Gait Rehabilitation for Foot and Ankle Impairments in Early Rheumatoid Arthritis: a Feasibility Study of a New Gait Rehabilitation Programme (GREAT Strides)

BackgroundFoot impairments in early rheumatoid arthritis are common and lead to progressive deterioration of lower limb function. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. This study evaluated the feasibility of a novel gait rehabilitation intervention (GREAT Strides) and a future trial. MethodsThis was a mixed methods feasibility study with embedded qualitative components. People with early (<2 years) rheumatoid arthritis (RA) and foot pain were eligible. Intervention acceptability was evaluated using a questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Participants and therapists were interviewed to explore intervention acceptability. Deductive thematic analysis was applied using the Theoretical Framework of Acceptability. For fidelity, audio recordings of interventions sessions were assessed using the Motivational Interviewing Treatment Integrity (MITI) scale. Measurement properties of four candidate primary outcomes, rates of recruitment, attrition and data completeness were evaluated.Results35 participants (68.6% female) with median age (inter-quartile range [IQR]) 60.1 [49.4-68.4] years and disease duration 9.1 [4.0-16.2] months), were recruited and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5-22.5]. One serious adverse event that was unrelated to the study was reported. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but also highlighted some barriers to completion. Mean MITI scores for relational (4.38) and technical (4.19) aspects of motivational interviewing demonstrate good fidelity. The Foot Function Index disability subscale performed best in terms of theoretical consistency and was deemed most practical. ConclusionGREAT Strides was viewed as acceptable by patients and therapists, and we observed high intervention fidelity, good patient adherence and no safety concerns. A future trial to test the additional benefit of GREAT Strides to usual care will benefit from amended eligibility criteria, refinement of the intervention and strategies to ensure higher follow-up rates. The Foot Function Index disability subscale was identified as the primary outcome.Trial registrationISRCTN14277030

Public Acceptability of Policy Interventions to Reduce Sugary Drink Consumption in Urban Vietnam

This study aims to assess the public acceptability of interventions to reduce sugary drinks in Vietnam, identify the key determinants, and develop a classification of consumers. A cross-sectional survey with 263 urban consumers evaluated perceptions of four potential interventions: restricting choice, taxation, nudging, and labeling. Thereby, specific attention was devoted to perceived intrusiveness and (personal and societal) effectiveness, as well personal characteristics, including Confucius values. Results showed that “hard” interventions like taxation are less acceptable to consumers than “soft” measures such as labeling. Acceptability is generally affected by perceived intrusiveness and effectiveness (especially on other people in the society), while other factors (sugary drink behavior, trust in government’s competence, personal values, age, education) only matter for some of the interventions. Cluster analysis revealed three consumer segments, depicted as anti-taxation (28%), pro-intervention (20%) and pro-labeling (52%), which further underpins the heterogeneity of intervention acceptability.

Insight into the Feasibility and Acceptability of a Multi-lifestyle Dementia Risk Intervention

Lifestyle interventions based on behaviour change principles may provide a useful mechanism in reducing dementia risk amongst older adults, however intervention acceptability remains relatively unexplored. We assessed the feasibility and acceptability of BRAIN BOOTCAMP, an Australian initiative aiming to improve dementia literary and reduce dementia risk by delivering a brain health box addressing multiple lifestyle factors through education, physical prompts and an individualised brain health profile. Semi-structured phone interviews were conducted with participants (N=94) at completion of the program (3-months) using a theoretical sampling approach to select a range of participants with varying brain health scores, age, gender, education and locality. Interview topics included participants’ overall experience and suggestions for program improvement. Interviews were transcribed and analysed using thematic analysis. Participants were mostly female (79%), with a mean age of 72.6 years (SD=5.4), from an English-speaking background (89.4%) and resided in metropolitan areas (76.6%). Participants positively perceived the program, resulting in high usability and acceptability. Valuable aspects included building dementia awareness in an innovative way, and having re-assessments which identified areas for personal improvement. Participants further discussed how the program prompted lifestyle change, including setting goals (e.g., physical activity) and facilitated a general awareness of their brain health. Suggested improvements included shorter surveys, regular check-ins, and specific tailoring of the program to be more inclusive for older adults with varying levels of health. Our study demonstrated that a simple, innovative program could be a promising medium for delivering comprehensive educational resources and induce lifestyle change for older adults.

