Robert L. Glueckauf

Computer-tailored health interventions delivered over the web: Review and analysis of key components

OBJECTIVE This systematic review explores how computer-tailored, behavioral interventions implemented and delivered via the Web have been operationalized in a variety of settings. METHODS Computer-tailored, online behavioral intervention studies published from 1996 to early 2007 were selected and reviewed by two independent coders. RESULTS Of 503 studies screened, 30 satisfied the selection criteria. The level of sophistication of these interventions varied from immediate risk/health assessment, tailored web content to full-blown customized health programs. The most common variables for tailoring content were health behaviors and stages of change. Message tailoring was achieved through a combination mechanisms including: feedback, personalization and adaptation. CONCLUSIONS Tailored, self-guided health interventions delivered via the Web to date have involved a great diversity of features and formats. While some programs have been relatively brief and simple, others have involved complex, theory-based tailoring with iterative assessment, tools for development of self-regulatory skills, and various mechanisms for providing feedback. PRACTICE IMPLICATIONS Our ability to fully optimize the use of computer-assisted tailoring will depend on the development of empirically based guidelines for tailoring across populations, health foci, health behaviors and situations. Further outcome research is needed to enhance our understanding of how and under what conditions computer-tailoring leads to positive health outcomes in online behavioral interventions.

A Meta-Analysis of Web-Delivered Tailored Health Behavior Change Interventions

Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.

Telehealth Interventions for Individuals With Chronic Illness: Research Review and Implications for Practice.

This article reviews outcome research on telehealth interventions for individuals with chronic illnesses. Only randomized controlled trials that provided data on specific health, quality of care, or clinical interview outcomes were selected. The overall findings suggested that telehealth interventions have shown promise as effective modes of treatment for people with chronic health conditions. Suggestions for improving the rigor and quality of future research are proposed, including the use of larger samples, conceptually meaningful control groups, cost analyses, strategies for enhancing ethnic minority recruitment, and experimental designs that examine interactions among different types of telecommunication technologies, specific health problems, and different patient populations. Implications for incorporating telehealth into psychological practice are also addressed.

Preparation for the delivery of telehealth services: A self-study framework for expansion of practice.

Linked to increasing consumer demand for access to health care information and to the worldwide expansion of telecommunication services, telehealth has emerged as a new domain of practice within professional psychology. Psychologists who plan to incorporate telecommunication technologies (e.g., Internet and point-to-point videoconferencing) into their practices should first conduct a self-assessment and then enhance their knowledge and skills in using these alternative forms of service delivery. The current article provides a self-study framework, known as STEPS, for psychologists to use in planning for telehealth practice. STEPS focuses on 5 key domains of telehealth practice and organizes specific self-study questions around each of these domains.

Telehealth for persons with severe functional disabilities and their caregivers: facilitating self-care management in the home setting.

Persons with severe functional disabilities are the highest users of health care services. Caring for the needs of this population represents a significant percentage of our national health care costs. A growing body of research has demonstrated the efficacy of self-management strategies and caregiver engagement for effective long-term care for individuals with chronic medical conditions. Economic forces over the past decade have led to new challenges and resulted in major changes in health care delivery resulting in shortened length of inpatient stays and greater limits on the length of outpatient treatment. Telehealth is an innovative method for health care delivery and a means of meeting this new challenge. This article highlights the findings of 3 pilot studies on the use of telecommunications technologies in promoting self-care management and enhancing health care outcomes in persons with severe disabilities and their family caregivers. The importance of matching technology to the needs of this population, lessons learned from these investigations, and future directions for research are addressed.

Assertiveness Training for Disabled Adults in Wheelchairs: Self-Report, Role-Play, and Activity Pattern Outcomes

Thirty-four physically disabled adults participated in an 11-week assertiveness training (AT) program. Ss were randomly assigned to either AT or a waiting-list (WL) condition. Each was asked to complete three self-report measures, a role-play test, and a social and recreational activity diary. The AT Ss showed significant improvements on both self-reported assertiveness and role-play performance from pre- to posttreatment, whereas WL controls showed no changes on these measures. No significant changes in frequency of social or recreational activities were found at posttest for either AT or control Ss. A mixed pattern of results was shown at 6-month follow-up. Posttest gains were maintained across all self-report measures of assertiveness and acceptance of disability, whereas role-play performance approached baseline levels at 6-month follow-up. Overall results support the use of AT in enhancing perceived social efficacy and interpersonal skill of physically disabled adults in wheelchairs.

Affective facial and lexical expression in aprosodic versus aphasic stroke patients.

Past research has shown that lesions in the left cerebral hemisphere often result in aphasia, while lesions in the right hemisphere frequently impair the production of emotional prosody and facial expression. At least 3 processing deficits might account for these affective symptoms: (1) failure to understand the conditions that evoke emotional response; (2) inability to experience emotions; (3) disruption in the capacity to encode non-verbal signals. To better understand these disorders and their underlying mechanisms, we investigated spontaneous affective communication in right hemisphere damaged (RHD) stroke patients with aprosody and left hemisphere damaged (LHD) stroke patients with aphasia. Nine aprosodic RHD patients and 14 aphasic LHD patients participated in a videotaped interview within a larger treatment protocol. Two naïve raters viewed segments of videotape and rated facial expressivity. Verbal affect production was tabulated using specialized software. Results indicated that RHD patients smiled and laughed significantly less than LHD patients. In contrast, RHD patients produced a greater percentage of emotion words relative to total words than did LHD patients. These findings suggest that impairments in emotional prosodic production and facial expressivity associated with RHD are not induced by affective-conceptual deficits or an inability to experience emotions. Rather, they likely represent channel-specific nonverbal encoding abnormalities.

