Applying Intervention Mapping to Develop a Community-Based Intervention Aimed at Improved Psychological and Social Well-Being of Unmarried Teenage Mothers in Uganda

ERIC Educational Resources Information Center

Leerlooijer, Joanne N.; Kok, Gerjo; Weyusya, Joseph; Bos, Arjan E. R.; Ruiter, Robert A. C.; Rijsdijk, Liesbeth E.; Nshakira, Nathan; Bartholomew, Leona K.

2014-01-01

Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried…

Influence of standing positions and beam projections on effective dose and eye lens dose of anaesthetists in interventional procedures.

PubMed

Kong, Y; Struelens, L; Vanhavere, F; Vargas, C S; Schoonjans, W; Zhuo, W H

2015-02-01

More and more anaesthetists are getting involved in interventional radiology procedures and so it is important to know the radiation dose and to optimise protection for anaesthetists. In this study, based on Monte Carlo simulations and field measurements, both the whole-body doses and eye lens dose of anaesthetists were studied. The results showed that the radiation exposure to anaesthetists not only depends on their workload, but also largely varies with their standing positions and beam projections during interventional procedures. The simulation results showed that the effective dose to anaesthetists may vary with their standing positions and beam projections to more than a factor of 10, and the eye lens dose may vary with the standing positions and beam projections to more than a factor of 200. In general, a close position to the bed and the left lateral (LLAT) beam projection will bring a high exposure to anaesthetists. Good correlations between the eye lens dose and the doses at the neck, chest and waist over the apron were observed from the field measurements. The results indicate that adequate arrangements of anaesthesia device or other monitoring equipment in the fluoroscopy rooms are useful measures to reduce the radiation exposure to anaesthetists, and anaesthetists should be aware that they will receive the highest doses under left lateral beam projection. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Integrated response toward HIV: a health promotion case study from China.

PubMed

Jiang, Zhen; Wang, Debin; Yang, Sen; Duan, Mingyue; Bu, Pengbin; Green, Andrew; Zhang, Xuejun

2011-06-01

Integrated HIV response refers to a formalized, collaborative process among organizations in communities with HIV at-risk populations. It is a both comprehensive and flexible scheme, which may include community-based environment promotion, skill coalition, fund linkage, human resource collaboration and service system jointly for both HIV prevention and control. It enables decisions and actions responds over time. In 1997, the Chinese government developed a 10-year HIV project supported by World Bank Loan (H9-HIV/AIDS/STIs). It was the first integrated STI/HIV intervention project in China and provides a unique opportunity to explore the long-term comprehensive STI/HIV intervention in a low-middle income country setting. Significant outcomes were identified as development and promotion of the national strategic plan and its ongoing implementation; positive knowledge, behavioral and STI/HIV prevalence rate change; and valuable experiences for managing integrated HIV/STI intervention projects. Essential factors for the success of the project and the key tasks for the next step were identified and included well-designed intervention in rural and low economic regions, unified program evaluation framework and real-time information collection and assessment.

Design of the DIRECT-project: interventions to increase job resources and recovery opportunities to improve job-related health, well-being, and performance outcomes in nursing homes.

PubMed

Spoor, Ellen; de Jonge, Jan; Hamers, Jan P H

2010-05-28

Because of high demands at work, nurses are at high risk for occupational burnout and physical complaints. The presence of job resources (such as job autonomy or social support) and recovery opportunities could counteract the adverse effect of high job demands. However, it is still unclear how job resources and recovery opportunities can be translated into effective workplace interventions aiming to improve employee health, well-being, and performance-related outcomes. The aim of the current research project is developing and implementing interventions to optimize job resources and recovery opportunities, which may lead to improved health, well-being and performance of nurses. The DIRECT-project (DIsc Risk Evaluating Controlled Trial) is a longitudinal, quasi-experimental field study. Nursing home staff of 4 intervention wards and 4 comparison wards will be involved. Based on the results of a base-line survey, interventions will be implemented to optimize job resources and recovery opportunities. After 12 and 24 month the effect of the interventions will be investigated with follow-up surveys. Additionally, a process evaluation will be conducted to map factors that either stimulated or hindered successful implementation as well as the effectiveness of the interventions. The DIRECT-project fulfils a strong need for intervention research in the field of work, stress, performance, and health. The results could reveal (1) how interventions can be tailored to optimize job resources and recovery opportunities, in order to counteract job demands, and (2) what the effects of these interventions will be on health, well-being, and performance of nursing staff.

Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis.

PubMed

Cordova-Pozo, Kathya; Hoopes, Andrea J; Cordova, Freddy; Vega, Bernardo; Segura, Zoyla; Hagens, Arnold

2018-02-08

Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants. We reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results. Strengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions. This analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.

The Heartfile Lodhran CVD prevention project--end of project evaluation.

PubMed

Nishtar, Sania; Badar, Asma; Kamal, Mohammad Umer; Iqbal, Azhar; Bajwa, Rashid; Shah, Tauqeer; Larik, Zahid; Karim, Fazle; Mehmood, Mahmood ul Hassan; Jehangir, Haroon; Azam, Syed Iqbal; Mirza, Yasir Abbas; Khan, Shahzad Ali; Qayyum, Aamra; Aqeel, Fauzia; Bakir, Abdul; Rahim, Ejaz

2007-01-01

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, U.K. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

Evidence-based ergonomics education: Promoting risk factor awareness among office computer workers.

PubMed

Mani, Karthik; Provident, Ingrid; Eckel, Emily

2016-01-01

Work-related musculoskeletal disorders (WMSDs) related to computer work have become a serious public health concern. Literature revealed a positive association between computer use and WMSDs. The purpose of this evidence-based pilot project was to provide a series of evidence-based educational sessions on ergonomics to office computer workers to enhance the awareness of risk factors of WMSDs. Seventeen office computer workers who work for the National Board of Certification in Occupational Therapy volunteered for this project. Each participant completed a baseline and post-intervention ergonomics questionnaire and attended six educational sessions. The Rapid Office Strain Assessment and an ergonomics questionnaire were used for data collection. The post-intervention data revealed that 89% of participants were able to identify a greater number of risk factors and answer more questions correctly in knowledge tests of the ergonomics questionnaire. Pre- and post-intervention comparisons showed changes in work posture and behaviors (taking rest breaks, participating in exercise, adjusting workstation) of participants. The findings have implications for injury prevention in office settings and suggest that ergonomics education may yield positive knowledge and behavioral changes among computer workers.

Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent–infant interaction with The Newborn Behavioral Observation

PubMed Central

Høifødt, Ragnhild Sørensen; Nordahl, Dag; Pfuhl, Gerit; Landsem, Inger Pauline; Thimm, Jens C; Ilstad, Linn Kathrin K; Wang, Catharina Elisabeth Arfwedson

2017-01-01

Introduction Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent–infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers. Methods The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16–22, 24–30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information. Ethics and dissemination The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences. Trials registration number NCT02538497; Pre-results. PMID:28963284

An Exploratory Study of Specific Factors in a Prison Environment That Affect a Manpower Training Project.

ERIC Educational Resources Information Center

Barton, Marlin C.; And Others

An exploratory study of a prison community is presented. The study employed a three-phase design: (1) a pre-survey of the prison community, (2) limited intervention, based on findings of the pre-survey, and (3) a post-survey to determine effects of intervention and to validate findings of the pre-survey for which no intervention had been designed.…

Mental health interventions among older adults: A systematic review.

PubMed

Niclasen, Janni; Lund, Lisbeth; Obel, Carsten; Larsen, Lars

2018-05-01

The aim of the present study was to conduct a systematic review to identify documented mental health promotion interventions developed and tested among population-based older adults. A systematic review based on PRISMA guidelines. The literature was searched in PsycINFO and PubMed between June and September 2016. The Effective Public Health Practice Project tool was used to assess the quality of the included study. In total 53 randomized controlled trial studies qualified for the systematic review. Across studies, three types of common conceptual themes emerged for interventions, including: 1) individual characteristics; 2) content and structure of the interventions; and 3) implementation of the interventions. No specific interventions could be recommended on the aforementioned basis. We conclude that a number of factors are of central importance for an intervention to have the desired effect. If these factors are considered, mental health can be successfully promoted among older adults.

Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

PubMed

Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

2016-02-01

Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Derivation and Evaluation of a Risk-Scoring Tool to Predict Participant Attrition in a Lifestyle Intervention Project.

PubMed

Jiang, Luohua; Yang, Jing; Huang, Haixiao; Johnson, Ann; Dill, Edward J; Beals, Janette; Manson, Spero M; Roubideaux, Yvette

2016-05-01

Participant attrition in clinical trials and community-based interventions is a serious, common, and costly problem. In order to develop a simple predictive scoring system that can quantify the risk of participant attrition in a lifestyle intervention project, we analyzed data from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention to prevent diabetes in 36 American Indian and Alaska Native communities. SDPI-DP participants were randomly divided into a derivation cohort (n = 1600) and a validation cohort (n = 801). Logistic regressions were used to develop a scoring system from the derivation cohort. The discriminatory power and calibration properties of the system were assessed using the validation cohort. Seven independent factors predicted program attrition: gender, age, household income, comorbidity, chronic pain, site's user population size, and average age of site staff. Six factors predicted long-term attrition: gender, age, marital status, chronic pain, site's user population size, and average age of site staff. Each model exhibited moderate to fair discriminatory power (C statistic in the validation set: 0.70 for program attrition, and 0.66 for long-term attrition) and excellent calibration. The resulting scoring system offers a low-technology approach to identify participants at elevated risk for attrition in future similar behavioral modification intervention projects, which may inform appropriate allocation of retention resources. This approach also serves as a model for other efforts to prevent participant attrition.

Reducing eating disorder risk factors: A pilot effectiveness trial of a train-the-trainer approach to dissemination and implementation.

PubMed

Greif, Rebecca; Becker, Carolyn Black; Hildebrandt, Tom

2015-12-01

Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the effectiveness of a TTT model at reducing risk factors in Body Project participants. Specifically, this study examined whether a master trainer could train a novice trainer to train undergraduate peer leaders to administer the Body Project such that individuals who received the Body Project (i.e., participants) would evidence comparable outcomes to previous trials. We hypothesized that participants would evidence reductions in ED risk factors, with effect sizes similar to previous trials. Utilizing a TTT model, a master trainer trained a novice trainer to train undergraduate peer leaders to administer the Body Project to undergraduate women. Undergraduate women aged 18 years or older who received the Body Project intervention participated in the trial and completed measures at baseline, post-treatment, and five-month follow-up. Primary outcomes included body dissatisfaction, thin ideal internalization, negative affect, and ED pathology. Participants demonstrated significant reductions in thin ideal internalization, ED pathology and body dissatisfaction at post-treatment and 5-month follow-up. At 5 months, using three different strategies for managing missing data, effect sizes were larger or comparable to earlier trials for 3 out of 4 variables. Results support a TTT model for Body Project implementation and the importance of utilizing sensitivity analyses for longitudinal datasets with missing data. © 2015 Wiley Periodicals, Inc.

Design of the DIRECT-project: interventions to increase job resources and recovery opportunities to improve job-related health, well-being, and performance outcomes in nursing homes

PubMed Central

2010-01-01

Background Because of high demands at work, nurses are at high risk for occupational burnout and physical complaints. The presence of job resources (such as job autonomy or social support) and recovery opportunities could counteract the adverse effect of high job demands. However, it is still unclear how job resources and recovery opportunities can be translated into effective workplace interventions aiming to improve employee health, well-being, and performance-related outcomes. The aim of the current research project is developing and implementing interventions to optimize job resources and recovery opportunities, which may lead to improved health, well-being and performance of nurses. Methods/design The DIRECT-project (DIsc Risk Evaluating Controlled Trial) is a longitudinal, quasi-experimental field study. Nursing home staff of 4 intervention wards and 4 comparison wards will be involved. Based on the results of a base-line survey, interventions will be implemented to optimize job resources and recovery opportunities. After 12 and 24 month the effect of the interventions will be investigated with follow-up surveys. Additionally, a process evaluation will be conducted to map factors that either stimulated or hindered successful implementation as well as the effectiveness of the interventions. Discussion The DIRECT-project fulfils a strong need for intervention research in the field of work, stress, performance, and health. The results could reveal (1) how interventions can be tailored to optimize job resources and recovery opportunities, in order to counteract job demands, and (2) what the effects of these interventions will be on health, well-being, and performance of nursing staff. PMID:20509923

The Coronary Health Improvement Projects Impact on Lowering Eating, Sleep, Stress, and Depressive Disorders

ERIC Educational Resources Information Center

Merrill, Ray M.; Aldana, Stephen G.; Greenlaw, Roger L.; Diehl, Hans A.

