uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 159) Show all publications
Kohi, T. W., von Essen, L., Masika, G. M., Gottvall, M. & Dol, J. (2019). Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: A qualitative study. BMC Cancer, 19(82)
Open this publication in new window or tab >>Cancer-related concerns and needs among young adults and children on cancer treatment in Tanzania: A qualitative study
Show others...
2019 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 19, no 82Article in journal (Refereed) Published
Abstract [en]

Background: Cancer is one of the leading causes of morbidity and mortality worldwide. Seventy percent of deaths of cancer occur in low or middle-income countries, where the resources to provide cancer treatment and care are minimal. Tanzania currently has very inadequate facilities for cancer treatment as there are only five sites, some with limited services; two are in Dar es Salaam and one each in Mwanza, Kilimanjaro and Mbeya that offer cancer treatment. Despite cancer being a prevalent problem in Tanzania, there is a significant shortage of information on the experiences of young people who receive cancer treatment and care. The aim of this study was to explore cancer-related concerns and needs of care and support among young adults and children who are receiving cancer treatment in Dar es Salaam, Tanzania.

Methods: Using an explorative, qualitative design, two focus group discussions (FGDs) with young adults (18 to 25 years) and four FGDs with children (9 to 17 years) were held. Data were transcribed into English and analyzed using content analysis.

Results: Identified concerns included physical effects, emotional effects, financial impacts, poor early care, and poor treatment. Identified needs included the need for improved care in hospital by the staff, need for community support, financial needs, needs for improved cancer care and treatment in the hospitals, and the need for increased education about cancer. Resilience was identified, particularly around hope or faith, having hope to be healed, and receiving good care from staff.

Conclusion: Young adults and children receiving cancer treatment in Tanzania have many needs and concerns. Improvements with regard to the care provided in hospital by the staff, the cancer care and treatment in the hospital, and population-wide education about cancer are necessary to address the identified needs and concerns. Further studies on specific approaches to address the concerns and needs are also warranted.

Keywords
Cancer, children, young adults, cancer treatment, Tanzania
National Category
Pediatrics Cancer and Oncology
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-371465 (URN)10.1186/s12885-019-5279-z (DOI)000455986800003 ()30654794 (PubMedID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2019-02-05Bibliographically approved
Masika, G. M., Gottvall, M., Kohi, T. W., von Essen, L. & Dol, J. S. (2019). Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study. Cancer Nursing
Open this publication in new window or tab >>Concerns and Needs of Support Among Guardians of Children on Cancer Treatment in Dar es Salaam: A Qualitative Study
Show others...
2019 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cancer in children in Tanzania is a concerning health issue, yet there is a shortage of information about the experiences of the guardians of children who receive cancer treatment.

OBJECTIVE: To explore concerns and needs of support among guardians of children on cancer treatment in Dar es Salaam, Tanzania.

METHOD: Using a qualitative design, 3 focus group discussions were held with 22 guardians of children aged 9 to 17 years. Guardians were recruited from Muhimbili National Hospital, Dar es Salaam, where their children were receiving cancer treatment. Data were analyzed using thematic content analysis.

RESULTS: Guardians experienced several issues during the initial stages of their child's cancer treatment, including the process of seeking a diagnosis, and experiences with care at the peripheral (regional) hospitals and national hospital. They also shared what they felt would lessen their difficult experiences. Seven themes emerged in this study: financial concerns, emotional concerns, barriers to cancer care, need for improved cancer care, need for information, need for tangible support, and gratitude and hope.

CONCLUSION: Guardians of children with cancer experience challenges during initial stages when seeking a diagnosis and have concerns and needs related to cancer care and treatment.

IMPLICATIONS FOR PRACTICE: Improvements are needed regarding care at regional hospitals, the cancer diagnosis, and the recognition of early signs of cancer and quick referral to diagnostic centers, compassionate caring behaviors by healthcare workers, budgetary support from the government to meet the medication supply demands, and meeting stakeholders' support needs.

