Trace Kershaw

Text Messaging as a Tool for Behavior Change in Disease Prevention and Management

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided.

Group prenatal care and perinatal outcomes: a randomized controlled trial.

OBJECTIVE: To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, and patient satisfaction and to examine potential cost differences. METHODS: A multisite randomized controlled trial was conducted at two university-affiliated hospital prenatal clinics. Pregnant women aged 14–25 years (n=1,047) were randomly assigned to either standard or group care. Women with medical conditions requiring individualized care were excluded from randomization. Group participants received care in a group setting with women having the same expected delivery month. Timing and content of visits followed obstetric guidelines from week 18 through delivery. Each 2-hour prenatal care session included physical assessment, education and skills building, and support through facilitated group discussion. Structured interviews were conducted at study entry, during the third trimester, and postpartum. RESULTS: Mean age of participants was 20.4 years; 80% were African American. Using intent-to-treat analyses, women assigned to group care were significantly less likely to have preterm births compared with those in standard care: 9.8% compared with 13.8%, with no differences in age, parity, education, or income between study conditions. This is equivalent to a risk reduction of 33% (odds ratio 0.67, 95% confidence interval 0.44–0.99, P=.045), or 40 per 1,000 births. Effects were strengthened for African-American women: 10.0% compared with 15.8% (odds ratio 0.59, 95% confidence interval 0.38–0.92, P=.02). Women in group sessions were less likely to have suboptimal prenatal care (P<.01), had significantly better prenatal knowledge (P<.001), felt more ready for labor and delivery (P<.001), and had greater satisfaction with care (P<.001). Breastfeeding initiation was higher in group care: 66.5% compared with 54.6%, P<.001. There were no differences in birth weight nor in costs associated with prenatal care or delivery. CONCLUSION: Group prenatal care resulted in equal or improved perinatal outcomes at no added cost. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00271960 LEVEL OF EVIDENCE: I

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family‐based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self‐efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.

Coping strategies and quality of life in women with advanced breast cancer and their family caregivers

Coping with advanced breast cancer is a challenge for both women and their family caregivers. The primary purposes of this study were to compare coping strategies used by patients with advanced breast cancer and their family caregivers and to examine how those strategies related to patient and caregiver quality of life. The sample consisted of 189 patient-family member dyads with advanced breast cancer. Profile analysis showed that patients reported greater use of emotional support, religion, positive reframing, distraction, venting, and humor coping while family members reported greater use of alcohol/drug coping. Regression analyses showed that among both patients and family caregivers, active coping was associated with higher quality of life and avoidant coping was associated with lower quality of life. In addition, the patient’s level of symptom distress moderated the relationship between coping and quality of life. The negative relationship between family caregivers’ avoidant coping strategies and family caregivers’ mental quality of life was strongest when patients had low levels of symptom distress and weakest when patients had high levels of symptom distress.

The intergenerational cycle of teenage motherhood: An ecological approach.

OBJECTIVE Daughters of teenage mothers have increased risk for teenage childbearing, perpetuating intergenerational cycles. Using Ecological Systems Theory, this study prospectively examined risk factors for teenage childbearing among a national sample of adolescent girls. DESIGN Data came from the National Longitudinal Survey of Youth 1997. Participants (N = 1,430) were recruited in early adolescence and interviewed yearly for 6 years. Survival analysis was used to examine the rate of childbirth across the teenage years by maternal age at first birth. Hierarchical Cox regression was used to identify multivariate predictors of teenage childbearing and to test whether risk factors differed between daughters of teenage versus older mothers. PRIMARY OUTCOME MEASURE Age at first childbirth was based on cumulative information collected at yearly interviews. RESULTS Daughters of teenage mothers were 66% more likely to become teenage mothers, after accounting for other risks. Individual (school performance), family (maternal education, marital status, number of children), peer (dating history), and environmental (race, enrichment) factors predicted teenage childbearing. Risks unique to daughters of teenage mothers were deviant peer norms, low parental monitoring, Hispanic race, and poverty. CONCLUSION Results support multidimensional approaches to pregnancy prevention, and targeted interventions addressing unique risk factors among daughters of teenage mothers.

The treatment of disabling single-level lumbar discogenic low back pain with total disc arthroplasty utilizing the Prodisc prosthesis: a prospective study with 2-year minimum follow-up.

Study Design. Prospective, longitudinal minimum 2-year follow-up. Objective. To assess the efficacy and safety of the Prodisc implant in patients with disabling multilevel discogenic low back pain (LBP). Summary of Background Data. Few, if any, alternatives have been proposed to treat recalcitrant and debilitating multilevel lumbar discogenic low back pain. To date, a prospective study specifically examining the use of multilevel Prodisc total disc arthroplasty has not been described Methods. A prospective analysis was performed on 25 patients (63 prostheses) treated with multilevel lumbar ProDisc total disc arthroplasty. Minimum follow-up was 2 years. Patients 18 to 60 years of age with disabling discogenic low back pain and minimal radicular pain secondary to multiple level lumbar spondylosis from L1 to S1 were included. Preoperative and postoperative disability and pain scores were measured using Oswestry and visual analog scores. Preoperative and postoperative neurologic, radiographic, and pain medication assessments were also performed at similar postoperative intervals. Results. A total of 29 patients (72 prostheses) were enrolled in the prospective analysis. Twenty-five patients (63 prostheses) fulfilled all follow-up criteria and are included for final analysis. Fifteen bisegmental and 10 trisegmental level cases were performed. Visual analog pain, Oswestry, and patient satisfaction scores were significantly reduced at the 3-month as well as at 48-month follow-up. Radiographic analysis revealed an affected disc height increases from 5 mm to 12 mm (P < 0.05) and affected disc motions from 3° to 7° (P < 0.05). No change in adjacent level disc heights was seen. Complications included a single case of subsidence of the inferior endplate of the L4–L5 segment in a bisegmental L4–L5/L5–S1 case. We also report a delayed case of anterior extrusionof a polyethylene component in a patient who had sustained a fall of a bicycle. Conclusions. Our preliminary data on multisegmental ProDisc lumbar total disc arthroplasty appear to be a safe and efficacious treatment method for debilitating lumbar spondylosis without significant facet arthropathy. In our select (non-Workers Compensation and/or medical legal) cohort of patients, we demonstrate a patient satisfaction rate of 93%. Careful and appropriate patient selection is essential in ensuring optimal surgical outcomes.

