Schedule at a Glance - Seminar Summary
Seminar #01: Creating Educational Tools: From Concept to Product
Cathy D. Meade, PhD, RN, FAAN Health Outcomes & Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
Summary: Studies that emphasize behavioral change often entail the use of printed, electronic or other novel technological communication interventions. National imperatives call for the creation of culturally, linguistically and literacy relevant communications in light of a demographically changing population. Yet, in many cases, information intended to inform and impact behaviors involves complex terminology and irrelevant concepts that don't resonate well with worldviews important to those to whom they are intended. Thus, the goal of this skill-building, interactive and hands-on seminar is to delve into a series of health communication strategies and processes for creating culturally and literacy appropriate educational tools. What is called for is a learner-centered approach that is dynamic and engaging, and involves iterative and systematic developmental processes. This means that health communications are not geared to a "one size fits all" approach. Seminar objectives are to: highlight the importance of culture and literacy in health communications; illustrate how to incorporate formative research findings into communications; describe learner centered procedures to ensure understanding, acceptability, efficacy, and usability, and persuasion; and examine practical aspects of preproduction, production, and post-production phases including budget considerations. The presenter draws from her broad media experiences and outlines a systematic framework to create customized educational tools (e.g., brochures, DVD/video, flipcharts). Specific examples will illustrate educational tools that address cancer prevention (breast/cervical, prostate), and stress management training techniques for English Speaking and Non-English Speaking groups undergoing chemotherapy. Attention to methods that foster behavioral outcomes including the use of testimonials and role-modeling techniques are also highlighted. Last, the use of the CLEAN Look Checklist, (CLEAN is an easy-to-remember mnemonic of Culture, Literacy, Education, Assessment, and Networking) is examined as a helpful aid when developing educational tools.
Seminar #02: Implementing Self-Management Support: Lessons from New Health Partnerships
Judith Schaefer, MPH, Group Health Cooperative Center for Health Studies, Seattle, WA
Summary: Delivering effective self-management support (SMS) of complex chronic conditions requires application of complex behavior change models in stressed and often unorganized clinical settings. We will present data from New Health Partnerships Learning Communities that demonstrate improvement in SMS from the perspective of the clinical team, patients and families, and from medical record documentation and promising results obtained across all measures. We will apply findings from real world settings to assure robust, representative, and replicable interventions.
Effective implementation of behavior change models involves innovations in roles for clinicians and staff, and use of other healthcare system and community supports from the Chronic Care Model(CCM). Over the course of a pilot and two learning communities, New Health Partnerships teams tested models utilizing the 5A's and motivational interviewing techniques, building a set of core competencies for supporting self-management of multiple behaviors and risk factors across disease conditions. Within a variety of primary care practice settings, improvement teams devised sustainable strategies that can be implemented by diverse clinical teams. Looking for sustainable models, teams instituted planned and group visits, optimized team care, utilized prompts and standing orders, engaged the patients themselves in peer interventions and developed community partnerships to provide services collaboratively.
This seminar will present lessons learned from three learning communities in 35 healthcare systems in delivering effective self-management support. We will demonstrate core competencies, skills and tools based on the 5 A's model of behavior change and motivational interviewing; discuss three implementation models based on the Chronic Care Model from health care teams with diverse system characteristics and populations; and introduce strategies involving patients and families as partners in leveraging improvement in their own health management and that of other patients.
Seminar #03: Translating Research into Practice: Developing a Best-Practice Program to Treat Concurrent Mental Summary: Health and Substance Abuse Problems
Shari McKee, PhD, Mental Health Centre Penetanguishene Georgianwood Concurrent Disorders, Penetanguishene, ON
Summary: Treat Concurrent Mental Health and Substance Abuse Problems
In the last decade or so, numerous best-practice manuals and guidelines have been produced about what an effective program for concurrent disorders should look like. However, much less seems to be known about how well existing frontline services actually implement such guidelines. This presentation will describe how one residential addictions program in Ontario made the transformation to a fully-integrated concurrent disorders program embodying best practice. Participants will hear how decisions were made with respect to the design of the new Georgianwood Concurrent Disorders Program: from choosing the program components and ensuring both addiction and mental health interventions were fully integrated to creating new curricula, training, and clinical supervision. Lessons learned along the way will also be described; for example, how to adapt guidelines intended for urban centres to services for small towns and more rural areas. Because this new concurrent disorders program will involve a program evaluation measuring client outcomes, the evaluation plan will be presented. Preliminary data on proximal outcomes will be presented (e.g., pre-post measures of symptoms, knowledge and skill acquisition, and various community reintegration outcomes). This talk will provide practical information on implementing best-practices for concurrent disorders, transforming from a traditional addictions model to truly integrated service, selecting intake assessments and measures of program integrity, and designing an outcome evaluation.
