Internet-Based Clinical Services: Virtual Support Groups for Family Caregivers

ABSTRACT

Objectives: An internet-based psychotherapeutic support group intervention for family caregivers of persons with neurodegenerative diseases was developed in a series of pilot studies and subsequently evaluated in a feasibility study with 34 participants. The aim was to duplicate online group interactions typical of face-to-face support groups. Methods: A user-friendly web site was developed according to usability criteria for older adult users. Unique features of the web site included video conferencing in two formats, one-on-one and a group format with up to 6 participants and a facilitator. Following ten professionally facilitated sessions, each group evolved into a web-based self-help support group facilitated online by a group member. Results: Qualitative analyses of early, middle and late group video conferencing sessions yielded themes congruent with face-to-face group process. Follow up interviews six months following the initiation of the online groups showed overall positive participant responses in each of the following areas: learning to use computers, negotiating the web site links, obtaining disease-specific information from the website, using technology to communicate, bonding with group members, providing mutual guidance and support, and benefiting in terms of coping with the stresses of caregiving.     

Fathering attitudes and behaviors among low-income fathers

ABSTRACT

This study evaluated the effectiveness of a fatherhood intervention designed to improve the fathering attitudes and behaviors of fathers who are low income from metropolitan and rural communities in Louisiana. The study was successful in recruiting a sample of predominantly African American fathers (N = 57) and retaining the participants over time. An adequate number of fathers achieved the intervention goals to obtain employment, increase their earnings, and complete educational (i.e., Graduate Equivalency Diploma [GED]) training. In addition, after having completed the program, there was a statistically significant improvement in fathers’ relationship with the mothers of their children. Additionally, there were increases in fathers’ positive attitudes about being a father, perceived closeness with their children, amount of contact with their children, and satisfaction with the amount of time spent with their children; however, none of these differences were statistically significant. Most of the fathers gave favorable reports regarding the fatherhood program’s goals and delivery.     

Physical activity and nutrition program for adults with metabolic syndrome: Process evaluation

IntroductionThe Vietnam Physical Activity and Nutrition (VPAN) program aimed to improve physical activity and nutrition for adults aged 50–65 years with Metabolic Syndrome in Vietnam. The VPAN program consisted of a range of resources and strategies, including an information booklet, resistance band, face-to-face education sessions, and walking groups. This process evaluation assessed the participation, fidelity, satisfaction, and reasons for completing and not-completing the VPAN.MethodsData were collected by mixed-methods from a sample of 214 intervention participants. Quantitative data were collected via surveys (n = 163); qualitative data via face-to-face exit interviews with intervention program completers (n = 10) and non-completers (n = 10), and brief post education session discussions.ResultsMost participants (87%–96%) reported the program resources and strategies useful, assisting them to increase their physical activity level and improving their diet. The education sessions were the most preferred strategy (97%) with high attendance (>78% of participants). The main reasons for withdrawal were work commitments and being too busy.ConclusionThe evaluation indicated that the program reached and engaged the majority of participants throughout the six-month intervention. The combination of printed resources and face-to-face intervention components was a suitable approach to support lifestyle behavioural change in the Vietnamese population.     

Tai Chi-based exercise for older adults with Parkinson's disease: a pilot-program evaluation

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson's disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71.51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < .05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation.     

Barriers to Implementing a Mentoring Program for Youth in Foster Care: Implications for Practice and Policy Innovation

The aim of this article is to report on the findings of an evaluation of a youth in foster care mentoring pilot program and the difficulty that arises when a program is not well implemented. The pilot program and evaluation of its effectiveness were mandated by the Texas 80th Legislature through the passing of HB 3008. Big Brothers Big Sisters of North Texas implemented the pilot to match youth in foster care age 14 years and older, who participate on a voluntary basis and who have been screened for participation by the Texas Department of Family and Protective Services (DFPS) with an adult mentor. As part of the pilot, youth were to receive 8 h of face-to-face time, and at least 1 h of phone, email, or text contact with their mentor. Though there were problems with implementation of the mentoring pilot, responses on the confidential youth survey suggest that those who did participate had positive experiences. Based on responses on the survey from the youth and based on the existing empirical literature on the benefits of mentoring programs for trouble youth and following the recommendations presented in this article the mentoring programs should be encouraged for youth aging out of foster care.     

Individual progress toward self-selected goals among older adults enrolled in a physical activity counseling intervention

The purpose of this study was to examine what happens to goals over the course of a physical activity counseling trial in older veterans. At baseline, participants (N = 313) identified 1 health-related goal and 1 walking goal for their participation in the study and rated where they perceived themselves to be relative to that goal at the current time. They rated their current status on these same goals again at 6 and 12 mo. Growth-curve analyses were used to examine longitudinal change in perceived goal status. Although both the intervention and control groups demonstrated improvement in their perceived proximity to their health-related and walking goals (L = 1.19, p < .001), the rates of change were significantly greater in the intervention group (β = -.30, p < .05). Our results demonstrate that this physical activity counseling intervention had a positive impact on self-selected goals over the course of the intervention.     

