Evidence-based practice (EBP) is an approach that aims to improve the process through which high-quality scientific research evidence can be obtained and translated into the best practical decisions to improve health. The interprofessional model of EBP emphasizes shared decision-making within the context of the most important advances of the various health professions. The model depicts three data streams that are integrated in the decision-making process: evidence, resources, and patient characteristics. Health professionals can play several different roles in the EBP process, including primary researchers, systematic reviewers, and clinicians. Carrying out the EBP process involves five steps, including Ask, Acquire, Appraise, Apply, and Analyze and Adjust. A new generation of research designs, such as the Sequential Multiphased Adaptive Randomized Trial, has been put forward to develop treatment algorithms that optimally capture the Apply, Analyze and Adjust steps of the EBP process. DefinitionEvidence-based practice (EBP) is an approach that aims to improve the process through which high-quality scientific research evidence can be obtained and translated into the best practical decisions to improve health. Research findings derived from the systematic collection of data through observation and experiment, as well as the formulation of questions and testing of hypotheses comprise the evidence supporting practice. EBP harmonizes the standards used to conduct, report, evaluate, and distribute research results so as to increase their application to practice and policy. EBP also involves the use of conscientious and explicit decision-making that integrates consideration of the best available research evidence, client characteristics (including preferences), and resources. Best available research is defined as contextually relevant and best in quality, according to consensually accepted scientific standards for different types of questions. Practical decisions relevant to EBP often involve the selection of an assessment or intervention. While professionals practicing evidence-based medicine (EBM) often need to choose among treatments involving drugs or devices, those practicing evidence-based behavioral medicine (EBBM) usually make selections among nondrug and nondevice behavioral or psychosocial interventions.

Background Suboptimal diet and inactive lifestyle are among the most prevalent preventable causes of premature death. Interventions that target multiple behaviors are potentially efficient; however the optimal way to initiate and maintain multiple health behavior changes is unknown. Objective The Make Better Choices 2 (MBC2) trial aims to examine whether sustained healthful diet and activity change are best achieved by targeting diet and activity behaviors simultaneously or sequentially. Study Design Approximately 250 inactive adults with poor quality diet will be randomized to 3 conditions examining the best way to prescribe healthy diet and activity change. The 3 intervention conditions prescribe: 1) an increase in fruit and vegetable consumption (F/V+), decrease in sedentary leisure screen time (Sed−), and increase in physical activity (PA+) simultaneously (Simultaneous); 2) F/V+ and Sed− first, and then sequentially add PA+ (Sequential); or 3) Stress Management Control that addresses stress, relaxation, and sleep. All participants will receive a smartphone application to self-monitor behaviors and regular coaching calls to help facilitate behavior change during the 9 month intervention. Healthy lifestyle change in fruit/vegetable and saturated fat intakes, sedentary leisure screen time, and physical activity will be assessed at 3, 6, and 9 months. Significance MBC2 is a randomized m-Health intervention examining methods to maximize initiation and maintenance of multiple healthful behavior changes. Results from this trial will provide insight about an optimal technology supported approach to promote improvement in diet and physical activity.

We offer a synopsis and commentary on J. Fanning and colleagues' article "Increasing Physical Activity with Mobile Devices: A Meta-Analysis" published in the Journal of Medical Internet Research. Although regular physical activity has a range of benefits, very few adults in the USA meet recommended guidelines for daily physical activity. The meta-analysis of Fanning et al. (2012) aimed to synthesize the results of research using mobile devices to increase physical activity. Their review identified 11 studies that used mobile technologies, including short message service (SMS), apps, or personal digital assistant (PDA) to improve physical activity behaviors among participants. Fanning et al. conclude that while literature in this area is limited to date, there is initial support for the efficacy of mobile-based interventions for improving physical activity. Included studies varied greatly, and the majority used only SMS to influence physical behaviors, meaning generalization of results to other forms of mobile technologies may be premature. This review does, however, provide a foundation for understanding how mobile-based interventions may be used efficaciously for the development of future interventions to improve health behaviors.

This study examined differences in mental health characteristics of Veterans who received VA Video Connect (VVC) or audio-only care during initial phases of the COVID-19 pandemic. A cohort of Veterans with primary diagnoses of depressive or anxiety disorders (diagnosed between March 2019 and February 2020) was identified, and data were obtained for Veterans who engaged in virtual care from April to December 2020. Two groups were created: Veterans receiving audio-only care (n = 161,071) and Veterans receiving two or more VVC visits (n = 84,505). Multiple logistic regression models examined symptom severity in the year before COVID as a predictor of treatment modality during COVID. Chi-square tests examined associations between modality and the number of assessments. Symptom severity as evaluated by the nine-item Patient Health Questionnaire and Generalized Anxiety Disorder-7 significantly predicted modality of encounters during the pandemic such that those who had moderate or severe symptoms prior to COVID-19 were more likely than those with low or no symptoms to have two or more VVC encounters during the pandemic. Of those who received VVC, 55.62% had no Patient Health Questionnaire-9 assessments compared to 68.96% of those who received audio-only. In the VVC group, 70.36% had no Generalized Anxiety Disorder-7 assessments compared to 81.02% in the audio-only group. Taken together, these findings suggest that VVC, when compared to audio-only, was used during the pandemic to reach Veterans with more severe mental health symptomatology and to engage in administration of measurementbased care. Impact StatementVeterans who received video telehealth completed more symptom assessments than those who received care via audio-only. Video-based mental health care during a health emergency may reach more symptomatic Veterans than audio-only care. Facilitating access to video-based mental health care is an important to ensuring high-quality care.

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