Objectives Participation in the Netherlands' three national cancer screening programs (breast, cervical, colorectal) is generally declining, especially among underserved populations. This study aimed to improve the official invitation letters distributed to eligible individuals by the National Health Screening Organization, in collaboration with the National Institute for Public Health and the Environment, thereby supporting informed decision-making about participation in the national screening programs. Two revised invitation letters were developed based on recommendation derived from previous research, aimed at improving design and communication. Methods Usability testing was conducted among 27 Dutch adults (aged 30–75): approximately two-thirds of whom had a lower level of education, lower socioeconomic status, or a migration background. Participants reviewed the two revised invitation letters either online or in person and provided feedback through semi-structured interviews and using the think-aloud method. Responses were qualitatively analyzed, using the framework method, cluster analysis and mind mapping, to identify and structure key themes. Results Participants found the revised letters clearer, more concise, and better structured than the original letters. Bolded key information and accessible contact details were appreciated and evaluated as means to ease access and comprehension. Icons generally did not improve the understandability of the letters and were considered unnecessary. Additionally, participants suggested adopting a more personal tone and adding information about the benefits of screening. Conclusion Our findings show that co-creating revised screening invitation letters with end users improves clarity and accessibility, supporting informed decision-making and more inclusive public health communication. Innovation This research is innovative by co-creating cancer screening invitation letters with end-users, especially those among underserved groups, and led to several participant-driven improvements which will be adopted in the national population-based cancer screening program.
Objective:This study explored how patients, care partners, and healthcare professionals perceive an autonomous Magnetic Resonance Imaging (MRI) scanning system in which individuals perform their own brain scans and images are interpreted using Artificial Intelligence (AI) for early detection and monitoring of brain-related conditions. Methods:Semi-structured interviews were conducted with patients (n = 11), care partners (n = 5), and healthcare professionals (n = 18). Data were coded using the Theoretical Domains Framework (TDF). Results:Twelve of fourteen TDF domains were found relevant. Knowledge and communication were key facilitators for confidence and trust. Participants emphasised the need for clear, step-by-step information before and during the scan. Concerns focused on patients' ability to manage scanning independently, the absence of on-site staff in emergencies, and the transparency and accountability of AI. Patients valued convenience, while professionals highlighted early detection and efficiency as primary benefits. Conclusion:Trust in autonomous MRI depends on clear communication and education, and clarity about human oversight and responsibility. Innovation:Our findings show the relevance of combining technological innovation with human-centred communication. Integrating effective communication strategies and educational materials, such as visual and interactive instructions, can empower patients and professionals and support the adoption of autonomous MRI in healthcare practice, making neuroimaging more accessible while maintaining safety and quality.
Objective The emotional and ethical experiences of Medical Laboratory Assistants (MLAs) during challenging patient phlebotomy encounters is largely unknown. This study identified verbal and non-verbal strategies used by MLAs and explored how they navigate systemic and interpersonal pressures during patient resistance. Methods We held four online focus groups with 12 MLAs working in hospital and community settings in Alberta, Canada. Transcripts were analyzed using a combined inductive and deductive thematic analysis guided by the Framework method. Results Participants described using plain-language explanations, distraction, translation resources, and support to facilitate phlebotomy involving pediatric patients, cognitive impairment, and language barriers. When these strategies failed, restraint was described as a last resort. These accounts suggest that escalation occurred within perceived constraints on authority and under pressure, rather than a preferred course of action. Conclusion Phlebotomy communication challenges are ethically and relationally complex. MLAs describe balancing procedural demands with patient assent under conditions of limited authority, suggesting a need for training and guidance that extends beyond technical proficiency. Innovation This study moves beyond the traditional technical view of phlebotomy by examining the ethical and relational challenges experienced by MLAs during routine patient care. It identifies experiences consistent with moral distress and constrained clinical agency as underexplored features of communication barriers in phlebotomy practice.