Pilot of a Low-Cost Elementary School Handwashing Intervention in Bangladesh: Acceptability, Feasibility, and Potential for Sustainability

Schoolchildren frequently transmit respiratory and gastrointestinal infections because of dense person-to-person contact in schools. We piloted a low-cost handwashing intervention among elementary schoolchildren in Bangladesh. We trained teachers to lead behavior change communication sessions using flipcharts to encourage students’ handwashing before eating, after defecating, and after cleaning school toilets; provided handwashing stations (reservoirs with taps and stool + basin + soapy water solution [mix of 30 gm detergent with 1.5 L water] + pump top bottle with steel holder); and formed hygiene committees for maintenance and covering the recurrent cost of detergent. We evaluated intervention acceptability, feasibility, and potential for sustainability at 1 and 14 months after the intervention. At baseline, of 300 before eating events, no one washed hands with soap, and 99.7% (299) did not wash hands at all as soap was unavailable. Out of 269 after toileting events, 0.7% (2) washed hands with soap, and 88% (237) did not wash hands. After 4 weeks of the intervention, 45% (87/195 before eating events), 83% (155/186 after toileting events), and 100% (15/15 after cleaning toilet events) washed both hands with soapy water as children found it accessible, low cost, and child friendly. After 14 months, 9.4% (55/586 before eating events) and 37% (172/465 after toileting events) washed both hands with soapy water for health benefits. The intervention was acceptable and feasible; it overcame limited access to soap and water and was affordable as schools covered the recurrent costs of detergent. Further research should explore long-term habit adoption and impact on health and attendance.

Is an individually tailored programme of intense leg resistance and dynamic exercise acceptable to adults with an acute lateral patellar dislocation? A feasibility study

Background Lateral patellar dislocations mainly affect active teenagers and young adults. To help people recover, non-surgical exercise-based treatment is often recommended but the optimal exercise-based treatment is unknown. Currently, treatment outcomes after this injury are variable. Common problems include recurrent dislocation, reduced activity levels, and later surgery. A programme of intense leg resistance exercises, and dynamic exercises related to participants’ activity-related goals, has rationale, but has not been previously reported. In line with the Medical Research Council guidance, this study aimed to assess the acceptability of a novel evidence-based exercise programme for adults after acute lateral patellar dislocation and the feasibility of future research evaluating this treatment. Methods A single-group prospective study was conducted at the John Radcliffe Hospital, Oxford, UK. Participants were 16 years or older with an acute first-time or recurrent lateral patellar dislocation. Participants received up to six face-to-face, one-to-one, physiotherapy sessions, over a maximum of 3 months, and performed intensive home exercises independently at least three times per week. Strategies to increase exercise adherence were used. Primary objectives were to determine the number of eligible patients, the recruitment rate (proportion of eligible patients that provided written informed consent), participant adherence to scheduled physiotherapy sessions and self-reported adherence to prescribed exercise, and intervention acceptability to participants measured by attrition and a study-specific questionnaire. Data were analysed using descriptive statistics. Results Fifteen of 22 (68%) patients with a lateral patellar dislocation were eligible. All eligible (100%) were recruited. Two of 15 (13%) participants provided no outcome data, 2/15 (13%) provided partial outcome data, and 11/15 (73%) provided all outcome data. Questionnaire responses demonstrated high intervention acceptability to participants. Participants attended 56/66 (85%) physiotherapy sessions and 10/11 (91%) participants reported they ‘always’ or ‘often’ completed the prescribed exercise. One participant redislocated their patella; another experienced knee pain or swelling lasting more than one week after home exercise on three occasions. Conclusion The intervention appeared acceptable to adults after acute lateral patellar dislocation, and a future randomised pilot trial is feasible. This future pilot trial should estimate attrition with increased precision over a longer duration and assess participants’ willingness to be randomised to different treatments across multiple centres. Trial registration ClinicalTrials.govNCT03798483, registered on January 10, 2019

