scholarly journals Individualized Web-Based Attention Training with Evidence-Based Counseling: Exploratory Study to Address HIV Treatment Adherence and Psychological Distress (Preprint)

10.2196/18328 ◽  
2020 ◽  
Author(s):  
Eric Houston ◽  
Javad Salehi Fadardi ◽  
Nina T. Harawa ◽  
Chris Argueta ◽  
Sukrit Mukherjee
Keyword(s):  
Psychological Distress ◽  
Treatment Adherence ◽  
Exploratory Study ◽  
Hiv Treatment ◽  
Attention Training ◽  
Evidence Based ◽  
Web Based

scholarly journals Individualized Web-Based Attention Training with Evidence-Based Counseling: Exploratory Study to Address HIV Treatment Adherence and Psychological Distress (Preprint)

2020 ◽  
Author(s):  
Eric Houston ◽  
Javad Salehi Fadardi ◽  
Nina T. Harawa ◽  
Chris Argueta ◽  
Sukrit Mukherjee
Keyword(s):  
Psychological Distress ◽  
Depressive Symptoms ◽  
Treatment Adherence ◽  
Service Providers ◽  
The United States ◽  
Hiv Treatment ◽  
Attention Training ◽  
Control Group ◽  
Evidence Based ◽  
Web Based

BACKGROUND The prevalence of mood and trauma-stress-related disorders is disproportionately higher among people living HIV compared to individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress. The study targeted African American and Latino young men who have sex with men (YMSM), two population groups in the United States that continue to experience disparities in HIV treatment outcomes. METHODS Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy (ART) were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the four-week intervention received weekly counseling for adherence and daily access to web-based attention training via their own mobile devices or computers. RESULTS Of the 14 participants who began the intervention, twelve (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to ART declined from 42% at baseline to 25% at intervention completion (P=.02, phi = .68). Mean depressive symptoms measured by the Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, d=1.2). In addition, participant attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (Ps = .01 and .02), and were accompanied by large effect sizes ranging from -.78 to -1.0. CONCLUSIONS Findings support the feasibility of web-based attention training combined with counseling to improve ART adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up. CLINICALTRIAL

scholarly journals Characteristics, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: A methodological replication and elaboration (Preprint)

2020 ◽  
Author(s):  
Eyal Karin ◽  
Monique Francis Crane ◽  
Blake Farran Dear ◽  
Olav Nielssen ◽  
Gillian Ziona Heller ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Treatment Adherence ◽  
Statistical Models ◽  
Post Treatment ◽  
Symptom Change ◽  
Web Based ◽  
Reduction Effect

BACKGROUND Missing cases present a challenge to our ability to evaluate the effects of web-based psychotherapy trials. As missing cases are often lost to follow up, less is known about their characteristics, their likely clinical outcomes, or the likely effect of the treatment being trialled. OBJECTIVE To explore the characteristics of missing cases, their likely treatment outcomes, and the ability of different statistical models to approximate missing post-treatment data. METHODS A sample of internet-delivered cognitive behavioural therapy participants, in routine care (n = 6701 with 36% missing cases at post-treatment), was used to identify predictors of dropping out of treatment and predictors that moderated clinical outcomes, such as psychological distress, anxiety and depressive symptoms. These variables were then incorporated into a range of statistical models that approximated replacement outcomes for missing cases, with the results compared using sensitivity and cross-validation analyses. RESULTS Treatment adherence, as measured by the rate of an individual’s progress through the treatment modules, and higher symptom scores at pre-treatment, were identified as the dominant predictors of missing cases probability (Nagelkerke R2 = 60.8%), as well as the rate of symptom change. Low treatment adherence, in particular, was associated with increased odds for presenting as missing cases during post-treatment assessment (eg, OR = 161.1:1) and at the same time, attenuate the rate of symptom change across anxiety (up to 28% of the total symptom 48% reduction effect), depression (up to 41% of the total 48% symptom reduction effect) and psychological distress symptom outcomes (up to 52% of the total 37% symptom reduction effect) at the end of an eight week window. Reflecting this pattern of results, statistical replacement methods that overlooked the features of treatment adherence, and baseline severity, underestimated missing case symptom outcomes by as much as 40% at post-treatment. CONCLUSIONS The treatment outcomes of the cases that were missing at follow up were distinct from the remaining observed sample. Thus, overlooking the features of missing cases is likely to result in an inaccurate estimate of the effect of treatment. CLINICALTRIAL

scholarly journals Readiness in HIV Treatment Adherence: A Matter of Confidence. An Exploratory Study§

2011 ◽  
Vol 5 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Helene Sylvain ◽  
Philippe Delmas
Keyword(s):  
Treatment Adherence ◽  
Life Events ◽  
Exploratory Study ◽  
Active Role ◽  
Hiv Treatment ◽  
Adherence To Treatment ◽  
Data Collection Process ◽  
Professional Perspectives ◽  
Depth Interviews ◽  
Optimal Adherence

