. Similar to earlier HIV/AIDS and Ebola arts interventions in other African countries, these Ghanaian COVID art forms translated public health information on COVID-19 in ways that connected emotionally, created social awareness and improved public understanding. However, some art forms had limitations: for example, songs that edutained using fear-based strategies or promoting conspiracy theories on the origins and treatment of COVID-19, and state-sponsored visual art that represented public health messaging decoupled from socio-economic barriers to health protection. These were likely to undermine the public health communication goals of behaviour modification. We outline concrete approaches to incorporate creative arts into COVID-19 public health interventions and post-pandemic health systems strengthening in Ghana. FUNDING: None declared.


Subject(s)
COVID-19/prevention & control , Health Communication/methods , Health Promotion/methods , Medicine in the Arts , Public Health/methods , Behavior Therapy/methods , Creativity , Ghana , Humans , SARS-CoV-2
6.
Open Heart ; 8(1)2021 06.
Article in English | MEDLINE | ID: covidwho-1263930

ABSTRACT

OBJECTIVES: This meta-analysis aims to (1) evaluate the efficacy of physical activity interventions in heart failure and (2) to identify intervention characteristics significantly associated with the interventions' efficacy. METHODS: Randomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (eg, cardiac rehabilitation), strategies used (eg, action planning), setting (eg, centre based), mode of delivery (eg, face to face or online), facilitator (eg, nurse), contact time and behavioural change theory use as predictors in the random-effect model. RESULTS: Interventions (n=21) had a significant overall effect (SMD=0.54, 95% CI (0.13 to 0.95), p<0.0005). Combining an exercise programme with behavioural change intervention was found efficacious (SMD=1.26, 95% CI (0.26 to 2.26), p<0.05). Centre-based (SMD=0.98, 95% CI (0.35 to 1.62), and group-based (SMD=0.89, 95% CI (0.29 to 1.50),) delivery by a physiotherapist (SMD=0.84, 95% CI (0.03 to 1.65),) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD=3.29, 95% CI (1.97 to 4.62)), credible source (standardised mean difference, SMD=2.08, 95% CI (0.95;3.22)), adding objects to the environment (SMD=1.47, 95% CI (0.41 to 2.53)), generalisation of the target behaviour SMD=1.32, 95% CI (0.22 to 2.41)), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI (0.05 to 1.98)), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI (0.06 to 1.52), graded tasks (SMD=0.73, 95% CI (0.22 to 1.24)), behavioural practice/rehearsal (SMD=0.72, 95% CI (0.26 to 1.18)), action planning (SMD=0.62, 95% CI (0.03 to 1.21)) and goal setting (behaviour) (SMD=0.56, 95% CI (0.03 to 1.08)). CONCLUSION: The meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behavioural change intervention delivered by a physiotherapist in a group-based and centre-based settings. PROSPERO REGISTERATION: CRD42015015280.


Subject(s)
Behavior Therapy/methods , Cardiac Rehabilitation/methods , Exercise/physiology , Heart Failure/rehabilitation , Heart Failure/physiopathology , Humans , Treatment Outcome
7.
Psychiatry Res ; 301: 113966, 2021 07.
Article in English | MEDLINE | ID: covidwho-1201985

ABSTRACT

Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of ambulatory behavioral health treatment has transitioned to a telehealth, or virtual, format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared patient satisfaction of partial hospital services delivered via telehealth to in-person treatment provided to patients treated prior to the COVID-19 outbreak. The sample included 240 patients who were treated virtually from May, 2020 to October, 2020, and a comparison group of 240 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction after the initial evaluation and at the end of treatment. For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with the initial diagnostic evaluation and were optimistic at admission that treatment would be helpful. At the completion of treatment, both groups were highly satisfied with all components of the treatment program and almost all would recommend treatment to a friend or family member. Thus, patient satisfaction was as high with telehealth partial hospital treatment as with in-person treatment.


