scholarly journals Effect of Follow-up Telephone by Enterostomal Nurses on Patients with Permanent Colostomy: A Systematic Review

2022 ◽  
Vol 21 (1) ◽  
pp. 54-66
Author(s):  
Herlina Semi ◽  
Sitti Syahriani Sambari ◽  
Yuliana Syam ◽  
Andi Masyitha Irwan
Keyword(s):  
Systematic Review ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Quality Care ◽  
Medical Science ◽  
Management Service ◽  
Adjustment Problems ◽  
Permanent Colostomy ◽  
Care Services

Background: Patients with permanent colostomy experience quality of life (QoL) decrease, complications, and colostomy adjustment problems. Technology-based interventions can be provided with telephone follow-up (TFU) to provide health education and advice on managing symptoms, identifying complications, and providing quality care services. Objective: To systematically describe and assess the effect of TFU on permanent colostomy include population, model and duration, instruments used, and effect of TFU. Materials and Methods: A systematic review was carried out using the Randomized Controlled Trial (RCT) approach in eight databases, including PubMed, Proquest, ScienceDirect, EBSCOhost, CANCERLIT, Wiley, Gray literature, and Scopus, to identify studies reported in English, published in the last ten years, available full text, and about TFU in permanent colostomy patients. Results and Discussion: Based on the 11 RCT articles analyzed, it was found that the TFU duration ranged from 27 days to 3 years. The TFU improved self-efficacy, QoL, colostomy adjustment, self-care, self-management, service satisfaction, and complications. Conclusion: The TFU has more effect on self-efficacy, QoL, and complications in patients with a permanent colostomy, and effective TFU was performed for at least three months. Further research is needed on the frequency or duration of telephone calls. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 54-66

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

scholarly journals Effectiveness of one-to-one peer support for patients with severe mental illness – a randomised controlled trial

2017 ◽  
Vol 42 ◽  
pp. 103-110 ◽  
Author(s):  
C.I. Mahlke ◽  
S. Priebe ◽  
K. Heumann ◽  
A. Daubmann ◽  
K. Wegscheider ◽  
...  
Keyword(s):  
Mental Illness ◽  
Peer Support ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Treatment As Usual ◽  
Secondary Outcomes ◽  
One To One ◽  
Randomised Controlled

AbstractBackgroundOne-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments.MethodsThis is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years’ duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations.ResultsPatients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses.ConclusionsThe findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.

scholarly journals A randomised controlled trial to investigate the effectiveness of sustained photoprotective behaviour in xeroderma pigmentosum after intervention

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S287-S287
Author(s):  
Tamara Searle ◽  
Jessica Walburn ◽  
Sam Norton
Keyword(s):  
Randomised Controlled Trial ◽  
Self Efficacy ◽  
Xeroderma Pigmentosum ◽  
Controlled Trial ◽  
Premalignant Lesions ◽  
Mental Wellbeing ◽  
Group Effect ◽  
Post Intervention ◽  
Randomised Controlled

AimsThis study aimed to investigate whether an intervention designed to improve photoprotective behaviours is effective at changing behaviour and whether any change could be maintained.BackgroundXeroderma Pigmentosum (XP) is a rare condition in which patients are at risk of malignancies when exposed to ultra-violet radiation (UVR). Sufferers must take extra precautions to protect themselves from UVR. They must apply sunscreen to exposed skin, wear thick clothing, gloves, and a UVR-protective visor. Treatments include preventative photoprotective measures; the use of sunscreen and protective clothing. Additionally, frequent eye and skin examinations are required and swift removal of any premalignant lesions.MethodIn this randomised controlled trial, 16 participants with XP were given questionnaires at 4 time points; baseline, post-intervention, 5 months and 9 months post-intervention. The intervention involved 7 one-on-one counselling sessions, as well as telephone consultations. Counselling sessions encouraged photoprotection adherence, self-efficacy and discussions of any barriers to improving photoprotective behaviour. This study focused on psychosocial variables, attitudes and photoprotection. Questionnaires included the photoprotection self-efficacy questionnaire, Self-Reported Behavioural Automaticity Index, Short Warwick-Edinburgh Mental Wellbeing Scale, Quality of Life and Brief Photoprotection Adherence Questionnaire.ResultThe intervention was shown to have no significant effect on participants’ questionnaires scores. Univariate ANCOVA revealed a group effect between follow-up 1 (FU1) and follow-up 2 (FU2); η2 = 0.422 for self-efficacy in wearing photoprotective clothing. A group effect was identified from BL to FU1 and FU1 to FU2; η2 = 0.343 and η2 = 0.378 respectively in how often participants reapplied sunscreen to their face when outside for longer periods. Univariate ANCOVA revealed no group or time effect for the other outcome variables; for example, sunscreen self-efficacy.ConclusionThe intervention had no significant effect on photoprotective behaviour questionnaire scores. Future research could focus on recruiting more participants globally to generate more statistically powered results. Research should focus on producing a maintainable intervention so that any positive change would produce better long-term health outcomes. This study lays the foundations for future XP research, which will be vital to improve understanding and enhance photo protective behaviour.