Seminar #04: Using the Statistical Language R to Analyze Item Response Data for Measurement Development
Yuelin Li, PhD, Memorial Sloan-Kettering Cancer Center Psychiatry & Behavioral Sciences, New York, NY
Summary: This seminar is developed for behavioral scientists who want to learn Item Response Theory with minimal mathematics. With the help of R (an open-source statistical computer language), many complicated quantitative concepts in IRT become more accessible to visual/spatial learners. This seminar is a How-To guide to IRT basic theories and a step-by-step tutorial on how to use R to analyze IRT data for measurement development. Participants are encouraged to bring a laptop with R already installed (http://www.r-project.org). The seminar is organized as follows. We will first cover a few basic techniques in using R for general statistical analysis and data visualization. For IRT, we will use real examples from our own research to cover the basic concepts as well as the more advanced topics. The basic skills include how to select/modify items and response categories by visually inspecting the Item Characteristic Curves and the Category Response Curves. The more advanced topics will include Differential Item Function (DIF) and Computerized Adaptive Testing (CAT). DIF addresses the question of whether or not some items work differently for different respondents (e.g., old vs. young, female vs. male). CAT addresses the interactive administration of an instrument, e.g., over the web. Time permitting, we will discuss the concept of latent-class IRT (by Jürgen Rost, on identifying respondents who give polarized responses).
Seminar #05: Mixed Models for Longitudinal Data: An Applied Introduction
Don Hedeker, PhD, University of Illinois at Chicago Division of Epidemiology & Biostatistics, Chicago, IL
Summary: Longitudinal, or repeated measures, data are increasingly observed in many research areas. Statistical methods and software for analysis of such data has rapidly advanced in the last twenty years or so. In particular, mixed models, aka multilevel or hierarchical linear models, are increasingly used for analysis of longitudinal data. These methods are more appropriate than traditional ANOVA techniques since they allow for missing data across time and also for a variety of variance-covariance structures of the longitudinal data. In this workshop, attendees will learn about use of mixed models for analysis of longitudinal data. The focus will be on application of these models, with direct application illustrated using standard statistical software (e.g., SAS and SPSS). In particular, the basic mixed-effects regression model for continuous outcomes will be introduced and described, including use of polynomials for expressing change across time, the multilevel representation of the mixed model, treatment of time-invariant and time-varying covariates, and modeling of the variance-covariance structure of the repeated measures. It will be shown how this model can allow for missing data across time in terms of the outcome variable, thus permitting analysis of subjects who have incomplete data across time. Methods will be illustrated using a psychiatric study in which patients level of depression is modeled over time as a function of time, diagnostic group, and drug-plasma levels.
Seminar #06: Problem-Solving Therapy: Behavioral Medicine Applications
Arthur Nezu, PhD, Drexel University, Philadelphia, PA
Summary: Problem-Solving Therapy (PST) is an evidenced-based, cognitive-behavioral intervention, based on research demonstrating a strong link between social problem solving (SPS) and psychopathology. SPS represents the process whereby people direct their coping efforts at altering the problematic nature of a given stressful situation, their emotional reactions to such stressors, or both. Rather than reflecting a singular type of coping behavior or activity, SPS is the multidimensional meta-process of idiographically identifying and selecting various coping responses to implement in order to adequately address the unique features of a given stressful situation at a given time. The overarching treatment goal of PST is to foster adoption and implementation of adaptive problem-solving attitudes and behaviors as a means of decreasing emotional distress and improving one's overall quality of life. More specifically, PST is geared to increase optimism, improve emotional regulation, and foster successful resolution of stressful problems. Although PST was originally developed to treat various mental health problems (e.g., major depressive disorder), it is increasingly being adopted successfully for use in behavioral medicine applications. Treatment goals include improving medical patients' quality of life, enhancing their ability to cope with chronic illness, fostering adherence to medical treatment, decreasing comorbid depression, and enhancing patient caregiver effectiveness. Moreover, PST has been implemented in a variety of venues, including face-to-face individual therapy, group counseling, bibliotherapy, internet-based protocols, and telephone counseling programs. Both qualitative and quantitative reviews of the relevant extant outcome literature define PST as an effective approach for a variety of health and mental health problems. In this seminar, we will (a) teach the basic principles comprising PST, (b) demonstrate its applicability across a variety of medical patient populations (e.g., oncology, cardiology, diabetes, pain), and (c) demonstrate the various means of implementing this intervention.