Keywords
Concerns, guardians, needs, pediatric cancer, Tanzania
National Category
Nursing
Research subject
Oncology; Pediatrics; Caring Sciences
Identifiers
urn:nbn:se:uu:diva-390727 (URN)10.1097/NCC.0000000000000722 (DOI)31107702 (PubMedID)
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14
Carlsson, T., Kukkola, L., Ljungman, L., Hovén, E. & von Essen, L. (2019). Psychological distress in parents of children treated for cancer: An explorative study. PLoS ONE, 14(6), Article ID e0218860.
Open this publication in new window or tab >>Psychological distress in parents of children treated for cancer: An explorative study
Show others...
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, article id e0218860Article in journal (Refereed) Published
Abstract [en]

Objective

To explore psychological distress experienced by parents who express a need for psychotherapy after curative treatment for their child’s cancer.

Methods

15 parents (eight mothers and seven fathers) of children treated for cancer (median time since end of curative treatment: two years) were recruited via a pediatric oncology center. Each parent was interviewed twice and data was analyzed with inductive latent qualitative content analysis.

Results

Two overarching themes emerged. One theme, An unfamiliar and frightening situation during treatment, portrayed experiences during the treatment period, and included the sub-themes Initial reactions to the uncontrollable situation, Adjustment to the situation, and Focus on supporting the child. Another theme, Emotional struggles after end of curative treatment, portrayed experiences following curative treatment, and included the sub-themes Transitioning back to life as it was before the diagnosis, Emotional scars, Uncontrollable fears and worries of diseases, and New perspectives on life.

Conclusions

Parents of children with cancer experience existential, physical, psychological, and social struggles. They describe an unstable situation after diagnosis and having focused their attention towards protecting their child during treatment. After the end of curative treatment, they experience challenges with transitioning back to life as it was before the diagnosis and dealing with their own emotional scars and fears related to the child’s cancer. The findings indicate an unmet need for psychological support among parents of children treated for cancer.

National Category
Psychology Cancer and Oncology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-390743 (URN)10.1371/journal.pone.0218860 (DOI)31226159 (PubMedID)
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14
Ljungman, L., Cernvall, M., Ghaderi, A., Ljungman, G., von Essen, L. & Ljótsson, B. (2018). An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization. PeerJ, 6, Article ID e4570.
Open this publication in new window or tab >>An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization
Show others...
2018 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 6, article id e4570Article in journal (Refereed) Published
Abstract [en]

Objective

A subgroup of parents of children who have been treated for childhood cancer report high levels of psychological distress. To date there is no empirically supported psychological treatment targeting cancer-related psychological distress in this population. The aim of the current study was to test the feasibility and preliminarily evaluate the effect of individualized face-to-face cognitive behavior therapy (CBT) for parents of children after the end of treatment for childhood cancer. A secondary aim was to present a cognitive behavioral conceptualization of cancer-related distress for these parents.

Methods

An open trial was conducted where 15 parents of children who had completed successful treatment for cancer three months to five years earlier and who reported psychological distress related to a child’s previous cancer disease were provided CBT at a maximum of 15 sessions. Participants were assessed at baseline, post-intervention, and three-month follow-up using self-reported psychological distress (including posttraumatic stress symptoms (PTSS), depression, and anxiety) and the diagnostic Mini-International Neuropsychiatric Interview. Feasibility outcomes relating to recruitment, data collection, and delivery of the treatment were also examined. Individual case formulations for each participant guided the intervention and these were aggregated and presented in a conceptualization detailing core symptoms and their suggested maintenance mechanisms.

Results

A total of 93% of the participants completed the treatment and all of them completed the follow-up assessment. From baseline to post-assessment, parents reported significant improvements in PTSS, depression, and anxiety with medium to large effect sizes (Cohen’s d = 0.65–0.92). Results were maintained or improved at a three-month follow-up. At baseline, seven (47%) participants fulfilled the diagnostic criteria for major depressive disorder and four (29%) fulfilled the criteria for posttraumatic stress disorder, compared to none at a post-assessment and a follow-up assessment. The resulting cognitive behavioral conceptualization suggests traumatic stress and depression as the core features of distress, and avoidance and inactivity is suggested as the core maintenance mechanisms.

Conclusion

The treatment was feasible and acceptable to the participants. Significant improvements in distress were observed during the study. Overall, results suggest that the psychological treatment for parents of children after end of treatment for childhood cancer used in the current study is promising and should be tested and evaluated in future studies.