scholarly journals Effectiveness of an Evidence-Based Practice Educational Intervention among School Nurses

2020 ◽  
Vol 17 (11) ◽  
pp. 4063
Author(s):  
Pei-Lin Hsieh ◽  
Sue-Hsien Chen
Keyword(s):  
Self Efficacy ◽  
Primary Schools ◽  
Flipped Classroom ◽  
Evidence Based Practice ◽  
Quality Care ◽  
School Nurses ◽  
Evidence Based ◽  
Learning Technology ◽  
Post Test

The evidence-based practice (EBP) approach to high-quality care is designed to improve patient outcomes. However, little research has been conducted to determine how EBP is adopted and implemented among school nurses in Taiwan. This study evaluated an EBP training program implemented among school nurses in Taiwan to determine whether and how effectively it improved their knowledge levels, attitudes, skills, and self-efficacy. A pretest-posttest research design was employed. Participants were recruited via convenience sampling from among 193 primary schools throughout Tao-Yuan and New Taipei City in Taiwan. The EBP program implemented both mobile learning technology and the flipped classroom format. The learning outcomes were evaluated before, immediately after, and at a 3-month follow-up. In this regard, the data were collected using the School Nurse Evidence-Based Practice Questionnaire. The results showed that the participant scores for the items of knowledge and self-efficacy significantly increased over the study period. Somewhat differently, scores for the skill items significantly increased from the pre-test to the immediate post-test, but significantly decreased from the immediate post-test to the final follow-up. Overall, however, the EBP program led to marked improvements in knowledge, skills, and self-efficacy. These findings can help guide the development of a creative evidence-based school nursing curriculum.

scholarly journals Promoting behavior-related low back health in nursing staff by in-person and interactive social media interventions in the workplace: a randomized trial

2020 ◽  
Author(s):  
Seyedeh Somayeh Kazemi ◽  
Sedigheh-Sadat Tavafian ◽  
Claire E Hiller ◽  
Alireza Hidarnia ◽  
Ali Montazeri
Keyword(s):  
Social Media ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Scientific Evidence ◽  
Low Back ◽  
Enabling Factors ◽  
Work Related ◽  
Reinforcing Factors ◽  
And Behavior

Abstract Background: Nurses are put at high risk of work-related low back pain (LBP) due to the nature of their work. There is wide scientific evidence that the incidence and prevalence of LBP in nurses is high. Therefore, promoting behaviors for low back health in nurses is essential. The aim of this study was to develop and evaluate a theory-based educational intervention on promoting behaviors of low back health via in-person and social media education among nursing personnel with LBP. Methods: The educational content was developed with six modules: knowledge, attitude, self-efficacy, reinforcing factors, enabling factors and behavior. Evaluation of the content was undertaken in nurses, mean age 36.50 ± 5.79 years, with LBP recruited to a community randomized controlled trial with two modes of delivery: in-person (n=60) and social media (n=60). Data were collected with a self-designed questionnaire at baseline, 3 and 6 months. Baseline comparisons between groups were made with Mann-Whitney U Test for non-normal data and T-Test for normal data. Comparison of change scores between groups and two delivery types across the three time periods used the mixed between-within subject analysis of variance. Results: A total of 120 nurses received the allocated intervention and completed the baseline and follow-up questionnaires. The results indicated there were no significant statistical differences between two delivery types in the variables at the baseline (p > .05). All educational component scores increased at 3-months in both groups. At the 6-month follow-up scores increased for enabling factors and behavior in the in-person group, while in the social media group all scores increased except for attitude. Based on Bonferroni Post hoc analysis there was the difference between the delivery types; social media was more effective in knowledge (p = .01), self-efficacy (p = .03), reinforcing factor (p = .05) and behavior (p = .001) than the in-person intervention. Conclusion: An educational program for low back health was developed based on the PRECEDE-PROCEED model and proved effective at improving knowledge, attitude, self-efficacy, reinforcing factors, enabling factors and behavior. However, delivery via social media was more successful than in-person in the maintenance of behavior over the long-term.

