Developing and Selecting Auditory Warnings for a Real-Time Behavioral Intervention.

Evaluating primary care behavioral counseling interventions: An evidence-based approach

A New Paradigm for Optimizing HIV Intervention Synergy

Sleep disturbances, and especially insomnia, are prevalent and prominent complaints among primary care patients. Behavioral interventions for several sleep disturbances are available and efficacious; behavioral insomnia interventions rival pharmacologic interventions in both effectiveness and expediency. Several barriers exist to the delivery of such behavioral interventions in the primary care setting including stigma associated with what may be perceived as mental health treatment, the patient’s readiness to change and engage in treatment, and provider time constraints. Chief among these barriers is the limited availability of staff trained to deliver behavioral sleep intervention effectively. Many of these barriers can be addressed by utilizing recent developments in the delivery of behavioral sleep interventions as well as by thoughtful planning of how to structure or restructure practices to accommodate this service. Indeed, the continued adaptation of sleep interventions to primary care settings may enhance overall dissemination efforts, resulting in greater availability of treatment for sleep-related difficulties on a large scale.

The rise of wearable smart devices raises unprecedented opportunities for self-improvement through ubiquitous behavior tracking and guidance. However, the design of effective wearable behavior intervention systems remains relatively unexplored. To address this gap, we conducted controlled studies focusing on the reduction of unwanted words (e.g., filler words, swear words) in daily communication through auditory feedback using wearable technology. We started with a design space exploration, considering various factors such as the type, duration, and timing of the auditory feedback. Then, we conducted pilot studies to reduce the space of design choices and prototyped a system called WSCoach (Wearable Speech Coach), which informs users when they utter unwanted words in near-real-time. To evaluate WSCoach, we compared it with a state-of-the-art mobile application supporting post-hoc conversation analysis. Both approaches were effective in reducing the occurrence of unwanted words, but WSCoach appears to be more effective in the long run. Finally, we discuss guidelines for the design of wearable audio-based behavior monitoring and intervention systems and highlight the potential of wearable technology for facilitating behavior correction and improvement. For supplementary material, please see the META Appendix and our OSF project at https://osf.io/6vhwn/?view_only=489498d3ac2d4703a17475fc6ca65dfa.

The INTER-Change program aims to use systematic frameworks to develop adjunct behavioral interventions to enhance long-term behavior change and improve outcomes in patients undergoing bariatric surgery (BS). This paper details the program strategies and how engagement of interested parties is shaping the research. The core elements of this work include: (a) A living systematic review of behavioral weight management (BWM) interventions adjunct to BS; (b) Focus groups of interested parties, including patients, healthcare professionals, and administrators, on different aspects of designing and implementing adjunct behavioral interventions; (c) A patient-generated survey to assess needs for behavioral interventions to support BWM; (d) An international eDelphi study involving interested parties to prioritize intervention components and delivery structures; and (e) An international consensus meeting to construct testing intervention protocol(s). The systematic review revealed that delivering BWM interventions during the postoperative period resulted in better weight maintenance; however, most interventions reviewed were poorly developed, and none included interested parties. Initial themes from ongoing focus groups highlighted nonweight-related outcomes as being key goals of adjunct behavior change interventions, with a strong emphasis on psychological well-being and health-related behaviors. The patient survey will add patients' feedback on current interventions and expectations. Finally, the eDelphi process and international consensus meeting will integrate all the findings to develop more efficient behavioral interventions and appropriate testing protocol(s). This integrated knowledge translation approach will help ensure that the behavioral adjunct interventions are relevant to interested parties' needs, well-designed, effective, and more likely to be implemented successfully. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Early childhood parenting interventions are increasingly delivered in primary care, but parental engagement with those interventions is often suboptimal. We sought to better understand parents' preferences for the content and delivery method of behavioral health guidance in pediatric primary care and to determine the relationship of those preferences with demographic characteristics, child behavior problems, and parenting style. Participants were 396 parents of young children recruited from primary care offices. We collected measures of parental preferences (including behavioral topics, intervention strategies, and methods of delivery) for behavioral intervention in primary care, child behavior symptoms, parenting style, and demographic characteristics. Descriptive statistics were used to identify parents' most preferred behavioral topics and intervention delivery methods. We used a hierarchical regression approach to determine whether parenting style predicted parents' preferences beyond demographic and child-level factors. Nearly all parents (96%) endorsed a behavioral topic (e.g., aggression) as important. Most preferred to receive intervention during routine medical appointments. Child behavior problems correlated with parents' overall interest in behavioral guidance, but clinically significant symptoms did not differentiate interest in any single topic. Socioeconomic factors and negative parenting practices predicted some parental preferences. Notably, lax parenting generally predicted higher interest in behavioral intervention, whereas hostile and physically controlling parenting predicted lower interest. Most parents are interested in behavioral guidance as part of primary care, but their preferences for the content and delivery of that guidance vary by known socioeconomic, child, and parenting risk factors. Tailoring intervention to parents' preferences may increase engagement with available interventions.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of different behavioural interventions, self‐management education and models of service delivery in promoting seizure control and improving quality of life‐related outcomes for children with epilepsy compared to usual care or another behavioural intervention.

