Barriers and considerations in the design and implementation of digital behavioral interventions: A qualitative analysis (Preprint)

2021 ◽  
Author(s):  
Gabriela Marcu ◽  
Steven J Ondersma ◽  
Allison N Spiller ◽  
Brianna M Broderick ◽  
Reema Kadri ◽  
...  
Keyword(s):  
Behavioral Interventions ◽  
Qualitative Interviews ◽  
Study Participant ◽  
Snowball Sampling ◽  
Convenience Sample ◽  
Recommended Care ◽  
Development Platform ◽  
Project Study ◽  
Design And Implementation ◽  
Digital Interventions

BACKGROUND Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and/or adherence to recommended care. However, many research teams with interests in this area are unable to develop digital interventions due to the challenges such as lack of technical skill, limited access to developers, and cost. The purpose of this study was to elicit in-depth qualitative feedback from intervention developers who have interests in digital behavioral interventions, but lack programming skills regarding the barriers they experience and key considerations that go into the design and implementation of digital interventions. OBJECTIVE To understand barriers to the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. METHODS We conducted semi-structured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System (CIAS) platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. RESULTS Interviews were completed with 18 individuals and lasted between 24-65 minutes (mean = 46.9 minutes; SD = 11.3 minutes). Interviewees were predominantly female (94.4%; 17/18) and represented different job roles ranging from researcher to project/study staff. Three key barriers to the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients’ technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. CONCLUSIONS Barriers to the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital are apparent. Appropriate training in regards to how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space.

Perceived benefits of digital interventions for behavioral health: A qualitative interview study (Preprint)

2021 ◽  
Author(s):  
Gabriela Marcu ◽  
Steven J Ondersma ◽  
Allison N Spiller ◽  
Brianna M Broderick ◽  
Reema Kadri ◽  
...  
Keyword(s):  
Behavioral Health ◽  
Behavioral Interventions ◽  
Relative Effectiveness ◽  
Behavioral Research ◽  
Future Research ◽  
Full Potential ◽  
Perceived Benefits ◽  
Convenience Sample ◽  
Digital Interventions ◽  
Qualitative Interview Study

BACKGROUND Digital interventions have been gaining momentum in behavioral health. There are no standard approaches or tools for creating digital behavioral interventions, so many clinical researchers find their own way to realize them. There is likely variability in how researchers conceive of digital interventions. Even when grounding these interventions in similar behavioral theory and existing clinical approaches, there will not be a direct or obvious translation into a digital form of delivery. Moreover, the challenges of developing technology remain a significant barrier to use of digital interventions. Effective implementation of digital interventions in behavioral research, and improving the availability of tools and guidance for researchers, will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. OBJECTIVE This investigation sought to understand the perceptions of behavioral researchers toward digital interventions, and inform use of these interventions, by documenting (a) reasons why researchers are increasingly focusing their efforts on digital interventions, and (b) their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. METHODS We conducted semi-structured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System (CIAS) platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. RESULTS Interviews were completed with 18 individuals and lasted between 24-65 minutes (mean = 46.9 minutes; SD = 11.3 minutes). Interviewees were predominantly female (94.4%; 17/18) and represented different job roles ranging from researcher to project/study staff. Four major themes came out of the interviews concerning benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients; support for implementing evidence-based interventions with fidelity; scaling and improving access to interventions; “getting a foot in the door” despite stigma and disenfranchisement. CONCLUSIONS Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability with digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike.

Protecting the Public’s Health Through Successful Reentry for Sex Offender After Incarceration

2021 ◽  
pp. 088626052110163
Author(s):  
Molly Simmons ◽  
Bo Kim ◽  
Justeen Hyde ◽  
Tiffany L. Lemon ◽  
Kirsten E. Scharer ◽  
...  
Keyword(s):  
Social Support ◽  
Mental Health Treatment ◽  
Sex Offender ◽  
Qualitative Interviews ◽  
A Priori ◽  
Behavioral Model ◽  
Snowball Sampling ◽  
Convenience Sample ◽  
Increased Risk ◽  
Housing Options

