Browsing by Subject "Intervention"

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Self-monitoring of dietary intake is a valuable component of behavioral weight loss treatment but engagement in self-monitoring declines quickly, resulting in suboptimal treatment outcomes. This dissertation examined a novel weight loss intervention that aims to lessen the decline in self-monitoring engagement by building mastery, self-efficacy, and self-regulatory skills—key constructs of behavior change—prior to self-monitoring diet. GoalTracker was a randomized controlled trial among 105 adults with overweight or obesity comparing three standalone 12-week weight loss interventions: (1) a Simultaneous arm with concurrent self-monitoring of weight and diet each day, along with weekly lessons, action plans, and tailored feedback via email; (2) a Sequential arm with the same components but that tracked only weight through week 4, then added diet tracking; and (3) an App-Only arm that only tracked diet, and did not receive additional behavior change components. All groups used the commercial app MyFitnessPal for self-monitoring and received a tailored calorie goal and a goal to lose 5% of initial weight by 12 weeks. Paper one examined the impact of the intervention on weight change and self-monitoring engagement (Aims 1-3) and found significant weight loss and engagement for all treatment arms, with no differences between arms. Paper two examined the relation between consistent self-monitoring and weight loss (Aim 4), revealing that consistent trackers lost significantly more weight than others. Lastly, paper three examined whether early weight loss predicts future engagement and weight loss success (Aim 5), which was supported. Regardless of the order in which diet is tracked, using tailored goals and a commercial app can produce clinically significant weight loss. Consistent self-monitoring and early weight loss should be emphasized. Standalone digital health treatments may be a viable option for those looking for a lower intensity approach.

Background: Myocardial Infarction (MI) was previously thought to be rare in sub-Saharan Africa (SSA) but a growing body of evidence suggests MI is in reality under-diagnosed. Multiple studies from Tanzania show there is a need for intervention to improve MI diagnosis, treatment, and outcomes. Our objective was to create an intervention targeting MI care in the emergency department of a Tanzanian referral hospital. Methods: To address this gap an interdisciplinary group of individuals from Tanzania and the United States formed a Design Team to co-create an intervention. The group utilized the ADAPT-ITT model to guide the process of assessing need, identifying an intervention to adapt, and begin the process of adaptation and production to meet the needs of the target population. Results: In the Assessment phase, the team found substantial under-diagnosis of MI, a low rate of aspirin administration, and a lack of both patient and provider awareness. In the Decision phase, the team reviewed 10 interventions of various types before deciding upon the BRIDGE-ACS study as an ideal target for adaptation. In the Adaptation phase, the team discussed intervention content with a focus on ensuring appropriateness for local context. The team is currently in the Production phase creating the necessary materials for implementation of the intervention. Conclusions: In the emergency department of a Tanzanian referral hospital, intervention is needed to improve MI diagnosis, treatment, and outcomes. While the adaptation process is still ongoing, this paper can serve as a guide for others wanting to engage in collaborative intervention development targeting clinical care.

The current study tested the effects of a brief, behavioral intervention for problems with emotion perception, the ability to perceive other people’s emotions, across a range of psychiatric disorders. The intervention was delivered through an in-person training session in which participants learned a mindful breathing skill, followed by a testing phase in which participants received phone-based reminders to practice the skill for one week. A sample of 80 adults with self-reported emotion regulation difficulties was recruited for this study and was randomized to either the Mindful Breathing condition, a Habituation condition, or a Control condition. Findings from this study suggested that, in the training session, participants in the Mindful Breathing condition had higher accuracy for perception of positive emotions and lower accuracy for perception of negative emotions than the control condition at the second and third timepoints. After the week of receiving phone reminders, participants in the mindful breathing condition had lower accuracy for perception of negative emotions than the control condition. Findings also suggest that the mindful breathing intervention reduces distress, which was associated with emotion perception performance. Therefore, this study’s findings provide preliminary evidence for a method of targeting emotion perception deficits that are associated with many psychiatric disorders. By combining both in-person and digital treatment components, this intervention also provides a feasible and effective complement to mainstream mental health services.