A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants

Obstructive sleep apnea syndrome (OSAS) is associated with impairment of cognitive function, and improvement is often noted with treatment. Golf is a sport that requires a range of cognitive skills. We evaluated the impact of nasal positive airway pressure (PAP) therapy on the handicap index (HI) of golfers with OSAS. Golfers underwent a nocturnal polysomnogram (NPSG) to determine whether they had significant OSAS (respiratory disturbance index > 15). Twelve subjects with a positive NPSG were treated with PAP. HI, an Epworth Sleepiness Scale (ESS), and sleep questionnaire (SQ) were submitted upon study entry. After 20 rounds of golf on PAP treatment, the HI was recalculated, and the questionnaires were repeated. A matched control group composed of non-OSAS subjects was studied to assess the impact of the study construct on HI, ESS, and SQ. Statistical comparisons between pre- and post-PAP treatment were calculated. The control subjects demonstrated no significant change in HI, ESS, or SQ during this study, while the OSAS group demonstrated a significant drop in average HI (11.3%, p = 0.01), ESS, (p = 0.01), and SQ (p = 0.003). Among the more skilled golfers (defined as HI ≤ 12), the average HI dropped by an even greater degree (31.5%). Average utilization of PAP was 91.4% based on data card reporting. Treatment of OSAS with PAP enhanced performance in golfers with this condition. Treatment adherence was unusually high in this study. Non-medical performance improvement may be a strong motivator for selected subjects with OSAS to seek treatment and maximize adherence.

ObjectivesInterventions for obesity that require individual behaviour change, such as behavioural weight management interventions, may contribute to health inequalities. We explored if there was evidence of inequalities in the attendance at and effectiveness of behavioural weight management interventions in adults.DesignTwo-stage individual participant data meta-analysis.Data sourcesEligible studies were extracted from a previous systematic review and an updated search was completed on PubMed.Eligibility criteriaUK-based randomised controlled trials of behavioural weight management interventions suitable for use in primary care, published until 31 December 2021.Data extraction and synthesisMultivariable regression analyses were conducted with weight at 12-month follow-up as the primary outcome and included an interaction between inequality characteristic and trial arm (control or intervention). Each model was adjusted for baseline weight, age and gender. Estimated interactions were combined across trials using a random-effects meta-analysis. Intervention attendance was defined as number of in-person sessions attended. Risk of bias was assessed using Cochrane’s RoB 2 tool.ResultsData from 13/16 eligible weight loss trials were analysed (complete case data n=5531 participants). The effect of the intervention on weight at 12 months was greater in male participants (−2.58 kg (95% CI −3.52 to 1.64)) than female participants (−1.71 kg (95% CI −2.79 to –0.63); p value for interaction=0.02, tau2=0) and greater for participants of white ethnicity (−2.74 kg (95% CI −4.30 to –1.19)), than those from an ethnic minority background (0.03 kg (95% CI −1.29 to 1.35); p interaction=0.04, tau2=0). Age, education, occupation, place of residence and household income did not significantly moderate effectiveness. We did not find evidence of inequalities in intervention attendance by ethnicity, occupation, gender/sex, area-level socioeconomic deprivation or age.ConclusionsBehavioural weight management interventions had smaller effects in people from ethnic minority backgrounds and larger effects in men. There was no evidence of other differences in intervention effectiveness or adherence. This is the first synthesis study to access individual participant data and quantitatively assess inequalities in these interventions. Future research should further explore reasons for differences in outcomes and consider how to prevent behavioural weight management interventions from potentially exacerbating health inequalities.

