Sustainability Planning for a Community Network to Increase Participation in Evidence-Based Lifestyle Change Programs: A Mixed-Methods Approach.

Community-based chronic disease prevention programs can have long-term, broad public health benefits. Yet, only 40 to 60% of evidence-based health programs are sustained. Using established frameworks and evidence-based tools to characterize sustainability allows programs to develop structures and processes to leverage resources effectively to sustain effective program activities and systems. This study used a mixed-methods, partner-engaged approach to identify barriers and facilitators to sustaining a community network (the Alliance program) aimed to increase participation in evidence-based lifestyle change programs delivered in the community. Surveys and qualitative interviews were conducted with the Alliance partners based on the Program Sustainability Assessment Tool and Consolidated Framework for Implementation Research. Overall, partners felt Alliance had a high capacity for sustainability. Strategic planning, communication, and partnerships were areas partners prioritized to improve the potential for sustaining the program. Results informed the co-development of a sustainability action plan. This paper furthers our understanding of factors critical for the sustainability of community-based programs for chronic disease prevention and health equity and presents a process for developing action plans to build sustainability capacity.

A Communitywide Collaboration to Increase Enrollment, Retention, and Success in Evidence-Based Lifestyle-Change Programs in Racial and Ethnic Minority Populations.

PURPOSE AND OBJECTIVES: Chronic diseases (eg, diabetes, hypertension) are the leading causes of death in the US and disproportionally affect racial and ethnic minority populations. This disparity is partially due to the unequal burden of unmet social needs that stem from several factors, including racism. INTERVENTION APPROACH: The Alliance is a collaboration among health care, public health, and community organizations formed to improve referral, enrollment, and successful completion of evidence-based lifestyle-change programs, particularly among Black people. The Alliance built 1) a system to assess and address social barriers through the screening and referral process and 2) a training center for frontline staff (eg, community health workers). EVALUATION METHODS: From January 2020 through September 2022, we conducted an evaluation that included both quantitative and qualitative methods. We developed an electronic database to make referrals and track key barriers to participation. Additionally, we conducted a focus group among frontline staff (N = 15) to understand the challenges in making referrals and discussing, documenting, and addressing barriers to participation. We used surveys that collected quantitative and open-ended qualitative responses to evaluate the training center and to understand perceptions of training modules as well as the skills gained. RESULTS: Frontline staff engaged with 6,036 people, of whom 847 (14%) were referred to a lifestyle-change program from January 2020 through September 2022. Of those referred, 257 (30%) were eligible and enrolled in a program. Food access and unreliable internet were the most common barriers to participation. Thirteen of 15 frontline staff participated in trainings, and, on average, trainees completed 4.2 trainings and gained several skills (eg, ability to monitor personal bias, de-escalate a crisis, educate on mental health, understand community and environmental factors). IMPLICATIONS FOR PUBLIC HEALTH: The Alliance is an example of how health care, public health, and community partners can work together to increase enrollment in lifestyle-change programs of residents disproportionately affected by chronic diseases. Lessons learned from implementation and evaluation can inform other complex partnerships to improve public health.

Age Differences in Thermal Pain Responses: A Direct Laboratory Comparison.

OBJECTIVES: According to a widely cited assertion, older adults are less likely than younger individuals to express pain complaints. Age-related differences in pain responses have been discussed in the literature despite a paucity of research involving direct comparisons of younger and older adults' pain reactions (i.e., verbal, nonverbal) in the context of a single experimental investigation. Our goal was to test the hypothesis that older adults are more stoic than younger adults in their expression of pain. METHODS: We measured trait stoicism as well as multiple responses to thermal pain. RESULTS: In contrast to suggestions in the literature, equivalence testing indicated that older and younger adults displayed similar verbal and nonverbal pain responses. Our results suggest that older adults are no more stoic about their pain than are younger persons. DISCUSSION: This is the first attempt to explore a wide array of age differences in pain expression within the context of a single experimental study.

Examining the consumer view of refreshing perception, relevant fruits, vegetables, soft drinks, and beers, and consumer age and gender segmentations.

