Tens-of-millions of women every year test positive for human papillomavirus (HPV) at routine cervical screening. We performed a mixed-methods systematic review using a results-based convergent design to provide the first comprehensive overview of emotional response to testing positive for HPV (HPV+). We mapped our findings using the cognitive behavioural framework. Six electronic databases were searched from inception to 09-Nov-2019 and 33 papers were included. Random-effects meta-analyses revealed that HPV+ women with abnormal or normal cytology displayed higher short-term anxiety than those with normal results (MD on State-Trait Anxiety Inventory = 7.6, 95% CI: 4.59–10.60 and MD = 6.33, CI: 1.31–11.35, respectively); there were no long-term differences. Psychological distress (general/sexual/test-specific) was higher in HPV+ women with abnormal cytology in the short-term and long-term (SMD = 0.68, CI: 0.32–1.03 and SMD = 0.42, CI: 0.05–0.80, respectively). Testing HPV+ was also related to disgust/shame, surprise and fear about cancer. Broadly, adverse response related to eight cognitive constructs (low control, confusion, cancer-related concerns, relationship concerns, sexual concerns, uncertainty, stigma, low trust) and six behavioural constructs (relationship problems, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes to sexual practice). Almost exclusive use of observational and qualitative designs limited inferences of causality and conclusions regarding clinical significance.
Background The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.
BACKGROUND The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. OBJECTIVE The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. METHODS A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. RESULTS Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). CONCLUSIONS This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.
Abstract Background and Objectives Buprenorphine/naloxone (BUP‐NX) and methadone are used to treat opioid use disorder (OUD), yet there is insufficient evidence on the impact of doses on interventions' effectiveness and safety when treating OUD attributable to other opioids than heroin. Methods We explored associations between methadone and BUP‐NX doses and treatment outcomes using data from OPTIMA, a 24‐week, pragmatic, open‐label, multicenter, pan‐Canadian, randomized controlled, two‐arm parallel trial with participants ( N = 272) with OUD who primarily use opioids other than heroin. Participants were randomized to receive flexible take‐home BUP‐NX ( n = 138) or standard supervised methadone treatment ( n = 134). We examined associations between highest BUP‐NX and methadone doses, and (1) percentage of opioid‐positive urine drug screens (UDS); (2) retention in the assigned treatment; and (3) adverse events (AEs). Results The mean (SD) highest BUP‐NX and methadone dose were 17.31 mg/day (8.59) and 67.70 mg/day (34.70). BUP‐NX and methadone doses were not associated with opioid‐positive UDS percentages or AEs. Methadone dose was associated with higher retention in treatment (odds ratio [OR]: 1.025; 95% confidence interval [CI]: 1.010; 1.041), while BUP‐NX dose was not (OR: 1.055; 95% CI: 0.990; 1.124). Higher methadone doses (70–110 mg/day) offered higher odds of treatment retention. Discussion and Conclusion Methadone dose was associated with higher retention, which may be related to its full µ‐opioid receptor agonism. Future research should notably ascertain the effect of pace of titration on a wide range of outcomes. Scientific Significance Our results extend previous findings of high doses of methadone increasing retention to be applied in our population using opioids other than heroin, including highly potent opioids.
Cannabis use is highly prevalent in people with psychotic disorders and is associated with adverse outcomes. We updated our 2020 systematic review related to the efficacy of technology-based psychological interventions (TBPIs) to decrease cannabis use in individuals with psychosis, the design of TBPIs, and their acceptability. We searched Medline, PubMed, Embase, CINAHL, PsycINFO, and EMB Reviews for references indexed between November 27, 2019, and July 27, 2023, and used the PRISMA guidelines to report the results. We screened 5083 unique records and retained three studies for the narrative synthesis. Two quantitative studies showed promising results of internet or virtual reality-based psychological interventions that incorporate cognitive behavioral therapy, motivational interviewing, and psychoeducation principles on the frequency and quantity of cannabis use. A qualitative exploratory study provided an integrative synthesis of patient and clinician opinions pertaining to the use of psychological approaches and technology to tackle cannabis misuse in individuals with psychosis. In contradiction with the rapidly expanding mobile-health solutions in the field of mental health, there is a dearth of research related to the use of internet and app-based psychological interventions for cannabis use in individuals with psychosis. The use of qualitative research is pivotal in the development of TBPIs. Our initial review and its update show that only 11 peer-reviewed journal articles that met our inclusion criteria have been published so far.
BACKGROUND High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. OBJECTIVE This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. METHODS Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. RESULTS Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (<i>χ</i><sup>2</sup><sub>1</sub>=20.55, <i>P</i><.001). The between-group difference in postintervention intentions (<i>χ</i><sup>2</sup><sub>3</sub>=1.70, <i>P</i>=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. CONCLUSIONS Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. CLINICALTRIAL ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228
Abstract Background: Most sexually active adults are infected with the Human Papillomavirus (HPV) in their lifetime and about 3800 Canadians are diagnosed each year with a HPV attributable cancer. Although highly effective HPV vaccines exist, the HPV is responsible for 4.5% of all cancers worldwide, that include cervical, anal, vaginal/vulvar, penile, and oropharyngeal cancers. The present HPV vaccine uptake rate for boys in Canada is well below the target set by the Canadian government. This study aimed to analyze the motives that influence a change in parents’ HPV vaccine-decision-making status for their sons over time. Methods: Data were collected using a web-based survey that measured knowledge, attitudes, beliefs, and behaviors regarding HPV vaccination. Canadian parents of boys aged 9 to 12 completed the survey at baseline (T1) and in a follow-up survey 9 months later (T2). Parents’ decision stage regarding their son receiving the HPV vaccine was categorized using the Precaution Adoption Process Model: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate, or vaccinated. Parents who moved stages from T1 to T2 responded to open-ended questions, and we used qualitative deductive and inductive methods to analyses data. In parallel, we used quantitative methods to analyses parents’ knowledge, attitudes, and beliefs. Results of quantitative and qualitative analyses were compared and interpreted. Results: Of the 1427 parents who completed the survey at both T1 and T2, 118 parents moved to decided not to vaccinate, 125 moved to decided to vaccinate , and 9 to vaccinated . Qualitative analyses revealed that parents who moved to decided not to vaccinate their son indicated harms, knowledge, and general anti-vaccination attitudes as the top categories for vaccine nonacceptability. These parents also scored lower on HPV and HPV vaccine knowledge scales. Benefits, knowledge, and hearing positive opinions from health care professionals (HCPs) were the most commonly assigned categories for parents who moved to decided to vaccinate their sons. Conclusions: Highlighting the benefits of the vaccine, countering negative stories about the vaccine, and having HCPs provide strong recommendations are critical to increase HPV vaccine uptake in boys.
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