scholarly journals A real world feasibility trial of the PLAYshop: an intervention to facilitate parent engagement in developing their child’s physical literacy

2020 ◽  
Author(s):  
Cassandra Lane ◽  
Kendra Reno ◽  
Madison Predy ◽  
Valerie Carson ◽  
Chris Wright ◽  
...  
Keyword(s):  
Real World ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Literacy Intervention ◽  
Feasibility Trial ◽  
Physical Literacy ◽  
Physical Competence ◽  
Physically Active ◽  
Implementation Challenges

Abstract Background Development of physical literacy, defined as “the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life”, can support children’s physically active behaviors and consequent health benefits. Little research exploring interventions to improve children's physical literacy exist, although substantive evidence shows parents play a key role in children's physically active behaviors and development of fundamental movement skills. The purpose of this study is to explore a novel, physical literacy intervention designed to assist parents to engage with their child in purposeful play; play that facilitates the development of physical literacy. Methods The PLAYshop was a 75-minute workshop to build parents' self-efficacy to support their child’s physical literacy through interactive activities and educational messages as well as educational resources focused on core physical literacy concepts. We collected quantitative pre- and post-workshop surveys of parents’ satisfaction, knowledge, confidence and intention to adopt practices as well as qualitative follow-up implementation focused interviews from both parents and facilitators. We used paired t-tests to examine changes in parents' self-reported physical literacy knowledge and confidence and thematic analysis of interviews to explore workshop feasibility. Results Six workshops were delivered to 33 parents of young children (3–8 years of age). 23 parents completed both pre- and post-workshop surveys. Follow-up interviews were completed with 11 parents and four workshop facilitators. Parents’ self-reported knowledge and confidence to support their child’s physical literacy development significantly increased after PLAYshop participation. Further, the majority of parents were satisfied with the workshop and motivated to apply workshop learnings at-home with their child. Workshop facilitators identified seven workshop strengths (e.g., workshop champions and skilled facilitators) and four challenges (e.g., recruitment and unfavorable spaces). Conclusions The PLAYshop was perceived positively by parents and facilitators and appeared to improve parent self-efficacy and intention to promote physical literacy with their child. Recruitment and attendance were key implementation challenges. The findings from this real world trial address an important evidence gap, highlighting areas for adaptations to improve the intervention and recruitment and suggesting that the PLAYshop is ready for efficacy testing in a more rigorous randomized controlled trial.

scholarly journals Integrated Care Intervention Supported by a Mobile Health Tool for Patients Using Noninvasive Ventilation at Home: Randomized Controlled Trial

10.2196/16395 ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. e16395 ◽  
Author(s):  
Erik Baltaxe ◽  
Cristina Embid ◽  
Eva Aumatell ◽  
María Martínez ◽  
Anael Barberan-Garcia ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Collaborative Work ◽  
Intervention Group ◽  
Likert Scale ◽  
Mobile App ◽  
Home Based ◽  
Centered Care

Background Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions The integrated care intervention supported by the mobile app did not improve patient self-management. However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175

scholarly journals The Use of Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2prevent): Results From a Pilot Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Emily S Ross ◽  
Brodie M Sakakibara ◽  
Martha H Mackay ◽  
David GT Whitehurst ◽  
Joel Singer ◽  
...  
Keyword(s):  
Study Protocol ◽  
Resource Use ◽  
Self Efficacy ◽  
Text Messaging ◽  
Controlled Trial ◽  
Text Messages ◽  
Self Management ◽  
Coronary Syndrome ◽  
Randomized Controlled

