Research Project

Project Onward: e-Health Intervention for Cancer Survivors

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Principal Investigator:  David C. Mohr, Ph.D. 

Funded by:  P30 CA60553-16 (PI: Rosen)

The time of transition from active treatment to survivorship for cancer patients has been identified as a time of high risk for depression and anxiety. We have designed, constructed, and are testing a prototype of an online intervention, Onward, that integrates an individual Internet intervention with an Internet support group for the treatment of depression among cancer survivors during their transition to survivorship. Based on two theoretical models: Supportive Accountability, and Online Collaborative Learning; Onward was designed to enhance adherence and improve learning of self-management skills. Supportive Accountability suggests that patients are more likely to adhere to and use an eHealth intervention if they know that they will have to account for their use or non-use at a future date. The Onward intervention website is engineered to maximize patient-to-patient interactions that foster supportive accountability and increase adherence. We have harnessed well-supported models of Online Collaborative Learning to design functionality that supports intersubjective or group cognitive processes that can enhance learning.

Mobile Support for Rural Mental Health in Zimbabwe

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Principal Investigator:  Dixon Chibanda, M.D., M.P.H.

Funded by: Grand Challenges Canada

Over 30% of people utilizing primary health care facilities in Zimbabwe suffer from common mental disorders, mostly depression and anxiety. Despite the lack of professional human resources in health, there are tens of thousands of lay health workers constituting a vital resource that can potentially significantly improve the health status of Zimbabweans, if empowered and supported appropriately. A recent pilot study tested the feasibility of The Friendship Bench program, a task shifted brief intervention delivered by supervised lay health workers who have received training in problem solving therapy and behavior activation. This study will test Bench with added technological platforms, such as tablets and mobile phones, to enhance supervision and support of the workers. The project has 3 phases; phase 1 seeks to refine and enhance the existing intervention and test methodological aspects of the trial; phase 2 will test the effectiveness and cost-effectiveness of this intervention, compared to enhanced usual care; phase 3 will involve scaling up of the intervention.

Using Care Managers and Technology to Improve the Care of Patients with Schizophrenia

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Principal Investigator: Dror Ben-Zeev, Ph.D.

Funded by:  ?

The goal of this project is to develop and conduct a field trial of a mobile Self-Management of Schizophrenia system that will use illness management strategies to target persistent symptoms of psychosis, social dysfunction, poor medication adherence, sleep disturbances and mood dysregulation, with the ultimate objective of creating a widely available tool that can be deployed by users as needed, in their own environments.

Mobile Application to Monitor Stress and Improve Coping in Veterans

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Principal Investigator:  Dror Ben-Zeev, Ph.D.

Funded by:  ?

This project aims to deploy smartphones with psychotherapeutic applications to both consumers and providers learning to specialize in interventions for veterans with serious mental illness (SMI) that seek care in community-based mental health agencies. If successful, this project will introduce an innovative mobile intervention program model that can be implemented in a wide range of community programs, providing scaffolding and support for consumer/provider therapeutic alliance, facilitating dissemination of brief evidence-based psychosocial interventions, and improving assessment and clinical care of individuals with SMI living in the community. 

A Mobile Technology Based (Smartphone) Intervention To Improve Adherence To Antipsychotic Medications

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Principal Investigator:  Julie A. Kreyenbuhl, Pharm. D., Ph.D.

Funded by:  R34MH094555-01

Up to 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, which can lead to symptom relapse, decreased functioning, hospitalization, and increased healthcare costs. A variety of internet- and mobile phone-based applications have been developed to improve health outcomes, such as medication adherence, for a number of medical and psychiatric disorders. However, no such applications have been developed for individuals with schizophrenia. We will develop and test an ecological momentary intervention (EMI), which is integrated into an individual’s daily life to improve antipsychotic adherence. Primary features of the EMI that will be installed on mobile SmartPhones include: an interactive tool that provides individuals reminders to take their medications as prescribed, asks them about their intent to take their medication or not, collects real-time psychiatric symptom and side effect data that can be view by themselves as well as by their clinicians, and provides them with the capability of communicating with their clinicians about problems they may be experiencing with their medications. Our goal for the EMI is to evaluate if there is an improvement in antipsychotic adherence as well as if the individuals’ psychotic symptoms and neuropsychological functioning correlate with the use of the program and its overall acceptability by individuals. Completion of this developmental study will enable us to develop and refine the research strategies to be utilized in a subsequent larger-scale study of the intervention.

Sun Protection Internet-based Program for Kidney Transplant Recipients

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Principal Investigator:  June K. Robinson, M.D.

Funded by:  R21

The goal of this proposal is to develop a sun protection educational program for kidney transplant recipients (KTRs) to prevent skin cancer. Kidney transplantation is the treatment of choice for patients with end-stage kidney disease; however, the requisite lifelong immunosuppressive therapy is associated with developing skin cancer, both melanoma and squamous cell carcinoma (SCC). Our hypothesis is that personalizing the sun protection message for each KTR delivered at the time when the KTR begins to feel better and starts seeking outdoor activity will increase use of sun protection, reduce the number of sunburns and limit pigment darkening. The proposed study develops culturally sensitive sun protection educational materials for KTRs. We will evaluate the effectiveness of the tablet educational modules and the booster text messages among English speaking White, Hispanic, and Black KTRs and evaluate the intervention in a randomized controlled trial. Our specific aims are to: 1) Develop culturally sensitive educational materials with the use of technology and 2) Conduct a randomized controlled trial to evaluate the effectiveness of the educational program.

