Browsing by Subject "INTERVENTION"

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  • Ronimus, Miia; Eklund, Kenneth; Westerholm, Jari; Ketonen, Ritva; Lyytinen, Heikki (2020)
    We used a randomized controlled trial to investigate if a mobile game, GraphoLearn (GL), could effectively support the learning of first graders (N = 70), who have severe difficulties in reading and spelling. We studied the effects of two versions of the game: GL Reading, which focused on training letter-sound correspondence and word reading; and GL Spelling, which included additional training in phonological skills and spelling. During the spring of first grade, the children trained with tablet computers which they could carry with them during the six-week intervention. The average exposure time to training was 5 hr 44 min. The results revealed no differences in the development of reading or spelling skills between GL players and the control group. However, pre-training self-efficacy moderated the effect among GL Reading players: children with high self-efficacy developed more than the control group in word reading fluency, whereas children with low self-efficacy developed less than the control group in spelling.
  • Mikkola, Ilona; Hagnäs, Maria; Hartsenko, Jelena; Kaila, Minna; Winell, Klas (2020)
    Aims To investigate whether the use of a personalized care plan is associated with clinical outcomes of type 2 diabetes (T2D) treatment in real-world. Methods Quality of treatment was assessed using data from a yearly sample of patients with T2D visiting primary care health centres in 2012–2016. Patients were divided into three groups: 1) patient has a copy of their personalized care plan, 2) care plan exists in the patient record only or 3) patient has no care plan. Data on smoking, laboratory tests, systolic blood pressure (sBP) and statin use were collected. We compared the outcomes between the three groups in terms of proportions of patients achieving the clinical targets recommended by international guidelines. Results Evaluable data were available for 10,403 patients. Of these, 1,711 (16%) had a copy of their personalized care plan, and 3,623 (35%) had no care plan. Those who had a copy of their care plan were significantly more likely than those without to achieve the sBP target (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.29–1.51, p
  • Leskinen, Heidi; Tringham, Maaria; Karjalainen, H.; Iso-Touru, T.; Hietaranta-Luoma, Hanna-Leena; Marnila, P.; Pihlava, J.-M.; Hurme, T.; Puolijoki, H.; Åkerman, K.; Mäkinen, Sari; Sandell, Mari; Vähäkangas, K.; Tahvonen, R.; Rokka, Susanna; Hopia, Anu (2022)
    Introduction: The APOE ε4 allele predisposes to high cholesterol and increases the risk for lifestyle-related diseases such as Alzheimer’s disease and cardiovascular diseases (CVDs). The aim of this study was to analyse interrelationships of APOE genotypes with lipid metabolism and lifestyle factors in middle-aged Finns among whom the CVD risk factors are common. Methods: Participants (n = 211) were analysed for APOE ε genotypes, physiological parameters, and health- and diet-related plasma markers. Lifestyle choices were determined by a questionnaire. Results: APOE genotypes ε3/ε4 and ε4/ε4 (ε4 group) represented 34.1% of the participants. Genotype ε3/ε3 (ε3 group) frequency was 54.5%. Carriers of ε2 (ε2 group; ε2/ε2, ε2/ε3 and ε2/ε4) represented 11.4%; 1.9% were of the genotype ε2/ε4. LDL and total cholesterol levels were lower (p < 0.05) in the ε2 carriers than in the ε3 or ε4 groups, while the ε3 and ε4 groups did not differ. Proportions of plasma saturated fatty acids (SFAs) were higher (p < 0.01), and omega-6 fatty acids lower (p = 0.01) in the ε2 carriers compared with the ε4 group. The ε2 carriers had a higher (p < 0.05) percentage of 22:4n-6 and 22:5n-6 and a lower (p < 0.05) percentage of 24:5n-3 and 24:6n-3 than individuals without the ε2 allele. Conclusions: The plasma fatty-acid profiles in the ε2 group were characterized by higher SFA and lower omega-6 fatty-acid proportions. Their lower cholesterol values indicated a lower risk for CVD compared with the ε4 group. A novel finding was that the ε2 carriers had different proportions of 22:4n-6, 22:5n-6, 24:5n-3, and 24:6n-3 than individuals without the ε2 allele. The significance of the differences in fatty-acid composition remains to be studied.