2008-01-01

Background: The Coronary Health Improvement Project (CHIP) is designed to lower cardiovascular risk factors among a group of generally healthy individuals through health education. Purpose: This study will evaluate the efficacy of the CHIP intervention at improving eating, sleep, stress, and depressive disorders. Methods: A health education…

Implementation and Institutionalization of Heart Health Programming in Schools: The Pawtucket Heart Health Program Experience.

ERIC Educational Resources Information Center

Gans, Kim M.; And Others

1994-01-01

Examines the development and implementation of the Pawtucket Heart Health Program (PHHP), a community research and demonstration project in Pawtucket (Rhode Island) focusing on PHHP's school intervention project, designed to help decrease the prevalence of cardiovascular disease risk factors among the students and staff of Pawtucket schools. (MDM)

The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions

ERIC Educational Resources Information Center

Reed, Sarah J.; Miller, Robin Lin

2014-01-01

Youth are infrequently included in planning the health promotion projects designed to benefit them as many of the factors infringing upon youth's health and well-being also limit their engagement in community-based public health promotion projects. This article explores youth engagement in 13 coalitions implementing structural changes meant…

No Aboriginal Students left Behind in Taiwan

ERIC Educational Resources Information Center

Wu, Sue-Jen; Hartzler-Miller, Cynthia

2005-01-01

The project is motivated by Taiwan's huge gap of educational levels between the aborigines and the Hans. The low achievement of aboriginal students lies in factors related to problems in finance, health, and cultural difference, which contribute to their sense of self-deprecation. The purpose of the project is to provide early intervention and…

Differences in Cardiovascular Disease Risk Factors and Health Behaviors Between Black and Non-Black Students Participating in a School-Based Health Promotion Program.

PubMed

Jamerson, Taylor; Sylvester, Rachel; Jiang, Qingmei; Corriveau, Nicole; DuRussel-Weston, Jean; Kline-Rogers, Eva; Jackson, Elizabeth A; Eagle, Kim A

2017-07-01

To compare cardiovascular disease (CVD) risk factors of black and non-black children participating in Project Healthy Schools (PHS), a school-based wellness program. Participants were surveyed and participated in physiological screenings pre- and post-PHS intervention. Middle schools in 4 Michigan communities of varying socioeconomic status. A total of 3813 sixth-grade students comprised the survey sample, and 2297 sixth-grade students comprised the screening sample. Project Healthy Schools is a school-based intervention designed to reduce the risk of obesity and CVD in children through the promotion of healthy eating and physical activity. Physical examination, blood test, and self-reported survey data on dietary habits, physical activity, and sedentary behaviors were collected pre- and post-PHS. Paired and independent t tests were used for physiologic variables. Wilcoxon sign-rank and rank-sum tests were used for survey variables. At baseline, blacks had a higher percentage of overweight/obese students (43% vs 34%; P < .0001) and demonstrated poorer health habits than non-blacks; however, non-blacks had poorer lipid profiles. At follow-up (post-PHS intervention), both groups demonstrated significant improvements in physiological measures and health behaviors. Despite disparities between the groups at both baseline and follow-up, changes seen post-PHS intervention were beneficial in both groups. These results suggest that early intervention for risk factor modification is possible and may be of great importance in the prevention of CVD, particularly in high-risk groups.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

PubMed

Muellmann, Saskia; Steenbock, Berit; De Cocker, Katrien; De Craemer, Marieke; Hayes, Catherine; O'Shea, Miriam P; Horodyska, Karolina; Bell, Justyna; Luszczynska, Aleksandra; Roos, Gun; Langøien, Lars Jørun; Rugseth, Gro; Terragni, Laura; De Bourdeaudhuij, Ilse; Brug, Johannes; Pischke, Claudia R

2017-12-06

The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men.

PubMed

Brown, Tiffany A; Keel, Pamela K

2015-11-01

Gay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project(©)) in reducing eating disorder risk factors among gay males in a university-based setting. Eighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures. Acceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms. Results support the acceptability and efficacy of The PRIDE Body Project(©) and provide support for theoretical models of eating pathology in gay men. Copyright © 2015 Elsevier Ltd. All rights reserved.

The International Resilience Project Findings from the Research and the Effectiveness of Interventions.

ERIC Educational Resources Information Center

Grotberg, Edith H.

This article discusses the nature of resilience in children, means to measure and verify it, and attempts to promote it through education; it also describes a study of parental, teacher and caregiver efforts to promote resilience in children. The International Resilience Project examined resilience factors children and their parents use in…

Young Children at Risk of Literacy Difficulties: Factors Predicting Recovery from Risk Following Phonologically Based Intervention

ERIC Educational Resources Information Center

Whiteley, Helen E.; Smith, Chris D.; Connors, Liz

2007-01-01

This longitudinal project identified young children at risk of literacy difficulties and asked why some of these children fail to benefit from phonologically based intervention. Reception class children were screened to identify a group at risk of literacy difficulties and a matched group of children not at risk. Profiles were compiled for each…

Psychosocial Predictors of Weight Loss among American Indian and Alaska Native Participants in a Diabetes Prevention Translational Project

PubMed Central

Dill, Edward J.; Manson, Spero M.; Jiang, Luohua; Pratte, Katherine A.; Gutilla, Margaret J.; Knepper, Stephanie L.; Beals, Janette; Roubideaux, Yvette; Special Diabetes Program for Indians Diabetes Prevention Demonstration Project

2016-01-01

The association of psychosocial factors (psychological distress, coping skills, family support, trauma exposure, and spirituality) with initial weight and weight loss among American Indians and Alaska Natives (AI/ANs) in a diabetes prevention translational project was investigated. Participants (n = 3,135) were confirmed as prediabetic and subsequently enrolled in the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented at 36 Indian health care programs. Measures were obtained at baseline and after completing a 16-session educational curriculum focusing on weight loss through behavioral changes. At baseline, psychological distress and negative family support were linked to greater weight, whereas cultural spirituality was correlated with lower weight. Furthermore, psychological distress and negative family support predicted less weight loss, and positive family support predicted greater weight loss, over the course of the intervention. These bivariate relationships between psychosocial factors and weight remained statistically significant within a multivariate model, after controlling for sociodemographic characteristics. Conversely, coping skills and trauma exposure were not significantly associated with baseline weight or change in weight. These findings demonstrate the influence of psychosocial factors on weight loss in AI/AN communities and have substantial implications for incorporating adjunctive intervention components. PMID:26649314

Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh.

