School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, Shanghai, 200032, China.
Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
AIDS Behav. 2024 Jun;28(6):1923-1935. doi: 10.1007/s10461-024-04290-6. Epub 2024 Apr 3.
Understanding the dose‒response relationship between patient engagement in cognitive behavioral therapy (CBT) and health outcomes is critical for developing and implementing effective CBT programs. In studies of CBT interventions, patient engagement is measured only at a single time point, and outcomes are typically assessed before and after the intervention. Examination of the dose‒response relationship between patient engagement in CBT and outcomes is limited. It is unclear whether a dose‒response relationship exists between patient engagement in on-site CBT intervention and anxiety and depression in people living with HIV (PLWH). If present, does this dose‒response relationship occur early or later in the intervention? This study aimed to address this gap by examining the dose‒response relationships between patient engagement and anxiety and depression in CBT interventions among PLWH. Utilizing data from a pilot randomized trial (10 participants) and a clinical controlled trial (70 participants), our secondary analysis spans baseline, 3-month, and 6-month assessments. Both trials implemented the nurse-led CBT intervention. Cluster analysis identified two groups based on on-site attendance and WeChat activity. Patients with good adherence (6-10 times) of on-site attendance exhibited significantly lower anxiety and depression scores at 3 months (β = 1.220, P = 0.047; β = 1.270, P = 0.019), with no significant differences observed at 6 months. WeChat activity did not significantly influence anxiety or depression scores. The findings highlight a significant short-term dose‒response relationship, endorsing nurse-led CBT interventions for mental health in PLWH. Organizational strategies should focus on incentivizing and facilitating patient engagement, particularly through enhancing WeChat features.
理解患者参与认知行为疗法（CBT）与健康结果之间的剂量-反应关系对于开发和实施有效的 CBT 计划至关重要。在 CBT 干预研究中，仅在单一时间点测量患者参与度，并且通常在干预前后评估结果。对 CBT 中患者参与度与结果之间的剂量-反应关系的检查受到限制。目前尚不清楚患者参与现场 CBT 干预与 HIV 感染者（PLWH）的焦虑和抑郁之间是否存在剂量-反应关系。如果存在，这种剂量-反应关系是在干预早期还是晚期发生？本研究旨在通过检查 PLWH 中 CBT 干预中患者参与度与焦虑和抑郁之间的剂量-反应关系来解决这一差距。利用一项试点随机试验（10 名参与者）和一项临床对照试验（70 名参与者）的数据，我们的二次分析跨越基线、3 个月和 6 个月评估。这两项试验都实施了护士主导的 CBT 干预。聚类分析根据现场出勤率和微信活动将患者分为两组。现场出勤率高（6-10 次）的患者在 3 个月时表现出明显较低的焦虑和抑郁评分（β=1.220，P=0.047；β=1.270，P=0.019），而在 6 个月时没有显著差异。微信活动对焦虑或抑郁评分没有显著影响。这些发现强调了一种显著的短期剂量-反应关系，支持针对 PLWH 心理健康的护士主导的 CBT 干预。组织策略应侧重于激励和促进患者参与，特别是通过增强微信功能。
