Diabetes mellitus is a major health problem among people with physical disabilities. Health coaching has been proven to be an effective approach in terms of behavioral changes, patient self-efficacy, adherence to treatment, health service use, and health outcomes. Telehealth systems combined with health coaching have the potential to improve the quality of health care by increasing access to services. Treatment fidelity is particularly important for behavior change studies; however, fidelity protocols are inadequately administered and reported in the literature.The aim of this study is to outline all the intervention fidelity strategies and procedures of a telecoaching intervention-artificial intelligence for diabetes management (AI4DM)-which is a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth platform in adults with type 2 diabetes and permanent impaired mobility. AI4DM aims to create a web-based disability-inclusive diabetes self-management program. We selected the National Institutes of Health Behavior Change Consortium (NIH BCC) fidelity framework to describe strategies to ensure intervention fidelity in our research.We have developed fidelity strategies based on the five fidelity domains outlined by the NIH BCC-focusing on study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The design of the study is grounded in the social cognitive theory and is intended to ensure that both arms would receive the same amount of attention from the intervention. All providers will receive standardized training to deliver consistent health coaching to the participants. The intervention will be delivered through various controlling and monitoring strategies to reduce differences within and between treatment groups. The content and structure of the study are delivered to ensure comprehension and participation among individuals with low health literacy. By constantly reviewing and monitoring participant progress and protocol adherence, we intend to ensure that participants use cognitive and behavioral skills in real-world settings to engage in health behavior.Enrollment for AI4DM will begin in October 2021 and end in October 2022. The results of this study will be reported in late 2022.Developing and using fidelity protocols in behavior change studies is essential to ensure the internal and external validity of interventions. This study incorporates NIH BCC recommendations into an artificial intelligence embedded telecoaching platform for diabetes management designed for people with physical disabilities. The developed fidelity protocol can provide guidance for other researchers conducting telehealth interventions within behavioral health settings to present more consistent and reproducible research.ClinicalTrials.gov NCT04927377; http://clinicaltrials.gov/ct2/show/NCT04927377.PRR1-10.2196/31695.
To determine if African American (AA) and Caucasian women grouped variables related to race and weight into discrete clusters and if there were discernable response patterns with unique subgroup characteristics.Women (N=277, 48% AA) completed a card sorting task, ranking 28 variables. We used multidimensional scaling to determine perceived similarities and differences between variables, and latent class analysis to identify subgroups responding similarly.We identified 5 clusters of variables and 4 response patterns, which were demographically and anthropometrically distinct.These results can be used for empirical cultural tailoring of behavioral weight loss interventions.
Abstract Background: Influence of migration on externalized behavioral problems (e.g., aggressive) among adolescents has been well assessed, yet lifestyle behaviors of migrant, left-behind and local adolescents have been largely overlooked by researchers and policy-makers. Therefore, this study aimed to identify clustering of multiple lifestyle behaviors and their associations with migrant status among Chinese adolescents. Methods : A cross-sectional survey was conducted in 2015 in Beijing City and Wuwei County. Adolescents self-reported age, gender, family economic status, migrant situation, and lifestyle behaviors (physical activity, sleep, smoke, drink, fruit and vegetable consumption) via a battery of validated questionnaires. Latent class analysis was conducted to identify behavioral clusters using Mplus 7.1. ANOVA, and multivariable logistic regression were used to examine associations between migrant situations and behavioral clusters using SPSS 22. Results: Three distinct behavioral clusters were exhibited among 1,364 students (mean age: 13.41±0.84 years): “low risk” (N=847), “moderate risk” (N=412) and “high risk” (N=105). The “high-risk” cluster had the highest prevalence of adolescents not meeting healthy behavioral recommendations. There were no significant differences in the prevalence of high-risk lifestyle among migrant, left-behind, rural local and urban local adolescents. But migrant adolescents had the lowest prevalence of low-risk lifestyle, followed by left-behind, rural and urban local adolescents. Moreover, compared with urban local, migrant (OR=2.72, 95%CI: 1.88,3.94), left-behind (OR=2.28, 95%CI: 1.46, 3.55), and rural local (OR=1.76, 95%CI:1.03,3.01) adolescents had a higher risk of moderate-risk lifestyle. Conclusions: Clustering of different lifestyles was observed. To achieve the target of a 15% relative reduction in insufficient physical activity by 2030 and to promote health eating, more attention should be paid on the migrant and left-behind adolescents in China.