PubMed

Rahman, Syed Moshfiqur; Ali, Nabeel Ashraf; Jennings, Larissa; Seraji, M Habibur R; Mannan, Ishtiaq; Shah, Rasheduzzaman; Al-Mahmud, Arif Billah; Bari, Sanwarul; Hossain, Daniel; Das, Milan Krishna; Baqui, Abdullah H; El Arifeen, Shams; Winch, Peter J

2010-05-03

Well-trained and highly motivated community health workers (CHWs) are critical for delivery of many community-based newborn care interventions. High rates of CHW attrition undermine programme effectiveness and potential for implementation at scale. We investigated reasons for high rates of CHW attrition in Sylhet District in north-eastern Bangladesh. Sixty-nine semi-structured questionnaires were administered to CHWs currently working with the project, as well as to those who had left. Process documentation was also carried out to identify project strengths and weaknesses, which included in-depth interviews, focus group discussions, review of project records (i.e. recruitment and resignation), and informal discussion with key project personnel. Motivation for becoming a CHW appeared to stem primarily from the desire for self-development, to improve community health, and for utilization of free time. The most common factors cited for continuing as a CHW were financial incentive, feeling needed by the community, and the value of the CHW position in securing future career advancement. Factors contributing to attrition included heavy workload, night visits, working outside of one's home area, familial opposition and dissatisfaction with pay. The framework presented illustrates the decision making process women go through when deciding to become, or continue as, a CHW. Factors such as job satisfaction, community valuation of CHW work, and fulfilment of pre-hire expectations all need to be addressed systematically by programs to reduce rates of CHW attrition.

Impact of a Six-Year Project to Enhance the Awareness of Community-Based Palliative Care on the Place of Death.

PubMed

Murakami, Nozomu; Tanabe, Kouichi; Morita, Tatsuya; Fujikawa, Yasunaga; Koseki, Shiro; Kajiura, Shinya; Nakajima, Kazunori; Hayashi, Ryuji

2018-05-03

To examine the clinical outcomes of a project to enhance the awareness of community-based palliative care (awareness-enhancing project), focusing on home death and care rates in communities. A single-center study on community-based intervention was conducted. The awareness-enhancing project, consisting of three intervention approaches (outreach, palliative care education for community-based medical professionals, and information-sharing tool use), was executed, and changes in the home death rate in the community were examined. The home death rate markedly exceeded the national mean from 2010. In 2012-2013, it was as high as 19.9%, greater than the previous 5.9% (p = 0.001). Through multivariate analysis, the participation of home care physicians and visiting nurses in a palliative care education program, and patients' Palliative Prognostic Index values were identified as factors significantly influencing the home death rate. The three intervention approaches time dependently increased the home death rate as a clinical outcome in the community, although they targeted limited areas. These approaches may aid in increasing the number of individuals who die in their homes.

The health Oriented pedagogical project (HOPP) - a controlled longitudinal school-based physical activity intervention program.

PubMed

Fredriksen, Per Morten; Hjelle, Ole Petter; Mamen, Asgeir; Meza, Trine J; Westerberg, Ane C

2017-04-28

The prevalence of non-communicable diseases (NCDs) is increasing worldwide, also among children. Information about primary prevention of NCD's is increasing; however, convincing strategies among children is needed. The present paper describes the design and methods in the Health Oriented Pedagogical Project (HOPP) study. The main objective is to evaluate the effects of a school-based physical activity intervention program on cardio-metabolic risk factors. Secondary objectives include assessment of physical, psychological and academic performance variables. The HOPP study is a 7 years longitudinal large-scale controlled intervention in seven elementary schools (n = 1545) with two control schools (n = 752); all aged 6-11 years at baseline. The school-based physical activity intervention program includes an increase in physical activity (PA) of 225 min/week as an integrated part of theoretical learning, in addition to the curriculum based 90 min/week of ordinary PA. Primary outcomes include cardio-metabolic risk factors measured as PA level, BMI status, waist circumference, muscle mass, percent fat, endurance test performance, total serum cholesterol, high-density lipoprotein (HDL), non-HDL, micro C-reactive protein (mCRP) and long-term blood sugar (HbA1c). In addition, secondary outcomes include anthropometric growth measures, physical fitness, quality of life (QoL), mental health, executive functions, diet and academic performance. HOPP will provide evidence of effects on cardio-metabolic risk factors after a long-term PA intervention program in elementary schoolchildren. School-based PA intervention programs may be an effective arena for health promotion and disease prevention. The study is registered in Clinical trials (ClinicalTrials.gov Identifier: NCT02495714 ) as of June 20 th - 2015, retrospectively registered. The collection of baseline values was initiated in mid-January 2015.

An educational approach to improve outcomes in acute kidney injury (AKI): report of a quality improvement project.

PubMed

Xu, Gang; Baines, Richard; Westacott, Rachel; Selby, Nick; Carr, Susan

2014-03-20

To assess the impact of a quality improvement project that used a multifaceted educational intervention on how to improve clinician's knowledge, confidence and awareness of acute kidney injury (AKI). 2 large acute teaching hospitals in England, serving a combined population of over 1.5 million people. All secondary care clinicians working in the clinical areas were targeted, with a specific focus on clinicians working in acute admission areas. A multifaceted educational intervention consisting of traditional didactic lectures, case-based teaching in small groups and an interactive web-based learning resource. We assessed clinicians' knowledge of AKI and their self-reported clinical behaviour using an interactive questionnaire before and after the educational intervention. Secondary outcome measures included clinical audit of patient notes before and after the intervention. 26% of clinicians reported that they were aware of local AKI guidelines in the preintervention questionnaire compared to 64% in the follow-up questionnaire (χ²=60.2, p<0.001). There was an improvement in the number of clinicians reporting satisfactory practice when diagnosing AKI, 50% vs 68% (χ²=12.1, p<0.001) and investigating patients with AKI, 48% vs 64% (χ²=9.5, p=0.002). Clinical audit makers showed a trend towards better clinical practice. This quality improvement project utilising a multifaceted educational intervention improved awareness of AKI as demonstrated by changes in the clinician's self-reported management of patients with AKI. Elements of the project have been sustained beyond the project period, and demonstrate the power of quality improvement projects to help initiate changes in practice. Our findings are limited by confounding factors and highlight the need to carry out formal randomised studies to determine the impact of educational initiatives in the clinical setting.

Stakeholder approach for evaluating organizational change projects.