Adherence to treatment is recognized as the essence of a successful HIV combination therapy. Optimal adherence implies a readiness to begin the treatment on the part of the patient. A better understanding of the "readiness phenomenon" will become an asset for optimizing HIV treatment. However, few studies have focused on understanding the process underlying the choice to adhere. The aim of this study is to understand the readiness process that leads to adhering to the HIV treatment, from both patient and professional perspectives. Twenty-seven in-depth interviews, with a qualitative exploratory design, were the source of our data. Participants were recruited in two hospitals in Paris. Throughout the data-collection process, analysed data were supplied to all participants and the research team, thus allowing for shared constructions. Four themes, interrelated with a constitutive pattern, emerged from the data we collected. Being ready to begin and adhere to treatment is a matter of confidence in oneself, as well as in relatives, in the treatment and in the health professional team. These themes are not constant and unvarying; instead, they constitute a picture moving across time and life events. Results of this study show that adherence that goes beyond “complying with” the medical instructions, but depends on how much of an active role the patient plays in the choice to adhere.

scholarly journals Feasibility of Four Interventions to Improve Treatment Adherence in Migrants Living with HIV in The Netherlands

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 980
Author(s):  
Sabrina K. Been ◽  
David A.M.C. van de Vijver ◽  
Jannigje Smit ◽  
Nadine Bassant ◽  
Katalin Pogány ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Treatment Adherence ◽  
Peer Support ◽  
Intervention Group ◽  
Hiv Treatment ◽  
Hiv Rna ◽  
Related Stigma ◽  
Living With Hiv ◽  
Group Medical Appointments

We evaluated the feasibility and efficacy of four existing interventions to improve adherence to them in migrants living with HIV (MLWH): directly administered antiretroviral therapy (DAART), group medical appointments (GMA), early detection and treatment of psychological distress, and peer support by trained MLWH. At baseline and after the interventions, socio-demographic characteristics, psychosocial variables, and data on HIV treatment adherence were collected. The two questionnaires were completed by 234/301 (78%) MLWH included at baseline. Detectable HIV RNA decreased (from 10.3 to 6.8%) as did internalized HIV-related stigma (from 15 to 14 points), and self-reported adherence increased (between 5.5 and 8.3%). DAART and GMA were not feasible interventions. Screening of psychological distress was feasible; however, follow-up diagnostic screening and linkage to psychiatric services were not. Peer support for and by MLWH was feasible. Within this small intervention group, results on HIV RNA < 400 copies/mL (decrease of 23.6%) and outpatient clinic attendance (up to 20.4% kept more appointments) were promising.

scholarly journals Comparative effects of telephone versus in-office behavioral counseling to improve HIV treatment outcomes among people living with HIV in a rural setting

2020 ◽  
Author(s):  
Seth C Kalichman ◽  
Harold Katner ◽  
Lisa A Eaton ◽  
Ellen Banas ◽  
Marnie Hill ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Self Regulation ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Evidence Based ◽  
Health Counseling ◽  
Behavioral Health Counseling ◽  
Hiv Treatment Outcomes ◽  
Living With Hiv ◽  
Delivery Formats

Abstract With the expansion of telehealth services, there is a need for evidence-based treatment adherence interventions that can be delivered remotely to people living with HIV. Evidence-based behavioral health counseling can be delivered via telephone, as well as in-office services. However, there is limited research on counseling delivery formats and their differential outcomes. The purpose of this study was to conduct a head-to-head comparison of behavioral self-regulation counseling delivered by telephone versus behavioral self-regulation counseling delivered by in-office sessions to improve HIV treatment outcomes. Patients (N = 251) deemed at risk for discontinuing care and treatment failure living in a rural area of the southeastern USA were referred by their care provider. The trial implemented a Wennberg Randomized Preferential Design to rigorously test: (a) patient preference and (b) comparative effects on patient retention in care and treatment adherence. There was a clear patient preference for telephone-delivered counseling (69%) over in-office-delivered counseling (31%) and participants who received telephone counseling completed a greater number of sessions. There were few differences between the two intervention delivery formats on clinical appointment attendance, antiretroviral adherence, and HIV viral load. Overall improvements in health outcomes were not observed across delivery formats. Telephone-delivered counseling did show somewhat greater benefit for improving depression symptoms, whereas in-office services demonstrated greater benefits for reducing alcohol use. These results encourage offering most patients the choice of telephone and in-office behavioral health counseling and suggest that more intensive interventions may be needed to improve clinical outcomes for people living with HIV who may be at risk for discontinuing care or experiencing HIV treatment failure.