  • Gatej, Alexandra-Raluca; Lamers, Audri; van Domburgh, Lieke; Crone, Matty; Ogden, Terje; Rijo, Daniel; Aronen, Eeva; Barroso, Ricardo; Boomsma, Dorret I.; Vermeiren, Robert (2019)
    Background: Severe behavioural problems (SBPs(1)) in childhood are highly prevalent, impair functioning, and predict negative outcomes later in life. Over the last decade, clinical practice guidelines for SBPs have been developed across Europe to facilitate the translation of scientific evidence into clinical practice. This study outlines the results of an investigation into academic experts' perspectives on the current prevalence, implementation, and utility of clinical guidelines for SBPs in children aged 6-12 across Europe. Methods: An online semi-structured questionnaire was completed by 28 psychiatry and psychology experts from 23 countries. Results: Experts indicated that approximately two thirds of the included European countries use at least an unofficial clinical document such as textbooks, while nearly half possess official guidelines for SBPs. Experts believed that, although useful for practice, guidelines' benefits would be maximised if they included more specific recommendations and were implemented more conscientiously. Similarly, experts suggested that unofficial clinical documents offer a wide range of treatment options to individualise treatment from. However, they stressed the need for more consistent, evidence-based clinical practices, by means of developing national and European clinical guidelines for SBPs. Conclusions: This study offers a preliminary insight into the current successes and challenges perceived by experts around Europe associated with guidelines and documents for SBPs, acting as a stepping stone for future systematic, in-depth investigations of guidelines. Additionally, it establishes experts' consensus for the need to develop official guidelines better tailored to clinical practice, creating a momentum for a transition towards European clinical guidelines for this population. (c) 2019 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (
  • Kytö, Mikko; Strömberg, Lisbeth; Tuomonen, Heli; Ruonala, Antti; Koivusalo, Saila; Jacucci, Giulio (2022)
    Gestational diabetes mellitus (GDM) has considerable and increasing health effects as it raises both the mother’s and offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and engaging insufficient physical activity. While telemedicine interventions requiring weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control amongst women with GDM, apps without extensive input from health care professionals are limited and have not shown to be effective. We aimed to improve the efficacy of GDM self-management apps by exploring desirable features in a review. We derived six desirable features from the multidisciplinary literature and we evaluated the state of implementation of these features in existing GDM apps. The results showed that features for increasing competence to manage GDM and for providing social support were largely lacking.
  • Pitkala, Kaisu H.; Strandberg, Timo E. (2022)
    Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is improving, but still the external validity of many trials may be questioned. Individuals participating in trials are generally less complex than many patients seen in geriatric clinics. Recruitment and retention of older participants are particular challenges in clinical trials. Multiple channels are needed for successful recruitment, and especially individuals experiencing frailty, multimorbidity and disabilities require support to participate. Cognitive decline is common, and often proxies are needed to sign informed consent forms. Older people may fall ill or become tired during the trial, and therefore, special support and empathic study personnel are necessary for the successful retention of participants. Besides the risk of participants dropping out, several other pitfalls may result in underestimating or overestimating the intervention effects. In nonpharmacological trials, imperfect blinding is often unavoidable. Interventions must be designed intensively and be long enough to reveal differences between the intervention and control groups, as control participants must still receive the best normal care available. Outcome measures should be relevant to older people, sensitive to change and targeted to the specific population in the trial. Missing values in measurements are common and should be accounted for when designing the trial. Despite the obstacles, RCTs in geriatrics must be promoted. Reliable evidence is needed for the successful treatment, management and care of older people.
  • Ahrens, W.; Siani, A.; Adan, R.; De Henauw, S.; Eiben, G.; Gwozdz, W.; Hebestreit, A.; Hunsberger, M.; Kaprio, J.; Krogh, V.; Lissner, L.; Molnar, D.; Moreno, L. A.; Page, A.; Pico, C.; Reisch, L.; Smith, R. M.; Tornaritis, M.; Veidebaum, T.; Williams, G.; Pohlabelnu, H.; Pigeot, I.; I Family Consortium (2017)
  • Valimaki, Maritta; Kuosmanen, Lauri; Hatonen, Heli; Koivunen, Marita; Pitkanen, Anneli; Athanasopoulou, Christina; Anttila, Minna (2017)
    Purpose: Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods: A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results: In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and > 30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P <0.001), and younger people and those with higher education were associated with more active use. Conclusion: Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.
