Engaging Turkish immigrants in psychotherapy: Development and proof-of-concept study of a culture-tailored, web-based intervention

Background Culturally tailored interventions can increase the engagement and the success rate of psychotherapy in immigrant and ethnic minority patients. In this regard, the integration of the patients’ illness beliefs is a key element. Applying principles of Motivational and Ethnographic Interviewing, we developed a culture-tailored, web-based intervention to facilitate engagement of Turkish immigrant inpatients in psychotherapy. Method The different aspects of the engagement intervention development are described and its acceptance and usefulness were tested in a proof-of-concept trial with an experimental control group design (active control condition: progressive muscle relaxation) in a sample of Turkish immigrant inpatients in Germany (N = 26). Illness perception, illness-related locus of control, and self-efficacy were assessed pre and post intervention. Results The engagement intervention was rated better than the control condition (p = .002) and in particular, participants felt better prepared for therapy after working with it (p = .013). By working with the engagement intervention, self-efficacy increased (p = .034) and external-fatalistic control beliefs diminished (p = .021). However, half of the participants needed assistance in using the computer and web-based interventions. Conclusion The developed intervention provides a first step towards feasible culture-tailored psychotherapeutic elements that can be integrated into routine clinical care. The first results regarding acceptance and usefulness are promising.

Reliability and validity of the Brief Illness Perception Questionnaire (B-IPQ) in individuals with a recently acquired spinal cord injury

Objective To assess the reliability and validity of the Brief Illness Perception Questionnaire (B-IPQ) and possible subscales, and to interpret Brief Illness Perception Questionnaire (B-IPQ) total scores, in individuals with a spinal cord injury. Design Cross-sectional Setting Seven Dutch rehabilitation centres Subjects Individuals with a recently acquired traumatic or non-traumatic spinal cord injury at the start of inpatient spinal cord injury rehabilitation (N = 270). Main measure The Brief Illness Perception Questionnaire (B-IPQ) consists of eight items on an individual's cognitive and emotional representation of one's health conditions. Principal component analysis was performed to identify possible Brief Illness Perception Questionnaire (B-IPQ) subscales. Validity was assessed by testing hypotheses on correlations between the Brief Illness Perception Questionnaire (B-IPQ) and other measures. Cut-off points of the Brief Illness Perception Questionnaire (B-IPQ) total score were determined. Results Mean (SD) age of participants was 60.1 (16.5) years, 188 (71%) were male, and 119 (44%) had tetraplegia. Three potential subscales were revealed. Cronbach's alpha was acceptable for only one subscale. This subscale was named ‘consequences’ and included the items ‘consequences’, ‘symptom burden’, ‘concern’, and ‘emotions’. The Brief Illness Perception Questionnaire (B-IPQ) total and the consequence subscale showed the expected strong correlations (>.50) with symptoms of anxiety and depression. Mean (SD) scores were 40.9 (12.3) on the 8-item Brief Illness Perception Questionnaire (B-IPQ) (range 0–80) and 25.1 (8.1) on the consequences subscale (range 0–40). Cut-off points for the Brief Illness Perception Questionnaire (B-IPQ) total score were determined as follows: <42 indicating low experienced threat, 42–49 indicating moderate experienced threat, and ≥50 indicating high experienced threat. Conclusion The Brief Illness Perception Questionnaire (B-IPQ) total and consequences subscale seem applicable in individuals with a spinal cord injury in the rehabilitation practice and research.

Post-COVID-19 illness trajectory: a multisystem investigation.

Background: The pathophysiology and trajectory of multiorgan involvement in post-COVID-19 syndrome is uncertain. Methods: A prospective, multicenter, longitudinal, cohort study involving post-COVID-19 patients enrolled in-hospital or early post-discharge (visit 1) and re-evaluated 28-60 days post-discharge (visit 2). Multisystem investigations included chest computed tomography with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging, digital electrocardiography, and multisystem biomarkers. The primary outcome was the adjudicated likelihood of myocarditis.Results: 161 patients (mean age 55 years, 43% female) and 27 controls with similar age, sex, ethnicity, and vascular risk factors were enrolled from 22 May 2020 to 2 July 2021 and had a primary outcome evaluation. Compared to controls, at 28-60 days post-discharge, patients with COVID-19 had persisting evidence of cardio-renal involvement, systemic inflammation, and hemostasis pathway activation. Myocarditis was adjudicated as being not likely (n=17; 10%), unlikely (n=56; 35%), probable (n=67; 42%) or very likely (n=21; 13%). Acute kidney injury (odds ratio, 95% confidence interval: 3.40 (1.13, 11.84); p=0.038) and low hemoglobin A1c (0.26 (0.07, 0.87); p=0.035) were multivariable associates of adjudicated myocarditis. During convalescence, compared to controls, COVID-19 was associated with worse health-related quality of life (EQ5D-5L) (p<0.001), illness perception (p<0.001), anxiety and depression (p<0.001), physical activity (p<0.001) and predicted maximal oxygen utilization (ml/kg/min) (p<0.001). These measures were associated with adjudicated myocarditis.Conclusions: The illness trajectory of COVID-19 includes persisting cardio-renal inflammation, lung damage and hemostasis activation. Adjudicated myocarditis occurred in one in eight hospitalized patients and was associated with impairments in health status, physical and psychological wellbeing during community convalescence. Public registration: ClinicalTrials.gov identifier is NCT04403607.