Development and Application of an Interdisciplinary Rapid Message Testing Model for COVID-19 in North Carolina

Introduction From the onset of the COVID-19 pandemic, public health officials have sought to develop evidence-based messages to reduce COVID-19 transmission by communicating key information to media outlets and the public. We describe the development of an interdisciplinary rapid message testing model to quickly create, test, and share messages with public health officials for use in health campaigns and policy briefings. Methods An interdisciplinary research team from the University of North Carolina at Chapel Hill assembled in March 2020 to assist the state health department in developing evidence-based messages to influence social distancing behaviors in the state. We developed and iteratively executed a rapid message testing model; the components of the 4-step model were message creation, survey development, survey administration, and analysis and presentation to health department officials. The model was executed 4 times, each during a 7-day period in April and May, and each subsequent survey included new phrasing and/or messaging informed by the previous week’s survey. A total of 917 adults from North Carolina participated in the 4 surveys. Results Survey participants rated messages focused on protecting oneself and others higher than messages focused on norms and fear-based approaches. Pairing behaviors with motivations increased participants’ desire to social distance across all themes and subgroups. For example, adding “Protect your grandmother, your neighbor with cancer, and your best friend with asthma,” to messaging received a 0.9-point higher score than the base message, “Stay 6 feet apart from others when out in public.” Practice Implications Our model to promote social distancing in North Carolina during the COVID-19 pandemic can be used for rapid, iterative message testing during public health emergencies

Diversifying Implementation Science: A Global Perspective.

We present a joint global perspective about the urgent need to diversify the loci of knowledge creation and sharing in global implementation science. We underscore the imperative of addressing implementation research questions relevant to practitioners, policy makers, and researchers from low- and middle-income countries

The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries : systematic review

Q1Artículo original1-13Aims and method This systematic review examines the effectiveness and costeffectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. Results Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. Clinical implications Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer fiveoriginal research questions related to moral judgments, negotiations, and implicit cognition. Participants from two separate large samples (total N > 15,000) were then randomly assigned to complete one version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: materials from different teams renderedstatistically significant effects in opposite directions for four out of five hypotheses, with the narrowest range in estimates being d = -0.37 to +0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for two hypotheses, and a lack of support for three hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, while considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim.</div

Examining systemic steroid use in older inflammatory bowel disease patients using hurdle models: a cohort study

Background\ud Interpreting clinical guideline adherence and the appropriateness of medication regimens requires consideration of individual patient and caregiver factors. Factors leading to initiation of a medication may differ from those determining continued use. We believe this is the case for systemic steroid therapy in inflammatory bowel disease (IBD), resulting in a need to apply methods that separately consider factors associated with initiation and duration of therapy. To evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use we apply a 2-part hurdle model to Medicare data. We do so in older patients with tumor necrosis factor antagonist (anti-TNFs) contraindications, as they are of special interest for compliance with Medicare-adopted, quality metrics calling for anti-TNFs and nonbiologic immune therapies to reduce steroid utilization. Many older patients have contraindications to anti-TNFs. However, nonbiologics cause adverse events that are concerning in older adults, limiting their use in this population and increasing reliance on systemic steroids.\ud \ud Methods\ud We used a national Medicare sample for 2006–2009 including patients with 12 months or greater of Parts A and B and 6 months or greater of Part D coverage, IBD confirmed with at least 2 claims for ICD-9CM 555.xx or 556.xx, anti-TNF contraindications and without contraindications to nonbiologic agents. We applied a negative binomial-logit hurdle model to examine patient characteristics associated with systemic steroid utilization.\ud \ud Results\ud Among the 1,216 IBD patients without baseline steroid use, 21 % used systemic steroids. Odds of receiving systemic steroids were greater in those younger, rural, and those receiving other agents. Available patient characteristics failed to predict longer steroid treatment duration.\ud \ud Conclusions\ud Our study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization patterns. Applying such a model to Medicare data, we determined that despite medical consensus that systemic steroid use should be minimized, its use was substantial. Findings indicate anticipated difficulties in implementing recently adopted quality measures to avoid systemic steroids

Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia : Preliminary Findings

Q2Q1Artículo completo1-6Objective: Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia. Methods: A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics. Results: In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively. Conclusions: Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into theworkflowof busy primary care clinics in Colombia indicates that this caremodel is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder

Addressing harmful alcohol use in primary care in Colombia : understanding the sociocultural context

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategQ3Q3Revista Nacional - Indexada

Addressing Harmful Alcohol Use in Primary Care in Colombia : Understanding the Sociocultural Context

El consumo nocivo de alcohol es un problema de salud pública en todo el mundo, que contribuye a aproximadamente el 5,1% de la carga mundial de la enfermedad. La detección y el abordaje del consumo nocivo de alcohol en atención primaria es una estrategia de intervención de atención en salud empíricamente respaldada para ayudar a reducir la carga de los problemas de consumo de alcohol. En preparación para introducir pruebas de detección y tratamiento para el consumo nocivo de alcohol en clínicas de atención primaria en Colombia, realizamos entrevistas con médicos, administradores clínicos, pacientes y participantes en Alcohólicos Anónimos. Las entrevistas se realizaron en el marco del proyecto de investigación Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, www.project-diada.org), y su fase cualitativa consistió en la recopilación de datos en 15 grupos focales, seis entrevistas y observaciones de campo en cinco entornos regionales. Todos los participantes proporcionaron consentimiento informado para participar en esta investigación. Los hallazgos muestran la asociación del consumo nocivo de alcohol con una cultura de consumo, en la cual esta se expresa como una práctica aprendida y socialmente aceptada. El reconocimiento del consumo nocivo de alcohol incluye un contexto social que influencia su detección, diagnóstico y prevención. La discusión resalta cómo, a pesar de la existencia de estrategias institucionales en el contexto de atención en salud y de la conciencia sobre la importancia del consumo nocivo de alcohol entre el personal sanitario, el reconocimiento del uso nocivo del alcohol como una patología debe estar integrada con la comprensión de las dimensiones históricas, sociales y culturales que pueden afectar diferentes escenarios de identificación y atención.Q3Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reducenthe burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.Revista Internacional - Indexad