Targeted eHealth Intervention to Reduce Fear of Recurrence Among Cancer Survivors

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Principal Investigator:  Lynne I. Wagner, Ph.D.

Funded by:  R21

The overall objective of this research proposal is to develop and evaluate a targeted eHealth intervention to reduce fear of cancer recurrence (FoR) among breast cancer survivors using an innovative methodological and delivery approach. Long-term cancer survivors have identified managing FoR as their most pressing unmet need. Conceptually, FoR is multi-dimensional with emotional (fear, anxiety) and cognitive (worry, preoccupation, intrusive thoughts) components. Psychosocial resources, including coping strategies and self- efficacy, are required to process FoR triggers and are a key determinant in FoR severity. Most extensively documented among breast cancer survivors, clinically significant FoR is prevalent (24-56%), lasts for years after cancer treatment, and has negative emotional and behavioral consequences. Even at low to moderate levels, FoR is positively associated with generalized anxiety, depression, symptom burden and quality of life impairments. eHealth interventions have the potential to address this salient and distressing concern through teaching coping strategies to bolster survivor’s psychosocial resources, yet these novel approaches have not been explored. Aim 1 is to develop and refine FoRtitude, a targeted FoR eHealth intervention. We will build FoRtitude based on our prior work with the Northwestern University Center for Behavioral Intervention Technologies (CBITs) developing a web-based program for cancer survivors. Intervention components will include three FoR-specific coping strategy modules and telephone coaching, targeting psychosocial resources. We will pilot FoRtitude with breast cancer survivors (n=25) to collect qualitative data on intervention content and design which will be used to refine the intervention. Aim 2 is to conduct a randomized trial to evaluate the effects of four intervention components on FoR among breast cancer survivors (n=144). The Multiphase Optimization Strategy (MOST) is a novel, innovative methodological approach for building and optimizing behavioral interventions. We will use this approach to guide our research aims and design. The MOST framework allows us to evaluate our intervention components with enough statistical power to detect significant effects on FoR, our primary outcome. Five NCI-designated Community Clinical Oncology Programs (CCOPs) will serve as recruitment sites. We will also recruit from our institution, the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Using the MOST framework, results will be used to identify effective intervention components for inclusion in a large-scale confirmatory trial to be conducted through the Eastern Cooperative Oncology Group. Our findings will produce an evidence-based targeted FoR intervention that can be widely disseminated among cancer survivors at relatively low cost and in doing so, will contribute to improving quality of cancer survivorship for this growing population.

Mobile Support for Treatment of Depression in Primary Care in Nigeria

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Principal Investigator:  Oye Gureje, Ph.D.

Funded by:  Grand Challenges Canada

Depression in the perinatal period is common and is associated with considerable disability and negative outcomes both for the mother and the infant. Attempts to deliver needed service to these women must be suitable for use by non-physician community health workers (including midwives and nurses) who routinely attend to expectant and nursing mothers. This research program includes an intervention package designed for use in the extant health system in Nigeria (as well as in other sub-Saharan countries with similar health system constraints) that will test its efficiency and cost-effectiveness for perinatal depression delivered by community midwives supported and supervised by general physicians (and specialists whenever available) using modern technology, including mobile telephones. The implementation package will be informed by the results of a randomized controlled trial (in which the package is compared to care as usual) and further qualitative study to make it ready for scaling up to routine care.

Heart To HAART: Smartphone Intervention To Improve HAART Adherence For Drug Users

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Principal Investigator:  Seth S. Himelhoch, M.D., M.P.H.

Funded by:   R34DA032411-01

Sustained medication adherence is critical to reducing HIV-related morbidity and mortality. Individuals who use drugs have greater difficulty adhering to Highly Active Antiretroviral Therapy (HAART) compared to non-drug users. The goal of this study is to use the stage model of behavioral therapy research to adapt, further develop, and test a smart phone based intervention called HEART (Helping Enhance Adherence to Retroviral therapy using Technology) to HAART, to enhance, promote and improve long-term adherence to HAART among HIV infected drug users in the non-methadone maintenance setting. If shown to be acceptable and effective, HEART to HAART will introduce a fundamentally new method of HAART medication self-management and provide a tailored, potentially sustainable, and less cost-intensive intervention that can increase adherence among HIV infected drug users over the long term.

Automated Text Messaging to Improve Depression Treatment in Low-Income Settings

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Principal Investigator:  Adrian Aguilera, Ph.D.

Funded by:  K23MH094442

Poor adherence to depression treatments (psychotherapy and pharmacotherapy) limits their effectiveness in community settings. Problems with adherence are especially pronounced in low-income settings. Innovative and cost-effective methods are needed to improve adherence to treatments and maximize mental health resources. Mobile phone based text messaging (or short messaging service: SMS) is a ubiquitous technology that has been used in various health applications across socioeconomic status. This technology has the potential to increase the fidelity of mental health treatments via increased adherence. The proposed research project will test whether adding an automated SMS adjunct to group cognitive behavioral therapy (CBT) for depression can increase adherence (homework adherence, attendance, medication adherence) and further reduce depression symptoms. The SMS adjunct will 1) prompt patients to monitor mood, thoughts and behaviors, 2) will provide medication and appointment reminders and 3) will send CBT based tips. The information that patients provide will be used within the clinical setting to highlight interrelations between thoughts, behaviors and symptoms.