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BACKGROUND: HIV-infected people who use drugs (PWUD) exhibit the highest rates of non-adherence to antiretroviral therapy (ART) among people living with HIV. This contributes to poor treatment outcomes, increased morbidity and mortality, and HIV transmission. However, current interventions fail to address the unique barriers to adherence faced by this population. Life Steps is a brief, single session intervention that demonstrated increased ART adherence among HIV-infected individuals. This study protocol seeks to improve clinical practice by adapting Life Steps for HIV-infected PWUD and adding a brief motivational intervention addressing drug use. This intervention will incorporate educational, motivational, and behavioral skills components specifically aimed at improving adherence and linkage to substance use treatment among HIV-infected PWUD. METHODS: This project will consist of three phases using a mixed-methods approach. In Phase 1, qualitative interviews with HIV-infected PWUD and community providers, coupled with feedback from an expert review panel, will be used to enhance the existing Life Steps manual and interventionist training protocol. In Phase 2, the prototype will be pilot tested and qualitative exit interviews with HPWUD will identify the strengths and limitations of the intervention. Data regarding feasibility, acceptability, and barriers to delivery will guide modifications to finalize a modified Life Steps-Drug Use (LS-DU) protocol. In Phase 3, a pilot type 1 hybrid effectiveness-implementation trial will examine the effectiveness of LS-DU relative to a health education intervention control condition on ART adherence and viral load data at 1-, 3-, and 6-months. Data regarding clinic readiness for implementation and intervention sustainability potential will be collected. DISCUSSION: This protocol will adapt and evaluate an intervention to improve adherence among HIV-infected PWUD. Results of this study will provide significant data on the acceptability, initial effectiveness, and sustainability potential of an adherence intervention for a high risk and underserved population. Trial registration NCT02907697.

Automatic speech recognition (ASR) is a crucial step in many natural language processing (NLP) applications, as often available data consists mainly of raw speech. Since the result of the ASR step is considered as a meaningful, informative input to later steps in the NLP pipeline, it is important to understand the behavior and failure mode of this step. In this work, we analyze the quality of ASR in the psychotherapy domain, using motivational interviewing conversations between therapists and clients. We conduct domain agnostic and domain-relevant evaluations using evaluation metrics and also identify domain-relevant keywords in the ASR output. Moreover, we empirically study the effect of mixing ASR and manual data during the training of a downstream NLP model, and also demonstrate how additional local context can help alleviate the error introduced by noisy ASR transcripts.

BACKGROUND: Better caregiver contribution to self-care in heart failure is associated with better patient outcomes. However, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep. OBJECTIVE: The aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. METHODS: This is a secondary outcome analysis of the MOTIVATE-HF trial. Patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). Data were collected between June 2014 and October 2018. The article has been prepared following the Consolidated Standards of Reporting Trials checklist. RESULTS: A sample of 510 patient-caregiver dyads was enrolled. Over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. CONCLUSIONS: Motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. Thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings.

BACKGROUND: Motivational interviewing (MI) promotes health-related behaviour change and improves patient health outcomes, but the effect of physical therapist-delivered MI is unclear. OBJECTIVE: To evaluate the effect of physical therapist-delivered MI on health-related behaviour change in adults attending physical therapy or rehabilitation. METHODS: CINAHL, Medline, PubMed, PEDro, Embase, and Cochrane databases were searched in August 2023. Randomised controlled trials evaluating physical therapist-delivered MI and health-related behaviour change were included. Internal validity was evaluated using the PEDro scale. GRADE approach was used for each meta-analysis. RESULTS: Ten publications from nine randomised controlled trials involving 909 participants were included. Physical therapist-delivered MI likely increased physical activity slightly (SMD 0.21, 95 % CI -0.05, 0.47) when compared to minimal intervention; however the evidence is very uncertain in relation to self-efficacy (SMD 0.51, 95 % CI -0.35, 1.38) and health-related quality of life (SMD 0.73, 95 % CI -0.64, 2.11). When physical therapist-delivered MI was combined with and compared to rehabilitation, there were no additional effects on physical activity (SMD 0.02, 95 % CI -0.37, 0.41), health-related quality of life (SMD 0.18, 95 % CI -0.27, 0.63), or endurance (SMD 0.15, 95 % CI -0.21, 0.52) and a likely small effect on self-efficacy (SMD 0.23, 95 % CI -0.1, 0.55). CONCLUSION: Physical therapist-delivered MI is likely to produce a small improvement in physical activity, but only in the absence of other comprehensive rehabilitation. The most beneficial application of MI may be for patients who are not receiving rehabilitation or who have low levels of motivation and self-efficacy.