PubMed

Peltokorpi, Antti; Alho, Antti; Kujala, Jaakko; Aitamurto, Johanna; Parvinen, Petri

2008-01-01

This paper aims to create a model for evaluating organizational change initiatives from a stakeholder resistance viewpoint. The paper presents a model to evaluate change projects and their expected benefits. Factors affecting the challenge to implement change were defined based on stakeholder theory literature. The authors test the model's practical validity for screening change initiatives to improve operating room productivity. Change initiatives can be evaluated using six factors: the effect of the planned intervention on stakeholders' actions and position; stakeholders' capability to influence the project's implementation; motivation to participate; capability to change; change complexity; and management capability. The presented model's generalizability should be explored by filtering presented factors through a larger number of historical cases operating in different healthcare contexts. The link between stakeholders, the change challenge and the outcomes of change projects needs to be empirically tested. The proposed model can be used to prioritize change projects, manage stakeholder resistance and establish a better organizational and professional competence for managing healthcare organization change projects. New insights into existing stakeholder-related understanding of change project successes are provided.

Systematic evaluation of implementation fidelity of complex interventions in health and social care

PubMed Central

2010-01-01

Background Evaluation of an implementation process and its fidelity can give insight into the 'black box' of interventions. However, a lack of standardized methods for studying fidelity and implementation process have been reported, which might be one reason for the fact that few prior studies in the field of health service research have systematically evaluated interventions' implementation processes. The aim of this project is to systematically evaluate implementation fidelity and possible factors influencing fidelity of complex interventions in health and social care. Methods A modified version of The Conceptual Framework for Implementation Fidelity will be used as a conceptual model for the evaluation. The modification implies two additional moderating factors: context and recruitment. A systematic evaluation process was developed. Multiple case study method is used to investigate implementation of three complex health service interventions. Each case will be investigated in depth and longitudinally, using both quantitative and qualitative methods. Discussion This study is the first attempt to empirically test The Conceptual Framework for Implementation Fidelity. The study can highlight mechanism and factors of importance when implementing complex interventions. Especially the role of the moderating factors on implementation fidelity can be clarified. Trial Registration Supported Employment, SE, among people with severe mental illness -- a randomized controlled trial: NCT00960024. PMID:20815872

How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme

PubMed Central

Baghaei, Abdolmehdi; Rabiei, Katayoun; Gharipour, Mojgan; Tavasoli, Ali Akbar; Shirani, Shahin; Bahonar, Ahamad; Davarpanah, Amir Hossein; Ramezani, Mohammad Arash; Kelishadi, Roya

2010-01-01

Introduction The Isfahan Healthy Heart Programme (IHHP) is a community-based programme for non-communicable diseases prevention and control using both a population and high risk approach in Iran. This study demonstrated the efficacy of IHHP interventional strategies to improve lifestyle behaviours in a population at risk for developing cardiovascular diseases. Material and methods Healthy Lifestyle for NCDs High Risk Population is one of ten projects of IHHP. High risk individuals were defined as those who have at least one risk factor for developing coronary artery disease (CAD). Changes of behavioural indicators have been compared between two areas with a survey after 5 years of intervention. Results Among high risk individuals in the intervention and reference areas, 77.8% and 82.5% had at least one major risk factor for CAD. The prevalence of major risk factors for CAD (except cigarette smoking) was decreased in both intervention and reference areas during 5 years of intervention and the pattern of diet and physical activity was improved. Conclusions Interventional activities in IHHP targeting the high risk population seem to be effective in improving lifestyle behaviour, increasing awareness and control of risk factors of the high risk population. PMID:22371716

[Health promotion and primary prevention strategies to fight chronic disease: a systematic review].

PubMed

da Silva, Luciana Saraiva; Cotta, Rosângela Minardi Mitre; Rosa, Carla de Oliveira Barbosa

2013-11-01

To analyze health promotion and primary prevention strategies in the global fight against chronic noncommunicable diseases (NCDs) and to reflect on the challenges of overcoming these diseases. In this systematic literature review, studies were analyzed on health programs identified by the Brazilian Health Ministry as the main global community intervention initiatives: the North Karelia Project, in Finland; the Stanford Three-Community Study, Stanford Five-City Project, Minnesota Heart Health and Pawtucket Heart Health Program, in the United States; the CINDI project, in Europe and Canada; CARMEN in South America; Mirame, in Chile; and Tianjin, in China. The LILACS, Medline, and SciELO databases were searched, as well as the Brazilian Health Ministry, Pan American Health Organization, and World Health Organization websites. Only original articles analyzing primary data were included. The outcomes evaluated in the studies were cholesterol, blood pressure, obesity, physical activity level, tobacco use, dietary habits, and other risk factors for NCDs. Seventeen studies were selected. The North Karelia Project, Three Community Study, and Five-City Multifactor Risk Reduction Project contributed to decrease tobacco use, cholesterol levels, and blood pressure levels. The Minnesota Heart Health Program and the Pawtucket Heart Health Program had moderate success in reducing the risk factors for NCD. The CINDI and CARMEN programs demonstrated the importance of integrated actions for decreasing the main risk factors. The Mirame project, which focused on educational interventions for school children, reached 30,000 students in 2001 without requiring a large financial investment. The Tianjin project was able to reduce salt intake, prevalence of arterial hypertension, and obesity by restructuring primary health care services. These successful experiences in community health improvement may serve as models for the implementation of more effective health policies, aiming at the development of actions that integrate health promotion and primary prevention of the main risk factors for NCDs.

Exploring experiences among adopters during the diffusion of a novel dance intervention in Sweden.

PubMed

Carlsson, Noomi; Kullberg, Agneta; Johansson, Ida-Klara; Bergman, Paula; Skagerström, Janna; Andersson, Agneta

2018-12-01

There is a demand for interventions aimed at adolescent girls with psychosomatic problems. In 2013, positive results were reported from a dance intervention programme addressing girls with internalizing problems. The research team behind the intervention immediately received requests from municipalities and county councils interested in using the intervention. From an implementation point of view it is unclear what made the intervention spread without an active plan. The aim of this study was to explore adopters' experiences about the diffusion and initiation of a public health intervention targeting adolescent girls with internalizing problems. Interviews were conducted with 12 people who were engaged in initiating the intervention in different settings. Data were analysed using conventional content analysis, yielding three categories: perceived appeal and trustworthiness, convenient information, and contextual factors. The results reflected that the participants found that there was a need for an intervention and found the dance intervention to be evidence based and not too complex to perform. Further, there was available information on the project which could easily be distributed to decision makers and others. When initiating the intervention, factors related to economy, possibility for collaboration and recruitment were of importance.

Planning a multi-site, complex intervention for homeless people with mental illness: the relationships between the national team and local sites in Canada's At Home/Chez Soi project.