Group Psychoeducational Intervention for Grandparents of Young Children with ASD: An Open Feasibility Study

This initial open feasibility trial reports on feasibility and preliminary effectiveness of the manualized, group-based psychoeducational intervention for grandparents of preschool-aged children with ASD provided by the outpatient habilitation services in Stockholm, Sweden. One hundred and twenty non-custodial grandparents participated in a 6-h intervention program. The study demonstrated good feasibility: 114 (95%) grandparents competed both pre- and post-intervention measures and evaluations and reported high intervention acceptability. The results also indicated that grandparents increased their knowledge about ASD from pre-intervention to post-intervention, gained skills about strategies of supporting their grandchildren and adult children, and appreciated the opportunity to meet and share experiences with other grandparents. Follow-up with a randomized controlled trial design is needed to firmly establish efficacy of this intervention.

A decade of Acceptability Research with Adolescents in Africa: Systematic review and evidence map

Interventions aimed at improving adolescent developmental outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability, acceptability research with adolescents in LMICs is still limited, and no known reviews synthesise the evidence from Africa. We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. This paper maps and qualitatively synthesizes the scope, characteristics, and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability. The review was carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key word searches generated 4692 unique records and 55 final eligible studies, assessing 60 interventions. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types. Our review exposes considerable scope for future acceptability research and review work. This should include: extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond, and examining the relationship between acceptability and uptake.

Associations of LGBTQ+ Identities with Acceptability and Response to Online Single-Session Youth Mental Health Interventions

Background: A majority of youth with depression and related difficulties never access treatment. Barriers such as stigma, financial costs, and provider shortages contribute to this problem. Single session interventions (SSIs) have been found to benefit youth and help reduce depression symptoms. Since many SSIs are brief and can be accessed online, they may circumvent traditional barriers to accessing treatment, thus supporting wellbeing in individuals otherwise unable to access care. SSIs may be particularly beneficial for LGBTQ+ youth, for whom barriers to treatment are often exacerbated. There is a need to determine whether LGBTQ+ youth respond as positively to SSIs as non-LGBTQ+ youth, or if adaptations are needed prior to widespread dissemination. Methods: We investigated whether changes in helplessness, agency, and self-hate from before to after completing online SSIs differed as a function of LGBTQ+ identity in a sample of 258 youths (N=258, 81.4% female assigned sex, 60.5% LGBTQ+, 47.3% BIPOC). We also quantitatively and qualitatively compared intervention acceptability ratings and feedback across LGBTQ+ and non-LGBTQ+ youths. Results: Analyses revealed no significant differences between cisgender LGBQ+, trans and gender diverse, and cisgender heterosexual youths for any intervention outcomes. Likewise, no group differences emerged in intervention acceptability ratings or written program feedback. Limitations: Self-selection bias and underrepresentation of certain populations, such as American Indian and Alaskan Native youths, may limit generalizability of results.Conclusions: Results suggest that online mental health SSIs are equally acceptable and useful to LGBTQ+ and non-LGBTQ+ youth alike, even without culturally specific tailoring.

Providing Telephone-Based Support for Patients With Haematological Malignancies: A Qualitative Investigation of Expert Nurses

Background Telephone-based interventions are frequently used to address cancer patient’s needs, often delivered by nurses; however, little is known about nurses’ opinions of such interventions. Purpose The objective of this study was to investigate expert nurses’ perceptions of hemato-oncology patient’s needs, use of telephone interventions providing support and symptom management and intervention acceptability from a service provider perspective. A qualitative study was undertaken with focus group and individual interview. Inductive and deductive data analysis was performed using Framework Analysis and the Theoretical Framework of Acceptability. Results Two themes emerged: (1) perceived needs of haemato-oncology patients across the cancer trajectory – multifactorial influences, dynamic information needs, and continuity of care, (2) acceptability for nurses delivering interventions was determined by identification of need, agreed expectations and organisational support for the intervention. Conclusions Greater understanding of contextual factors for recipients and individuals delivering healthcare interventions may contribute to identification of potential barriers and facilitators to adoption in clinical practice.