This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction.... more This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction. This secondary data analysis pooled three large population-based TTM-tailored school, worksite, medical, and home-based intervention studies and examined use of constructs across three groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. The criteria for successful change, at the time, were that less than 30% of calories came from fat. A total of 2,718 adults met criteria for an unhealthy diet at baseline. The majority of participants were female, White, married, and middle-aged. Demographics, Stage of Change, Processes of Change, Decisional Balance, and Temptations were measured. Dynatype groups were assessed with reliable and valid scales assessing constructs at baseline and 6, 12, and 24 months. Analyses included a multivariate analysis of variance followed by a series of analyses of variance, with Tukey follow-up tests assessing dif...
BACKGROUND The research marketplace has seen a flood of open-source or commercial m-Health platfo... more BACKGROUND The research marketplace has seen a flood of open-source or commercial m-Health platforms that can both collect and utilise user-data in real time. However, the practical literature on how these platforms are developed, integrated into study designs, and adopted — including important information around cost and effort considerations — is lacking. OBJECTIVE To build critical literacy in the clinician-researcher readership into the cost, effort, and processes involved in developing and operationalising an mHealth platform. Specifically, we focus on a platform we have developed — Intui. METHODS We describe the development of Intui m-Health platform, and general principles of its operationalisation across sites. RESULTS We provide a worked example in the form of a case study. Intui was operationalised in the design of a behavioural activation intervention in collaboration with a mental health service provider. We describe the design specifications of the study site, the devel...
Background. Stress levels among Americans are considerable. This research examined Transtheoretic... more Background. Stress levels among Americans are considerable. This research examined Transtheoretical Model of Behavior Change (TTM) constructs for stress management in groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. Methods. Secondary data analysis of a computer-tailored intervention group examined construct use over time across the three groups. Adults (n=427) meeting criteria for not engaging in stress management behaviors at baseline comprised the analytic sample. Participants received three TTM-tailored feedback interventions to help facilitate change at baseline, 3 and 6 months. Demographics, Stage of Change, 10 Processes of Change, Decisional Balance (Pros and Cons), and Self-Efficacy were assessed at baseline, 6, 12, and 18 months. Repeated measures MANOVA followed by ANOVAs, with Tukey follow-up tests assessed differences in use of TTM constructs longitudinally across dynatype groups. Results. Ten of the 13 TTM construct...
Title: Understanding collaborative care implementation in the Department of Veterans Affairs: Cor... more Title: Understanding collaborative care implementation in the Department of Veterans Affairs: Core functions and implementation challenges Authors: Jessica Lipschitz (jmlipschitz@gmail.com) Justin Benzer (justin.benzer@va.gov) Christopher Miller (Christopher.Miller8@va.gov) Seina Easley (Siena.Easley@va.gov) Jenniffer Leyson (jenniffer.leyson@gmail.com) Edward Post (Edward.Post@va.gov) James Burgess (james.burgess@va.gov) Version: 1 Date: 07 Aug 2017 Author’s response to reviews: Editor Comments: Thank you for submitting this manuscript, which clearly has some merit. I agree with the reviewers that it could be suitable for publication with some revisions, and encourage you to careful read and directly address their comments. I look forward to receiving and having the opportunity to review the revised version in future.
Based on recent data, it is looking more and more like the answer may be that social media is not... more Based on recent data, it is looking more and more like the answer may be that social media is not particularly beneficial for most of us.
Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS... more Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different op...
Background Acceptability of mobile phone text messaging as a means of asynchronous communication ... more Background Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementa...
Cognitive dysfunction is common in many psychiatric disorders. While it has long been described a... more Cognitive dysfunction is common in many psychiatric disorders. While it has long been described as a core feature in schizophrenia, more recent data suggest qualitatively similar impairments in patients with bipolar disorder and major depressive disorder. There is compelling evidence to suggest that cognitive impairment contributes directly to functional disability and reduced quality of like across these disorders. As current treatments focus heavily on “primary” symptoms of mood and psychosis, the standard of care typically leaves cognitive deficits unmanaged. With this in mind, the field has recently begun to consider intervening directly on this important symptom domain, with several ongoing trials in schizophrenia. Fewer studies have targeted cognition in bipolar disorder and still fewer in MDD. With progress toward considering this domain as a target for treatment comes the need for consensus guidelines and methodological recommendations on cognitive trial design. In this manu...
Military veterans who could benefit from mental health services often do not access them. Researc... more Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) ...
The collaborative care model is an evidence-based practice for treatment of depression in which d... more The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with em...
This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction.... more This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction. This secondary data analysis pooled three large population-based TTM-tailored school, worksite, medical, and home-based intervention studies and examined use of constructs across three groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. The criteria for successful change, at the time, were that less than 30% of calories came from fat. A total of 2,718 adults met criteria for an unhealthy diet at baseline. The majority of participants were female, White, married, and middle-aged. Demographics, Stage of Change, Processes of Change, Decisional Balance, and Temptations were measured. Dynatype groups were assessed with reliable and valid scales assessing constructs at baseline and 6, 12, and 24 months. Analyses included a multivariate analysis of variance followed by a series of analyses of variance, with Tukey follow-up tests assessing dif...