360 Video: A prototyping process for developing virtual reality interventions

Abstract

Virtual reality (VR) has emerged as a promising technological intervention for anxiety disorders. However, there are no existing standards and best practices to evaluate the effectiveness of environments to achieve their intervention goals. The purpose of this study was to develop a VR intervention for student veterans with social anxiety disorder and test feasibility utilizing a three-stage development model. The development of a therapeutic VR environment may benefit from an interdisciplinary collaboration of researchers from various fields of study. Utilizing three stages of prototyping with two virtual reality platforms, fully immersive video (n?=?6) and three-dimensional (3-D) immersive virtual reality (n?=?8), the research team designed an intervention for student veterans with social anxiety disorder, testing bio-reactivity of participants. Results of prototyping include user feedback validating increased stress levels and increased bio-reactivity specifically in galvanic skin response and heart rate elevation. Implications include the use of 360° video for prototyping 3-D virtual reality interventions.     

Development and Evaluation of a Web-Based Clinician Training Program for a Family-Focused Depression Preventive Intervention

This study evaluated the acceptability, feasibility, and satisfaction associated with a newly developed online clinician training program for the Family Talk preventive intervention, both alone and together with a redesigned, shortened, face-to-face component. Fifty-eight predominately in-home therapy clinicians participated in the study. Results indicated that clinician participants found the online training to be enjoyable and comprehensive, and they reported that the most beneficial training package involved the combination of web-based and in-person training. This combined training could efficiently cover necessary didactic material online while also delivering important clinical skill practice and in-person discussion. Exceptions, limitations, and important future research questions are discussed.     

Feasibility and Acceptability of Smartphone Assessment in Older Adults with Cognitive and Emotional Difficulties

This feasibility study assessed perceived acceptability, adherence rates, and reasons for nonadherence to smartphone-based ecological momentary assessment (EMA). At two sites, participants (n = 103) ages 65 years or older with diagnosed anxiety or depressive disorder and cognitive concerns responded three times daily to smartphone-based EMA questions assessing clinical outcomes for two 10-day periods. Quantitative and qualitative measures followed both 10-day EMA periods. Overall, 76% of participants completed surveys on ≥ 10 of the 20 assessment days, and 70% of participants completed at least 30% of the total surveys. Reasons for nonadherence included technical, logistical, physiological, and cognitive issues. Smartphone-based EMA is feasible in older adults with cognitive and emotional difficulties. EMA tools should be responsive to the needs and preferences of participants to ensure adequate acceptability and adherence in this population. Our findings can inform the design, development, and implementation of mobile technologies in older adults in research and clinical contexts.     

Religion,spirituality, coping,and resilience among African Americans with diabetes

Study aims were to explore how religion and spirituality impacted attitudes about self-management practices among African Americans with homelessness histories and to understand resilience in diabetes care practices. Qualitative semistructured face-to-face interviews were conducted with 42 African Americans older than 18 years. All audio-taped interviews lasted between 1–1.5 hr, transcribed verbatim, and analyzed using ATLAS.ti (version 7.0). Five resilience themes emerged. While participants recognized diabetes as an illness requiring professional treatment, the context of balancing treatment with religion and spiritual practices mattered. The study findings highlight the importance of spirituality, religious beliefs, and coping strategies in diabetes self-care activities.     

Adherence and accuracy. Self-medication during inpatient psychiatric treatment.

1. The goals of the Medication Education and Self-Administration Program were to develop a way to assess inpatient self-medication accuracy; create a comprehensive intervention that would address individual characteristics that may produce nonadherence; and evaluate the effectiveness of the intervention. 2. The majority of program participants demonstrated significant errors within days when given the opportunity to administer their own medications, suggesting that participants' in-hospital self-administration may be an accurate predictor of postdischarge performance. 3. Even in cases where training failed to influence self-administered performance, program participation provided valuable information that guided subsequent treatment decisions and programmatic refinements.     

Abstinence versus Moderation Goals in Brief Motivational Treatment for Pathological Gambling

The present study examined the nature and impact of participant goal selection (abstinence versus moderation) in brief motivational treatment for pathological gambling via secondary analyses from a randomized controlled trial. The results demonstrated that the pattern of goal selection over time could be characterized by both fluidity and stability, whereby almost half of participants switched their goal at least one time, over 25 % of participants selected an unchanging goal of ‘quit most problematic type of gambling’, almost 20 % selected an unchanging goal of ‘quit all types of gambling’, and approximately 10 % selected an unchanging goal of ‘gamble in a controlled manner.’ The results also demonstrated that pretreatment goal selection was uniquely associated with three variables, whereby compared to participants who selected the goal to ‘cut back on problem gambling’, those who selected the goal to ‘quit problem gambling’ were more likely to have greater gambling problem severity, to have identified video lottery terminal play as problematic, and to have greater motivation to overcome their gambling problem. Finally, the results demonstrated that goal selection over time had an impact on the average number of days gambled over the course of treatment, whereby those with abstinence-based goals gambled significantly fewer days than those with moderation-based goals. Nevertheless, goal selection over time was not related to dollars gambled, dollars per day gambled, or perceived goal achievement. The findings do not support the contention that abstinence-based goals are more advantageous than moderation goals and are discussed in relation to the broader alcohol treatment literature.     