PubMed

Nelson, Geoffrey; Macnaughton, Eric; Goering, Paula; Dudley, Michael; O'Campo, Patricia; Patterson, Michelle; Piat, Myra; Prévost, Natasha; Strehlau, Verena; Vallée, Catherine

2013-06-01

This research focused on the relationships between a national team and five project sites across Canada in planning a complex, community intervention for homeless people with mental illness called At Home/Chez Soi, which is based on the Housing First model. The research addressed two questions: (a) what are the challenges in planning? and (b) what factors that helped or hindered moving project planning forward? Using qualitative methods, 149 national, provincial, and local stakeholders participated in key informant or focus group interviews. We found that planning entails not only intervention and research tasks, but also relational processes that occur within an ecology of time, local context, and values. More specifically, the relationships between the national team and the project sites can be conceptualized as a collaborative process in which national and local partners bring different agendas to the planning process and must therefore listen to, negotiate, discuss, and compromise with one another. A collaborative process that involves power-sharing and having project coordinators at each site helped to bridge the differences between these two stakeholder groups, to find common ground, and to accomplish planning tasks within a compressed time frame. While local context and culture pushed towards unique adaptations of Housing First, the principles of the Housing First model provided a foundation for a common approach across sites and interventions. The implications of the findings for future planning and research of multi-site, complex, community interventions are noted.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

PubMed Central

Perry, C L; Williams, C L; Veblen-Mortenson, S; Toomey, T L; Komro, K A; Anstine, P S; McGovern, P G; Finnegan, J R; Forster, J L; Wagenaar, A C; Wolfson, M

1996-01-01

OBJECTIVES. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS. Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS. At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS. The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use. PMID:8669519

Optimizing care in osteoporosis: The Canadian quality circle project

PubMed Central

Ioannidis, George; Thabane, Lehana; Gafni, Amiram; Hodsman, Anthony; Kvern, Brent; Johnstone, Dan; Plumley, Nathalie; Salach, Lena; Jiwa, Famida; Adachi, Jonathan D; Papaioannou, Alexandra

2008-01-01

Background While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines. Methods The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results After the 1st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7). Conclusion Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines. PMID:18828906

Testing the Impact of The Worksite Heart Health Improvement Project on Cardiovascular Disease Risk factors Overtime.

PubMed

Doran, Kelly; Resnick, Barbara; Zhu, Shijun; Alghzawi, Hamzah

2018-02-13

We aimed to test the impact of the Worksite Heart Health Improvement Project (WHHIP) on cardiovascular risk factors among long-term care staff. The WHHIP was an 18-month cluster randomized control trial conducted in four long-term care facilities (n = 98). A significant positive delayed intervention effect for diastolic blood pressure was seen in intervention group (80.34 mm/Hg [SD = 6.10] at baseline to 73.08 mm/Hg [SD = 4.99] at 18-months; p = <.001). Whereas, a significant negative intervention effect was seen for steps with a mean increase from 5,807.18 (SD = 3,934.30) steps at baseline to 7,839.19 (SD = 3,126.09) steps at 18-months (p = .022) as well as body mass index with a mean change from 29.86 (SD = 7.38) at baseline to 26.67 (SD = 5.29) at 18-months (p = .045). (p = .045). The WHHIP demonstrated the ability to impact participants' blood pressure over time.

Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model.

PubMed

Kattelmann, Kendra K; White, Adrienne A; Greene, Geoffrey W; Byrd-Bredbenner, Carol; Hoerr, Sharon L; Horacek, Tanya M; Kidd, Tandalayo; Colby, Sarah; Phillips, Beatrice W; Koenings, Mallory M; Brown, Onikia N; Olfert, Melissa; Shelnutt, Karla P; Morrell, Jesse Stabile

2014-01-01

To develop a tailored, theory-based, Web-delivered intervention to prevent excessive weight gain in young adults using a Community-Based Participatory Research model. Investigators from 14 universities developed the intervention and supporting administrative portal using the 4 phases of the PRECEDE model. Steering committees were composed of the target audience (aged 19-24 years) and key health/wellness personnel were formed at each institution and provided information during each phase that was used to guide development of the intervention, Project YEAH (Young Adults Eating and Active for Health). Piloting results were used to refine the curriculum and identify and avoid barriers to delivery. Qualitative and quantitative data collected at each phase informed Project YEAH development. In Phase 1, factors of highest priority to young adults were identified. In Phase 2, environmental supports for healthful lifestyles were elucidated. In Phase 3, behavior and environmental changes considered important and changeable were identified. In Phase 4, the 10-week, theory-based, stage-tailored, interactive-learning intervention with a 10-month reinforcement period was developed. Applying the PRECEDE model with fidelity during development of Project YEAH resulted in an intervention that pilot participants found relevant and useful, gained attention, instilled confidence in the ability to apply the information, and provided a sense of satisfaction. Copyright © 2014. Published by Elsevier Inc.

Does a socio-ecological school model promote resilience in primary schools?

PubMed

Lee, Patricia C; Stewart, Donald E

2013-11-01

This research investigates the extent to which the holistic, multistrategy "health-promoting school" (HPS) model using a resilience intervention can lead to improved resilience among students. A quasi-experimental design using a study cohort selected from 20 primary schools in Queensland, Australia was employed. Ten intervention schools using HPS protocols, with training support, were compared with 10 control schools in student resilience scores and protective factors. Baseline data explored the interactive effect of protective factors on overall resilience scores. Postintervention analysis compared changes in protective factors and resilience, after implementing the HPS project. Baseline data analysis indicated no significant differences in the mean scores of protective factors and resilience scores between intervention and control groups (except for school connection). After 18 months of implementation, a resurvey showed that the intervention group had significantly higher scores than the control group on students' family connection, community connection, peer support, and their overall resilience. Results showed that students in the HPS group had significantly higher scores on resilience than did students in the control group. A comprehensive, whole-school approach to building resilience that integrates students, staff, and community can strengthen important protective factors and build student resilience. © 2013, American School Health Association.

Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications.