Objectives:Conversation aids (CAs) support shared decision making (SDM) by presenting options and enabling the collaborative co-creation of care plans in clinical encounters. Fidelity assessment in implementation studies may require distinction between implementation of SDM and of the CA, as suboptimal CA implementation can disrupt SDM. We aimed to develop and pilot test an observer-based instrument for assessing implementation fidelity in a study of SDM using an electronic CA. Methods:Candidate items were guided by definitions of intervention components and constructs from (a) the Agency for Healthcare Research and Quality's SHARE Approach, and (b) a conceptual framework of implementation fidelity. The instrument and coding manual were developed using video-recorded encounters. We assessed response distributions and inter-observer agreement. Results:The final instrument included 10 items assessing clinician behaviors and 12 potential moderators (3 tool integration, 4 quality of delivery, and 5 participant responsiveness). Observer agreement was moderate to very good on all items. It was lowest for the item assessing whether the tool displayed risk with auto-populated patient data like age and cholesterol. Conclusion:An adapted conceptual framework for implementation fidelity guided checklist development in key domains related to CA implementation and how clinicians use CAs to foster SDM. Innovation:This study demonstrates the feasibility of observing implementation fidelity of SDM interventions and introduces an approach that distinguishes fidelity of intervention implementation from the clinical practice of SDM. This distinction is critical for interpreting effectiveness outcomes in hybrid effectiveness-implementation studies and targeting implementation strategies to bolster routine adoption of SDM.
Objective:Patient involvement in perioperative safety is increasingly emphasized, yet opportunities for patients and caregivers to participate meaningfully are often constrained by clinical workflows and limited role clarity. We adapted the One Safe Act (OSA) approach, a resilience-based intervention originally designed for staff, to evaluate whether a simple reflective prompt could foster patient and caregiver engagement. Methods:We conducted an exploratory quality-improvement study in the Perioperative Care Unit between February and August 2024. After routine surgical and anesthesia review, patients and caregivers were invited to identify one action they used or planned to use to promote safety and to complete brief survey items (awareness of safety, perceived role, comfort asking questions, and trust in facility efforts). Free-text responses underwent inductive thematic analysis. Associations between attitudes and behaviors were examined using Fisher's exact test with false-discovery-rate adjustment. Proactive engagement was also assessed at the respondent level. Results:We collected 122 OSA responses (98 patients, 24 caregivers). Most respondents reported awareness of patient safety (71%), endorsed a personal role (90%), felt comfortable asking questions (94%), and trusted the facility's safety efforts (84%). A composite high-engagement profile ("Proactivity Trust") was met by 28%. Eight behavioral themes emerged, most commonly dietary adjustments (33%), strategic planning (32%), and medication adherence (28%); 3% of responses described no specific action. When classified by engagement type, 58% of coded behaviors were routine and 41.8% were proactive. At the respondent level, 40.8% of patients and 45.8% of caregivers reported at least one proactive behavior (p = 0.65). Strong belief in a personal role was associated with greater comfort asking questions (p = 0.001), and "Proactivity Trust" was associated with greater safety knowledge (p = 0.002). Conclusions:Although most patients recognized a role in safety, fewer reported proactive engagement. The OSA prompt elicited patient- and caregiver-generated safety behaviors and identified opportunities to strengthen engagement. Practice implications:Embedding OSA in preoperative counseling may provide a scalable approach to normalize patient- and caregiver-initiated safety behaviors and strengthen communication at a vulnerable point in care.
Objective:In this participatory design study, we investigated which inputs a workshop panel had for the content and format of an oral presentation about how to prepare for end of life, and which inputs they had for questions in two evaluation tools (questionnaires and an interview guide). Methods:We co-developed an intervention consisting of an oral presentation and evaluation tools. Two structured workshops were conducted with a workshop panel. The development followed three phases of a participatory framework: needs assessment, idea generation, and testing/retesting. The data included audio recordings, post-it notes and participant feedback. Post-it notes were thematically analyzed, inspired by affinity diagramming (the KJ Method), and feedback was analyzed by content analysis. Results:Participants identified key themes, including legal rights and ethical dilemmas related to treatment decisions, care options and pathways, psychosocial concerns regarding quality of life, clear communication with healthcare professionals, and conceptual clarity. The workshop panel suggested a narrative communication strategy to foster personal reflection and emotional resonance. Participants also recommended developing handouts to encourage further dialogue and highlighted the value of follow-up opportunities and support networks. Feedback on the presentation was on slide design, content clarity, and performance. Conclusion:This study identifies themes and formats that can guide the development of early advance care planning interventions perceived as meaningful and accessible. The findings also highlight which domains older adults consider important to address early. Innovation:This study is innovative in using a participatory co-development process with a workshop panel of older adults, relatives, and healthcare professionals to develop an early advance care planning intervention.