National Category
Cancer and Oncology Psychology
Identifiers
urn:nbn:se:uu:diva-349407 (URN)10.7717/peerj.4570 (DOI)000429852600001 ()29666751 (PubMedID)
Funder
Swedish Research Council, VR521-2010-3042; VR521-2014-3337Swedish Cancer Society, CAN2013/580;CAN2014/613
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-19Bibliographically approved
Woodford, J., Wikman, A., Einhorn, K., Cernvall, M., Grönqvist, H., Romppala, A. & von Essen, L. (2018). Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer: Web-Based Survey. Journal of Medical Internet Research, 5(4), Article ID e10085.
Open this publication in new window or tab >>Attitudes and Preferences Toward a Hypothetical Trial of an Internet-Administered Psychological Intervention for Parents of Children Treated for Cancer: Web-Based Survey
Show others...
2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 5, no 4, article id e10085Article in journal (Refereed) Published
Abstract [en]

Background:

Clinical trials are often challenged with issues of recruitment and retention. Little is known concerning general attitudes and preferences toward trial design and willingness to participate among parents of children treated for cancer. Furthermore, willingness to participate in internet-administered psychological interventions remains unexplored. In this study, we examined attitudes and preferences of the population regarding study procedures for a hypothetical trial of an internet-administered psychological intervention. In addition, differences in the response rate between modes of study invitation and willingness to engage in internet-administered interventions were examined.

Objective:

The primary objective of this study was to examine attitudes and preferences toward participating in an internet-administrated psychological intervention. The secondary objective was to examine the response rates and help-seeking behavior among parents of children treated for cancer.

Methods:

A cross-sectional, Web-based survey was conducted with parents of children who had completed cancer treatment. This Web-based survey examined self-reported emotional distress, prior help-seeking and receipt of psychological support, past research participation, attitudes toward research, preferences concerning recruitment procedures, and attitudes toward different types of trial design.

Results:

Of all the parents invited, 32.0% (112/350) completed the survey, with no difference in response rate between modes of study invitation (χ21=0.6, P=.45). The majority (80/112, 71.4%) of parents responded that they had experienced past emotional distress. Responses indicated high (56/112, 50.0%) or somewhat high trust in research (51/112, 45.5%), and the majority of parents would accept, or maybe accept, internet-administered psychological support if offered (83/112, 74.1%). In addition, responses showed a preference for postal study invitation letters (86/112, 76.8%), sent by a researcher (84/112, 75.0%) with additional study information provided on the Web via text (81/112, 72.3%) and video (66/112, 58.9%). Overall, parents responded that trials utilizing a waiting list control, active alternative treatment control, or a patient-preference design were acceptable.

Conclusions:

Parents of children treated for cancer appear willing to participate in trials examining internet-administered psychological support. Findings of this study will inform the design of a feasibility trial examining internet-administered psychological support for the population.

Keywords
Cancer, Parents, eHealth, Clinical Trial, Depression, Anxiety
National Category
Health Sciences Clinical Medicine Psychology
Research subject
Psychology; Health Care Research
Identifiers
urn:nbn:se:uu:diva-357971 (URN)10.2196/10085 (DOI)000453827700001 ()
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-09-10Bibliographically approved
Wikman, A., Kukkola, L., Börjesson, H., Cernvall, M., Woodford, J., Grönqvist, H. & von Essen, L. (2018). Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach. Journal of Medical Internet Research, 20(4), Article ID e133.
Open this publication in new window or tab >>Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach
Show others...
2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 4, article id e133Article in journal (Refereed) Published
Abstract [en]

Background: Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child’s cancer disease after end of treatment.

Objective: One aim of this study was to develop an internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention.

Methods: Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection.

Results: A 10-week, internet-administered, cognitive behavior therapy–based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in future studies testing and evaluating the intervention were discussed; consensus was not reached for all aspects.

Conclusions: To the best of our knowledge, this study is the first use of a participatory action research approach to develop a psychological intervention for parents of children previously treated for cancer and to identify acceptable study procedures. Involvement of parents with lived experience was vital in the development of a potentially relevant and acceptable intervention for this population.