Barriers to Remarriage Among Older People: Viewpoints of Widows and Widowers

We conducted this research based on a qualitative approach to describe the opinions of older widows and widowers on remarriage obstacles. Based on purposive sampling and inclusion criteria, we chose 48 participants on maximum diversity of sex, age, education, employment, and socioeconomic status. Two thirds of the participants were female, 40% had spent more than 10 years widowed, and 65% were living with their children. We collected data individually through semistructured, face-to-face interviews. Based on conventional content analyses, 2 independent researchers implemented data analysis manually. Barriers to remarriage were finally categorized into 4 main themes: personal, normative, interactive, and financial factors. Results of this study showed that older people are more concerned about public opinions and social norms surrounding remarriage. As long as these thoughts and norms are not changed, the concept of remarriage among widows and widowers remains a vital taboo and concern.     

Eliciting Street-Based Sex Worker Perspectives to Inform Prostitution Policy Development

Using a visual method developed with input from program participants, this study reports on data collected from people attending a Baltimore drop-in center for women in street-based sex work (N = 17). Respondents created collages expressing future hopes and aspirations, which they discussed in focus groups and interviews. Respondents focused on health, reunification with family, employment and housing. Although respondents’ easily visualized goals, they often seemed out of reach. Hurdles that they noted were largely due to poverty and lack of opportunities. Our findings highlight the negative impact of prostitution policy on women’s choices and their ability to achieve self-identified goals.     

The Use of the Computer in Counseling College Students

The purpose of this study was to examine the usefulness of a computer program in helping clients clarify their concerns and identify goals for behavior change, prior to their first session counselor. A counseling treatment consisting of three initial computer-interaction sessions, followed by two sessions with a counselor, was compared to a treatment consisting of five sessions with a counselor and no computer interaction, and to a no-contact control group. Participants were 46 college students. The two treatment groups achieved their self-determined goals, as measured by the Goal Attainment Scale (Kiresuk & Sherman, 1968), and reported similar levels of satisfaction with counseling than students working with the computer-based counseling system. It was concluded that computers may be effectively used as part of the counseling process, allowing for a more efficient use of the counselor's time. However, more research is needed to identify the type of counselor intervention needed to facilitate the acceptance of these systems by students.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

A Preliminary Qualitative Analysis on the Feasibility of Using Gaming Technology in Caregiver Assessment

This exploratory qualitative study examined the feasibility of utilizing gaming technology that will ultimately assess task performance and stress among caregivers of dementia patients. The long-term goal is to use this unobtrusive application (app) to detect caregiver burnout for the purposes of early intervention. This preliminary study examined participant interface with a specific gaming technology called CAST (Caregiver Assessment Using Serious Gaming Technology). Ten dementia caregivers participated. Participants attended a demonstration and then interacted with a preliminary version of the CAST tablet application. Social work researchers interviewed participants using open-ended questions to gauge interest, technology skill level, and comfort with the app. Participants expressed interest and identified potential ways to further develop the system in order to increase ease of use, decrease time commitment, and improve suitability for daily use. The provided feedback will be used to refine the user interface of the application, which will then be used to monitor caregivers’ stress in future development.     

A principles-focused evaluation of community mental health short-term case management

Principles-focused evaluations allow evaluators to appraise each principle that guides an organization or program. This study completed a principles-focused evaluation of a new community mental health intervention called Short Term Case Management (STCM) in Toronto, Canada. STCM is a time limited intervention for clients to address unmet needs and personalized goals over 3 months. Findings showcase that a principles-focused evaluation, assessing whether program principles are guiding, useful, inspiring, developmental and/or evaluable (GUIDE), is a practical formative evaluation approach. Specifically, offering an understanding of a novel intervention, including its key components of assessment and planning, support plan implementation and evaluation and care transitions. Findings also highlight that STCM may work best for those clients ready to participate in achieving their own goals. Future research should explore how best to apply the GUIDE framework to complex interventions, including multiple principles, to increase evaluation feasibility and focus.     

Participatory research to promote physical activity at congregate-meal sites

The purpose of this study was to determine the feasibility and effectiveness of an on-site physical activity (PA) program offered with congregate meals. Study 1 surveyed meal-site users on their likelihood to participate. Study 2 used meal-site-manager interviews and site visits to determine organizational feasibility. Study 3, a controlled pilot study, randomized meal sites to a 12-week group-based social-cognitive (GBSC) intervention or a standard-care control. Studies 1 and 2 indicated that most meal-site users would participate in an on-site PA program, and meal sites had well-suited physical resources and strong organizational support for this type of program. In Study 3, GBSC participants increased their weekly PA over those in the control condition (p < .05, ES = .79). Results indicated that changes in task cohesion might have mediated intervention effectiveness. These studies demonstrate that a PA program offered in this venue is feasible, is effective in promoting PA, and could have a strong public health impact.