People with disabilities (PWD) frequently experience preventable and/or manageable secondary health conditions such as weight problems, depression, and chronic pain (Jones & Bell, 2003; Seekins, Clay, & Ravesloot, 1994). Importantly, high rates of secondary conditions are correlated with low employment rates in Vocational Rehabilitation (VR) consumers (Ipsen, Seekins, & Ravesloot, 2010; Ipsen, Seekins, & Arnold, 2011). Thus, one pathway to improving employment outcomes in rehabilitation programs may involve enhancing health through the reduction of limiting secondary conditions (Ipsen, 2006; Ipsen et al., 2010). This pilot study tested whether the addition of telephone-based Motivational Interviewing (HPE+MI) to Health Plans for Employment (HPE), an internet-based health promotion and goal setting intervention targeting secondary conditions, resulted in higher self-efficacy beliefs than a factsheets only minimal intervention group or HPE alone. One-hundred and forty-two male and female active VR consumers were randomized to 1 of these 3 intervention groups. Contrary to expectation, no group effects or group × time interaction effects on targeted specific health behavior self- efficacy, reduction in limitation resulting from secondary conditions, or health related quality of life were observed. A main effect for time was, however, observed for targeted specific health behavior self-efficacy suggesting that participation in both the HPE and the HPE+MI interventions led to higher self reported self-efficacy beliefs on specific targeted health behaviors such as balanced diet, stress management, sleep, and physical activity. Importantly, main effects for time were also observed on measures of secondary condition limitation and health related quality of life suggesting the possibility that all three intervention groups were effective in reducing limitation and enhancing health related quality of life. Of note, program adherence across groups was high, and, contrary to expectation, program adherence did not differ between groups. Study findings suggest that PWD enrolled in VR programs can benefit from health behavior change interventions targeting multiple health behaviors, which are delivered remotely, and that the specific delivery modality (e.g., telephone, interactive website, or emailed factsheets) of health information may be less important than was originally thought. Study implications and future research areas are discussed.

BACKGROUND: Cardiovascular disease (CVD) is an important worldwide cause of mortality. In The Netherlands, CVD is the leading cause of death for women and the second cause of death for men. Recommendations for diagnosis and treatment of CVD are not well implemented in primary care. In this study, we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with (high risk for) CVD. METHODS/DESIGN: A two-arm cluster randomized trial is planned. We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values, risk profiling and lifestyle advice. Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management (CVRM). They are also advised to screen for the presence and severity of depressive symptoms in patients. We also advise practice nurses to use selected E-health options (selected websites and Twitter-consult) in patients without symptoms of depression. Patients with mild depressive symptoms are referred to a physical exercise group. We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM. Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practices in several geographical areas in The Netherlands. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients. Patients' health-related lifestyles (physical exercise, diet and smoking status) will be measured with validated questionnaires and medical record audit will be performed to document estimated CVD risk. Additionally, we will survey and interview participating healthcare professionals for exploration of processes of change. The control practices will provide usual care. DISCUSSION: Tailored interventions can improve healthcare. An understanding of the methods to reach the improved healthcare can be improved. This research contributes a share of it. Identification of the determinants of practice and developing implementation interventions were two steps which were completed. The subsequent step was implementation of the tailored intervention program. TRIAL REGISTRATION: Name trial register: Nederlands trial register. Web address of trial register: http://www.trialregister.nl. Data of registration: 11 July 2013. Number of registration: NTR4069.

