Conducting Epidemiological Research in South Africa: Challenges in the Data Collection Process

This article addresses the challenges faced by research supervisors and research assistants while collecting data to explore the prevalence of psychiatric disorders among children and adolescents in South Africa. The article focuses on budgetary constraints, interviewee expectations, moral issues, limited confidentiality, fatigue factors and racial issues that threatened the completion of the project. These challenges are examined from the emic-etic theoretical paradigm and the interactions between the research supervisors, the research assistants and the research participants are analyzed. The authors propose recommendations that can serve to prepare researchers who embark on conducting research in similar socio-cultural environments

Examining the 2016 CACREP Standards: A National Survey

The U.S Department of Education and the Council for Higher Education Accreditation (CHEA) both recognize national, regional, and programmatic accreditors across the country. However, there is a lingering question about whether accreditation is linked to the quality of education. In an effort to address this question, we conducted a study to examine the accreditation standards of the Council for Accreditation and Related Educational Program (CACREP). Based on the paucity of existing empirical studies specific to the CACREP accreditation standards, we developed a national survey to gather faculty members’ perceptions of the relevance and clarity of the accreditation standards for counselor education. The results provide insight into the perceptions of educators, directions for future revisions of the accreditation standards, and implications for the counseling profession

Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes

OBJECTIVE: Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. METHODS: The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. CONCLUSIONS: This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM

The impact of colonial culture in South Africa and Zimbabwe on identity development

This study investigated how colonial culture impacted on the identity formation of seven individuals from southern Africa. Iographies focussed on factors participants believed impacted on their identity. Results indicated that: (1) participants were forced into a particular racial/cultural identity because of colonialism; (2) separation of individuals on racial lines prevented a collective anti-colonial/oppression identity from evolving; (3) participants experienced a sense of limited worthiness and/or of being more worthy than others because of their race; (4) participants' identities included an anti-colonial component; (5) white individuals who did not wish to participate in the colonial system were considered by some whites as unworthy and were mistrusted by some nonwhites; (6) participants' identity shifted over time. Implications for counselling are provided. Keywords: apartheid, Bulhan's developmental stages, counselling, psychological experiences, race, southern AfricaJournal of Psychology in Africa 2005, 15(1): 41–5

Six-Minute Walk Test as a Predictive Measure of Exercise Capacity in Adults with Type 2 Diabetes

Objective: The 6 Minute Walk Test (6MWT) is a measure that is routinely used to assess a response to treatment for cardiopulmonary diseases such as pulmonary fibrosis and congestive heart failure. The measure has never been verified as a valid measure of exercise capacity in the highly prevalent patient population of type 2 diabetes (T2DM). This study investigated the correlation between the 6MWT and graded exercise testing (GXT) in an effort to validate the 6MWT as a quality tool for assessing exercise capacity in adults with T2DM. Research Design and Method: This is a secondary data analysis of Program ACTIVE II, a randomized controlled trial designed to assess the effectiveness of two behavioral interventions on depression and glycemic outcomes in adults with T2DM. The correlation of 6MWT and predicted VO2 max (PVO2M) using GXT was examined in a subsample of participants at the time of study enrollment and at post-intervention. Results: PVO2M showed a significant correlation with 6MWT distance both at baseline (r=0.57, p=0.014) and post-intervention (r = 0.66, p = 0.037). The regression analysis of baseline data revealed that 6MWT distance alone explained 45% (F = 13.03, p = .0024) of the variability in PVO2M. When combined with the SF-12 physical health component score (PCS), 6MWT explained 66% (F = 13.62, p < .001) of the variance in PVO2M. After adjusting for PCS, 6MWT distance explained an additional 30% variability in PVO2M. Conclusions: Findings from this study indicate that the 6MWT and predicted exercise capacity are significantly correlated. The 6MWT can be used to estimate exercise capacity in adults with T2DM

Recruitment effort and costs from a multi-center randomized controlled trial for treating depression in type 2 diabetes

© 2019 The Author(s). Background: Participant recruitment for clinical trials is a significant challenge for the scientific research community. Federal funding agencies have made continuation of funding of clinical trials contingent on meeting recruitment targets. It is incumbent on investigators to carefully set study recruitment timelines and resource needs to meet those goals as required under current funding mechanisms. This paper highlights the cost, labor, and barriers to recruitment for Program ACTVE II, a successful multisite randomized controlled trial of behavioral treatments for depression in adults with type 2 diabetes, conducted in rural and urban settings in three states. Methods: Quantitative and qualitative data on recruitment were gathered from study staff throughout the study recruitment period and were used to calculate costs and effort. The study utilized two main approaches to recruitment: (1) relying on potential participants to see ads in the community and call a toll-free number; and (2) direct phone calls to potential participants by study staff. Results: Contact was attempted with 18,925 people to obtain the enrolled sample of 140. The cost of recruitment activities during the 4.5-year recruitment period totaled 190,056, an average cost of 1358 per enrolled participant. Qualitative evaluations identified multiple barriers to recruitment. Conclusions: Recruitment for Program ACTIVE II exemplifies the magnitude of resources needed to reach recruitment targets in the current era. Continuous evaluation, flexibility, and adaptation are required on the part of investigators, community partners, and funding agencies to successfully reach high-risk populations in rural and urban areas. Trial registration: ClinicalTrials.gov, NCT03371940. Registered on 13 December 2017

Program ACTIVE II: Outcomes From a Randomized, Multistate Community-Based Depression Treatment for Rural and Urban Adults With Type 2 Diabetes.

© 2019 by the American Diabetes Association. OBJECTIVE Depression (major depressive disorder [MDD]) in adults with type 2 diabetes mellitus (T2DM) is associated with worsened diabetes complications, increased health care costs, and early mortality. Program ACTIVE II was a randomized, controlled, multicenter treatment trial designed to test the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) on diabetes and depression outcomes compared with usual care (UC). RESEARCH DESIGN AND METHODS Using a 2×2 factorial randomized controlled trial design, adults with T2DM for ≥1 year who met DSM-IV-TR criteria for MDD were randomized to CBT (10 sessions occurring over 12 weeks; N = 36), EXER (12 weeks of community-based exercise including six sessions with a personal trainer; N = 34), CBT+EXER (concurrent over a 12-week period; N = 34), and UC (N = 36). Primary outcomes were depression remission rate (assessed by psychiatric interviewers blind to assignment) and change in glycemic control (HbA1c). RESULTS Themean age was 56.0 years (SD 10.7). Participants were female (77%), white (71%), and married (52%). After controlling for education and antidepressant use, odds of achieving full MDD remission in the intervention groups were 5.0-6.8 times greater than UC (P \u3c 0.0167). The CBT+EXER group demonstrated improved HbA1c compared with UC. For participants with a baseline HbA1c ≥7.0%, exploratory post hoc subgroup analysis showed that the CBT+EXER group had a 1.1% improvement in HbA1c (P \u3c 0.0001) after controlling for covariates. CONCLUSIONS The Program ACTIVE behavioral treatment interventions demonstrated clinically meaningful improvements in depression outcomes in adults with T2DM and MDD. These community-based interventions are complementary to medical care and extend access to those in rural and urban areas