Introduction:Triadic communication is frequently observed in adolescent and young adult cancer care. Communication is fundamental to quality healthcare and patient-centred care. Little research has focussed on triadic communication specifically in this age group. Importantly professionals find communicating with young people difficult, compounded by limited training opportunities. Methods:A multi-phase, co-design approach was used to develop a triadic communication educational intervention. The prototype teaching was delivered to twelve multidisciplinary professionals. Feedback on the training experience was gained from semi-structured interviews and analysed using framework analysis. Results:Virtual blended learning was accessible and engaging. Three key themes were generated. The young person's voice was a core driver to the learners engaging with the teaching. The teaching was considered transformative for learners, particularly gaining insight into the need to give the young person time alone with a healthcare professional, without their supporter. Even within brief virtual teaching, learners wanted an opportunity to practise new skills. Conclusion:Healthcare professionals valued teaching that enhanced their triadic communication skills. They learnt practical strategies to help them ensure care centred around the young person. The training may be optimised by incorporating experiential elements such as roleplay. Innovation:We have co-designed innovative triadic teaching for multidisciplinary healthcare professionals. Feedback suggests it was transformative for learners, with some modifications being required. This teaching may be of value in triadic communication beyond adolescent and young adult cancer care and will require further refining and evaluation of the impact on patient outcomes.
Background:Despite the advent of shared-decision making, person-centered care, and early palliative care, many oncology patients and oncologists may face challenges that are not easily solved within these existing paradigms. Adaptive healthcare has been proposed as a framework with which to understand complex problems and guide physician actions. However, it is unknown to what extent patients would endorse this framework as applicable to their own experience. Method:Semi-structured interviews were conducted with patients selected through purposive sampling. Interviews were analyzed both deductively using Heifetz' adaptive leadership framework, and inductively for new insights in a qualitative descriptive approach. Results:Twelve interviews were conducted. Despite good conceptual understanding of adaptive challenges, some participants struggled to analyze own experiences using this lens. Nonetheless, numerous adaptive challenges and responses to them were identified. Innovation:Divergent from the original adaptive leadership framework, some patients deliberately chose not to adapt in some domains as a means of maintaining autonomy in the midst of upheaval. Our results suggest that consideration of patient autonomy be integrated into the adaptive healthcare if it is to be applied to oncology. Conclusions:Patients with advanced colon or pancreatic cancer reported facing numerous adaptive challenges, confirming the applicability of the conceptual framework to the patient experience. The highly individual nature of the adaptive challenges faced, and the individual variability in responses to challenges, calls for oncologists to carefully explore challenges faced by their patients, as well as patients' preferred way to address them, in order to optimize and individualize adaptive.