British <scp>HIV A</scp>ssociation guidelines for the management of hepatitis viruses in adults infected with <scp>HIV</scp> 2013

We investigated the effectiveness of a theoretically motivated intervention at reducing procedural errors in train yard operations, where making these errors could be costly or life-threatening. A widespread and persistent memory error that people commit on a daily basis is the postcompletion error (PCE), that is, forgetting to complete the final step of a procedural task in which the final step occurs after completion of the task goal. PCEs occur in the railroad industry when a locomotive conductor changes the direction of a rail switch but fails to report this change. This particular error could contribute to unsafe conditions as another train traveling on the same track could derail. Although training can help reduce some of the factors leading to unsafe conditions on the rail, research has demonstrated that PCEs are different from other errors of omission in that they cannot be eliminated through training, which makes them a difficult problem to address. Twenty-eight undergraduates completed train yard tasks within a mid-fidelity simulator used in commercial rail operations for training. Each participant received the behavioral intervention in one block and no intervention in another. Specifically, participants were required to perform an additional task designed to remind participants of the postcompletion step. Our intervention significantly reduced PCE rates in the context of train yard operations, on average by 65%. We discuss implications of the effectiveness of our intervention at reducing train yard accidents and how this outcome can contribute to the literature on the cause of PCEs. In cases such as the railroad industry, where redesigning technology is prohibitive, our behavioral intervention is an effective alternative for significantly reducing PCEs.

Nurse-Delivered Antiretroviral Treatment Adherence Intervention for People With Low Literacy Skills and Living With HIV/AIDS

BackgroundIndividuals diagnosed under the spectrum of fetal alcohol spectrum disorders (FASD) experience numerous cognitive and behavioral impairments, including learning disabilities, executive functioning dysfunction, and difficulties in emotional regulation. Studies of direct child‐centered nonpharmacological behavioral interventions to improve outcomes have steadily developed over the past few decades. Systematic reviews of this literature have documented the wide collection of studies, and an overall review of these reviews permits a single, comprehensive analysis encompassing behavioral intervention research.MethodsElectronic databases were searched for systematic reviews from 2005 to 2024. Included reviews reported the effectiveness of child‐centered behavioral, nonpharmacological interventions in noneducational settings for individuals with FASD from birth until the age of 18. screening, full‐text screening, and data extraction were conducted using Covidence. AMSTAR‐2 was utilized to assess the methodological quality of systematic reviews.ResultsA total of seven systematic reviews were included for comprehensive analysis. Two reviews were of high quality, two were of low quality, and three were of critically low quality, as per AMSTAR‐2 grading criteria. Categories of behavioral interventions within systematic reviews included executive functioning interventions, self‐management interventions, social skill interventions, family‐based interventions, cognitive behavioral interventions, and applied behavior analysis‐based treatment. While numerous positive outcomes were identified across several behavioral interventions, the systematic reviews identified multiple limitations, such as high risk of bias and small sample sizes.ConclusionNumerous positive outcomes were identified from among systematic reviews regarding FASD interventions; however, the current evidence base is limited by methodological weaknesses and potential risks of bias. Further research and implementation are necessary to strengthen the delivery of interventions and continue improving outcomes for individuals with FASD.

Measurement and assessment of fidelity and competence in nonspecialist-delivered, evidence-based behavioral and mental health interventions: A systematic review