Patients’ Perceptions and Attitudes Regarding the Pre-Anesthesia Clinic (PAC) at the National Guard Hospital in Riyadh, Saudi Arabia: An Exploratory Study (Preprint)

2020 ◽  
Author(s):  
Ghdeer Tashkandi ◽  
Samina Abidi
Keyword(s):  
Saudi Arabia ◽  
Exploratory Study ◽  
National Guard ◽  
Active Role ◽  
Relevant Information ◽  
Educational Interventions ◽  
Evidence Based ◽  
Quantitative Research Methods ◽  
Perceptions And Attitudes ◽  
Educational Information

BACKGROUND Preoperative services and education allow patients to take an active role in their recovery and reduce the risk of post-operative complications. Exploring patients’ perceptions and attitudes regarding pre-anesthesia services and education helps reveal gaps in patients’ uptake of them so that targeted educational interventions can be designed and implemented. OBJECTIVE This is an exploratory study aimed at increasing the understanding of patients’ perceptions and concerns about and the adequacy of the pre-anesthesia services and educational content provided to them at the pre-anesthesia clinic (PAC) of the National Guard Hospital (NGH) in Riyadh, Saudi Arabia. The information gathered will be used to design and develop an electronic patient education system that will allow patients to access personalized, evidence-based pre-anesthesia information relevant to their upcoming surgeries. METHODS Quantitative research methods are used to collect relevant information from patients using a closed-ended questionnaire. The questionnaire includes items on demographics, patients’ perceptions and concerns regarding anesthesia, and the assessment of pre-anesthesia information adequacy. RESULTS Our results showed that 94% of the participants consider the PAC very important, and more than half of the participants (56%) were interested in receiving additional educational information about anesthesia via mobile applications. While 100% of the participants were satisfied with the information and services provided at the clinic, the assessment of this information and service adequacy indicated that participants were not adequately informed about anesthesia. Among the most common anesthesia-related concerns were the inability to wake up after anesthesia, becoming paralyzed after spinal anesthesia, the possibility of staying in the ICU after the surgery and developing back pain. CONCLUSIONS This gathered information will be used to design and develop an educational intervention that will deliver evidence-based, personalized and easy to understand educational instructions to patients to better prepare them for their upcoming surgery. The proposed system will overcome the problems of (i) the spread of generalized unrelated educational information and instructions, (ii) patients forgetting or misunderstanding the given instructions, (iii) issues with the accessibility of information, and (iv) a lack of communication and interaction between patients and their anesthetist.

Investigating the Efficacy and Cost-Effectiveness of a Web-based Self-help Program for People With Adjustment Problems After an Accident (SelFIT): Protocol for a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Julia Hegy ◽  
Noemi Anja Brog ◽  
Thomas Berger ◽  
Hansjoerg Znoj
Keyword(s):  
Health Care ◽  
Psychological Distress ◽  
Cost Effectiveness ◽  
Well Being ◽  
User Friendliness ◽  
Adjustment Problems ◽  
Health Care Consumption ◽  
Web Based ◽  
Self Help ◽  
Wide Range

BACKGROUND Accidents and the resulting injuries are one of the world’s biggest health care issues often causing long-term effects on psychological and physical health. With regard to psychological consequences, accidents can cause a wide range of burdens including adjustment problems. Although adjustment problems are among the most frequent mental health problems, there are few specific interventions available. The newly developed program SelFIT aims to remedy this situation by offering a low-threshold web-based self-help intervention for psychological distress after an accident. OBJECTIVE The overall aim is to evaluate the efficacy and cost-effectiveness of the SelFIT program plus care as usual (CAU) compared to only care as usual. Furthermore, the program’s user friendliness, acceptance and adherence are assessed. We expect that the use of SelFIT is associated with a greater reduction in psychological distress, greater improvement in mental and physical well-being, and greater cost-effectiveness compared to CAU. METHODS Adults (n=240) showing adjustment problems due to an accident they experienced between 2 weeks and 2 years before entering the study will be randomized. Participants in the intervention group receive direct access to SelFIT. The control group receives access to the program after 12 weeks. There are 6 measurement points for both groups (baseline as well as after 4, 8, 12, 24 and 36 weeks). The main outcome is a reduction in anxiety, depression and stress symptoms that indicate adjustment problems. Secondary outcomes include well-being, optimism, embitterment, self-esteem, self-efficacy, emotion regulation, pain, costs of health care consumption and productivity loss as well as the program’s adherence, acceptance and user-friendliness. RESULTS Recruitment started in December 2019 and is ongoing. CONCLUSIONS To the best of our knowledge, this is the first study examining a web-based self-help program designed to treat adjustment problems resulting from an accident. If effective, the program could complement the still limited offer of secondary and tertiary psychological prevention after an accident. CLINICALTRIAL ClinicalTrials.gov NCT03785912; https://clinicaltrials.gov/ct2/show/NCT03785912?cond=NCT03785912&draw=2&rank=1

Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

2020 ◽  
Author(s):  
Kyoung Ja Moon ◽  
Chang-Sik Son ◽  
Jong-Ha Lee ◽  
Mina Park
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Cloud System ◽  
Evidence Based ◽  
Methodological Study ◽  
Term Care ◽  
Web Based ◽  
Care Facilities ◽  
Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

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