Iterative development of a web-based intervention for families of young children with type 1 diabetes: DIPPer Academy.

OBJECTIVE: A new diagnosis of Type 1 diabetes mellitus (T1D) can be stressful for families as they are expected to learn a large amount of information regarding disease management and treatment in a short period of time. Currently, parents complete diabetes education at the time of diagnosis. However, this format may not be sustainable as rates of T1D climb. The current study aimed to develop an online platform to provide educational material in the form of video micro-lectures using an iterative, user-centered, design process. METHODS: In the first stage of development, parents of young children with T1D identified information they felt most important to their child's T1D care. In the second stage, healthcare providers contributed qualitative and quantitative feedback regarding the educational material and video mock-ups. The third stage involved parents of young children with T1D providing feedback on the completed video micro-lectures. RESULTS: Providers and parents reported that the videos were highly useful, important to T1D care, and the majority would recommend them to other parents. CONCLUSIONS: The iterative design process used by the research team incorporated multiple perspectives and ultimately developed educational resources that were well-received by providers, researchers, and parents. IMPLICATIONS FOR IMPACT STATEMENT: This study used an iterative, user-centered design to develop a series of web-based videos for parents of young children with type 1 diabetes. Primary stakeholders, both healthcare providers and parents, described videos as highly important, useful, enjoyable, and would recommend these resources to others. Parents rated videos highly across a variety of presentations that ranged in development time and cost, indicating that researchers can feasibly and cost-effectively create web-based resources for parents.

A Randomized Controlled Trial of Rise, a Community-Based Culturally Congruent Adherence Intervention for Black Americans Living with HIV.

BACKGROUND: Evidence-based HIV treatment adherence interventions have typically shown medium-sized effects on adherence. Prior evidence-based HIV treatment adherence interventions have not been culturally adapted specifically for Black/African Americans, the population most affected by HIV disparities in the USA, who exhibit lower adherence than do members of other racial/ethnic groups. PURPOSE: We conducted a randomized controlled trial of Rise, a 6-month culturally congruent adherence counseling intervention for HIV-positive Black men and women. METHODS: Rise was delivered by a trained peer counselor who used a problem-solving approach to address culturally congruent adherence barriers (e.g., medical mistrust, HIV stigma) and assisted with linkage to supportive services. A total of 215 participants were randomized to the intervention group (n = 107) or a wait-list control group (n = 108). Adherence was assessed daily via electronic monitoring. RESULTS: In a repeated measures multivariate logistic regression model of dichotomous adherence (using a clinically significant cutoff of 85% of doses taken), adjusted for sociodemographic and medical covariates, adherence in the intervention group improved over time relative to the control group, (OR = 1.30 per month (95% CI = 1.12-1.51), p < 0.001), representing a large cumulative effect after 6 months (OR = 4.76, Cohen's d = 0.86). CONCLUSIONS: Rise showed a larger effect on adherence than prior HIV adherence intervention studies. For greater effectiveness, interventions to improve adherence among Black people living with HIV may need to be customized to address culturally relevant barriers to adherence. ( ClinicalTrials.gov #NCT01350544).

Mobile technology for obesity prevention: a randomized pilot study in racial- and ethnic-minority girls.

BACKGROUND: Mobile technologies have wide-scale reach and disseminability, but no known studies have examined mobile technologies as a stand-alone tool to improve obesity-related behaviors of at-risk youth. PURPOSE: To test a 12-week mobile technology intervention for use and estimate effect sizes for a fully powered trial. METHODS: Fifty-one low-income, racial/ethnic-minority girls aged 9-14 years were randomized to a mobile technology (n=26) or control (n=25) condition. Both conditions lasted 12 weeks and targeted fruits/vegetables (FVs; Weeks 1-4); sugar-sweetened beverages (SSBs; Weeks 5-8), and screen time (Weeks 9-12). The mobile intervention prompted real-time goal setting and self-monitoring and provided tips, feedback, and positive reinforcement related to the target behaviors. Controls received the same content in a written manual but no prompting. Outcomes included device utilization and effect size estimates of FVs, SSBs, screen time, and BMI. Data were collected and analyzed in 2011-2012. RESULTS: Mobile technology girls used the program on 63% of days and exhibited trends toward increased FVs (+0.88, p=0.08) and decreased SSBs (-0.33, p=0.09). The adjusted difference between groups of 1.0 servings of FVs (p=0.13) and 0.35 servings of SSBs (p=0.25) indicated small to moderate effects of the intervention (Cohen's d=0.44 and -0.34, respectively). No differences were observed for screen time or BMI. CONCLUSIONS: A stand-alone mobile app may produce small to moderate effects for FVs and SSBs. Given the extensive reach of mobile devices, this pilot study demonstrates the need for larger-scale testing of similar programs to address obesity-related behaviors in high-risk youth.

A qualitative examination of the indirect effects of modified directly observed therapy on health behaviors other than adherence.

Modified directly observed therapy (mDOT), in which a portion of doses in a medication regimen are ingested under supervision, has had some demonstrated success in improving the high levels of adherence necessary to achieve maximum benefit from antiretroviral medications. Consistent with the Information-Motivation-Behavioral skills (IMB) model, mDOT's success is likely due to its direct impact on patients' knowledge, motivation, and behaviors related to adherence. However, mDOT's potential impact on patients' information, motivation, and behaviors related to health activities other than adherence to antiretroviral medications has not been explored. Data from participants enrolled in Project MOTIV8, a randomized controlled trial to test the efficacy of novel behavioral adherence interventions, were analyzed to explore the potential impact of mDOT on health behaviors other than adherence. Participants were recruited from local HIV clinics from 2004-2008. Thirty-four percent of those approached, agreed to participate in the study. Data from all participants randomized to the mDOT intervention arm thus far (n = 50, mean age 39.7 standard deviation [SD] = 9.0, 78% male 64% African American, and 86% infected via sexual transmission) were included. Overall, participants reported a high level of satisfaction with the mDOT intervention. Qualitative data revealed that mDOT had a positive impact on participants' adherence to nonantiretroviral medications as well as their involvement and communication with health care providers. In addition, participants reported that the daily mDOT visits had indirect effects on their daily functioning, including improvements in their daily living activities (e.g., earlier awakenings, getting dressed, and cleaning their homes) and an increased level of community involvement.