PubMed

Boccia, D; Hargreaves, J; Lönnroth, K; Jaramillo, E; Weiss, J; Uplekar, M; Porter, J D H; Evans, C A

2011-06-01

To quantify the impact of cash transfer and microfinance interventions on a selected list of tuberculosis (TB) risk factors and assess their potential role in supporting TB control. Published and unpublished references identified from clinical and social electronic databases, grey literature and web sites. Eligible interventions had to be conducted in middle- or low-income countries and document an impact evaluation on any of the following outcomes: 1) TB or other respiratory infections; 2) household socio-economic position; and 3) factors mediating the association between low household socio-economic position and TB, including inadequate health-seeking behaviours, food insecurity and biological TB risk factors such as human immunodeficiency virus (HIV) and adult malnutrition. Interventions targeting special populations were excluded. Fifteen cash transfer schemes (four unconditional and 11 conditional) and seven microfinance programmes met the eligibility criteria. No intervention addressed TB or any other respiratory infection. Of 11 cash transfer and four microfinance interventions, respectively seven and four reported a positive impact on indicators of economic well-being. A positive impact on household food security was documented in respectively eight of nine and three of five cash transfer and microfinance interventions. Improved health care access was documented respectively in 10 of 12 cash transfer and four of five microfinance interventions. The only intervention evaluating impact on HIV incidence was a microfinance project that found no effect. No cash transfer or microfinance interventions had an impact on adult malnutrition. Cash transfer and microfinance interventions can positively impact TB risk factors. Evaluation studies are urgently needed to assess the impact of these social protection interventions on actual TB indicators.

Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: project northland Chicago.

PubMed

Komro, Kelli A; Perry, Cheryl L; Veblen-Mortenson, Sara; Farbakhsh, Kian; Toomey, Traci L; Stigler, Melissa H; Jones-Webb, Rhonda; Kugler, Kari C; Pasch, Keryn E; Williams, Carolyn L

2008-04-01

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings. Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units and assigned randomly to intervention or 'delayed program' control condition. The study sample (n = 5812 students) was primarily African American, Hispanic and low-income. Students, beginning in sixth grade (age 12 years), received 3 years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing). Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey and alcohol purchase attempts. Overall, the intervention, compared with a control condition receiving 'prevention as usual', was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06). Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project

PubMed Central

2010-01-01

Background Recruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants. Methods Design of the PCPPP incorporated strategies to maximize recruitment and retention. These included an advanced database system tracking follow-up status and assessment completion rates; cultural sensitivity training for staff; communication to the community and eligible women of the benefits of participation; financial incentives; assistance with transportation and supervised childcare services; and reminder calls for convenient, flexibly scheduled appointments. Analyses reported here: 1) compare recruitment projections to actual enrollment 2) explore recruitment bias; 3) validate the randomization process 4) document the extent to which contact was maintained and complete assessments achieved 5) determine if follow-up was conditioned upon socio-economic status, race/ethnicity, or other factors. Results Of eligible women approached, 1,126 (77.7%) agreed to participate fully. Of the 324 not agreeing, 118 (36.4%) completed a short survey. Consenting women were disproportionately from minority and low SES backgrounds: 71.5% consenting were African American, versus 38.8% not consenting. Consenting women were also more likely to report homelessness during their lifetime (14.6% vs. 0.87%) and to be unmarried at the time of delivery (81.6% versus 47.9%). First one-month postpartum assessment was completed for 83.5% (n = 472) of the intervention group (n = 565) and 76% (426) of the control group. Higher assessment completion rates were observed for the intervention group throughout the follow-up. Second, third, fourth and fifth postpartum assessments were 67.6% vs. 57.5%, 60.0% vs. 48.9%, 54.2% vs. 46.3% and 47.3% vs. 40.8%, for the intervention and control group women, respectively. There were no differences in follow-up rates according to race/ethnicity, SES or other factors. Greater retention of the intervention group may reflect the highly-valued nature of the medical and behavior services constituting the intervention arms of the Project. Conclusion Findings challenge beliefs that low income and minority women are averse to enrolling and continuing in clinical trials or community studies. PMID:20920265

Violence in Adolescent Dating Relationships

ERIC Educational Resources Information Center

Jouriles, Ernest N.; Platt, Cora; McDonald, Renee

2009-01-01

Beginning with a definition of dating and dating violence among adolescents, this article explores the factors which impact such violence. It concludes with a review of two school-based prevention/intervention programs (Safe Dates and The Youth Relationships Project). (Contains 1 table.)

Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

PubMed

Taylor, Stephanie L; Ridgely, M Susan; Greenberg, Michael D; Sorbero, Melony E S; Teleki, Stephanie S; Damberg, Cheryl L; Farley, Donna O

2009-04-01

To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006. Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability. Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability. The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had. Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

Dissonance-based prevention of eating disorder risk factors in middle school girls: results from two pilot trials.

PubMed

Rohde, Paul; Auslander, Beth A; Shaw, Heather; Raineri, Kate M; Gau, Jeff M; Stice, Eric

2014-07-01

Although several eating disorder prevention programs reduce eating disorder risk factors and symptoms for female high school and college students, few efficacious prevention programs exist for female middle school students, despite the fact that body image and eating disturbances often emerge then. Two pilot trials evaluated a new dissonance-based eating disorder prevention program for middle school girls with body image concerns. Female middle school students with body dissatisfaction from two sites [Study 1: N = 81, M age = 12.1, standard deviation (SD) = 0.9; Study 2: N = 52, M age = 12.5, SD = 0.8] were randomized to a dissonance intervention (MS Body Project) or educational brochure control; Study 2 included a 3-month follow-up. Intervention participants showed significant post-test reductions in only one of the six variables with both Studies 1 and 2 (i.e., pressure to be thin and negative affect, respectively), though post-test effect sizes suggested medium reductions in eating disorder risk factors and symptoms (Study 1: M d = .40; Study 2: M d = .65); reductions at 3-month follow-up in Study 2 were not evident (M d = .19). Results suggest that this new middle school version of the Body Project is producing medium magnitude reductions in eating disorder risk factors at post-test but that effects are showing limited persistence. Continued refinement and evaluation of this intervention appears warranted to develop more effective prevention programs for this age group. © 2014 Wiley Periodicals, Inc.

Factors related to risky sexual behaviors and effective STI/HIV and pregnancy intervention programs for African American adolescents.

PubMed

Lee, Young Me; Cintron, Adanisse; Kocher, Surinder

2014-01-01

The purpose of this integrative literature review study was to investigate factors related to risky sexual behaviors among African American adolescents, to evaluate which of the factors are common across successful and effective STI/HIV and pregnancy intervention programs, and finally, to propose suggestions for future intervention programs for African American adolescents in West Englewood, Chicago. An integrative literature review was conducted. Using CINAHL, PubMed, and ProQuest database, the following terms were searched: African American, Black, adolescents, teenagers, sexual behavior, cultural factors, pregnancy, STIs/HIV/AIDS, and intervention programs. A total of 18 articles were reviewed, findings indicated there were five major contributing factors related to risky sexual behaviors: substance use, gender roles, peer influences, parental involvement, and level of knowledge and information on sex and STIs. Six successful STI/HIV and pregnancy programs that incorporated those factors to effectively reduce risky sexual behaviors were identified. After analyzing six national intervention programs proven to be effective, the findings suggest that future prevention programs should be designed with more emphasis on avoidance or limited substance use, increased parental involvement, integration of cultural teaching components such as storytelling and history as suggested from the Aban Aya Youth Project. This study also concluded that future prevention programs should consider the length of programs be longer than 1 year, as it has been shown to be more effective than shorter programs. © 2014 Wiley Periodicals, Inc.

