Early Afternoon Seminars - April 27, 2011
12:00 - 2:45 pm
Seminar 01: Introduction to the Multiphase Optimization Strategy (MOST) for Building More Effective Behavioral Interventions
Linda M. Collins, PhD, Penn State, State College, PA
The majority of behavioral interventions in use today have been evaluated as a treatment package using a two-group randomized controlled trial (RCT). This approach is an excellent way to determine whether an intervention is effective. However, the treatment package approach is less helpful at providing empirical information that can be used to improve the intervention's effectiveness. In this seminar an innovative methodological framework for building more effective behavioral interventions, the Multiphase Optimization Strategy (MOST), will be presented. MOST is based on ideas inspired by engineering methods, which stress careful management of research resources and ongoing improvement of products. A comprehensive strategy, MOST includes a series of steps devoted to establishing the conceptual foundation of an intervention; gathering empirical information on individual intervention components via experiments designed for efficiency and conservation of research resources; making decisions based on the results of the experiments to develop the intervention; and evaluating the intervention via a RCT. Using MOST it is possible to engineer an intervention targeting a particular effect size, level of cost-effectiveness, or any other criterion.
This seminar will provide an introduction to MOST. Ongoing intervention development studies using the MOST approach will be used as illustrative examples. A substantial amount of time will be devoted to experimental design, which is an important tool in MOST. In particular, factorial experiments and fractional factorial experiments will be discussed. Time will be reserved for open discussion of how the concepts presented can be applied in the research of seminar attendees. Attendees will be given a handout with the Power Point slides and a list of articles containing additional information.
Attendees may also be interested in Seminar 06: Getting SMART about Developing Individualized Sequences of Health Interventions, presented by Drs. Murphy and Almirall, which will build on the information on experimental design presented here.
Seminar 02: Using the Internet to Translate Evidence-Based Interventions and Self-Management Information for Cancer Patients: Lessons from the Field
Anna M. McDaniel, PhD, School of Nursing and School of Informatics, Indiana University, Indianapolis, IN
Cancer patients, survivors, and their families have significant needs for 1) information about diagnosis and treatment, 2) help with symptom management, 3) communication and coordination of care, and 4) prevention and surveillance of further problems. Provision of cancer-related information helps patients and their families to accept their diagnosis, improve symptom management and treatment compliance, and reduce anxiety and uncertainty, thus increasing overall quality of life. Our research team has designed a web portal to serve as the application architecture for online access to evidence-based cancer information and interactive interventions. In this seminar, we will share the results of our research and discuss implications for practice.
Seminar 03: Mind-body Skills Training for Resilience and Stress Management: Theoretical Foundations, Clinical Evidence and Public Health Applications
Matthew J. Fritts, MPH, E-RYT, Samueli Institute, Alexandria, VA, United States
This seminar will present the theoretical foundations, state of the science, and practical applications of a novel approach to stress management based on self-care and skills training in evidence-based mind-body practices (MBP). Stress is a major facilitator of multiple chronic diseases that are costly in pain and suffering, and also in dollars and lost productivity. The current social, political and economic climate is ripe for a paradigm shift-- from a disease treatment model to a health promoting model based on cultivating wellness and proactive disease prevention. Self-care with MBP is a cornerstone of this paradigm.
Presenters will review the physiology of stress and resilience, the theory of MBP, and physiologic and cognitive/affective mechanisms of action. Through experiential activities and structured dialogue, participants will experience 3 types of MBP and explore feasibility and clinical applications of MBP as adjunctive treatments for stress-related illness. They will use the Optimal Healing Environments framework to describe the relevance of MBP to "inner environments" (such as cultivating meaning, intention and spiritual beliefs) and outer environments (such as healing spaces and relationships).
Finally, presenters will summarize the evidence base supporting use of MBP for prevention and treatment of stress-related disease. They will describe their current efforts to synthesize and translate this evidence into clinical practice guidelines, existing federal and state public health programs, and health policy efforts that leverage implementation of the wellness and health promotion sections of the Patient Protection and Affordable Care Act.