Consumer perspective of refreshing perception is underexplored, despite it being an emotional attribute to describe foods, beverages, hygiene products, and household items. An online survey (N = 1518) was designed to collect consumer insight into the importance of refreshing, the definition and factors related to it, and the identification of refreshing fruits, vegetables, and drinks. Nearly all participants (99.8%) cited that they have had the need to consume a food or beverage to feel refreshed, and 76.3% cited that they need this at least once per day. The factors most associated with refreshing were thirst-quenching (84.1%), temperature (86.2%), and cooling taste (86.0%). Water (86.6%), watermelons (80.8%), and cucumbers (83.5%) were the beverages/foods most frequently specified as refreshing. A second survey (N = 1050) examined refreshing perception specifically related to beer consumption and associated flavor. Beer was rated highly refreshing by 75.5% of participants, affirming its refreshing reputation. Refreshing perceived from beer was most associated with cool temperature (95.4%), flavor of the beer (88.6%), lightened mood (87.1%), and thirst-quenching (49.0%). Beers with crisp/clean flavors (87.3%) and citrus flavors (35.7%-51.7%) were most frequently specified as refreshing. There were no gender differences in the definition of refreshing and associated thirst-quenching and cold, although age differences in defining beer refreshing were significant (p ≤ .05). There were significant gender and age differences in types of refreshing vegetables, soft drinks, beer flavors, and varieties. The study provided consumer insight into refreshing perception and the gained knowledge could be used in new product design.

Contextual influences in decoding pain expressions: effects of patient age, informational priming, and observer characteristics.

We aimed to examine the effects of contextual factors (ie, observers' training background and priming texts) on decoding facial pain expressions of younger and older adults. A total of 165 participants (82 nursing students and 83 nonhealth professionals) were randomly assigned to one of 3 priming conditions: (1) information about the possibility of secondary gain (misuse); (2) information about the frequency and undertreatment of pain in the older adult (undertreatment); or (3) neutral information (control). Subsequently, participants viewed 8 videos of older adults and 8 videos of younger adults undergoing a discomforting physical therapy examination. Participants rated their perception of each patient's pain intensity, unpleasantness, and condition severity. They also rated their willingness to help, sympathy level, patient deservingness of financial compensation, and how negatively/positively they feel towards the patient (ie, valence). Results demonstrated that observers ascribed greater levels of pain and other indicators (eg, sympathy and help) to older compared with younger patients. An interaction between observer type and patient age demonstrated that nursing students endorsed higher ratings of younger adults' pain compared with other students. In addition, observers in the undertreatment priming condition reported more positive valence towards older patients. By contrast, priming observers with the misuse text attenuated their valence ratings towards younger patients. Finally, the undertreatment prime influenced observers' pain estimates indirectly through observers' valence towards patients. In summary, results add specificity to the theoretical formulations of pain by demonstrating the influence of patient and observer characteristics, as well as informational primes, on decoding pain expressions.

A Systematic Review of Knowledge Translation (KT) in Pediatric Pain: Focus on Health Care Providers.

OBJECTIVES: Pain is inadequately managed in pediatric populations across health care settings. Although training programs to improve health care provider knowledge and skills have been developed and evaluated, clinical practices have not always kept pace with advancing knowledge. Consequently, the goal of this review was to systematically examine the pediatric pain literature of knowledge translation (KT) programs targeting health care providers. MATERIALS AND METHODS: Systematic searches of PubMed, Web of Science, CINAHL, and PsycINFO were undertaken. KT initiatives directed toward health care providers and in which the primary focus was on pediatric pain were included. Primary outcomes, intervention characteristics, and risk of bias were examined across studies. Study outcomes were conceptually organized and a narrative synthesis of results was conducted. RESULTS: A total of 15,191 abstracts were screened for inclusion with 98 articles retained on the basis of predetermined criteria. Across studies, KT approaches varied widely in format and focus. Knowledge-level changes and self-reported increases in comfort or confidence in skills/knowledge were consistently achieved. Practice-level changes were achieved in many areas with varying success. Design and reporting issues were identified in the majority of studies. Examination of patient-related outcomes and of the long-term impact of pediatric pain KT programs was limited across studies. DISCUSSION: KT programs vary in quality and impact. Although several successful programs have been developed, many studies include a high risk of bias due to study quality. Evidence-based KT program implementation and a focus on sustainability of outcomes must be given greater consideration in the field of pediatric pain.

The effects of emotion regulation strategies on the pain experience: a structured laboratory investigation.