The HIV epidemic in the United States continues to be a significant public health problem, with approximately 50,000 new infections occurring each year. National public health priorities have shifted in recent years towards targeted HIV prevention efforts among people living with HIV/AIDS (PLWHA) that include: increasing engagement in and retention in care, improving HIV treatment adherence, and increasing screening for and treatment of substance use and psychological difficulties. This study evaluated the efficacy of Positive Choices (PC), a brief, care-based, theory-driven, 3-session counseling intervention for newly HIV-diagnosed men who have sex with men (MSM), in the context of current national HIV prevention priorities. The study involved secondary analysis of data from a preliminary efficacy trial of the PC intervention (n=102). Descriptive statistics examined baseline substance use, psychological characteristics and strategies, and care engagement and HIV-related biological outcomes. Generalized Estimating Equations (GEE) examined longitudinal changes in these variables by study condition. Results indicated that PC improved adherence to HIV treatment, but increased use of illicit drugs, specifically amyl nitrates and other stimulant drugs; additionally, moderation analyses indicated differences in patterns of change over time in viral load by baseline depression status. Implications of the findings and suggestions for future research are discussed.

Emerging changes in health care reform have further accelerated the need for brief and cost-effective interventions. As such, the current study tested the efficacy of two brief, phone-administered, behavioral interventions derived from behavioral activation (BA) in reducing burnout among graduate students. 66 adults currently enrolled in a doctoral program in the state of North Carolina and demonstrating current burnout were randomly assigned to one of three intervention conditions: 1) Reward: a brief intervention to help participants increase pleasant, rewarding behaviors, 2) Approach: a brief intervention to help participants approach important goals that they have been avoiding due to emotion (fear, stress, sadness) or 3) Control: a condition that involves monitoring only. All participants completed three days of daily monitoring, conducted through an online survey platform, in order to attain baseline indices of mood and activities. They then received a brief intervention over the phone and completed 7 days of additional online self-monitoring while completing the intervention. Participants completed a self-report packet assessing burnout, perceived stress, behavioral activation, experiential avoidance, mastery, anxiety and depression symptoms, quality of life, and functional impairment at baseline, post-intervention, and a 1-week follow-up assessment.

The study found that individuals in the Approach condition showed significant reductions in burnout post-intervention and at a one-week follow-up assessment, compared to individuals in the Control condition. In addition, individuals in the Approach condition showed significant improvements in well-being and significant increases in behavioral activation, compared to individuals in the Control condition. These findings suggest that a one-time intervention designed to help individuals approach challenging, avoided tasks may significantly improve indices of distress and dysfunction among doctoral-level graduate students.

The Russian Federation emerged from the ruins of the USSR a diminished power, attempting to reconcile its imperial past with a new post-Cold War order. However, while the Kremlin may have lost a degree of global influence, Russia maintained the mantel of regional hegemon. Moscow was able to maintain this “privileged sphere of influence” through leveraging Russian diaspora communities–a decisive strategy that Russian leaders continued to refine and direct against the expansion of the European Union and North Atlantic Treaty Organization. Despite being the source of much focus in the foreign policy community in the twenty-first century, research around Russian diaspora communities tend to focus on the mechanics of why Russia projects influence through a diaspora population in a given country. However, the opportunity is often missed to explore how and why the diaspora itself can be co-opted by Russia in the first place. This is due to an under appraisal of how Russia developed and executed its diaspora policy in the 1990s and what Russia learned from this experience. By examining the diaspora policy development and actions of the Russian Federation in the former Soviet space during the 1990s, the West is better placed to understand the execution of Russian policy in the twenty-first century and develop defenses to it. Through a historical assessment of 1990 diaspora policy development and a case study analysis of Russian intervention in the 1990s, this thesis will also answer the contemporary policy question of how Russia can maintain a sphere of influence when it is once again weak due to its war in Ukraine, and examine the course Russia’s future military interventions will take. There are defenses to Russian diaspora policy that can be identified from historical successes and failures, which must inform Western deterrence measures.

This dissertation examines U.S. diplomatic intervention for the purposes of conflict resolution. When are different diplomatic foreign policy tools used effectively? Understanding the effectiveness of U.S. diplomatic foreign policy in conflict resolution requires a multi-pronged approach that takes seriously the role of individual presidents, domestic political constraints and incentives, and the unique efficacy of different types of policy tools.