This paper describes the post-incarceration reintegration experiences of military veterans convicted of sex offenses and identify potential interventions to ease reintegration for this population. Participants were a convenience sample of 14 veterans who were on sex offender (SO) registries and 21 community stakeholders involved in supporting persons during re-entry. Subjects were identified purposively and through snowball sampling, in Massachusetts. We employed semi-structured qualitative interviews of participants, followed by analysis including process mapping to identify barrier and facilitation points. We used both a grounded thematic approach and a priori codes, guided by the Behavioral Model for Vulnerable Populations. We found re-entry barriers include older age, stigma, lack of social support, inadequate information about sexual offense levels, limited housing options and access to mental health treatment to reduce sexual impulses, and re-entry information tailored to SOs. Re-entry facilitators include access to SO treatment, knowledge about services, self-efficacy, ability to self-advocate, and social support. Interventions to aid successful re-entry include pre-release counseling and classes tailored to SO needs, re-entry planning including housing resources, sexual deviance treatment, and referral to legal counseling to assist with altering assigned SO level. Specific needs and resources unique to veterans should be integrated into reentry plans. Convicted SOs often lack information and assistance to prepare for life after release, putting them at increased risk of homelessness, emotional difficulties, and financial hardship. Failure to recognize the unique needs of this population, and to leverage resources, creates a public health risk as it increases the likelihood that SOs will recidivate. Veterans who are SOs have unique resources available to them through the Veterans Administration such as SO treatment and peer-support specialists. Nevertheless there are additional steps that could be beneficial, such as timely provision of information, creating more opportunities for treatment, and providing more housing options.

scholarly journals COVID-19 and doctor emigration: the case of Ireland

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Niamh Humphries ◽  
Jennifer Creese ◽  
John-Paul Byrne ◽  
John Connell
Keyword(s):  
Health System ◽  
Large Scale ◽  
Qualitative Interviews ◽  
Snowball Sampling ◽  
Contact Potential ◽  
Work From Home ◽  
Travel Restrictions ◽  
Hospital Doctors ◽  
June July ◽  
Global Travel

Abstract Background Since the 2008 recession, Ireland has experienced large-scale doctor emigration. This paper seeks to ascertain whether (and how) the COVID-19 pandemic might disrupt or reinforce existing patterns of doctor emigration. Method This paper draws on qualitative interviews with 31 hospital doctors in Ireland, undertaken in June–July 2020. As the researchers were subject to a government mandated work-from-home order at that time, they utilised Twitter™ to contact potential respondents (snowball sampling); and conducted interviews via Zoom™ or telephone. Findings Two cohorts of doctors were identified; COVID Returners (N = 12) and COVID Would-be Emigrants (N = 19). COVID Returners are Irish-trained emigrant doctors who returned to Ireland in March 2020, just as global travel ground to a halt. They returned to be closer to home and in response to a pandemic-related recruitment call issued by the Irish government. COVID Would-be Emigrants are hospital doctors considering emigration. Some had experienced pandemic-related disruptions to their emigration plans as a result of travel restrictions and border closures. However, most of the drivers of emigration mentioned by respondents related to underlying problems in the Irish health system rather than to the pandemic, i.e. a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system. Discussion/conclusion This paper illustrates how the pandemic intensified and reinforced, rather than radically altered, the dynamics of doctor emigration from Ireland. Ireland must begin to prioritise doctor retention and return by developing a coherent policy response to the underlying drivers of doctor emigration.

scholarly journals Terminal Logic Behavior and Strategic Defection of Governmental Officials during Presidential Transitions in Guatemala: Implications for the Sustainability of Food and Nutrition Security Policy

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Jessica L Escobar-Alegria ◽  
Edward A Frongillo ◽  
Christine E Blake
Keyword(s):  
Political Parties ◽  
Security Policy ◽  
Qualitative Interviews ◽  
A Priori ◽  
Snowball Sampling ◽  
Food And Nutrition Security ◽  
Nutrition Security ◽  
Presidential Transitions ◽  
Use Of Resources ◽  
Food And Nutrition