Although emotion regulation modulates the pain experience, inconsistencies have been identified regarding the impact of specific regulation strategies on pain. Our goal was to examine the effects of emotion suppression and cognitive reappraisal on automatic (ie, nonverbal) and cognitively mediated (ie, verbal) pain expressions. Nonclinical participants were randomized into either a suppression (n = 58), reappraisal (n = 51), or monitoring control (n = 42) condition. Upon arrival to the laboratory, participants completed the Emotion Regulation Questionnaire, to quantify self-reported suppression and reappraisal tendencies. Subsequently, they completed a thermal pain threshold and tolerance task. They were then provided with instructions to use, depending on their experimental condition, suppression, reappraisal, or monitoring strategies. Afterward, they were exposed to experimentally induced pain. Self-report measures of pain, anxiety, and tension were administered, and facial expressions, heart rate, and galvanic skin response were recorded. The Facial Action Coding System was used to quantify general and pain-related facial activity (ie, we defined facial actions that occurred during at least 5% of pain stimulation periods as "pain-related actions"). Reappraisal and suppression induction led to reductions in nonverbal and verbal indices of pain. Moreover, self-reported tendencies to use suppression and reappraisal (as measured by the Emotion Regulation Questionnaire) did not interact with experimental condition in the determination of participants' responses. Results suggest that consciously applying emotion regulation strategies during a painful task can moderate both cognitively mediated (e.g., verbal) and automatic (e.g., facial activity) expressions of pain.

Client experiences of guided internet cognitive behavior therapy for postpartum depression: a qualitative study.

Postpartum depression (PPD) afflicts up to 15 % of women following childbirth and negatively impacts both mother and child. Therapist-assisted internet cognitive behavior therapy (TAICBT) is a promising intervention for the treatment of PPD; however, women's perceptions of TAICBT have not been examined. Responses to 10 open-ended questions from 24 women who received TAICBT for PPD were thematically analyzed. The majority of women expressed that the TAICBT program afforded flexibility, accessibility, and convenience, as well as anonymity and privacy. Some participants described the program as helping them take a step in the right direction and enhance their self-awareness and parenting skills. Participants also described having the internet therapist individualize their treatment. Challenges related to the TAICBT program were also identified by a minority of participants including managing time to log onto the program, the fast pace, completion of homework around childcare duties, and challenges of not having a face-to-face therapist. Participants also made suggestions for future programming. The large majority of participants consistently described their internet therapist favorably; however, challenges related to the internet therapy were also identified. Results should be integrated in the development of future programming.

A brief couples' workshop for improving sexual experiences after prostate cancer treatment: a feasibility study.

PURPOSE: The most difficult survivorship issue reported by prostate cancer patients is the dramatic changes in their sexual relationships. The purpose of this study was to investigate the feasibility of a workshop designed to improve patients' and partners' sexual relationships. METHOD: Participants attended one 3.5-h workshop. A total of three separate workshops were held over a 12-month period. Patients and partners complete the Sexual Functioning Questionnaire (SFQ) prior, 2 months following, and if couples registered early enough, 2 months before the workshop. Change scores were calculated. RESULTS: Over the three workshops, 77 participants attended. All targets were met for feasibility and acceptability. Patients and partners both demonstrated significant gains on the medical impact subscale of the SFQ, and partners also demonstrated significant gains in sexual interest, problems, and total sexual function. CONCLUSIONS: The results suggest that attending one 3.5-h workshop that is offered every 4 months is feasible and acceptable to patients and their partners. Furthermore, the SFQ proves to be a sensitive assessment instrument of sexual function for patients and their partners.

Androgen Deprivation Therapy and maintenance of intimacy: a randomized controlled pilot study of an educational intervention for patients and their partners.

PURPOSE: Androgen Deprivation Therapy (ADT) for prostate cancer is associated with many treatment side effects that tend to erode couples' intimacy. We piloted a randomized controlled trial to investigate the effect of an educational intervention designed to preserve couples' intimacy in the face of ADT. METHODS: Couples were recruited at the time the patient was first prescribed ADT and were randomized to a treatment or control group. Those in the treatment group were asked to read an educational guide and participate in an educational session designed to inform couples about possible ADT side effects and management strategies. To assess changes in the couples' relationships, they were administered the Dyadic Adjustment Scale and the Personal Assessment of Intimacy in Relationships questionnaire prior to randomization and again at 6 months. RESULTS: While results were not statistically significant, trends and effect sizes suggest that the educational intervention helped attenuate declines in intimacy for patients, but not for their partners. Couples who participated in the intervention were more successful at maintaining sexual activity than were couples in the control group. CONCLUSIONS: ADT places considerable strain on intimate relationships, particularly for the partners. It appears that patients who receive help in anticipating and managing ADT related changes report better dyadic adjustment and closer intimacy. More efforts are needed to develop interventions to benefit patients' partners. We conclude that the intervention holds promise and that a full-scale evaluation of the intervention is both feasible and warranted.