Diabetes-related foot disease (DFD) – which includes foot ulceration and infection - often leads to hospitalisation and amputation without good clinical care and self-care. Motivational interviewing (MI) has shown promise in promoting self-care changes in persons with DFD. This thesis designed, implemented and investigated the effects of a MI-related training course for podiatrists who treat people with DFD on their MI-related skills and experiences in clinical practice. Findings indicated that podiatrists who treat people with DFD can improve their MI-related skills in the short-term following MI-training. However, additional training and support may be required to sustain these effects in the longer-term.

OBJECTIVES: Systematic coding is used to study interactions between patients and healthcare professionals from an independent observer perspective. Many coding systems are available, but an up-to-date overview is lacking. We aimed to: (1) provide a comprehensive overview of systems for systematic coding of patient-healthcare professional interactions; and describe their 2) general characteristics and development, and 3) validation and adaptation. METHODS: We systematically searched peer-reviewed empirical articles in five databases (Cochrane, Embase, PubMed/Medline, CINAHL, PsychINFO) using variations of the following keywords: (i) patient and/or other stakeholder, (ii) healthcare professional (iii), interactions in healthcare, (iv) coding tool, and (v) development and/or validation. All titles/abstracts and full-texts were screened independently and in duplicate. Additionally, coding systems were identified through an earlier review, an open-access research database, and a forward-reference search of all included coding systems up to that point. For all eligible systems, we extracted characteristics and psychometric properties. RESULTS: From a total of 6950 identified articles from literature databases, 188 full-text articles were screened. Thirty-five articles were included from additional sources. In total, we included 124 articles describing 98 coding systems. Systems were highly variable in terms of topic (e.g., patient-centered communication, shared decision making, behavior change counseling), clinical context (e.g., oncology, pediatrics, generic), rigor of development and reporting, coding complexity, and extent of psychometric testing. Inter-rater reliability was reported for most coding systems; only few were tested for other types of reliability or for validity. CONCLUSIONS: A plethora of coding systems are available, but more systematic reporting and psychometric testing are urgently needed to enhance evidence of validity. Testing may initially focus on the most relevant and broadly applicable coding systems. PRACTICE IMPLICATIONS: These results can aid researchers in selecting the most suitable coding system for their purposes. Researchers may consider using or adapting existing systems, before developing new coding systems.

BACKGROUND: A substantial body of research has established the effectiveness of brief interventions for problem alcohol use. Following these studies, national dissemination projects of screening, brief intervention (BI), and referral to treatment (SBIRT) for alcohol and drugs have been implemented on a widespread scale in multiple states despite little existing evidence for the impact of BI on drug use for non-treatment seekers. This article describes the design of a study testing the impact of SBIRT on individuals with drug problems, its contributions to the existing literature, and its potential to inform drug policy. METHODS/DESIGN: The study is a randomized controlled trial of an SBIRT intervention carried out in a primary care setting within a safety net system of care. Approximately 1,000 individuals presenting for scheduled medical care at one of seven designated primary care clinics who endorse problematic drug use when screened are randomized in a 1:1 ratio to BI versus enhanced care as usual (ECAU). Individuals in both groups are reassessed at 3, 6, 9, and 12 months after baseline. Self-reported drug use and other psychosocial measures collected at each data point are supplemented by urine analysis and public health-related data from administrative databases. DISCUSSION: This study will contribute to the existing literature by providing evidence for the impact of BI on problem drug use based on a broad range of measures including self-reported drug use, urine analysis, admission to drug abuse treatment, and changes in utilization and costs of health care services, arrests, and death with the intent of informing policy and program planning for problem drug use at the local, state, and national levels. TRIAL REGISTRATION: ClinicalTrials.gov NCT00877331.