ABSTRACT Background Presidents with no possibility of re-election overvalue far-future rewards and succumb to terminal logic behavior (TLB), responding to end-of-tenure legacy concerns despite political context. Government authorities perceiving the outgoing government is losing power at the end of term behave under the logic of strategic defection (SD), dissociating from the outgoing government once it is perceived powerless. In countries where re-election is impossible and government turnover and inconstant political parties are concerns, governmental officials at all levels may show TLB and SD during transitions that affect policy sustainability. Objectives This study aimed to understand the context during presidential transitions that makes TLB and SD relevant, whether TLB and SD affect sustainability of food and nutrition security policy (FNSP), and the tactics for navigating transitions that favor sustainability. Methods A case-study design was used with semi-structured qualitative interviews and document review of news articles in Guatemala. Purposeful criteria and snowball sampling were used to recruit 52 policy actors implementing an FNSP across 2 transitions; 252 news articles from the referenced period covering topics on policy programmatic areas were purposefully sampled. Interviews were analyzed using coding and thematic analyses. News articles were analyzed using a priori thematic coding for verifying themes in interviews and data triangulation. Results Governmental officials were replaced by others during transitions; political parties were perceived as inconstant. TLB and SD occurred at all levels and had consequences for sustainability of FNSP: implementation slow-down, dysfunctional collaboration, inefficient use of resources, benefits not reaching targeted groups, and loss of momentum. These occurred through individual, institutional, and political mechanisms. Civil society, international organizations, and government adopted tactics for maximizing sustainability. Conclusions Understanding governmental officials’ experiences and the extent to which TLB and SD occur and affect sustainability could be advantageous to develop compensatory actions for reaching long-term FNSP goals.

scholarly journals A qualitative exploration of the experience and quality of life of patients, and their family carers, admitted to a specialist eye hospital with microbial keratitis

2020 ◽  
Author(s):  
Shelley Anne Tranter ◽  
Maria Cabreras-Aguas ◽  
Mandy Riddell ◽  
Joanna McCulloch ◽  
Therese Riley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Qualitative Interviews ◽  
Family Carers ◽  
Microbial Keratitis ◽  
Structured Interviews ◽  
Post Discharge ◽  
Convenience Sample ◽  
Family Work ◽  
Related Quality

Abstract Background: Microbial keratitis is a vision-threatening condition requiring intensive treatment. Understanding patients’ and carers’ experience during and after hospitalisation can inform improvements in care and outcomes. This study explored the vision-related quality of life, and the experiences of patients with microbial keratitis and their family carers when admitted to a quaternary referral eye hospital in AustraliaMethods: The study employed mixed methods, including qualitative interviews and a survey in hospital and a telephone interview post-discharge. A convenience sample was recruited of 33 patients with microbial keratitis who presented to hospital between March and October 2017, and 10 of their family carers. Semi-structured interviews were audiotaped, transcribed verbatim, coded and analysed using thematic analysis. Patient participants completed the National Eye Institute Visual Functioning Questionnaire – 25 (NEIVFQ-25).Results: Qualitative analyses identified two main themes: Saving sight, with subthemes of costs of saving sight, and travel and transportation; Safe-guarding home and normal life with subthemes of family, work and pastimes. A group mean NEIVFQ-25 score of 74 was similar to other ophthalmic disease groups but pain scores were higher.Conclusion: Findings provide insights into the experiences and often unspoken concerns of microbial keratitis patients and their family carers, revealing the priority and the associated costs of saving sight, and the implications for family and lifestyles. These patients reported similarly reduced vision-related quality of life but greater pain compared to other ophthalmic groups. Findings point to ways to improve their experience and potentially reduce the high rates of unplanned representations of this patient group.

Design and Implementation of a Novel Peer-to-Peer Coaching Program to Support Digital Mental Health (Preprint)

2021 ◽  
Author(s):  
Benjamin M Rosenberg ◽  
Tamar Kodish ◽  
Zachary D Cohen ◽  
Elizabeth Gong-Guy ◽  
Michelle G Craske
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer To Peer ◽  
Design And Implementation ◽  
Digital Interventions ◽  
Competency Based ◽  
Peer Coach ◽  
Principles Of Learning ◽  
University Setting

UNSTRUCTURED Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present one avenue for increasing the reach of mental health services. These interventions often rely upon paraprofessionals, or “coaches,” to support the treatment. While existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts.