  • Airaksinen, Noora K.; Nurmi-Lüthje, Ilona S.; Kataja, J. Matti; Kröger, Heikki P. J.; Lüthje, Peter M. J. (2018)
    Background: Most of the cycling accidents that occur in Finland do not end up in the official traffic accident statistics. Thus, there is minimal information on these accidents and their consequences, particularly in cases in which alcohol was involved. The focus of the present study is on cycling accidents and injuries involving alcohol in particular. Methods: Data on patients visiting the emergency department at North Kymi Hospital because of a cycling accident was prospectively collected for two years, from June 1, 2004 to May 31, 2006. Blood alcohol concentration (BAC) was measured on admission with a breath analyser. The severity of the cycling injuries was classified according to the Abbreviated Injury Scale (AIS). Results: A total of 217 cycling accidents occurred. One third of the injured cyclists were involved with alcohol at the time of visiting the hospital. Of these, 85% were males. A blood alcohol concentration of Conclusions: Cyclists involved with alcohol were, in most cases, heavily intoxicated and were not wearing a bicycle helmet. Head injuries were more common among these cyclists than among sober cyclists. As cycling continues to increase, it is important to monitor cycling accidents, improve the accident statistics and heighten awareness of the risks of head injuries when cycling under the influence of alcohol. (c) 2018 Elsevier Ltd. All rights reserved.
  • Törmänen, Minna; Roebers, Claudia M. (2018)
    This longitudinal study investigates the differences in cognitive and socio-emotional development and academic achievement between children educated in special education classes (N = 37) and regular classes (N = 37). The study is retrospective. The first measurement point was while children were attending play-oriented kindergarten and no decision about their education had yet been made. The second measurement point followed after 2 years of schooling. Comparing carefully matched groups, no differences in executive functions (EFs) were found before beginning school. Children assigned to special education had poorer language, fine motor skills and a lower pre-academic self-concept, self-regulatory skills and social integration. Notably, every fourth child in special education was an immigrant, 9% of whom later attended regular classes. After 2 years of schooling in either setting, the groups differed significantly in academic achievement, EFs, fine motor skills and cognitive self-regulatory skills. However, it was not - as school officials had intended - that children in special education classes had caught up, except in regard to their academic self-concept and social integration.
  • the TRIGR Invest; Virtanen, Suvi M.; Cuthbertson, David; Nucci, Anita M.; Hyytinen, Mila; Salonen, Marja; Savilahti, Erkki; Knip, Mikael (2021)
    The international Trial to Reduce IDDM in the Genetically at Risk (TRIGR) tested the hypothesis whether extensively hydrolyzed casein-based versus regular cow's milk-based infant formula reduces the risk of type 1 diabetes. We describe dietary compliance in the trial in terms of study formula intake, feeding of nonrecommended foods, and serum cow's milk antibody concentration reflecting intake of cow's milk protein among 2,159 eligible newborn infants with a biological first-degree relative affected by type 1 diabetes and with HLA-conferred susceptibility to type 1 diabetes. The participating infants were introduced to the study formula feeding at the median age of 15 days with a median duration of study formula use of 63 days. During the intervention, 80% of the infants received study formula. Of these, 57% received study formula for at least 2 months. On average, 45.5 l of study formula were used per infant. Only 13% of the population had received a nonrecommended food by the age of 6 months. The dietary compliance was similar in the intervention and control arm. The reported cow's milk consumption by the families matched very well with measured serum casein IgA and IgG antibody concentration. To conclude, good compliance was observed in this randomized infant feeding trial. Compliance varied between the regions and those infants who were breastfed for a longer period of time had a shorter exposure to the study formula. High dietary compliance in infant feeding trial is necessary to allow accurate interpretation of study results.