Objective:To determine the effects of video-assisted education on postoperative physiological parameters and recovery outcomes of patients undergoing laparoscopic cholecystectomy. Background:Laparoscopic cholecystectomy is a widely used minimally invasive surgical method to treat gallstones. Effective preoperative education is critical to enhance postoperative recovery and reduce complications. Design:A randomized controlled trial. Methods:This study was conducted between October 1, 2023, and January 17, 2024, in the General Surgery Department of a public state hospital in Turkey. A total of 92 patients were randomly assigned to the intervention (n = 46) and control (n = 46) groups. The intervention group received video-assisted education, whereas the control group received the same content through a brochure. Educational content included information about postoperative pain, nausea-vomiting management, nutrition, early mobilization, fluid intake, wound care, bathing, and follow-up instructions. Data were collected using a sociodemographic form, Visual Analog Scale (VAS), pre/postoperative patient assessment form, and a dietary habits questionnaire. Primary outcome was bowel recovery, assessed as the presence of defecation on the follow-up day (postoperative day 5-7). Secondary outcomes included nausea/vomiting at discharge, pain intensity (VAS), bathing related support needes for assistance, vital signs/physiological parameters, mobilization, and dietary habits. Results:Vital signs remained stable in both groups, with no significant intergroup differences. Defecation at follow-up was more common in the intervention group (p < 0.001). Vomiting at discharge was lower in the intervention group (p < 0.05). Bathing-related support needs differed between groups at follow-up (p = 0.001). Innovation:This study integrates standardized video-based education into perioperative nursing care and evaluates functional recovery indicators alongside physiological measures. Conclusion:Video-assisted education was more effective than brochure-based education in promoting bowel recovery after laparoscopic cholecystectomy, while effects on other outcomes may vary by clinical context. Combining written materials with standardized video content may further enhance patient education in perioperative care.
Background:Cancer clinical trials (CCTs) are essential to advancing treatment, yet enrollment remains low. An oncologist's recommendation influences participation, but many eligible patients are never offered the option, and discussions often lack clarity or equity. CCT communication skills training can improve oncologists' confidence and patient-centered communication behaviors, yet most Hematology-Oncology fellowship programs lack structured curricula in this area. To address this gap, we implemented a CCT communication skills workshop (COMM-CCT) for Hematology-Oncology fellows. Methods:We implemented the COMM-CCT workshop at seven Hem-Onc fellowship programs in 2024. The three-hour, synchronous web-based workshop included a one-hour didactic session followed by two hours of small-group role play with cancer survivors acting as patients. We evaluated reach, acceptability, feasibility, and fidelity using post-course surveys and semi-structured interviews. Results:Across seven sites, 72% (n = 62) of eligible fellows attended with 87% (n = 54) completing the post-workshop survey and 23% (n = 14) participating in interviews. Fellows reported high acceptability, including satisfaction with the workshop (M = 4.30, SD = 0.79) and content (M = 4.28, SD = 0.79). Feasibility was also high, with communication skills taught being viewed as compatible (M = 4.35, SD = 0.70) and useful (M = 4.33, SD = 0.73) to their clinical practice. Interview findings reinforced survey results. Conclusions:The COMM-CCT workshop is acceptable and feasible to implement in Hem-Onc fellowship programs. Findings will inform its refinement, broader scaling, and continued integration into graduate medical education programs. Innovation:This study's innovation is in its integration of a nationwide communication-focused intervention on clinical trials into existing training structures.
Objectives:This study systematically describes neonatal nurses' communication and interactions with parents of preterm infants during nurse-guided caregiving events in the first week after birth, in family-centered neonatal intensive care units with single-family rooms. Methods:In-situ video observations were analysed using an interaction analysis approach. Results:Six nurses and eleven parents of seven preterm infants participated in the study. Six video observations were conducted in two NICUs, each lasting 25-65 min. The analysis suggested five communication patterns, coded as progress, sensitive & empathic communication, supervision & teaching, positive feedback, and correction, and two themes-dual roles and micro-interactions-based on the nurse's communication and nurse-parent interactions. Innovation:This study focused on interactions in family-centered neonatal intensive care units with single-family rooms. The in situ video observation of nurse-guided caregiving events provides a new and important perspective on the implementation and operation of single-family room design in neonatal intensive care units. Conclusion:Our study suggests that nurse-parent communication and interactions during caregiving events are complex and multifaceted. Nurses must balance the provision of advanced care to preterm infants with support for parents. The implementation of family-centered care and single-family room design has positive outcomes for both infants and parents, but it requires advanced communication skills in comprehensive interactions with parents. We recommend that the implementation of family-centered models of care and single-family rooms in new NICUs in the future be accompanied by a broader focus on communication with parents as a core component of care.