Seminar #07: Theoretical Approaches to Obesity Prevention in Underserved Youth: A Developmental Perspective
Dawn Wilson, PhD, University of South Carolina, Columbia, SC
Summary: This seminar will provide data on a variety of obesity prevention interventions that are currently being conducted in underserved youth across development stages ranging from preschool to adolescence. Four community-based trials will be described in detail and findings will demonstrate the importance of integrating relevant theoretical approaches for preventing obesity in youth. Several of the interventions focus on integrating schools and parents in developing successful approaches to diet and physical activity change relevant to obesity prevention. Several of the trials also address the relevance of motivational approaches that may increase engagement in behavior change efforts across different development ages. Key conceptual issues will be highlighted by the discussant as well as on-going challenges for the field.
Seminar #08: Cancer Information Service Research Consortium (CISRC): A model for translating research into evidence based interventions for cancer patients.
Michael A. Diefenbach, PhD, Mount Sinai School of Medicine Department of Urology & Oncological Sciences, New York, NY
Summary: This seminar will provide information and "lessons learned" about developing a program of research within a large service organization, the Cancer Information Service (CIS). The CIS serves cancer patients who are calling about cancer-disease and treatment specific information. Callers speak to a Cancer Information Specialist to receive evidence based information about cancer and its treatment options. The goal of this seminar is to introduce the audience to the CIS and its potential to serve as a platform for patient-centered evidence-based behavioral research of high public health relevance. First, Al Marcus, Ph.D., Scientific Director of the AMC Cancer Research Center, University of Colorado Cancer Center will provide an introduction of the CIS and its research program. Next, Kwang Yi Wen, Ph.D., and Linda Fleisher, MPH, Assistant Vice President, Health Communications and Disparities at Fox Chase Cancer Center will discuss the lessons learned from developing three interactive web-based patient education tools, the application of health behavior theory to the design of the interventions, the involvement of the patient target group to obtain feedback, and the use of state-of-the art software to assess usability. There will be ample opportunity for participants to ask questions about the logistics of developing interactive material within a large service organization. Issues about data-sharing and communication software to facilitate interaction among researchers and software developers will also be discussed. Annette Stanton, Ph.D., will integrate this approach of designing evidence-based interventions with current advances in intervention development and dissemination.
Seminar #09: Patient-Reported Outcomes Measurement Information System (PROMIS): Using New Theory and Technology to Improve Assessment of Health-Related Quality of Life in Clinical Research
Richard Gershon, PhD, Center on Outcomes, Research, and Education, Evanston Northwestern Healthcare, Evanston, IL
Summary: The Patient-Reported Outcomes Measurement Information System (PROMIS, www.nihpromis.org) is an NIH Roadmap initiative with the goal of establishing national patient-reported outcome (PRO) tools in self-reported health-related quality of life/symptoms across people with various chronic diseases. The goals of PROMIS are to: (1) develop and test item banks in five domains (fatigue, pain, physical function, emotional distress and social health) by using modern test theories such as Item Response Theory models; (2) create a computerized adaptive test (CAT) platform allowing for valid, efficient and tailored PRO assessments; and (3) create a publicly available, adaptable and sustainable system allowing clinical researchers access to a common item repository and CAT.
PROMIS represents an exciting new approach to measuring patient-reported outcomes in clinical research that is more precise, tailored to the patient, and less burdensome to both patients and staff than currently used measures. This workshop will introduce researchers to the PROMIS project and tools. Speakers will describe the PROMIS domain and instrument development process, wave 1 testing, and evaluation of psychometric properties of the item bank by using fatigue as an example. Both qualitative and quantitative results will be presented. Assessment CenterSM, a free online software application that can utilize a CAT engine, will be demonstrated in depth. This software allows researchers to create study-specific websites to administer CAT and short form instruments to participants. It includes features allowing for complex longitudinal study designs, customized instruments, randomization, online consenting, and real-time data export.