  • Stolt, Suvi; Korja, Riikka; Matomaki, Jaakko; Lapinleimu, Helena; Haataja, Leena; Lehtonen, Liisa (2014)
    Background: It is not clearly understood how the quality of early mother-child interaction influences language development in very-low-birth-weight children (VLBW). Aims: We aim to analyze associations between early language and the quality of mother-child interaction, and, the predictive value of the features of early mother-child interaction on language development at 24 months of corrected age in VLBW children. Study design: A longitudinal prospective follow-up study design was used. Methods: The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother-child interaction was assessed using PC-ERA method at 6 and at 12 months of age. Results: Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother-child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly. Conclusions: The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
  • Dorenbos, Elke; Drummen, Mathijs; Adam, Tanja; Rijks, Jesse; Winkens, Bjorn; Alfredo Martinez, J.; Navas-Carretero, Santiago; Stratton, Gareth; Swindell, Nils; Stouthart, Pauline; Mackintosh, Kelly; Mcnarry, Melitta; Tremblay, Angelo; Fogelholm, Mikael; Raben, Anne; Westerterp-Plantenga, Margriet; Vreugdenhil, Anita (2021)
    Background Pubertal insulin resistance (IR) is associated with increased risk of type 2 diabetes mellitus development in adolescents with overweight/obesity. Objectives The PREVIEW study was a randomized parallel trial assessing the change in IR, analyzed by Homeostatic Model Assessment of IR (HOMA-IR), at 2 years after randomization to a high protein vs a moderate protein diet in adolescents with overweight/obesity. It was hypothesized that a high protein/low glycaemic index diet would be superior in reducing IR compared to a medium protein/medium GI diet, in insulin resistant adolescents with overweight or obesity. Methods Adolescents with overweight/obesity and IR from the Netherlands, United Kingdom and Spain were randomized into a moderate protein/moderate GI (15/55/30En% protein/carbohydrate/fat, GI >= 56) or high protein/low GI (25/45/30En% protein/carbohydrate/fat, GI < 50) diet. Anthropometric and cardiometabolic parameters, puberty, dietary intake and physical activity (PA) were measured and effects on HOMA-IR were analyzed. Results 126 adolescents were included in this study (13.6 +/- 2.2 years, BMI z-score 3.04 +/- 0.66, HOMA-IR 3.48 +/- 2.28, HP n = 68, MP n = 58). At 2 years, changes in protein intake were not significantly different between timepoints or intervention groups and no effects of the intervention on IR were observed. The retention rate was 39%, while no compliance to the diets was observed. Conclusions The PREVIEW study observed no effect of a high protein/low GI diet on IR in adolescents with overweight/obesity and IR because of lack of feasibility, due to insufficient retention and dietary compliance after 2 years.
  • Rossi, Vilma; Salimäki, Johanna; Sandler, Charlotta; Airaksinen, Marja; Kauppi, Paula (2021)
    Objectives: The objective of this study was to examine how Inhalation Technique Assessment Service (ITAS) by community pharmacies affect patients' inhalation techniques when using the Respimat (R) soft mist inhaler. The inhaler was simultaneously updated into a reusable inhaler. The study focused on the Respimat (R) inhaler because its use is known to be challenging for patients. Methods: The study was performed as a pre-post design in 33 community pharmacies (CPs) in Finland. Patients' inhalation technique was assessed before ITAS (baseline) and immediately after ITAS (follow-up 1). Follow-up 2 was performed when the patient came to the pharmacy for a refill (1-3 months after the baseline and the followup 1). A Respimat specific twenty item checklist was used to assess inhalation technique. The checklist included 1) preparation steps before the first use of the Respimat (R) inhaler (8 items) and 2) daily use steps of the Respimat (R) inhaler (12 items). After ITAS, the patients received a brief questionnaire to assess their asthma/ COPD history. Results: A total of 228 patients were enrolled at the first visit (mean age 67.8 years, 61.0% female, 85.5% had previous Respimat (R) use experience) and 42 of them attended the follow-up 2, 1-3 months later (mean age 70.1 years, 69.0% female, 92.9% had previous Respimat (R) use experience. The median number of the steps performed correctly increased from 17/20 at the baseline to all the 20 steps at the follow-up 1 (p < 0.001). At the baseline, 27.6% of the patients (n = 228) performed all preparation steps correctly, while 87.3% at the follow-up 1 and 71.4% at the follow-up 2. The percentage of the patients with acceptable inhalation technique (all critical daily use steps correct) increased from 69.7% at the baseline to 93.0% at the follow-up 1 (p < 0.001). The corresponding figure at the follow-up 2 was 69.0%. At the baseline, 30.3% of patients had optimal inhalation technique (all daily use steps correct). At the follow-up 1 corresponding figure was 85.1%, and 54.8% at the followup 2. Conclusions: A pharmacist-led intervention significantly improved asthma and COPD patients' inhalation technique with the Respimat (R) inhaler. Significant improvements were found in the daily use steps and the preparation steps before the first use.