BACKGROUND The research marketplace has seen a flood of open-source or commercial m-Health platfo... more BACKGROUND The research marketplace has seen a flood of open-source or commercial m-Health platforms that can both collect and utilise user-data in real time. However, the practical literature on how these platforms are developed, integrated into study designs, and adopted — including important information around cost and effort considerations — is lacking. OBJECTIVE To build critical literacy in the clinician-researcher readership into the cost, effort, and processes involved in developing and operationalising an mHealth platform. Specifically, we focus on a platform we have developed — Intui. METHODS We describe the development of Intui m-Health platform, and general principles of its operationalisation across sites. RESULTS We provide a worked example in the form of a case study. Intui was operationalised in the design of a behavioural activation intervention in collaboration with a mental health service provider. We describe the design specifications of the study site, the devel...
Background. Stress levels among Americans are considerable. This research examined Transtheoretic... more Background. Stress levels among Americans are considerable. This research examined Transtheoretical Model of Behavior Change (TTM) constructs for stress management in groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. Methods. Secondary data analysis of a computer-tailored intervention group examined construct use over time across the three groups. Adults (n=427) meeting criteria for not engaging in stress management behaviors at baseline comprised the analytic sample. Participants received three TTM-tailored feedback interventions to help facilitate change at baseline, 3 and 6 months. Demographics, Stage of Change, 10 Processes of Change, Decisional Balance (Pros and Cons), and Self-Efficacy were assessed at baseline, 6, 12, and 18 months. Repeated measures MANOVA followed by ANOVAs, with Tukey follow-up tests assessed differences in use of TTM constructs longitudinally across dynatype groups. Results. Ten of the 13 TTM construct...
Title: Understanding collaborative care implementation in the Department of Veterans Affairs: Cor... more Title: Understanding collaborative care implementation in the Department of Veterans Affairs: Core functions and implementation challenges Authors: Jessica Lipschitz (jmlipschitz@gmail.com) Justin Benzer (justin.benzer@va.gov) Christopher Miller (Christopher.Miller8@va.gov) Seina Easley (Siena.Easley@va.gov) Jenniffer Leyson (jenniffer.leyson@gmail.com) Edward Post (Edward.Post@va.gov) James Burgess (james.burgess@va.gov) Version: 1 Date: 07 Aug 2017 Author’s response to reviews: Editor Comments: Thank you for submitting this manuscript, which clearly has some merit. I agree with the reviewers that it could be suitable for publication with some revisions, and encourage you to careful read and directly address their comments. I look forward to receiving and having the opportunity to review the revised version in future.
Based on recent data, it is looking more and more like the answer may be that social media is not... more Based on recent data, it is looking more and more like the answer may be that social media is not particularly beneficial for most of us.
Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS... more Background The Veterans Health Administration (VHA) is deploying an automated texting system (aTS) to support patient self-management. Objective We conducted a qualitative evaluation to examine factors influencing national rollout of the aTS, guided by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, which is intended to support the evaluation of novel technologies. Methods Semistructured interviews were conducted with 33 staff and 38 patients who were early adopters of the aTS. Data were analyzed following deductive and inductive approaches using a priori codes and emergent coding based on the NASSS. Results We identified themes across NASSS domains: (1) Condition: The aTS was considered relevant for a range of patient needs; however, perceptions of patient suitability were guided by texting experience and clinical complexity rather than potential benefits. (2) Technology: Onboarding of the aTS presented difficulty and the staff had different op...
Background Acceptability of mobile phone text messaging as a means of asynchronous communication ... more Background Acceptability of mobile phone text messaging as a means of asynchronous communication between health care systems and patients is growing. The US Department of Veterans Affairs (VA) has adopted an automated texting system (aTS) for national rollout. The aTS allows providers to develop clinical texting protocols to promote patient self-management and allows clinical teams to monitor patient progress between in-person visits. Texting-supported hepatitis C virus (HCV) treatment has not been previously tested. Objective Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), we developed an aTS HCV protocol and conducted a mixed methods, hybrid type 2 effectiveness implementation study comparing two programs supporting implementation of the aTS HCV protocol for medication adherence in patients with HCV. Methods Seven VA HCV specialty clinics were randomized to usual aTS implementation versus an augmented implementation facilitation program. Implementa...
Cognitive dysfunction is common in many psychiatric disorders. While it has long been described a... more Cognitive dysfunction is common in many psychiatric disorders. While it has long been described as a core feature in schizophrenia, more recent data suggest qualitatively similar impairments in patients with bipolar disorder and major depressive disorder. There is compelling evidence to suggest that cognitive impairment contributes directly to functional disability and reduced quality of like across these disorders. As current treatments focus heavily on “primary” symptoms of mood and psychosis, the standard of care typically leaves cognitive deficits unmanaged. With this in mind, the field has recently begun to consider intervening directly on this important symptom domain, with several ongoing trials in schizophrenia. Fewer studies have targeted cognition in bipolar disorder and still fewer in MDD. With progress toward considering this domain as a target for treatment comes the need for consensus guidelines and methodological recommendations on cognitive trial design. In this manu...
Military veterans who could benefit from mental health services often do not access them. Researc... more Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department of Veterans Affairs (VA) care, including those specific to accessing mental health care (e.g., fear of stigmatization). More work is needed to streamline access to VA mental health-care services for veterans. In the current study, we interviewed 80 veterans from 9 clinics across the United States about initiation of VA mental health care to identify barriers to access. Results suggested that five predominant factors influenced veterans' decisions to initiate care: (a) awareness of VA mental health services; (b) fear of negative consequences of seeking care; (c) personal beliefs about mental health treatment; (d) input from family and friends; and (e) motivation for treatment. Veterans also spoke about the pathways they used to access this care. The four most commonly reported pathways included (a) ...
The collaborative care model is an evidence-based practice for treatment of depression in which d... more The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same- both with em...
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