Seminar 04: Recruiting, Training, and Evaluating Peer Supporters: The Peers for Progress Network
Guadalupe X. Ayala, PhD, MPH, Graduate School of Public Health, San Diego State University and the San Diego Prevention Research Center, San Diego, CA
Peer support is an evidence-based approach for chronic disease prevention and control. However, models of peer support differ on important dimensions including how peer supporters are identified, whether they are paid or volunteer, and how peer support is delivered and tracked. With a background of common core functions of peer support (assistance in daily behavior, social/emotional support, linkage to clinical care, ongoing support), this seminar will teach participants how to design feasible and effective peer support programs through key tasks of identifying, recruiting, training, and tracking peer supporters. Instructors will draw on their experiences with multi-ethnic populations and programs based in communities and health centers in Alabama, California, and Michigan as part of Peers for Progress, an international program of the American Academy of Family Physicians Foundation to promote peer support in prevention and health care. Participants will learn about varied methods for identifying, recruiting, and selecting peer supporters and how these might differ based on cultural and contextual factors, including payment/incentive structure. Participants will receive examples of training materials and discuss how these materials were conceptualized from both a theoretical and practical perspective. Participants will also learn varied approaches to evaluating training outcomes, including methods to assess intervention fidelity during implementation. Concepts and strategies will be reinforced through case examples, simulations, and a hands-on exercise.
Seminar 05: Acceptance and Commitment Therapy for Health Related Problems
Maria Karekla, PhD, Psychology, University of Cyprus, Nicosia, Cyprus
This seminar will cover the application of Acceptance and Commitment Therapy (ACT) for individuals with a variety of health related problems (e.g. smoking, cancer, diabetes etc). ACT is based on the view that most psychological difficulties and suffering are a result of experiential avoidance and fusion with literal thinking getting in the way of value guided action and living. ACT teaches clients how to connect with their values, become more accepting of the world within (thoughts, memories, experiences, sensations etc) and move towards valued action and change in their lives. Concepts will be illustrated using live demonstrations, experiential exercises (acceptance, mindfulness, defusion), metaphors, and worksheets. This workshop is designed to teach basic skills needed to explore ACT as an assessment model and intervention method. It will be both didactic and experiential and will balance an understanding of the model with a personal connection with the issues raised in ACT, and with skill development.
Late Afternoon Seminars - April 27, 2011
3:15 - 6:00 pm
Seminar 06: Getting SMART about Developing Individualized Sequences of Health Interventions
Susan A. Murphy, PhD, Department of Statistics and Institute for Social Research, University of Michigan, Ann Arbor, MI
The effective management of a wide variety of chronic health disorders often requires individualized, sequential decision making, whereby treatment is dynamically adapted over time based on a patient's changing course. Adaptive health interventions operationalize individualized, sequential, decision making via a sequence of decision rules that specify whether, how, for whom, and when to alter the intensity, type, or delivery of psychosocial, behavioral, and/or pharmacological treatments at critical decision points in the management of chronic disorders. Adaptive health interventions can be used to develop or supplement clinical treatment guidelines; and they inform the evidence-base for treating chronic health disorders. In this seminar, we present a novel experimental design-sequential multiple assignment randomized trials, or SMART-intended specifically for the purpose of developing and optimizing adaptive health interventions.
Specifically, we will discuss why adaptive health interventions are important; introduce SMART designs; contrast SMARTs with other experimental approaches; discuss SMART design principles, including common choices for primary and secondary aims; and acquaint the audience with data-analytic approaches for developing optimized adaptive health interventions that are accordant with these primary and secondary aims. Illustrative examples will be drawn from studies using SMART designs that have been completed or are currently in the field. Participants will be encouraged to share experiences and ideas from their own research as a way to connect with the material.
Attendees of this seminar may also be interested in attending the seminar titled an "Introduction to the Multiphase Optimization Strategy (MOST) for Building More Effective Behavioral Interventions" presented by Dr. Linda M. Collins. The SMART experimental design is one of a variety of study designs that can be used under MOST to build more effective behavioral interventions.