  • Markkula, N.; Lehti, V.; Adhikari, P.; Pena, S.; Heliste, J.; Mikkonen, E.; Rautanen, M.; Salama, E.; Guragain, B. (2019)
    Background. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. Methods. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35-60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. Results. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4-50.4)]. The difference in BDI scores at T2 between PSY and EUC was -7.43 (95% CI -9.71 to -5.14). Conclusions. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.
  • Toija, Anu Susanna; Kettunen, Tarja Helena; Leidenius, Marjut Hannele Kristiina; Vainiola, Tarja Hellin Kaarina; Roine, Risto Paavo Antero (2019)
    PurposeBreast cancer is the most common cancer of Finnish women. Peer support could be a way to help breast cancer patients to deal with the disease but studies on its effectiveness have produced conflicting results. The aim of this randomized controlled trial was to study the effectiveness of peer support on health-related quality of life (HRQoL) of breast cancer patients.MethodsPatients with recently diagnosed breast cancer at the Helsinki University Hospital were randomly allocated to intervention (n=130) or control (n=130) groups. The intervention group patients received peer support via telephone one to five times according to their preference. The control group received usual care only. HRQoL was assessed with generic (15D) and disease-specific (EORTC QLQ-30 and its breast cancer specific module BR23) instruments at baseline and at 3-, 6-, and 12-month follow-up points.ResultsThe mean (SD) age of the patients was 60.0 (10.5) years and their baseline mean 15D score 0.922 (0.066). At baseline, the intervention and control groups did not differ from each other. During follow-up, the 15D score deteriorated statistically significantly (p
  • Liimatta, Heini; Lampela, Pekka; Laitinen-Parkkonen, Pirjo; Pitkälä, Kaisu H. (2019)
    Objective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. Design: A randomised controlled trial. Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. Setting: Hyvinkaa town municipality, Finland. Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.
  • Mustonen, Erja; Hörhammer, Iiris; Patja, Kristiina; Absetz, Pilvikki; Lammintakanen, Johanna; Talja, Martti; Kuronen, Risto; Linna, Miika (2021)
    Background: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). Methods: 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis. Results: The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study. Conclusions: No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching. Trial registration: NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009).
  • Tuominen, L; Ritmala-Castren, M; Nikander, P; Makela, S; Vahlberg, T; Leino-Kilpi, H (2021)
    Background: Chemotherapy-induced side effects may have a negative effect on nutrition intake, thus increasing the risk of malnutrition and consequently, other serious complications for patients with cancer. The prevalence of malnutrition is common among patients with colorectal cancer. Nurse-led empowering education may have a positive effect on self-care activity in this patient group. Therefore, our purpose is to develop an empowering educational nursing intervention and test its effect on self-care activation and knowledge level among patients with colorectal cancer during chemotherapy. Secondary outcomes are quality of life and risk of malnutrition. Methods: An interdisciplinary expert group developed a face-to-face empowering educational intervention using teach-back method. A two-arm, single-centre, superiority trial with stratified randomisation (1:1) and pre-post measures will be used to assess the effect of the intervention compared to standard care. Patients (N = 40 + 40) will be recruited in one university hospital outpatient clinic in Finland. Eligibility criteria are adult patients diagnosed with colorectal cancer starting oral fluoropyrimidine or combination chemotherapy treatment. A registered nurse experienced in oncology will deliver the intervention 2 weeks after the first chemotherapy. Outcomes are measured before intervention (M0) and after a two-month follow-up period (M1). Discussion: This study will assess whether nurse-led empowering education using teach-back method is effective on self-care activity among patients with colorectal cancer. If the intervention has a positive effect, it may be implemented into patient education in a corresponding context.
  • Nurmi, Johanna; Knittle, Keegan; Ginchev, Todor; Khattak, Fida; Helf, Christopher; Zwickl, Patrick; Castellano-Tejedor, Carmina; Lusilla-Palacios, Pilar; Costa-Requena, Jose; Ravaja, Niklas; Haukkala, Ari (2020)
    Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. KEYWORDS health app; mHealth; human-computer interaction; prevention; service design; usability design; intrinsic motivation; reflective processes; spontaneous processes; engagement; self-determination theory; autonomous motivation; gamification; physical activity