Keywords
cognitive therapy; psychology, clinical; e-therapy; community participation; Sweden
National Category
Psychology Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-349408 (URN)10.2196/jmir.9457 (DOI)000430392800001 ()29669710 (PubMedID)
Funder
Swedish Research Council, K2015-99X-20836-08-4Swedish Cancer Society, 140790
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-19Bibliographically approved
Ander, M., Thorsell Cederberg, J., von Essen, L. & Hovén, E. (2018). Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support. PLoS ONE, 13(4), Article ID e0195899.
Open this publication in new window or tab >>Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195899Article in journal (Refereed) Published
Abstract [en]

Objective

In this qualitative study, we aimed to provide an in-depth exploration of cancer-related psychological distress experienced by young survivors of cancer during adolescence reporting a need for psychological support.

Methods

Two individual interviews were held with ten young survivors of cancer diagnosed in adolescence. The interviews were audio-recorded and transcribed verbatim. Analysis followed the guidelines for inductive qualitative manifest content analysis.

Results

The survivors described distress experienced during and after the end of treatment. Five categories comprising 14 subcategories were generated. The categories included: A tough treatment, Marked and hindered, Not feeling good enough, Struggling with the fragility of life, and finally, An ongoing battle with emotions.

Conclusion

Young survivors of adolescent cancer reporting a need for psychological support described feeling physically, socially, and mentally marked by the cancer experience. They struggled with powerlessness, insecurity, social disconnection, loneliness, and feelings of being unimportant and a failure, and had difficulties understanding and managing their experiences. These concerns should be addressed in psychological treatments for the population irrespective of which approach or model is used to understand survivors’ difficulties. A transdiagnostic approach targeting processes that underpin different manifestations of distress may be effective.

Keywords
adolescence, cancer, psychological distress, psychological treatment, survivorship, qualitative methods
National Category
Psychology Cancer and Oncology
Research subject
Medical Science; Psychology
Identifiers
urn:nbn:se:uu:diva-330127 (URN)10.1371/journal.pone.0195899 (DOI)000430262300041 ()29664926 (PubMedID)
Funder
U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish ExampleSwedish Childhood Cancer Foundation, 2013-0039; 2016-0004Swedish Research Council
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-06-26Bibliographically approved
Wiman, H., Ander, M., Woodford, J., Hasselblad, T., Grönqvist, H., Ljungman, G., . . . von Essen, L. (2018). Guided Internet-Administered Self-Help to Reduce Symptoms of Anxiety and Depression Among Adolescents and Young Adults Diagnosed with Cancer During Adolescence: Lessons Learned. Paper presented at 50th congress of the International Society of Paediatric Oncology (SIOP), November 16-19, 2018, Kyoto, Japan.. Pediatric Blood & Cancer, 65(suppl.2), S597-S597
Open this publication in new window or tab >>Guided Internet-Administered Self-Help to Reduce Symptoms of Anxiety and Depression Among Adolescents and Young Adults Diagnosed with Cancer During Adolescence: Lessons Learned
Show others...
2018 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 65, no suppl.2, p. S597-S597Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2018
National Category
Cancer and Oncology Hematology Pediatrics
Identifiers
urn:nbn:se:uu:diva-365107 (URN)000445195005115 ()
Conference
50th congress of the International Society of Paediatric Oncology (SIOP), November 16-19, 2018, Kyoto, Japan.
Available from: 2018-11-16 Created: 2018-11-16 Last updated: 2018-11-16Bibliographically approved
Norlund, F., Wallin, E., Olsson, E., Wallert, J., Burell, G., von Essen, L. & Held, C. (2018). Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial. Journal of Medical Internet Research, 20(3), Article ID e88.
Open this publication in new window or tab >>Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
Show others...
2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 3, article id e88Article in journal (Refereed) Published
Abstract [en]

Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitivebehavioral therapy (iCBT) has shown good results in other patient groups.

Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms ofdepression and anxiety among patients with a recent MI.

Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided,14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients.The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessedover the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For themain analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.

Results: There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no differencebetween the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of46.2% (54/117) of the iCBT group did not complete the introductory module.

Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety comparedwith TAU. Low treatment adherence might have influenced the result.

Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webciteat http://www.webcitation.org/6xWWSEQ22)

National Category
Psychology Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-336209 (URN)10.2196/jmir.9710 (DOI)000428245500002 ()25873137 (PubMedID)
Funder
Swedish Research Council, dnr 2009-1093Swedish Heart Lung Foundation, dnr E 148/11Forte, Swedish Research Council for Health, Working Life and Welfare, dnr 2014-4947Vårdal Foundation, dnr 2014-0114
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-07-24Bibliographically approved
Wallert, J., Gustafson, E., Held, C., Madison, G., Norlund, F., von Essen, L. & Olsson, E. (2018). Predicting Adherence to Internet-Delivered Psychotherapy for Symptoms of Depression and Anxiety After Myocardial Infarction: Machine Learning Insights From the U-CARE Heart Randomized Controlled Trial. Journal of Medical Internet Research, 20(10), Article ID e10754.
Open this publication in new window or tab >>Predicting Adherence to Internet-Delivered Psychotherapy for Symptoms of Depression and Anxiety After Myocardial Infarction: Machine Learning Insights From the U-CARE Heart Randomized Controlled Trial
Show others...
2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 10, article id e10754Article in journal (Refereed) Published
Abstract [en]

Background: Low adherence to recommended treatments is a multifactorial problem for patients in rehabilitation after myocardial infarction (MI). In a nationwide trial of internet-delivered cognitive behavior therapy (iCBT) for the high-risk subgroup of patients with MI also reporting symptoms of anxiety, depression, or both (MI-ANXDEP), adherence was low. Since low adherence to psychotherapy leads to a waste of therapeutic resources and risky treatment abortion in MI-ANXDEP patients, identifying early predictors for adherence is potentially valuable for effective targeted care.

Objectives: The goal of the research was to use supervised machine learning to investigate both established and novel predictors for iCBT adherence in MI-ANXDEP patients.

Methods: Data were from 90 MI-ANXDEP patients recruited from 25 hospitals in Sweden and randomized to treatment in the iCBT trial Uppsala University Psychosocial Care Programme (U-CARE) Heart study. Time point of prediction was at completion of the first homework assignment. Adherence was defined as having completed more than 2 homework assignments within the 14-week treatment period. A supervised machine learning procedure was applied to identify the most potent predictors for adherence available at the first treatment session from a range of demographic, clinical, psychometric, and linguistic predictors. The internal binary classifier was a random forest model within a 3×10–fold cross-validated recursive feature elimination (RFE) resampling which selected the final predictor subset that best differentiated adherers versus nonadherers.

Results: Patient mean age was 58.4 years (SD 9.4), 62% (56/90) were men, and 48% (43/90) were adherent. Out of the 34 potential predictors for adherence, RFE selected an optimal subset of 56% (19/34; Accuracy 0.64, 95% CI 0.61-0.68, P<.001). The strongest predictors for adherence were, in order of importance, (1) self-assessed cardiac-related fear, (2) sex, and (3) the number of words the patient used to answer the first homework assignment.

Conclusions: For developing and testing effective iCBT interventions, investigating factors that predict adherence is important. Adherence to iCBT for MI-ANXDEP patients in the U-CARE Heart trial was best predicted by cardiac-related fear and sex, consistent with previous research, but also by novel linguistic predictors from written patient behavior which conceivably indicate verbal ability or therapeutic alliance. Future research should investigate potential causal mechanisms and seek to determine what underlying constructs the linguistic predictors tap into. Whether these findings replicate for other interventions outside of Sweden, in larger samples, and for patients with other conditions who are offered iCBT should also be investigated.

Place, publisher, year, edition, pages
Air University Press, 2018
Keywords
Applied predictive modeling, cardiac rehabilitation, linguistics, supervised machine learning, recursive feature elimination, treatment adherence and compliance, Web-based interventions
National Category
Cardiac and Cardiovascular Systems Health Care Service and Management, Health Policy and Services and Health Economy Applied Psychology
Research subject
Health Care Research; Psychology
Identifiers
urn:nbn:se:uu:diva-357964 (URN)10.2196/10754 (DOI)000446936700001 ()30305255 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947Vårdal Foundation, 2014-0114U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example, 2009-1093
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-06-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5816-7231

Search in DiVA

Show all publications