Seminar #10: Functional Analytic Causal Modeling in Behavioral Medicine
William O'Brian, PhD, Bowling Green State University, Bowling Green, OH
Summary: Behavioral medicine scientist-practitioners must often design treatments for individual patients who present with a wide array of biobehavioral disorders. Functional analytic causal modeling (FACM) is an empirically based cognitive-behavioral assessment technique used to systematically gather, integrate, and summarize information about the form and function of a patient's symptoms.
FACM is a critical component of effective treatment design because most interventions attempt to modify relationships between causal factors and symptoms. Many behavioral medicine scientist-practitioners only construct intuitively-derived causal models because they lack the necessary training to know how to translate research into clinical practice as it applies to empirically based assessment (e.g., Bayesian statistical models, causal questioning techniques). Purely intuitive approaches are problematic because they commonly lead to decisional errors including: failure to consider base rate information, illusory correlations, recall biases, and judgment overconfidence. In turn, these decisional errors negatively impact treatment design.
This seminar is designed to provide participants with a foundation in cognitive-behavioral conceptualizations of biobehavioral disorders. In presenting these foundations, we will compare and contrast traditional cognitive-behavioral conceptualizations with newer "third wave" conceptualizations (Acceptance and Commitment Therapy and Functional Analytic Psychotherapy) which are showing promise as alternative approaches to the assessment and treatment of biobehavioral disorders. Participants will also be provided with step-by-step instruction on how to construct functional analytic causal models and use important decision making aids (Bayes theorem, computer programs) that can enhance clinical decision making. Finally, participants will be provided with hands-on experience in constructing functional analytic causal models using actual cases from inpatient and outpatient behavioral medicine settings.
Seminar #11: Effect Sizes: Everything you wanted to know but weren't even sure what to ask
Jennifer McGrath, PhD, Concordia University, Montreal, QC
Summary: Contrary to popular belief, traditional null hypothesis significance testing or p values tell us nothing about the magnitude of an effect or the probability of replication of a study. All too often, "statistically significant" is incorrectly taken to mean important or big findings. An important paradigm shift is occurring as the field has been moving away from emphasizing only statistical significance tests and toward emphasizing evaluations of both practical significance and result replicability. Relatedly, a shift in editorial policy has taken place, with leading journals now requiring the reporting of effect size statistics. An effect size is a unit-free measure of the magnitude of the strength of the relationship between an independent (predictor) and dependent (outcome) variable. There are two predominant classes of effect sizes: standardized difference and variance accounted for. As behavioral medicine scientist practitioners, it is essential that we be informed about effect sizes, know how to calculate effect sizes, know how to interpret effect sizes, and be competent consumers of effect sizes reported by others.
Participants in this seminar will learn six critical skills: 1) to understand the difference between the two classes of effect sizes, 2) to calculate effect sizes using appropriate and straight-forward formulas depending on the research question of interest, 3) to be able to interpret effect sizes and know how to compare different types of effect sizes, 4) to understand the relationship with power and sample size dependence, 5) to know how effect sizes can facilitate understanding of what non-significant results might mean, and 6) to realize when trivial differences become significant. All of the seminar content is presented in a clear, user-friendly format assuming no prior knowledge of effect sizes; advanced information will be highlighted as well. Participants also will receive a valuable packet that will serve as a convenient reference for calculating and interpreting effect sizes.
Seminar #12: Medically Unexplained Illness: A Behavioral Approach
Fred Friedberg, PhD, Stony Brook University, Stony Brook, NY
Summary: An estimated 30-80% of patients in medical care present with medically unexplained symptoms. Although physicians often express skepticism about these patients, the behavioral clinician can offer significant help. This seminar will focus on three related categories of unexplained illness: (1) chronic widespread pain and fibromyalgia, (2) chronic fatigue and chronic fatigue syndrome, and (3) multiple chemical sensitivities.
The use of a relatively new evidence-based cognitive behavioral model of clinical assessment and intervention provides credibility and understanding to these patients' difficulties (Friedberg, 2006; Friedberg & Sohl, in press; Jason, Torres-Harding, Friedberg et al., 2007; Taylor, Friedberg & Jason, 2001). Assessment procedures, as explained in this seminar, include (a) differential diagnosis with depressive and anxiety disorders and (b) identification of lifestyle and stress factors related to illness severity and persistence.
