Background Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ≥65 years) living with multimorbidity. Objective This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50% in Ireland and 60/120, 50% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID) RR1-10.2196/22125

BACKGROUND Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practice around the provision of well-coordinated, person-centred care for persons with multimorbidity (PwMs). Present health systems across the European Union (EU) focus on supporting a single disease framework of care; the primary challenge is to create a patient centric integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale Horizon 2020 funded project, that involved the design, development and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged 65+) living with multimorbidity. OBJECTIVE This paper describes the trial implementation protocol of a proof of concept (PoC) digital health platform (ProACT) in two EU member states (Ireland and Belgium) to support older persons with multimorbidity self-managing at home, supported by their care network. METHODS Research was conducted across two EU member states, Ireland and Belgium. A twelve month action research trial design, divided into three evaluation cycles, lasting three months each, with a reflective re-design phase of one month after cycles 1 and 2 was conducted. Participants were 120 (n=60 in Ireland and Belgium respectively) older persons with multimorbidity (PwMs) diagnosed with two or more of the following chronic conditions: diabetes; chronic obstructive pulmonary disease (COPD); chronic heart failure (CHF); cardiovascular diseases (CVDs). With permission from the PwM, members of their care network (CN) were invited to participate in the study. PwM participants were provided with ProACT technologies (tablet/devices/sensors) to support them in self-managing their conditions. CN members also received access to an application to remotely support their PwM. Qualitative and quantitative feedback and evaluation data from PwM and CN participants was collected across 4 time-points: baseline (T1); at the end of each 3-month action research cycle (T2; T3) and in a final post-trial interview (T4). Thematic analysis was used to analyse qualitative interview data. Quantitative data were analysed via platform usage statistics (to assess engagement) and standardised questionnaires (using descriptive and inferential statistics). This study was approved by ethics committees in Ireland and Belgium. RESULTS The trial implementation phase for this 44 month (2016-2019) funded study was April 2018 to June 2019. Trial outcomes are being submitted for publication in 2020. CONCLUSIONS ProACT aims to co-design and develop a digital intervention with PwMs and their CN, incorporating clinical guidelines with the state of the art in; human computer interaction, behavioural science, health psychology and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive integrated model of supported person-centred care.

Attachment and Biobehavioural Catch-Up" (ABC) is a 10 session home visiting program, grounded in attachment theory. It aims to improve child emotion regulation, attachment and behavioral outcomes through changing caregivers' attachment related behaviors. There is increasing evidence with respect to the effectiveness of ABC in producing positive child outcomes, but the intervention's direct effect on parent outcomes remains unclear. This review examined the association of ABC with attachment related parent outcomes. The PubMed, EMBASE, PyschINFO and SCOPUS databases were searched for relevant studies in August 2021, and again in April 2022. The eligibility criteria for included studies were (1) infants aged 0-27 months at time of the ABC intervention,(2) "at risk" parents, (3) controlled trials published in peer-reviewed journals and (4) utilized a measure of attachment related parent outcomes. Eleven eligible studies were included. The findings showed ABC had a significant small to medium effect on a variety of attachment related parent outcomes among parents presenting with multiple psychosocial risk factors. "Sensitivity" was measured most frequently, with small to medium main effect sizes recorded at follow-up, compared to controls. Implications for the clinical effectiveness of the ABC program in community settings are discussed. Future research should clarify who ABC is most effective for and how it compares to similar interventions.

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