Development of Parallel Scales to Measure HIV-Related Stigma

HIV-related stigma is a multidimensional concept which has pervasive effects on the lives of HIV-infected people as well as serious consequences for the management of HIV/AIDS. In this research three parallel stigma scales were developed to assess personal views of stigma, stigma attributed to others, and internalised stigma experienced by HIV-infected individuals. The stigma scales were administered in two samples: a community sample of 1,077 respondents and 317 HIV-infected pregnant women recruited at clinics from the same community in Tshwane (South Africa). A two-factor structure referring to moral judgment and interpersonal distancing was confirmed across scales and sample groups. The internal consistency of the scales was acceptable and evidence of validity is reported. Parallel scales to assess and compare different perspectives of stigma provide opportunities for research aimed at understanding stigma, assessing the consequences or evaluating possible interventions aimed at reducing stigma.

Urban Teens: Trauma, Posttraumatic Growth, and Emotional Distress among Female Adolescents.

Urban teens face many traumas, with implications for potential growth and distress. This study examined traumatic events, posttraumatic growth, and emotional distress over 18 months among urban adolescent girls (N = 328). Objectives were to (a) describe types of traumatic events, (b) determine how type and timing of events relate to profiles of posttraumatic growth, and (c) prospectively examine effects of event type and posttraumatic growth on short- and long-term emotional distress with controls for pre-event distress. Results indicate that type of event was related to profiles of posttraumatic growth, but not with subsequent emotional distress. When baseline emotional distress was controlled, posttraumatic growth was associated with subsequent reductions in short- and long-term emotional distress. Implications for future research and clinical practice with adolescents are addressed.

Power, community mobilization, and condom use practices among female sex workers in Andhra Pradesh, India.

Objectives:We used a structural interventions framework to analyse the associations between power and condom use among a sample of female sex workers (FSW), and how exposure to a local community mobilization intervention (CMI) affects these associations. Design:Data came from a cross-sectional survey of 812 FSW in the East Godavari district of Andhra Pradesh, India, recruited through respondent-driven sampling. Methods:We identified three types of power – collective power, control over work, and economic power, and three dimensions of collective power – collective identity, efficacy, and agency. Multivariate logistic regression analysis was used to analyse the relationship of these three types of power and exposure to a CMI with consistent condom use with clients. Results:A total of 803 respondents exchanged sex with an occasional or regular client in the 7 days before the interview. Multivariate logistic regression shows that control over both the type of sex [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.23–2.34] and the amount charged (AOR 1.56, 95% CI 1.12–2.16), and economic dependence (AOR 0.54, 95% CI 0.35–0.83) are associated with consistent condom use as is programme exposure (AOR 2.09, 95% CI 1.48–2.94). The interaction between programme exposure and collective agency was also significant (chi-square 6.62, P = 0.01). Among respondents who reported both programme exposure and high levels of collective agency, the odds ratio of consistent condom use was 2.5 times that of other FSW. Conclusion:A structural interventions framework is useful for understanding HIV risk among FSW. More needs to be done to promote FSW control over work and access to economic resources.

Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse

Objectives:To examine the effect of a 15-session coping group intervention compared with a 15-session therapeutic support group intervention among HIV-positive men and women with a history of childhood sexual abuse (CSA) on sexual transmission risk behavior. Design:A randomized controlled behavioral intervention trial with 12-month follow-up. Methods:A diverse sample of 247 HIV-positive men and women with histories of CSA was randomized to 1 of 2 time-matched group intervention conditions. Sexual behavior was assessed at baseline; immediately after the intervention; and at 4-, 8-, and 12-month follow-up periods (5 assessments). Changes in frequency of unprotected anal and vaginal intercourse by intervention condition were examined using generalized linear mixed models for all partners, and specifically for HIV-negative or serostatus unknown partners. Results:Participants in the HIV and trauma coping intervention condition decreased their frequency of unprotected sexual intercourse more than participants in the support intervention condition for all partners (P < 0.001; d = 0.38, 0.32, and 0.38 at the 4-, 8-, and 12-month follow-up periods, respectively) and for HIV-negative and serostatus unknown partners (P < 0.001; d = 0.48, 0.39, and 0.04 at the 4-, 8-, and 12-month follow-up periods, respectively). Conclusion:A group intervention to address coping with HIV and CSA can be effective in reducing transmission risk behavior among HIV-positive men and women with histories of sexual trauma.