Effects of a Brief Video Intervention on Attitudes Toward Counseling Services

This study investigated the effects of a brief video intervention on attitudes toward counseling services. Two hundred and seventy-seven participants were divided into four groups (anxious-preoccupied, dismissive-avoidant, fearful-avoidant, and secure) by their attachment scores. Then, the participants of each group were randomly assigned to three conditions (stigma-reducing, utility-enhancing, and control). A split-plot factorial design was performed to examine the intervention effects. The results indicate that the stigma-reducing video intervention was more effective for the anxious-preoccupied group, whereas the utility-enhancing video intervention was more effective for the dismissive-avoidant group than other groups. These results suggest the importance of implementing strategies tailored to each attachment group.

A Dialysis Center Educational Video Intervention Increases Patient Self-Efficacy and Kidney Transplant Evaluations

Introduction: The optimal treatment for end-stage kidney disease is renal transplant. However, only 1 in 5 (21.5%) patients nationwide receiving dialysis are on a transplant waitlist. Factors associated with patients not initiating a transplant evaluation are complex and include patient specific factors such as transplant knowledge and self-efficacy. Research Question: Can a dialysis center-based educational video intervention increase dialysis patients’ transplant knowledge, self-efficacy, and transplant evaluations initiated? Design: Dialysis patients who had not yet completed a transplant evaluation were provided a transplant educational video while receiving hemodialysis. Patients’ transplant knowledge, self-efficacy to initiate an evaluation, and dialysis center rates of transplant referral and evaluation were assessed before and after this intervention. Results: Of 340 patients approached at 14 centers, 252 (74%) completed the intervention. The intervention increased transplant knowledge (Likert scale 1 to 5: 2.53 [0.10] vs 4.62 [0.05], P < .001) and transplant self-efficacy (2.55 [0.10] to 4.33 [0.07], P < .001. The incidence rate per 100 patient years of transplant evaluations increased 85% (IRR 1.85 [95% CI: 1.02, 3.35], P = .0422) following the intervention. The incidence rates of referrals also increased 56% (IRR 1.56 [95% CI: 1.03, 2.37], P = .0352), while there was a nonsignificant 47% increase in incidence rates of waitlist entries (IRR 1.47 [95% CI: 0.45, 4.74], P = .5210). Conclusion: This dialysis center-based video intervention provides promising preliminary evidence to conduct a large-scale randomized controlled trial to test its effectiveness in increasing self-efficacy of dialysis patients to initiate a transplant evaluation.

Elderhood as an Anti-Ageism Intervention

Ageism is a complex, multi-layered phenomenon impacting feelings, thoughts and behaviors toward self and others. Due to the complexity of ageism, evidence-based anti-ageism interventions have proved challenging and costly. To date, using the concept of elderhood as a mechanism to mitigate the negative impacts of ageism has not been explored. As an anti-ageism strategy, elderhood reframes later life as a stage that encompasses growth and development and expected loss and decline. The current study evaluated a brief video intervention among first-year medical students before participating in a year-long senior mentoring program. First-year medical students (N = 585) from 2018-2021 responded to open-ended questions after viewing the video. Thematic analysis revelated four themes: neutrality, elderhood as development, reframing stigma and elderhood as othering. Findings suggest that elderhood may be a viable and productive anti-ageism strategy.

A(pp)ceptance: Increasing physicians’ acceptance for chronic pain apps (Preprint)

BACKGROUND Chronic pain is one of the most costly and widespread medical conditions in the world. Despite effective forms of treatment, there is an urgent need to optimize therapies. Studies on the effectiveness of health apps for chronic pain patients are increasing and show promising results as a treatment adjunct or stand-alone treatment. Nevertheless, physicians’ acceptance of electronic health interventions has been somewhat reluctant, resulting in low prescription rates of health apps. OBJECTIVE The aim of our study was to determine and enhance physicians’ acceptance, performance expectancy and credibility of health apps for chronic pain patients. We further investigated predictors of acceptance. METHODS In a repeated measures design, 248 physicians were randomly assigned to either an experimental group (short educational video about health apps) or a control group (short video about chronic pain). Primary outcome measure was acceptance. Performance expectancy and the credibility of health apps were secondary outcomes. In addition, we assessed 101 medical students to evaluate the effectiveness of the video intervention in young professionals. RESULTS In general, physicians' acceptance of health apps for chronic pain patients was moderate (M=9.51, SD=3.53, scale ranges from 3-15). All primary and secondary outcomes were enhanced by the video intervention: A repeated-measures ANOVA yielded a significant interaction effect for acceptance (F(1, 246)=15.28, P=.01), performance expectancy (F(1, 246)=6.10, P=.01) and credibility (F(1, 246)=25.61, P<.001). The same pattern of results was evident among medical students. Linear regression analysis revealed credibility (β=.34, P<.001) and performance expectancy (β .30, P<.001) as the two strongest factors influencing acceptance, followed by skepticism (β=-.18, P<.001) and intuitive appeal (β=.11, P=.03). CONCLUSIONS Physicians’ acceptance of health apps was moderate, and was strengthened by a three minutes video. Besides performance expectancy, credibility seems to be a promising factor associated with acceptance. Future research should focus on ways to implement acceptability-increasing interventions into routine care. CLINICALTRIAL Open Science Framework: https://osf.io/x693r Registration DOI: 10.17605/OSF.IO/X693R

Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial

Background During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). Methods The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. Results Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes. Conclusions VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT. Trial registration ClinicalTrials.govNCT03374904. Registered on 14 December 2017

Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial

Background In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs (“mentor mothers”). Methods and findings We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants’ median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers’ time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. Conclusions This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs’ direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. Trial registration The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.