A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial

Background Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine’s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results Participants were enrolled at, on average, 9.6 (SD 1.8) weeks’ gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions A financial incentive–based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive–based interventions for healthy GWG behaviors. Trial Registration ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194

A MODEL OF ENGAGEMENT FOR CORRECTIONAL PRACTICE

<p>Despite recent advances in correctional rehabilitation, rates of treatment attrition remain high and low efficacy rates suggest improvements in treatment development and delivery are needed. Treatment engagement is an important concept which remains poorly understood. In order to enhance understanding and facilitate higher levels of engagement in treatment, robust theoretical models need to be developed. In light of this, two key questions need to be answered; (1) what is engagement? And (2) what are the underlying causal mechanisms which facilitate or hinder engagement? I explore the contributions of current conceptualisations and models of correctional treatment engagement. I explain how evolutionary psychology, agency, norms and the therapeutic alliance can contribute to our theoretical understanding. These concepts are then integrated to form the Model of Engagement for Correctional Practice. Engagement is conceptualised as a set of adaptive, goal-directed behaviours occurring as a result of the dynamic interactions between contextual, psychological and social processes. I argue that these factors influence the nature of the therapeutic alliance and subsequently participant engagement. The model is then evaluated in terms of critical features required for a robust theory of engagement. I then suggest some practice principles and guidelines to demonstrate how this model can be applied to enhance treatment engagement.</p>

A MODEL OF ENGAGEMENT FOR CORRECTIONAL PRACTICE

<p>Despite recent advances in correctional rehabilitation, rates of treatment attrition remain high and low efficacy rates suggest improvements in treatment development and delivery are needed. Treatment engagement is an important concept which remains poorly understood. In order to enhance understanding and facilitate higher levels of engagement in treatment, robust theoretical models need to be developed. In light of this, two key questions need to be answered; (1) what is engagement? And (2) what are the underlying causal mechanisms which facilitate or hinder engagement? I explore the contributions of current conceptualisations and models of correctional treatment engagement. I explain how evolutionary psychology, agency, norms and the therapeutic alliance can contribute to our theoretical understanding. These concepts are then integrated to form the Model of Engagement for Correctional Practice. Engagement is conceptualised as a set of adaptive, goal-directed behaviours occurring as a result of the dynamic interactions between contextual, psychological and social processes. I argue that these factors influence the nature of the therapeutic alliance and subsequently participant engagement. The model is then evaluated in terms of critical features required for a robust theory of engagement. I then suggest some practice principles and guidelines to demonstrate how this model can be applied to enhance treatment engagement.</p>

Decrease of Hospitalizations and Length of Hospital Stay in Patients with Schizophrenia Spectrum Disorders or Bipolar Disorder Treated in a Mobile Mental Health Service in Insular Greece

In recent years serious mental health issues, such as schizophrenia spectrum disorders and bipolar disorder, have been treated in the community by community-based mental health services. In the present study our goal was to estimate the modification in the number of hospitalizations and duration of admissions in either psychotic patients or patients with bipolar disorder, treated by a Mobile Mental Health Unit in the islands of Kefalonia, Zakynthos and Ithaca (MMHU-KZI). Data were collected from a total of 108 patients with schizophrenia spectrum disorders and bipolar disorder. For each patient comparison was made for the same time interval prior and after engagement to treatment with the MMHU-KZI and not for the total hospitalizations that patients had in their history. There was a statistically significant reduction (45.9%) in hospitalizations after treatment engagement with the MMHU-KZI, as the Wilcoxon signed ranks test indicated. Furthermore, a major decrease (54.5%) of hospitalization days was noted after treatment engagement with the unit. This pattern of mental health provision may be beneficial for the reduction of the number and duration of psychiatric hospitalizations. Despite the beneficial contribution of community-based mental health units, hospital based treatment should always be available, since severe relapses are better treated in inpatient setting.

Nurses’ perceptions of factors influencing treatment engagement among patients with cardiovascular diseases: a systematic review

Background Nurses are key to the success of patient engagement, yet we know little about nurses’ perceptions on treatment engagement and how they can contribute to treatment engagement. Qualitative evidence to identify factors that influence treatment engagement among patients with CVD from nurse’s perspective is limited. Methods This systematic review of qualitative research was based on the PRISMA reporting guidelines. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess quality by two reviewers independently. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase- Non-Medline, Scopus, and the Cochrane Library, were systematically searched from 2001 to 2020. The search strategy included keywords and MeSH terms to identify relevant studies written in English. Results Eight articles were included in the review. Four key themes were synthesised from the findings: nurses need training and up to date information, providing support for patients, patient motivation to engage with treatment plans and perceived lack of time. Conclusion Nurses described the importance of training to help them support patients to engage as effectively as possible and their role in providing social and psychological support. They also described the importance of patient motivation to engage in a treatment and plan and sustain engagement and time.

Adjunctive Telehealth Mindfulness Therapy for Persons With Dementia and Their Caregivers in the Rural Deep South

The emotional care needs of persons with dementia (PwD) and their caregivers are multitudinous. Multicomponent interventions may be necessary to meet their multiple needs. Mindfulness interventions have a positive impact on well-being but are often only offered as a stand-alone treatment and typically are available only to the caregiver. This presentation will describe a telephone-delivered adjunctive mindfulness intervention that was offered to caregivers and dyads in conjunction with care consultation. Participants were 26 caregivers and 22 PwD living in the Deep South. The adjunctive mindfulness therapy included four core sessions and an additional five sessions that were optional. Mindfulness was deemed to be a “good fit” for almost 75% of the sample. Duration of mindfulness sessions ranged from 30 to 65 minutes. Participants attended more sessions as a dyad (M=10.10) compared to caregivers alone (M=6.5). Information regarding attendance and treatment engagement will be presented.