The dissertation uses an empirical approach, combining original observational data sources with survey results and supplementary illustrative case studies. I present the results of a survey of academic experts on the relationship between U.S. presidents and the foreign policy bureaucracy, demonstrating the variation across different administrations in the relationship and conduct of foreign affairs. I also collect and utilize an original dataset on U.S. diplomatic involvement in peace processes (U.S.D.I.P.P. data) in large-N statistical analyses of the president’s choices . A set of original survey experiments provide insight into how the public views foreign policy choices and outcomes. Finally, a set of cross-case comparisons and a case study of George Mitchell as the U.S. Special Envoy to Northern Ireland provide evidence for the efficacy of special envoys as a diplomatic tool.

I find that U.S. presidents’ relationship with the foreign policy bureaucracy shape their use of diplomacy for conflict resolution, and also find evidence that the president is motivated by the ability to claim credit for successes and avoid blame for failures. Results suggest that the public does differentially assign credit and blame to the president based on context. I also demonstrate the particular mechanism by which special envoys can be an effective tool of conflict diplomacy. Overall, the dissertation provides a clear picture of the relationship between the U.S. president and executive branch and the conduct of peacemaking. U.S. diplomatic intervention for the purposes of conflict resolution is shaped by the relationship between the president and the foreign policy bureaucracy as well as the president's ability to claim personal political credit and avoid blame for policy failures. This incentive structure also maps onto the specific efficacy of diplomatic foreign policy tools, such as the use of special envoys.

Digital health interventions are widely considered a highly promising solution to issues with access to evidence-based care. However, digital health interventions are limited by lower rates of engagement than are typically seen in traditional, face-to-face interventions. Despite the importance of engagement for intervention efficacy, engagement is rarely a primary outcome in intervention studies, and few studies have empirically tested intervention changes to improve engagement. Hazel was a two-arm, randomized controlled exploratory study designed to investigate the impact of intervention design on engagement as a primary outcome. We conducted a trial of a mental health intervention, based on the Unified Protocol, delivered entirely online. Participants were randomized to complete the 12-week intervention self-guided (the unsupported arm) or with 4 weeks of therapist support (the supported arm). We sought to measure engagement as comprehensively as possible and therefore collected numerous self-report, behavioral, and objective measures of multiple facets of engagement, including how participants felt about the intervention, how they used the intervention technology, and how their behavior changed over the course of the intervention. We collected engagement outcomes at baseline, weekly during the intervention, and immediately following completion of the intervention. We hypothesized that a low dose of therapist support would improve engagement and subsequent mental health outcomes while being more scalable and feasible to implement than offering therapist support during all intervention weeks. The aims of this small, exploratory study were to learn more about patterns of engagement with the intervention and identify issues with the current intervention and trial design. We used descriptive statistics and visualizations to understand and describe trends in the data rather than p-value significance testing, in line with best practices for pilot studies. We recruited 23 North Carolina-based adults with clinically elevated depression and/or anxiety symptoms. Overall, the intervention and trial design appeared acceptable to participants. Participants in both arms had relatively positive attitudes toward the intervention at all time points, and there was no evidence that the response burden of our outcome measures was too high. However, several of our measures showed little variation between participants or over time. Our findings provides guidance for future studies to select alternative measures and/or to administer some engagement measures less frequently. This represents a meaningful step forward for the field of engagement research, as prior to this study, there was almost no empirical guidance on how to select measures of engagement or how frequently to administer them. We observed a substantial drop in engagement for participants in the supported arm when video sessions began, contrary to our expectations that video sessions would improve engagement. Notably, video sessions began partway through the intervention and participants were blinded to condition until the onset of these sessions; changes to blinding and/or timing of video sessions might improve engagement. At the same time, those participants in the supported arm who did engage in video sessions (n=4) completed more of each weekly lesson than participants in the unsupported arm, indicating that there is evidence that therapist support can increase engagement. Secondary outcomes were sample diversity and depression and anxiety symptom change. Our sample was comparably diverse to other digital health studies in terms of race and socioeconomic status, and we overrecruited LGBTQ+-identified participants. Despite finding little evidence of changes in behavior or the theoretical mechanisms underlying the intervention, the majority of participants showed improvement in their symptoms.