Background Hospice performance is an overlooked area in the health care field due to the difficulty of measuring quality of care and the infrequent quality inspection. Based on the daily reimbursement mechanism for different levels of hospice care, inpatient services provision could influence both hospice-level length of stay (LOS) and financial performance. Purpose The objective of this study was to explore the relationship between hospice inpatient services provision and hospice utilization and financial performance. Methodology/Approach A longitudinal secondary data set (2009–2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare & Medicaid Services, (b) the Provider of Services files, and (c) the Area Health Resources Files. The dependent variable in this study was hospice average LOS and financial performance measured by total operating margin (TOM) and return on assets. The independent variable was hospice inpatient services’ offering. Mixed-effects regression models were used in the multivariate regression analyses. Results When comparing to hospices not providing inpatient services, offering inpatient services by staff was negatively related to average LOS ( b = −0.063, p < .05) and TOM ( b = −0.022, p < .05). The combination method with providing inpatient services by staff and under arrangement was negatively associated with return on assets ( b = −0.073, p < .05). Conclusion Hospice inpatient services provision was associated with average LOS and financial performance. Practice Implications Offering the inpatient services to patients by staff decreased average LOS and TOM. Hospice agencies may seek strategies to maintain their financial sustainability through outsourcing.
Political and economic changes have created challenges for physician attrition rates in Ukraine. This study examined how a cross-section of Ukrainian physicians prioritised the factors hypothesised to influence decisions about continuing to work in medicine. A survey was conducted with 443 physicians in Ukraine. Latent class choice analysis (LCA) was used to model the heterogeneity in pair-wise comparisons of factors related to physician continued employment in medicine. The response rate was 70% (N = 310). Respondents, on average, were 45.4 years old, practiced 21.6 years. Four groups were identified on the basis of how they prioritised factors about work. Group 1 (47.7%) was ‘culture-focused’, group 2 (27.7%) was ‘advancement-focused’, group 3 (16.2%) was ‘routinisation-focused’, and group 4 (8.5%) was ‘externally-focused’. The use of a person-centred analytical approach represents an alternative for examining career decision issues that should be considered for subgroups within the workforce.
Purpose To identify, prioritize, and organize components of a cultural competence curriculum to address disparities in cardiovascular disease. Method In 2006, four separate nominal group technique sessions were conducted with medical students, residents, community physicians, and academic physicians to generate and prioritize a list of concepts (i.e., ideas) to include in a curriculum. Afterward, 45 educators and researchers organized and prioritized the concepts using a card-sorting exercise. Multidimensional scaling (MDS) and hierarchical cluster analysis produced homogeneous groupings of related concepts and generated a cognitive map. The main outcome measures were the number of cultural competence concepts, their relative ranks, and the cognitive map. Results Thirty participants generated 61 concepts; 29 were identified by at least two participants. The cognitive map organized concepts into four clusters, interpreted as (1) patient's cultural background (e.g., information on cultures, habits, values), (2) provider and health care (e.g., clinical skills, awareness of one's bias, patient centeredness, professionalism), communication skills (e.g., history, stereotype avoidance, health disparities epidemiology), (3) cross-culture (e.g., idiomatic expressions, examples of effective communication), and (4) resources to manage cultural diversity (e.g., translator guides, instructions, community resources). The MDS two-dimensional solution demonstrated a good fit (stress = 0.07; R2 = 0.97). Conclusions A novel, combined approach allowed stakeholders' inputs to identify and cognitively organize critical domains used to guide development of a cultural competence curriculum. Educators may use this approach to develop and organize educational content for their target audiences, especially in ill-defined areas like cultural competence.
