Cognitive behaviour therapy for older adults experiencing insomnia and depression in a community mental health setting: Study protocol for a randomised controlled trial
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
- Date: 2015
- Type: Text , Journal article
- Relation: Trials Vol. 16, no. 1 (2015), p.1-12
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- Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.
Key design considerations using a cohort stepped-wedge cluster randomised trial in evaluating community-based interventions : lessons learnt from an Australian domiciliary aged care intervention evaluation
- Authors: Mohebbi,Mohammadreza , Sanagou, Masoumeh , Ottmann, Goetz
- Date: 2017
- Type: Text , Journal article
- Relation: International journal of statistics in medical research Vol. 6, no. 3 (2017), p. 123-133
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- Description: The ‘stepped-wedge cluster randomised trial’ (SW-CRT) harbours promise when for ethical or practical reasons the recruitment of a control group is not possible or when a staggered implementation of an intervention is required. Yet SW-CRT designs can create considerable challenges in terms of methodological integration, implementation, and analysis. While cross-sectional methods in participants recruitment of the SW-CRT have been discussed in the literature the cohort method is a novel feature that has not been considered yet. This paper provides a succinct overview of the methodological, analytical, and practical aspects of cohort SW-CRTs.We discuss five issues that are of special relevance to SW-CRTs. First, issues relating to the design, secondly size of clusters and sample size; thirdly, dealing with missing data in the fourth place analysis; and finally, the advantages and disadvantages of SW-CRTs are considered. An Australian study employing a cohort SW-CRT to evaluate a domiciliary aged care intervention is used as case study. The paper concludes that the main advantage of the cohort SW-CRT is that the intervention rolls out to all participants. There are concerns about missing a whole cluster, and difficulty of completing clusters in a given time frame due to involvement frail older people. Cohort SW-CRT designs can be successfully used within public health and health promotion context. However, careful planning is required to accommodate methodological, analytical, and practical challenges.
Information sharing and willingness-to-pay for CBPP vaccine in rural Kenya
- Authors: Iles, Richard , Gatumu, Haniel , Kagundu, Samuel , Draheim, Christopher
- Date: 2019
- Type: Text , Journal article
- Relation: Vaccine Vol. 37, no. 12 (2019), p. 1659-1666
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- Description: •Improved sharing of CBPP risk information increases CBPP vaccine up-take.•Demand increases by 1.5 and 2.3 per cent for improved access and information.•WTP for a 1 h reduction in travel duration is KES 54 (USD 0.52) per vaccine.•WTP for receipt of CBPP risk information is KES 52 (USD 0.67) per vaccine.•Controlling for attribute non-attendance improves model fit and estimates. The study estimates cattle owners' willingness-to-pay (WTP) for Contagious Bovine Pleuropneumonia (CBPP) vaccine in Samburu county, Kenya. Of particular policy relevance, the study presents findings on WTP for i) improved access to vaccines and ii) timely access to disease-risk information. The mean price for a CBPP vaccine was estimated at KES 66 (USD 0.64). This price relates to a CBPP vaccine that requires a 1.8 h commute, cattle owners' receipt of timely information that the CBPP disease risk is low-moderate and the vaccine lowers the risk of either tail-drop or post-vaccine abortion. The conditional WTP for mean travel duration and high-risk information are similar at KES 53.9 and KES 51.5. The marginal effect on demand for a 1 h additional travel duration and provision of CBPP disease risk information was estimated as a 1.5 per cent reduction and 2.3 increase. The results of this study indicate that cattle owners value greater levels of knowledge concerning the changing risk profile of CBPP in their community and improved access to CBPP vaccination services. Enhanced engagement with cattle owners concerning CBPP would likely result in a greater utilisation of available CBPP vaccines, conditional on the perceived CBPP disease risk.