Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review.

Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management-promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P=.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes. Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.

Mental Health Screening of Medically-Admitted Patients With Cystic Fibrosis.

BACKGROUND: Multi-national studies have identified an increased risk for depression and anxiety among the cystic fibrosis population. People with cystic fibrosis and depression have decreased lung function, adherence, and quality of life, and increased health care utilization. This is a pilot study of mental health screening and referral of patients with cystic fibrosis in a large tertiary medical center. OBJECTIVE: Patients with a diagnosis of cystic fibrosis aged 8 and older, medically admitted to a tertiary hospital, were screened for eligibility and offered mental health screening for depression and anxiety. METHODS: Patients indicating elevated rates of anxiety, depression, or suicidal ideation were offered a psychiatric consultation, and all participants were offered mental health referrals. Health-related outcomes were gathered via medical record review. RESULTS: The pediatric population showed elevated rates/at risk of depression (17%), anxiety (22%) and clinically-elevated depression (5%), and anxiety (11%). Twenty-two percent of the youth reported suicidal ideation. The adult population reported mild rates of depression (11%), anxiety (28%), and suicidality (11%). The mental health screening process resulted in 1 mental health referral, 16 patients eligible for psychiatric consultation, and 4 completed psychiatric consultations. DISCUSSION: This study represents a pilot mental health screening in the inpatient medical setting. The results indicate an elevated rate of depression, anxiety, and suicidal ideation, and a protocol for responding to elevated responses via psychiatric consultation. This study indicates the need for further exploration of implementation of mental health screening, rapid response to suicidal ideation, referral process, and treatment interventions.

Rethinking the measurement of energy poverty in Europe: A critical analysis of indicators and data.

Energy poverty - which has also been recognised via terms such as 'fuel poverty' and 'energy vulnerability' - occurs when a household experiences inadequate levels of energy services in the home. Measuring energy poverty is challenging, as it is a culturally sensitive and private condition, which is temporally and spatially dynamic. This is compounded by the limited availability of appropriate data and indicators, and lack of consensus on how energy poverty should be conceptualised and measured. Statistical indicators of energy poverty are an important and necessary part of the research and policy landscape. They carry great political weight, and are often used to guide the targeting of energy poverty measures - due to their perceived objectivity - with important consequences for both the indoor and built environment of housing. Focussing on the European Union specifically, this paper critically assesses the available statistical options for monitoring energy poverty, whilst also presenting options for improving existing data. This is examined through the lens of vulnerability thinking, by considering the ways in which policies and institutions, the built fabric and everyday practices shape energy use, alongside the manner in which energy poor households experience and address the issue on a day-to-day basis.

Health, Well-Being and Energy Poverty in Europe: A Comparative Study of 32 European Countries.

Despite growing pan-European interest in and awareness of the wide-ranging health and well-being impacts of energy poverty-which is characterised by an inability to secure adequate levels of energy services in the home-the knowledge base is largely British-centric and dominated by single-country studies. In response, this paper investigates the relationship between energy poverty, health and well-being across 32 European countries, using 2012 data from the European Quality of Life Survey. We find an uneven concentration of energy poverty, poor health, and poor well-being across Europe, with Eastern and Central Europe worst affected. At the intersection of energy poverty and health, there is a higher incidence of poor health (both physical and mental) amongst the energy poor populations of most countries, compared to non-energy poor households. Interestingly, we find the largest disparities in health and well-being levels between energy poor and non-energy poor households occur within relatively equal societies, such as Sweden and Slovenia. As well as the unique challenges brought about by rapidly changing energy landscapes in these countries, we also suggest the relative deprivation theory and processes of social comparison hold some value in explaining these findings.

Depression, illness severity, and healthcare utilization in cystic fibrosis.

Cystic fibrosis (CF) is an illness associated with high healthcare utilization and healthcare costs, even when compared to other chronic illnesses. In a variety of medical populations, depression has been found to be associated with lower adherence and poorer medical outcomes. The current study is a retrospective chart review of a matched set of 40 patients with CF, half with and half without a depressive disorder diagnosis. Participants were matched on the basis of their age, gender and lung function, and compared in terms of their illness severity (lung function and weight), medical adherence, and healthcare utilization during the year prior to and following diagnosis of depression and a comparable time period for the non-depressed group. Results show an association between depression and BMI, with only the depressed group showing significant decreases in the year following their depressive disorder diagnosis (from a mean BMI z-score of -0.48 to -1.04). Depression was also strongly associated with greater healthcare utilization and healthcare costs relative to those of comparably medically ill controls, in that depressed youth were hospitalized at over three times the rate of non-depressed youth, and their healthcare costs were more than four times higher (mean number of admissions per year for the depressed group of 4.00 vs. 1.20 for the non-depressed group; mean annual costs of $280,000 for the depressed vs. $60,116 for the non-depressed). These findings highlight the importance of addressing the mental health needs of chronically ill patients as a path to better health outcomes and decreasing need for medical services.