Certified Electronic Health Records (EHR) have been shown to improve the health service quality in some health settings, but there is scant evidence related to its adoption in psychiatric hospitals. This paper aimed to examine the relationship between certified EHR adoption and patient experience across psychiatric hospitals in the United States.A cross-sectional study design compared the difference in patient experience measures between psychiatric hospitals with and without certified EHR. Data were drawn from the American Hospital Association (AHA) Annual Survey Database and Hospital Compare datasets. Eleven publicly reported measures for patient experience from the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS) were applied for analysis. Independent relationship of certified EHR adoption and patient experience was explored with multiple linear regression models adjusted for hospital organizational characteristics.Positive associations were identified between certified EHR adoption and five patient perception measures-"recommend hospital" (β = 0.66, 95% CI = [0.16,1.16]; t = 2.68, p = 0.010), "overall hospital rating" (β = 0.39, 95% CI = [0.03,0.75]; t = 2.11, p = 0.035), "discharge information" (β = 0.45, 95% CI = [0.03,0.86]; t = 2.09, p = 0.037), "care transition" (β = 0.44, 95% CI = [0.14, 0.75]; t = 2.84, p = 0.005), and "responsiveness of hospital staff" (β = 0.47, 95% CI = [0.04, 0.90]; t = 2.13, p = 0.033).Our results suggest the positive association between certified EHR adoption and patient experience. More studies are needed to explore impacts of certified EHR adoption and potential improvement in patient experience to quality of care.
Background and objectives African Americans are disproportionately affected by ESRD, but few receive a living donor kidney transplant. Surveys assessing attitudes toward donation have shown that African Americans are less likely to express a willingness to donate their own organs. Studies aimed at understanding factors that may facilitate the willingness of African Americans to become organ donors are needed. Design, setting, participants, & measurements A novel formative research method was used (the nominal group technique) to identify and prioritize strategies for facilitating increases in organ donation among church-attending African Americans. Four nominal group technique panel interviews were convened (three community and one clergy). Each community panel represented a distinct local church; the clergy panel represented five distinct faith-based denominations. Before nominal group technique interviews, participants completed a questionnaire that assessed willingness to become a donor; 28 African-American adults (≥19 years old) participated in the study. Results In total, 66.7% of participants identified knowledge- or education-related strategies as most important strategies in facilitating willingness to become an organ donor, a view that was even more pronounced among clergy. Three of four nominal group technique panels rated a knowledge-based strategy as the most important and included strategies, such as information on donor involvement and donation-related risks; 29.6% of participants indicated that they disagreed with deceased donation, and 37% of participants disagreed with living donation. Community participants' reservations about becoming an organ donor were similar for living (38.1%) and deceased (33.4%) donation; in contrast, clergy participants were more likely to express reservations about living donation (33.3% versus 16.7%). Conclusions These data indicate a greater opposition to living donation compared with donation after one's death among African Americans and suggest that improving knowledge about organ donation, particularly with regard to donor involvement and donation-related risks, may facilitate increases in organ donation. Existing educational campaigns may fall short of meeting information needs of African Americans.
The primary aim of this study was to examine whether parent affect and child temperament characteristics differ across feeding styles in low-income families, given suggestive evidence. The secondary aim was to examine whether feeding styles were still related to children's body mass index independent of parent affect, child temperament, and known correlates.Participants in this study were 718 parents of children attending Head Start programs across two sites (Texas and Alabama). Parents were categorized into feeding styles of authoritative (n = 118), authoritarian (n = 219), indulgent (n = 240) and uninvolved (n = 141) using a parent-report questionnaire characterizing feeding in a general parenting paradigm. Parents completed questionnaires and measured height and weight was obtained from parents and children.Differences were found across feeding styles on parent affect and child temperament characteristics. Indulgent parents reported lower Negative Affect for themselves and lower Negative Affectivity for their children. The indulgent feeding style was significantly associated with higher child body mass index after controlling for parent affect, child temperament, and correlates (ethnicity, child age, parent body mass index).The results of this study not only show a robust association between the indulgent feeding style and weight status of low-income preschool children, but also suggest how congruence between parent emotional affect and child temperament characteristics may contribute to excess consumption among children of indulgent parents.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)