Objectives: We tested the effect of a 1.5-h e-learning course, which presents a new model for information-giving based on Motivational Interviewing, on practitioners' skills to inform patients. Methods: Thirty-two physicians and nurses at Lausanne University Hospital participated in a pilot randomized controlled trial to assess the impact of the e-learning on performance during an encounter with a simulated patient (SP). Participants were randomized (1:1) to complete the e-learning before (intervention) or after (control) the SP encounter. Encounters were coded using an adapted version of the validated MITI (Motivational Interviewing Treatment Integrity) coding scale. Analyses compared group differences and explored effects by clinical experience. Results: The intervention group showed significantly better communication behaviors when delivering information, using less persuasion and more collaborative strategies (e.g., asking permission, checking understanding, eliciting patient reaction). Effects varied by experience level, with less experienced practitioners showing greater effects in empathy, partnership, seeking collaboration and use of open questions. Conclusion: The e-learning impacted the way providers inform patients and shows promise as an effective tool for skill development, especially among less experienced practitioners.Innovation: This study introduces a novel framework for conceptualizing and teaching information delivery as a structured interactive process and provides an institution-wide program for all staff involved in patient communication.
Objective:Children frequently experience fear and distress during medical procedures. 'My Hospital Passport' app was co-created to help children identify and share their preferred coping strategies. This study explored the feasibility and acceptability of the app in clinical practice. Methods:A qualitative feasibility study was conducted in a tertiary pediatric hospital. Semi-structured interviews were held with children (n = 3), parents (n = 8), and HCPs (n = 10) who had used or supported use of the app. Data were analyzed using reflexive thematic analysis. Results:All participants viewed 'My Hospital Passport' as a valuable communication tool to enhance predictability, trust, and shared understanding around medical procedures. For children and parents, completing the app encouraged reflection and dialogue about coping preferences, contributing to a sense of control and calm. When HCPs acknowledged these preferences, it fostered partnership and predictability. However, when preferences were overlooked, children and parents reported disappointment. HCPs recognized the app's potential to support communication and continuity of care but noted barriers such as lack of integration with electronic health records and limited time during clinical routines. Conclusion:'My Hospital Passport' is an acceptable and feasible tool that helps children prepare for medical procedures by articulating and sharing their coping strategies. Its successful use, however, depends on active engagement by HCPs and structural embedding in care routines. Organizational and technological integration are essential to ensure consistent recognition of children's preferences and sustainable implementation in practice. Innovation:'My Hospital Passport' enables two-way communication on coping strategies, improving procedural support.
Purpose This study aimed to test innovative Motivational Interviewing (MI) training strategies: remote workshop and avatar conversation simulations among community mental health staff. Innovation Researchers provided an engaging, interactive tool for learning and practicing MI to a variety of real-world practitioners and compared two methods for measuring skills: automated scoring from avatar simulations and coded interviews using the validated Motivational Interviewing Treatment Integrity (MITI) tool. Methods Attitudes, beliefs, and MI skills of 127 practitioners implementing three distinct research projects were examined: ACHIEVE-D (weight loss); IMPACT (tobacco smoking cessation); and RHYTHM (CVD risk reduction). Results 95% of participants believed MI was important to learn; 88% completed the workshop; 64% used the avatar-based training. Practice improvements were modest and inconsistent over time across the three projects. While underutilized, 47 participants (75%) who tried the avatar training at least once felt that it helped develop their skills. Conclusions Community mental health practitioners value learning MI. Their engagement with the asynchronous avatar training resources was insufficient and did not meaningfully improve their observed MI skills. Although a novel feature of the avatar-based training, the automated conversation scoring appeared to overestimate performance for all MI metrics relative to MITI scores at the same time points.