Health Care for the Whole Person: Research Update

NADINE J. KASLOW, PhD, ABPP, earned her PhD in clinical psychology from the University of Houston. She is professor and chief psychologist at Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences. Her research and clinical work are focused on women’s mental health, family violence, depression and suicide, and family systems medicine. She is active in predoctoral internship and postdoctoral fellowship education and training. ANNIE M. BOLLINI received her PhD in clinical psychology from Emory University, completed her postdoctoral training at Emory School of Medicine, and is a licensed clinical psychologist in Georgia. Her main research areas have included schizophrenia and spectrum disorders, cognitive functioning, and stress. Currently, she is a behavioral scientist at the Centers for Disease Control and Prevention in Atlanta. She conducts research and develops and evaluates programs on HIV/AIDS prevention on international projects, mainly in African countries. BENJAMIN DRUSS received his MD degree from New York University in 1989. He is the Rosalynn Carter Chair in Mental Health at the Rollins School of Public Health at Emory University. His work focuses on improving care on the interface between mental health and primary care. ROBERT L. GLUECKAUF, MD, is a professor in the Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University. He received his PhD in clinical psychology from Florida State University in 1981. His current research interests lie in the areas of telehealth, program evaluation, and family intervention for persons with chronic illnesses. LEWIS R. GOLDFRANK received his medical degrees from the University of Brussels Medical School in 1970. He is chair and professor of the Department of Emergency Medicine at New York University and Medical Director of New York City Health Department’s Poison Center. His work focuses on preparedness and medical toxicology. KELLY J. KELLEHER received his MD degree from Ohio State University College of Medicine and his MPH from Johns Hopkins University School of Hygiene and Public Health. He currently is a professor of pediatrics and psychiatry, The Ohio State University Colleges of Medicine and Public Health. His research interests focus on accessibility, effectiveness, and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse, or violence. ANNETTE MARIE LA GRECA received her PhD in clinical psychology from Purdue University. A professor of psychology and pediatrics, she is director of clinical training at the University of Miami. Her research addresses peer influences in the physical health and emotional adjustment of children and adolescents, risk and resilience factors in children’s reactions to natural disasters and other traumatic events, and family and peer support in the management of childhood chronic disease. R. ENRIQUE VARELA, PhD, received his doctorate from the University of Kansas. He is an assistant professor of psychology at Tulane University. His main research interests are in the areas of cross-cultural manifestations of childhood anxiety and parenting practices in Latin American families. He is also interested in adherence issues in chronically ill children. SAMUEL S.-H. WANG received his PhD in neuroscience from Stanford University. He currently is in the Department of Molecular Biology and Program in Neuroscience at Princeton University. His areas of research are neuroscience, synaptic plasticity, and in vivo and in vitro physiology. LINDA WEINREB received her MD in 1982 from Pennsylvania State University Medical School. She is vice chair and professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School. She has expertise in developing innovative models of integrated behavioral health care and mental health care for vulnerable populations, including homeless populations. LONNIE ZELTZER received her MD from the University of Cincinnati College of Medicine. She is a professor of pediatrics, anesthesiology, psychiatry, and biobehavioral sciences at the David Geffen School of Medicine at UCLA and director of the Pediatric Pain Program at UCLA Mattel Children’s Hospital. Her interests lie in gender differences in pain and pathways to pain and pediatric pain. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Nadine J. Kaslow, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Grady Health System, 80 Jesse Hill Jr. Drive, Atlanta, GA 30303. E-mail: nkaslow@emory.edu Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association 2007, Vol. 38, No. 3, 278–289 0735-7028/07/

Integrative cognitive-behavioral and spiritual counseling for rural dementia caregivers with depression.

12.00 DOI: 10.1037/0735-7028.38.3.278

Therapeutic Alliance in Family Therapy for Adolescents with Epilepsy: An Exploratory Study.

OBJECTIVE Discuss initial evaluation of a program for training faith community nurses (FCNs) to conduct cognitive-behavioral and spiritual counseling (CBSC) for rural dementia caregivers (CGs), and present 2 case studies on the use of CBSC for treating depression in this population. STUDY DESIGN Pre-post evaluation of the effectiveness of CBSC training and a case study analysis of the effectiveness of CBSC on CG problem improvement and depression. OUTCOME MEASURES For FCN training, we used the FCN Counseling Comfort Scale, FCN Counseling Efficacy Scale, and the FCN Counseling Workshop Satisfaction Survey. The Problem Severity Scale and Center for Epidemiologic Studies Depression Scale were used in the case studies. RESULTS Significant post-training increases in FCN counseling comfort and perceived counseling efficacy were obtained. Case study findings provided evidence of substantial improvement in caregiving problems and reductions in depression. CONCLUSIONS Preliminary outcomes of FCN training and CBSC for dementia CGs were promising. However, replication across the sample is required to evaluate the overall effectiveness of CBSC for reducing CG depression. Specific competencies and ethical considerations in supervising this form of intervention are also addressed.