The presenter will also describe the model's stepwise approach to intervention -- based on the principal of balancing activity and rest for these highly stressed individuals. The activity/rest balance is achieved by using clinical assessments to individualize six mind-body techniques. These techniques include relaxation, sleep improvement, cognitive coping skills, graded activity and pacing, scheduling of low effort pleasant experiences, and strategies to increase healthy social support. With this targeted approach, the behavioral clinician can offer realistic hope for substantial improvement to these often difficult-to-treat and medically underserved patients.
Seminar #13: Secondary Data Analysis of National and State Health Survey Data: Access, Analysis and Funding
Richard Moser, PhD, National Cancer Institute, Bethesda, MD
Summary: Numerous federal and state health survey databases are publicly available that are currently underutilized by research scientists, such as the National Health Interview Survey, the Health Information National Trends Survey, the California Health Interview Survey, and the Behavioral Risk Factor Surveillance System. Many of these databases capture national estimates of health-related behavior, knowledge, and attitudes. Secondary data analyses of existing databases may serve as an economical alternative to expensive and time-consuming new data collection projects and may serve as a valuable tool to test complex statistical models, perform meta-analyses and develop and test empirical hypotheses.
The seminar, through lecture, applied demonstrations, and group discussion will inform participants about Internet-based health survey databases available for analysis and describe the utility and content of these databases, as well as explain how to access and analyze the data. Presentations will highlight analytic issues involved with utilizing these data, describe statistical software available to perform analyses, demonstrate the types of analyses that can be completed, describe relevant NIH funding mechanisms, and discuss the process of obtaining funding with successful applicants.
Seminar #14: Cultural Translation of Chronic Disease Interventions
Judith DePue, EdD, MPH, Miriam Hospital Center for Behavioral & Preventive Medicine, Providence, RI
Summary: Translating recent research advances into clinical practice for communities at risk is important in order to eliminate disease disparities. However, doing so requires thoughtful adaptation in order to effectively meet the needs of the community and culture. This seminar presents a model for cultural translation of chronic disease self management interventions intended for those currently designing or conducting translational research projects.
We will use examples from our ongoing behavioral intervention study "Diabetes Care in American Samoa", and from "Project Sugar-2", a nurse-community health worker team intervention to support diabetes self management with African Americans in Baltimore. The Samoan project is the first diabetes intervention research in that community and is modeled after parts of Project Sugar-2. We will describe translational research steps including: 1) considerations for choosing evidence-based studies to translate, 2) preliminary meetings with community partners, 3) formative focus groups and qualitative interviews, 4) cognitive interviews for planned measures, 5) adaptation of theory, measures and interventions, 6) implementation of randomized controlled trial, and 7) follow-up focus groups to verify appropriateness of cultural adaptations.
We will address challenges encountered, practical solutions, and lessons learned in both Baltimore and Pacific island settings. The session will be interactive and encourage sharing of experiences from attendees. Therefore, participants are encouraged to bring examples from their own research for discussion and feedback. The discussion will identify key considerations for cultural translation intervention research that may be generalizable across settings.
Seminar #15: Translation Research: Design and Methodology Considerations
Rodger Kessler, PhD, ABPP University of Vermont College of Medicine, Burlington, VT
Christine Hunter, PhD ABPP, National Institute of Diabetes & Digestive & Kidney Disease, Bethesday, MD
Summary: Although efficacy research has a critical role in scientific advancement, improved public health is not always realized because of challenges related to issues such as adoption, cost, duration, acceptability and sustainability. Promoting high quality phase two translation research is an important step towards bridging the gap between science and practice. However, translating established efficacy research into effectiveness trials requires research designs that balance internal and external validity and researchers that understand the special issues involved in translation research in relation to such issues as sampling, comparison condition, and approach to causal inference. For many investigators trained in traditional randomized controlled trial design and methodology, moving toward translation research requires a new skill set that includes an appreciation of the strengths and limitations in translation research. As such, this seminar is designed to provide a beginner to intermediate level overview of these skills and issues. The specific topics covered in the seminar include a) an overview of the fundamentals of phase two translation research including the state of the science in this area; b) review of research designs and methodologies commonly used; c) review of some promising new design and analytic techniques to that are likely to enhance translation research. The seminar format will include instruction and active discussion between speakers and attendees.