Influence of Islamic Traditions on Breastfeeding Beliefs and Practices Among African American Muslims in West Philadelphia: A Mixed-Methods Study

2017 ◽  
Vol 34 (1) ◽  
pp. 164-175 ◽  
Author(s):  
Camilia Kamoun ◽  
Diane Spatz
Keyword(s):  
African American ◽  
Community Education ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Community Leaders ◽  
American Muslims ◽  
Convenience Sample ◽  
Beliefs And Practices ◽  
Attitudes And Practices ◽  
Breastfeeding Attitudes

Background: Little is known regarding the influence of religion on breastfeeding in African American communities. In particular, whether Islamic traditions influence breastfeeding beliefs and practices among African American Muslims has not been studied. Research aim: This study sought to gain understanding of breastfeeding attitudes, rates, and education among African American Muslims in West Philadelphia and to examine if engaging Islamic teachings in breastfeeding education can positively influence breastfeeding attitudes. Methods: Open-ended, in-person, digitally recorded qualitative interviews were conducted with 10 community leaders and analyzed by conventional content analysis. A study tool distributed to a convenience sample of 44 community members and 11 leaders was used to gather information about education received from community leaders, breastfeeding attitudes and practices, and the potential for Islamic teachings to positively affect breastfeeding attitudes and practices. To obtain further data on this last topic, preliminary data analysis guided the creation of an education pamphlet, about which feedback was gathered through another study tool. Results: Education surrounding Islamic perspectives on breastfeeding was not prevalent. African American Muslims in West Philadelphia view breastfeeding favorably and have higher rates of breastfeeding than African Americans as a whole. Community education about breastfeeding that engaged Islamic teachings improved respondents’ breastfeeding attitudes. Conclusion: Increasing education among providers and African American Muslims about Islamic perspectives on breastfeeding may improve breastfeeding exclusivity and duration. Healthcare providers who care for Muslim women should be aware of Islam’s tradition of positive attitudes toward breastfeeding and partner with Muslim leaders to improve breastfeeding rates and duration among such women.

From “Codeine Diet” to “Gutter Water”: polydrug use among Nigerian young adults

2020 ◽  
Vol 20 (2) ◽  
pp. 95-107 ◽  
Author(s):  
Emeka W. Dumbili ◽  
Emmanuel Ezekwe ◽  
Ogochukwu Winifred Odeigah
Keyword(s):  
Young Adults ◽  
Illicit Drugs ◽  
Soft Drink ◽  
Qualitative Interviews ◽  
Snowball Sampling ◽  
Law Enforcement Agencies ◽  
Polydrug Use ◽  
Content Type ◽  
Polysubstance Use ◽  
Cough Syrup

Purpose The purpose of this paper is to explore polydrug use and the factors that motivate the use of multiple substances among selected young adults. Design/methodology/approach A total of 23 male and female participants (aged 23-29 years) who use illicit drugs and prescription pharmaceuticals for non-medical purposes were recruited through snowball sampling. Qualitative interviews were conducted, and the data were analysed thematically. Findings The use of drug “concoctions” and cocktails was widespread among the participants. Some used what they called Codeine Diet (codeine-based cough syrup mixed with a Coca-Cola® product or malt drink), while others took Gutter Water (a cocktail of cannabis, codeine, tramadol, vodka and juice or water). The use of Monkey Tail (a mixture of local gin, cannabis leaves, stems, roots and seeds) and petrol mixed with glue and La Casera® (carbonated soft drink) combined with Tom-Tom® (menthol-flavoured candy) was also revealed. Pleasure, better highs, the need to experience prolonged intoxication and the use of one drug to douse the effects of another substance motivated polysubstance use. Social implications The findings revealed that the reasons why codeine-based cough syrups are mixed with soft drinks (Codeine Diet) include avoiding social discrimination and evading law enforcement agencies. Results suggest that these drug use practices require specifically tailored public health interventions. Social stigmatization against substance users and the use of extra-legal measures by the police should be discouraged to facilitate harm reduction. Originality/value This study represents the first qualitative research to explore polydrug use among an understudied Nigerian population.

Sign in / Sign up

Export Citation Format

Share Document