Objectives Primary care visits average 15 min or less, limiting physician time for engaging in detailed shared decision-making. The ZIP approach—Zeroing in on Individualized, Patient-Centered Decisions—offers a practical path to improving decisions within time constraints. This study assesses the feasibility and acceptability of the ZIP approach in facilitating patient-centered decision-making for lung cancer screening (LCS) and blood pressure (BP) management in primary care. Methods Multiple-methods study using audio-recorded primary care appointments and patient and physician feedback from surveys and semi-structured interviews. 23 patients who were eligible for an initial LCS (n = 4) or BP medication intensification (n = 19) and 10 primary care physicians were enrolled in a single center study in a VA medical center. Feasibility was assessed through observing duration (in minutes) for initial ZIP presentation, total conversation, completion of ZIP components, and patient-survey-based SDM measure (SDM-Q-9). Acceptability was assessed through conducting thematic analysis of patient and physician interviews. Results ZIP discussions took less than 4 min. The median time for the initial ZIP presentation was 1.8 min (IQR) for LCS and 2 min (IQR) for BP conversations. Almost half of the encounters (43%; n = 9/21) had perfect ZIP fidelity scores (median = 9/10); The mean SDM-Q-9 score, reflecting patients' perceptions of the extent of SDM during the appointment, was 90.9 out of 100. Patients reported valuing personalized communication, trust, and collaborative decision-making. Physicians perceived that the SDM discussions were shorter, appreciated the tailored information and data visualizations, but suggested improvements to better align ZIP with conversational flow. Conclusions The ZIP approach is a promising method for facilitating brief, patient-centered discussions in primary care. Its high acceptability among patients and physicians suggests strong potential for improving decision quality across diverse preventive care topics. Innovation ZIP introduces a novel framework for integrating shared decision-making into routine care by addressing longstanding implementation barriers. Future research should examine scalability across diverse settings and evaluate sustainable approaches to integrate ZIP guidance into primary care.
Objective Stroke survivors and their carers report receiving insufficient information about recovery, particularly how much is expected and the associated timescales. Providing this information is challenging for stroke unit staff, due to concerns about maintaining patients' hope and motivation for rehabilitation, and a lack of training. We aimed to design an intervention to support staff to provide information about recovery in ways which meet patient and carer needs. Methods Five stroke survivors, four carers, and six stroke unit professionals participated in six, monthly coproduction workshops. Results The group created an intervention designed to increase staff confidence and skills in providing post-stroke recovery information. The intervention encourages a patient-centred approach and includes good practice guidance and a training package for staff (including communication skills training), with associated materials to deliver the approach. Conclusion An evidence-based, theory-informed intervention has been coproduced, with the potential to meet the needs of intervention targets (staff) and information recipients (patients/carers). Innovation A novel approach to designing an intervention to improve provision of post-stroke recovery information was employed. Inclusion of stroke survivor and carer perspectives aimed to ensure the intervention would meet patients and carers' needs, whilst professionals' perspectives ensured it was feasible to implement in practice.
Objective: To explore decision-making experiences of women who decide not to undergo fertility preservation therapy before breast-cancer treatment. Methods: This quantitative, descriptive study recruited women diagnosed with breast cancer who underwent the decision-making process regarding fertility preservation, ultimately deciding not to pursue fertility preservation. Participants completed a questionnaire after a routine medical examination. Results: Of 39 participants, 18 (46.2%) wanted to have children pre-diagnosis, and 10 (25.6%) expressed this wish afterward. Twenty-four percent of women who did not undergo fertility preservation indicated that they did not have sufficient information, and 14% felt uncertain about their decision. Women who wished for children even post-diagnosis frequently expressed regret about not undergoing treatment. Conclusions: These findings underscore the importance of providing adequate and timely information, decision-making support, and post-decisional psychological care for women facing fertility decisions following a cancer diagnosis. Developing systems to guide when and how to intervene immediately post-diagnosis is essential to promote informed reproductive decision-making and support women in managing these complex, value-laden choices.