Subject(s)
Behavior Therapy/methods , COVID-19 , Mental Disorders/therapy , Office Visits/statistics & numerical data , Patient Satisfaction , Personal Satisfaction , Telemedicine/methods , Ambulatory Care , Ambulatory Care Facilities , COVID-19/epidemiology , Delivery of Health Care , Health Services Accessibility , Hospitalization , Hospitals , Humans , Male , Mental Disorders/psychology , Outpatients , Pandemics , Rhode Island , SARS-CoV-2
8.
Prev Sci ; 22(3): 269-283, 2021 04.
Article in English | MEDLINE | ID: covidwho-1081679

ABSTRACT

Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent-Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.


Subject(s)
Behavior Therapy/methods , COVID-19/epidemiology , Child Behavior Disorders/psychology , Child Behavior Disorders/therapy , Parent-Child Relations , Telemedicine , Adult , Child , Female , Florida , Humans , Male , Pandemics , Pilot Projects , SARS-CoV-2
9.
Br J Health Psychol ; 26(1): 1-14, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066632

ABSTRACT

PURPOSE: Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action. METHODS: Iterative consensus (O'Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques. RESULTS: We propose a worldwide network of 'Centres for Understanding Behaviour Change' (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide. CONCLUSION: Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID-19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions.


Subject(s)
Behavior Therapy/methods , COVID-19 , Humans , International Cooperation , Obesity
10.
J Subst Abuse Treat ; 120: 108150, 2021 01.
Article in English | MEDLINE | ID: covidwho-1023674

ABSTRACT

The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond.


Subject(s)
COVID-19 , Substance-Related Disorders/therapy , Telemedicine/methods , Behavior Therapy/methods , Economics, Behavioral , Humans , Precision Medicine
11.
J Pediatr Psychol ; 45(9): 983-989, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-780412

ABSTRACT

OBJECTIVE: We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. RESULTS: Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. CONCLUSIONS: When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.


Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Behavior Therapy/methods , Betacoronavirus , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Parents/psychology , Pneumonia, Viral/prevention & control , Psychotherapy, Group/methods , Telemedicine/methods , Attention Deficit Disorder with Hyperactivity/psychology , COVID-19 , Caregivers/psychology , Child , Child, Preschool , Female , Humans , Male , SARS-CoV-2
13.
J Subst Abuse Treat ; 118: 108102, 2020 11.
Article in English | MEDLINE | ID: covidwho-714497

ABSTRACT

The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences.


Subject(s)
Behavior Therapy/methods , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Substance-Related Disorders/therapy , COVID-19 , Central Nervous System Stimulants/administration & dosage , Central Nervous System Stimulants/adverse effects , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Factors , Substance-Related Disorders/epidemiology , Vulnerable Populations
14.
J Behav Med ; 43(3): 341-345, 2020 06.
Article in English | MEDLINE | ID: covidwho-116743

ABSTRACT

Our public health approaches to addressing COVID-19 are heavily dependent on social and behavioral change strategies to halt transmissions. To date, biomedical forms of curative and preventative treatments for COVID-19 are at best limited. Four decades into the HIV epidemic we have learned a considerable amount of information regarding social and behavioral approaches to addressing disease transmission. Here we outline broad, scoping lessons learned from the HIV literature tailored to the nature of what we currently know about COVID-19. We focus on multiple levels of intervention including intrapersonal, interpersonal, community, and social factors, each of which provide a reference point for understanding and elaborating on social/behavioral lessons learned from HIV prevention and treatment research. The investments in HIV prevention and treatment research far outweigh any infectious disease in the history of public health, that is, until now with the emergence of COVID-19.


Subject(s)
Behavior Therapy/methods , Coronavirus Infections/epidemiology , Coronavirus , Disease Transmission, Infectious/prevention & control , HIV Infections/prevention & control , Health Behavior , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Communicable Disease Control , Contact Tracing , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Disease Outbreaks/prevention & control , HIV Infections/epidemiology , HIV Infections/therapy , HIV Infections/transmission , Humans , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Public Health Surveillance , SARS-CoV-2 , Social Stigma
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