Seminar 07: Social Media Marketing and Health Behaviours: Industry Strategies, Consumer Behaviours, and Public Health Responses
W. Doug Evans, PhD, Department of Prevention and Community Health, George Washington University, Washington, DC
Public health focuses attention on the link between industry messaging in mainstream media sources (t.v., print) and health outcomes, and uses these spaces in health communication strategies. However social media (internet, mobile technology) will soon become the dominant messaging spaces for industry to influence consumer behaviour.
What does this mean for public health agencies who wish to counter, and respond to these messaging tactics? How are consumers are engaging and acting upon a competing range of messages in social media spaces? Can public health effectively utilize these new technologies to develop more effective health promotion and prevention messaging strategies? Or does the answer lie in public/private collaboration?
This interactive seminar offers unique insights into the theory behind the social media communication strategies of private industry and public health agencies, including how social media is defined and measured, and how social media is used to 'push messages' to the public. We review the current evidence about social media impacts on health behaviours, exploring which types of social media are most likely to be utilized by different subgroups, and the socio-cultural factors that may impact on the ways in which groups respond to messaging tactics.
Finally we provide a practical case example of how social media may be used by health practitioners as a communication tool to change health behaviour and promote health care. Text4baby utilises Mobile Health technology (mHealth) to improve maternal and child health behavioral outcomes such as increased Medicaid-sponsored care utilization, reduced smoking during pregnancy, taking pre-natal vitamins, improved nutrition and related behaviours. In this session, we will examine the intervention strategy, theoretical assumptions underlying it, and early results from an evaluation of its behavioral outcomes.
Seminar 08: Gene-Environment Interplay in Health Behavior: From Mechanisms to Translation
Colleen McBride, PhD, Social and Behavioral Research Branch, National Institutes of Health, Bethesda, MD
Significant investment in the science of genetic and genomic discovery has occurred over the last decade. However, we are just beginning to make inroads into the science of gene-environment interplay when studying the complex causes of common diseases, particularly within the field of behavioral medicine. We also have few examples to guide us in anticipating the translational promise of basic research in gene-environment interaction (GxE). To engage the research imagination of behavioral medicine researchers, leaders in the field of GxE will outline basic concepts and provide examples of the potential for translation of results from basic research to interventions in behavioral medicine. This Seminar will first lay the methodological foundation for the study of gene-environment interplay by defining GxE, outlining the models for the pathways through which GxE operates, and describing study designs to detect it. We will then discuss emerging technology and its promise to advance our measurement of the environment within GxE research and to improve the delivery of interventions. Describing new in-field, real-time sensors that continuously measure personal exposure to rest, activity, and circadian light and darkness, we will discuss the utility of advanced measurement strategies for both basic research and translational applications. The seminar will close by highlighting the promise of personalized medicine through individualizing interventions to genotype. We will discuss the genetic and biological mechanisms that explain differential psychological and physiological responses to exercise, and discuss how models of behavior can build on these findings to enable the design, implementation, and evaluation of interventions to improve health behavior.
Seminar 09: Using Empirical Binomial Hierarchical Bayesian Modeling (EBHBM) to Determine Whether a Behavioral Intervention Works Well for Some Participant Groups but Less so for Others
Yuelin Li, PhD, Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
Behavioral medicine intervention trials often recruit participants from multiple disease clusters or from different geographical sites but randomize them individually to the intervention conditions. EBHBM is a useful tool in testing moderation of treatment effect by disease/site clusters.
With minimal mathematics, we first go over the basics in EBHBM modeling. Basics of Bayesian analysis using Gibbs Sampling is also covered using primarily graphs. Next, a step-by-step tutorial covers how to fit EBHBM using the open-source statistical packages R and OpenBUGS. Finally, basic diagnostics of convergence in Gibbs Sampling are summarized. Further readings are provided.
