The positive affect, promoting Positive Engagement, and Adherence for Life (APPEAL) feasibility trial: Design and rationale.

Abstract

Objective: To describe development of the Positive Affect, Promoting Positive Engagement, and Adherence for Life (APPEAL) program. Method: APPEAL is intended to increase HIV medication adherence through promotion of positive affect, and was developed through an iterative process involving 6 focus groups (N ϭ 34) that elicited feedback on intervention content, followed by an individually administered prepilot of the entire intervention (N ϭ 7). Results: Participants provided feedback on important potential moderator variables, including depression, on mode of intervention administration, and on anticipated barriers and benefits to participation. Insights gained were used to finalize study procedures in preparation for a feasibility trial. For the feasibility trial, a total of 80 participants who, in the past 6 months have had at least one plasma HIV RNA Ͼ200 copies/mL, will be randomized to receive APPEAL or standard of care (N ϭ 40 per group). Intervention group participants will receive 3 monthly, individually administered sessions, and all participants will have their medication adherence monitored and complete structured interviews at baseline and at 3 and 6 months. Conclusion: The APPEAL program is innovative in that it focuses on promoting self-regulation of positive emotions, an understudied approach to promoting chronic disease self-management behaviors such as HIV medication adherence. Findings from the feasibility trial will gauge suitability of the APPEAL intervention and evaluation methods for subsequent testing in a confirmatory trial and will examine changes in positive affect, the primary mechanism of change targeted in the intervention.

Using early phase studies to advance intervention research: The science of behavior change.

“…Wilson and colleagues report on their protocol to assess the feasibility and effectiveness of the APPEAL intervention, which is designed to promote positive affect as a means to enhance HIV medication adherence (Wilson et al, 2020). Individuals who have reported adherence difficulties will be randomly assigned to the APPEAL program or standard of care and changes in the mechanism of action (i.e., positive affect) will be assessed at follow-up.…”

An online Paper Authoring Tool (PAT) to improve reporting of, and synthesis of evidence from, trials in behavioral sciences.

“…As an example, one of the articles in this special issue focuses on “positive affect” as a target for improving “HIV medication adherence” (Wilson et al, 2020). There are numerous ways in which both of these constructs can be construed and measured, and it is crucial to be clear on all aspects of measurement described above in order to be able to interpret the findings.…”

Toward an open mechanistic science of behavior change.

“…The 10 articles in this commentary illustrate the considerable breadth and depth of thought involved in conducting a robust mechanistic science of behavior change (Birk et al, 2020; Brewer, Roy, Deluty, Liu, & Hoge, 2020; Dong et al, 2020; Halbert et al, 2020; Leahey et al, 2020; Mackiewicz Seghete et al, 2020; McHugh, Nguyen, Fitzmaurice, & Dillon, 2020; Otto et al, 2020; Scioli et al, 2020; Wilson et al, 2020). There are a wide range of different populations being supported (e.g., patients with acute coronary syndrome, parent/adolescent dyads, African American women breast cancer survivors, adults experiencing opioid use disorder), intervention strategies (e.g., mindfulness, delay discounting tasks, affect labeling, exercise), mechanisms (e.g., fear of recurrence, delay discounting, stress reactivity, neuropeptide Y, self-regulation), and behaviors/health outcomes (e.g., physical activity, sleep, worry, medication adherence).…”

“…behavioral skills learned under one emotional context may not extend to a different emotional context” (p. 816). This assertion, particularly when viewed under the lens of the many layers of emotion regulation from Wilson et al (2020), suggests considerable complexity involved in mechanisms related to emotions. The Halbert et al (2020) article forces us to think about the extent to which the “root cause” issue is primarily biological, sociocultural, or both.…”