Promoting coping in children facing pediatric surgery.

Surgery is challenging for children and their families, calling upon them to cope with an invasive procedure, deal with the uncertainty of the surgical outcome, and manage the stress of hospitalization. Contributors to children's distress when facing pediatric surgery include their coping style, interactions with their parents, developmental level, and temperament. A pragmatic approach is outlined that can help surgeons promote successful coping in their patients while at the same time fostering successful working relationships with parents.

Stakeholder participation in management of invasive vertebrates.

Stakeholders are increasingly involved in species conservation. We sought to understand what features of a participatory conservation program are associated with its ecological and social outcomes. We conducted a case study of the management of invasive vertebrates in Australia. Invasive vertebrates are a substantial threat to Australia's native species, and stakeholder participation in their management is often necessary for their control. First, we identified potential influences on the ecological and social outcomes of species conservation programs from the literature. We used this information to devise an interview questionnaire, which we administered to managers of 34 participatory invasive-vertebrate programs. Effects of invasive species were related to program initiator (agency or citizen), reasons for use of a participatory approach, and stakeholder composition. Program initiator was also related to the participation methods used, level of governance (i.e., governed by an agency or citizens), changes in stakeholder interactions, and changes in abundance of invasive species. Ecological and social outcomes were related to changes in abundance of invasive species and stakeholder satisfaction. We identified relations between changes in the number of participants, stakeholder satisfaction, and occurrence of conflict. Potential ways to achieve ecological and social goals include provision of governmental support (e.g., funding) to stakeholders and minimization of gaps in representation of stakeholder groups or individuals to, for example, increase conflict mitigation. Our findings provide guidance for increasing the probability of achieving ecological and social objectives in management of invasive vertebrates and may be applicable to other participatory conservation programs.

Parenting Stress among Parents of Deaf and Hearing Children: Associations with Language Delays and Behavior Problems.

OBJECTIVE: This study evaluates predictors of both general and context-specific parenting stress in a cross-sectional sample of hearing parents of young deaf and hearing children. DESIGN: Participants were 181 children who were deaf and 92 children with normal hearing. Perceived parenting stress was measured using both general and context-specific measures. Predictors of parenting stress included parent-reported and observed child behavior problems and language delays. RESULTS: After controlling for maternal education and family income, parents of deaf children reported more context-specific but not general parenting stress than parents of hearing children. Both parent-reported and observed behavior problems were higher in the deaf group compared to the hearing group. Children's hearing status related to child behavior problems by way of oral language delays. Furthermore, hearing status related to parenting stress by way of language delays and child behavior difficulties. CONCLUSIONS: Context-specific measures of parenting stress reflect unique challenges of this population. Both language delays and child behavior problems are associated with increased parenting stress. Identification of specific stressors related to parenting a deaf child helps to inform the development of early interventions.

Prevalence and impact of depression in cystic fibrosis.

PURPOSE OF REVIEW: Numerous studies have demonstrated that patients with chronic illnesses are at an increased risk for depression, with serious direct and indirect consequences for health outcomes. The few studies examining rates of depression in patients with cystic fibrosis (CF) or parent caregivers have found clinically significant elevations. Given the importance of identifying and treating symptoms of depression, the purpose of this review was to highlight recent data on the prevalence and impact of depression in CF patients and to propose recommendations for screening and treatment. RECENT FINDINGS: Recent studies in CF have revealed higher rates of depression in children, adolescents, adults, and parent caregivers than in healthy populations. Evidence also suggests that depression has negative effects on treatment adherence, family functioning, and health-related quality of life. Briefly, well validated screening tools for depression are available but are not currently utilized in routine CF care. Effective psychological and pharmacological interventions are available to treat depression, but have not yet been evaluated in patients with CF. SUMMARY: Depression is a significant risk factor for the effective management of CF. Screening and treatment of depression in CF centers is recommended and holds promise for improving social, emotional, and physical health outcomes.