The example dataset comes from a smoking cessation trial. Smokers newly diagnosed with cancer and scheduled for surgery were recruited from 7 oncology clinics and randomized individually into the Scheduled Reduced Smoking intervention (SRS, N=96) prompted by a handheld computer or Standard Care (SC, N=89). All patients received NRT and counseling. EBHBM used biochemically verified 24-hour point abstinence rates to estimate the difference between the SRS and SC quit rates across disease clusters. The step-by-step tutorial covers how to use EBHBM to estimate the probability that SRS is more efficacious than SC: highest in Colorectal (88%), followed by Breast (85%), Urology (71%), and Gyn (68%). By contrast, SRS was less efficacious for Gastric (28%), Thoracic (33%), and Head & Neck (15%).
The overall goal of this seminar is to make EBHBM immediately usable to a behavioral scientist. To facilitate this, the dataset and WinBUGS syntax will be available on the instructor's website at http://idecide.mskcc.org. Participants are encouraged to try them before we meet.
Seminar 10: Changing Behavior in Older Adults: Using Research to Impact Policy
Barbara Resnick, PhD, CRNP, FAAN, FAANP, University of Maryland, Baltimore, MD
Behavior change can be strongly influenced through policy. Thus we have a critical need to influence policy to optimize health of older adults through behavior change initiatives across settings, locally and nationally. The purpose of this seminar is to present some current research findings and their potential utility for influencing policy, to describe the ways in which our messages can be disseminated and to address where we need to go and how we have to get there to influence policy makers. The first section of our seminar includes a group of papers demonstrating effective health behavior interventions with policy implications delineated. The second section provides examples of how to disseminate our findings to continue messaging to persistently advocate for the health of older adults. Specifically we will describe the use of older adults as the disseminators of policy messages and the use of evidence to advocate for policy initiatives around training as well as access to services. The third section of our seminar, provided by a nationally recognized lawyer and political advocate with expertise in health care, particularly as it relates to older adults, will address how we move from our findings to next steps for influencing policy makers. Specifically, the process of identifying "the ask", getting to the table, using our local and national impact as members of a larger organization, and being attuned to appropriate timing of our messages will be reviewed. Participants of this seminar will gain new insight into the translation of research into policy as well as network with others who may be doing similar research and have similar policy related interests and agendas.
Seminar 11: Clinical Seminar in Behavioral Activation Treatment for Depression With a Co-Morbid Health Condition
Sherry Pagoto, PhD, Medicine, University of Massachusetts Medical School, Worcester, MA
Depression is co-morbid with many health conditions, including type 2 diabetes, HIV/AIDS, CVD, obesity, smoking, and substance abuse. Depression is associated with treatment nonadherence, poor self-care, and unhealthy lifestyle behaviors. Brief Behavioral Activation Treatment for Depression (BATD) is an evidence-based therapy for depression that is uniquely suited for use in medical settings, given its straightforward, time efficient nature, and ease of application to co-morbid health conditions. BATD is based on reinforcement theory and specifically targets contextual factors that affect behavior using principles of the matching law. Matching law suggests that depression persists because reinforcement for healthy behavior is low, and/or depressed behavior produces a relatively high rate of reinforcement. BATD is designed to increase exposure to positive consequences of healthy behavior, thereby increasing the likelihood of such behavior and reducing the likelihood of future depressed behavior. BATD has been applied to health conditions that are often co-morbid with depression such as obesity, type 2 diabetes, HIV/AIDS, smoking, and substance abuse. The purpose of this clinical seminar is to provide instruction on how to administer BATD in the context of a co-morbid health condition for the purpose of reducing depressive symptomatology, as well as increasing healthy behaviors (e.g., healthy diet, physical activity, and medical adherence) and decreasing unhealthy behaviors (e.g., smoking, overeating, alcohol use). We will teach the basic principles of BATD, briefly review the efficacy literature, provide session-by-session instructions, and outline strategies for adapting BATD for application to a wide variety of co-morbid conditions with practical recommendations on addressing barriers, including treatment resistance, and integrating BATD into other treatments. Participants will receive a treatment manual and reference list. All skill levels are welcome.