BACKGROUND Acute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. Text messaging has the potential to provide support to patients during this post-discharge period. OBJECTIVE This study pilot-tested a 60-day text-messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and healthcare resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention. METHODS This was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada and randomized them to one of two groups within seven days of discharge. The Txt2Prevent program included automated one-way text messages about follow-up care, self-management and healthy living. Data was collected during the index admission and at 60-days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ visual analogue scale, Sullivan Cardiac Self-Efficacy Scale, Morisky Medication Adherence Scale and self-reported healthcare resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with two survey questions and semi-structured interviews. RESULTS There were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference: health directed activity: –0.13 [95% confidence interval (CI): –0.39-0.13]; positive and active engagement in life: 0.03 [95% CI: –0.19-0.25]; emotional distress: 0.04 [95% CI: –0.22-0.29]; self-monitoring and insight: 0.14 [95% CI: –0.33-0.05]; constructive attitudes and approaches: –0.10 [95% CI: –0.36- 0.17]; skill technique and acquisition: 0.05 [95% CI: –0.18-0.27]; social integration and support: –0.12 [95% CI: –0.34-0.19]; health services navigation: –0.05 [95% CI: –0.29-0.19]). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in one self-efficacy domain (‘Total Plus’), where the Txt2Prevent group had lower scores (mean difference: –0.36 [95% CI: –0.66 to -0.50]). The study protocol was feasible although recruitment took longer than expected. Over 90% of participants reported they were satisfied with the program. CONCLUSIONS The Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the two groups in adjusted analyses except for one self-efficacy domain. As the intervention appeared acceptable, there is potential in using text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures. CLINICALTRIAL ClinicalTrials.gov NCT02336919 INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.6968

scholarly journals A real world feasibility trial of the PLAYshop: a brief intervention to facilitate parent engagement in developing their child’s physical literacy

2020 ◽  
Author(s):  
Cassandra Lane ◽  
Valerie Carson ◽  
Kayla Morton ◽  
Kendra Reno ◽  
Chris Wright ◽  
...  
Keyword(s):  
Real World ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Literacy Intervention ◽  
Feasibility Trial ◽  
Physical Literacy ◽  
Physical Competence ◽  
Physically Active ◽  
Implementation Challenges

Abstract Background: Development of physical literacy, defined as “the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life”, can support children’s physically active behaviors and consequent health benefits. Little research exploring interventions to improve children's physical literacy exist, although substantive evidence shows parents play a key role in children's physically active behaviors and development of fundamental movement skills. The purpose of this study is to explore a novel, physical literacy intervention designed to assist parents to engage with their child in purposeful play; play that facilitates the development of physical literacy. Methods: The PLAYshop was a 75-minute workshop to build parents' self-efficacy to support their child’s physical literacy through interactive activities and educational messages as well as educational resources focused on core physical literacy concepts. We collected quantitative pre- and post-workshop surveys of parents’ satisfaction, knowledge, confidence and intention to adopt practices as well as qualitative follow-up implementation focused interviews from both parents and facilitators. We used paired t-tests to examine changes in parents' self-reported physical literacy knowledge and confidence and thematic analysis of interviews to explore workshop feasibility.Results: Six workshops were delivered to 33 parents of young children (3-8 years of age). Twenty-three parents completed both pre- and post-workshop surveys. Follow-up interviews were completed with 11 parents and four workshop facilitators. Parents’ self-reported knowledge and confidence to support their child’s physical literacy development significantly increased after PLAYshop participation. Further, the majority of parents were satisfied with the workshop and motivated to apply workshop learnings at-home with their child. Workshop facilitators identified seven workshop strengths (e.g., workshop champions and skilled facilitators) and four challenges (e.g., recruitment and unfavorable spaces).Conclusions: The PLAYshop was perceived positively by parents and facilitators and appeared to improve parent self-efficacy and intention to promote physical literacy with their child. Recruitment and attendance were key implementation challenges. The findings from this real world trial address an important evidence gap, highlighting areas for adaptations to improve the intervention and recruitment and suggesting that the PLAYshop is ready for efficacy testing in a more rigorous randomized controlled trial.

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