Objective This conceptual article proposes a patient-counseling framework that integrates epigenetic aging measures into the Transtheoretical Model (TTM) to support personalized health behavior change. Methods We developed a conceptual model by mapping potentially motivational properties of epigenetic age feedback, including its interpretability, biological science, and modifiability, onto stage-specific behavior-change processes within the TTM. Results The proposed model describes how epigenetic age feedback may be introduced differently across precontemplation, contemplation, preparation, action, maintenance, and relapse phases. Rather than functioning as a stand-alone motivator, epigenetic age is positioned as a complementary tool alongside established approaches such as motivational interviewing, wearable monitoring, and conventional risk assessment. This framework also outlines how repeat measurement may be used selectively to reinforce progress, re-engage patients after slippage, and personalize counseling around behaviors such as physical activity, sleep, nutrition, and stress management. Conclusion Integrating epigenetic age data into stage-matched counseling offers a plausible, patient-centered approach to behavior change, but it remains conceptual and requires empirical evaluation of feasibility, acceptability, and communication effects. Innovation This article frames epigenetic age from a research biomarker into a stage-specific patient education tool and proposes a modified TTM in which repeat biological age assessment is used as a targeted relapse-prevention and re-engagement strategy.
Objective:Cystic fibrosis (CF) is a chronic disease that requires intensive daily self-management. Adherence can be challenging for adolescents and young adults (AYA) with CF. This manuscript reports on the characteristics, participation, and satisfaction outcomes of "tele-coaches" who virtually delivered an intervention to promote adherence in this population. Methods:Health care professionals from six CF centers were recruited, trained, and supervised to serve as tele-coaches for AYA with CF (ages 14-25). Demographic and participation data were collected. Tele-coaches completed a post-training knowledge assessment to establish preparedness for intervention delivery. Fidelity to intervention delivery was collected. Tele-coaches completed a satisfaction survey regarding their experiences delivering the skills-based intervention. Results:Fifteen health care professionals were recruited. They felt adequately trained to serve as tele-coaches. All tele-coaches passed the knowledge assessment (M = 91.8%, SD = 7.78), demonstrated acceptable fidelity to the intervention (M = 83.1% SD = 8.46), rated training and supervision as helpful, and were satisfied with the intervention and participant engagement. Conclusion:Tele-coaches provided valuable feedback that can be incorporated into future training, supervision, and intervention delivery to promote self-management in AYA with CF. Innovation:Multidisciplinary health care professionals can be adequately trained to implement a flexible, tailored, and supportive adherence intervention in AYA with CF. Clinical trial registration:•Name: Tele-Coaching Intervention to Improve Treatment Adherence in Cystic Fibrosis•URL: https://clinicaltrials.gov/study/NCT03921229•ClinicalTrials.gov ID: NCT03921229.
Objective This paper describes the development and user evaluation of a web-delivered oral health behavior change intervention grounded in the spirit and methods of motivational interviewing (MI). Methods The current project builds on prior research in which MI delivered by oral health professionals was found to be efficacious in promoting changes in oral health behavior. The incorporation of MI features into a web-based adaptation was guided by input from key stakeholders (dental patients, dental hygienists, and dentists) and feedback obtained during an iterative process of testing with patients. A pilot trial was conducted to assess the program's usability, acceptability, and inclusion of MI-consistent elements that promote behavior change. Results Twenty-two dental patients used the web-based program and completed evaluative measures. Ratings confirmed that the program was perceived as user friendly, helpful, engaging, relevant, and characterized by MI-consistent features that research suggests will motivate and prepare patients for changes in oral health-related behavior. The participants reported that the program made use of MI-consistent strategies and satisfied basic needs for autonomy, competence, and relatedness. The participants also expressed a strong likelihood of recommending the program to family and friends and of using it again if they had the chance. Conclusion Including specific MI elements such as evocative questions, affirmations, reflections, and a collaborative style that emphasizes patient autonomy yielded a web-delivered program that embodies both the technical and the relational aspects of human-delivered MI. Additional research is needed to evaluate the program's ability to promote changes in oral health-related behavior. Innovations This study developed the first comprehensive, web-based motivational interviewing (MI) program for oral health, targeting multiple behaviors (interdental cleaning, diet, tobacco avoidance) in a scalable tool. It advances beyond didactic or single-behavior digital tools by translating MI's relational techniques into responsive web delivery. Innovations include user-needs tailoring, self-determination theory integration (autonomy, competence, relatedness), and stakeholder design for dental settings—pioneering MI for oral health disparities via permission-based education and change plans.