People Awakening: Collaborative Research to Develop Cultural Strategies for Prevention in Community Intervention

PubMed Central

Allen, James; Mohatt, Gerald V.; Beehler, Sarah; Rowe, Hillary L.

2014-01-01

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup’ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science. PMID:24903819

Culturally Tailored Depression/Suicide Prevention in Latino Youth: Community Perspectives.

PubMed

Ford-Paz, Rebecca E; Reinhard, Christine; Kuebbeler, Andrea; Contreras, Richard; Sánchez, Bernadette

2015-10-01

Latino adolescents are at elevated risk for depression and suicide compared to other ethnic groups. Project goals were to gain insight from community leaders about depression risk factors particular to Latino adolescents and generate innovative suggestions to improve cultural relevance of prevention interventions. This project utilized a CBPR approach to enhance cultural relevance, acceptability, and utility of the findings and subsequent program development. Two focus groups of youth and youth-involved Latino community leaders (n = 18) yielded three overarching themes crucial to a culturally tailored depression prevention intervention: (1) utilize a multipronged and sustainable intervention approach, (2) raise awareness about depression in culturally meaningful ways, and (3) promote Latino youth's social connection and cultural enrichment activities. Findings suggest that both adaptation of existing prevention programs and development of hybrid approaches may be necessary to reduce depression/suicide disparities for Latino youth. One such hybrid program informed by community stakeholders is described.

Using logic models in a community-based agricultural injury prevention project.

PubMed

Helitzer, Deborah; Willging, Cathleen; Hathorn, Gary; Benally, Jeannie

2009-01-01

The National Institute for Occupational Safety and Health has long promoted the logic model as a useful tool in an evaluator's portfolio. Because a logic model supports a systematic approach to designing interventions, it is equally useful for program planners. Undertaken with community stakeholders, a logic model process articulates the underlying foundations of a particular programmatic effort and enhances program design and evaluation. Most often presented as sequenced diagrams or flow charts, logic models demonstrate relationships among the following components: statement of a problem, various causal and mitigating factors related to that problem, available resources to address the problem, theoretical foundations of the selected intervention, intervention goals and planned activities, and anticipated short- and long-term outcomes. This article describes a case example of how a logic model process was used to help community stakeholders on the Navajo Nation conceive, design, implement, and evaluate agricultural injury prevention projects.

To examine the effectiveness of a hospital-based nurse-led secondary prevention clinic.

PubMed

Mainie, Paula M; Moore, Gillian; Riddell, John W; Adgey, A A Jennifer

2005-12-01

Modification of cardiovascular risk factors can reduce the incidence of myocardial infarction (MI), effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with known cardiovascular disease. Pharmacological treatments and important lifestyle changes reduce people's risks substantially (by 1/3 to 2/3) and can slow and perhaps reverse progression of established coronary disease. When used appropriately, these interventions are more cost-effective than many other treatments, currently provided by the National Health Service [Department of Health National Service Frameworks: coronary heart disease. Preventing coronary heart disease in high risk patients. 2000. HMSO.] Secondary prevention clinics are effective means by which to ensure targets are achieved and assist primary care in long-term maintenance of lifestyle change and drug optimisation. A 2-year hospital-based pilot project was established at the Royal Hospitals, April 2001-April 2003. The aim of the project was to target patients with coronary heart disease, post-MI and/or coronary artery bypass grafting and/or percutaneous coronary intervention, 6 months following their cardiac event. The plan was to assess patient risk factors and medication a minimum of 6 months following their cardiac event to ascertain if government targets were being achieved; secondly, to examine the effectiveness of a hospital-based nurse-led secondary prevention clinic on modifying risk factors and optimising drug therapies.

Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions.

PubMed

Levy, Karen; Smith, Shanon M; Carlton, Elizabeth J

2018-06-01

Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data. A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.

An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project.

PubMed

Balcázar, Hector; Wise, Sherrie; Rosenthal, E Lee; Ochoa, Cecilia; Rodriguez, Jose; Hastings, Diana; Flores, Leticia; Hernandez, Lorraine; Duarte-Gardea, Maria

2012-01-01

To address cardiovascular disease risk factors among Hispanics, a community model of prevention requires a comprehensive approach to community engagement. The objectives of our intervention were to reduce cardiovascular disease risk factors in Hispanics living in 2 low-income areas of El Paso, Texas, and to engage the community in a physical activity and nutrition intervention. Drawing on lessons learned in phase 1 (years 2005-2008) of the HEART Project, we used an iterative, community-based process to develop an intervention based on an ecological framework. New community partners were introduced and community health workers delivered several elements of the intervention, including the curriculum entitled "Mi Corazón, Mi Comunidad" ("MiCMiC" [My Heart, My Community]). We received feedback from the project's Community Health Academy and Leadership Council throughout the development process and established a policy agenda that promotes integration of community health workers into the local and state workforce. Collaboration with 2 new community partners, the YWCA and the Department of Parks and Recreation, were instrumental in the process of community-based participatory research. We enrolled 113 participants in the first cohort; 78% were female, and the mean age was 41 years. More than 50% reported having no health insurance coverage. Seventy-two (60%) participants attended 1 or more promotora-led Su Corazón, Su Vida sessions, and 74 (62%) participants attended 1 or more of the 15 exercise classes. HEART phase 2 includes a multilevel ecological model to address cardiovascular disease risk among Hispanics. Future similarly targeted initiatives can benefit from an ecological approach that also embraces the promotora model.

Discussions with adults and youth to inform the development of a community-based tobacco control programme

PubMed Central

Arora, Monika; Tewari, Abha; Dhavan, Poonam; Nazar, Gaurang P.; Stigler, Melissa H.; Juneja, Neeru S.; Perry, Cheryl L.; Reddy, K. Srinath

2013-01-01

Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10–19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY’s intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10–19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development. PMID:22824533

Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients.

PubMed

Lopez, Priscilla M; Zanowiak, Jennifer; Goldfeld, Keith; Wyka, Katarzyna; Masoud, Ahmad; Beane, Susan; Kumar, Rashi; Laughlin, Phoebe; Trinh-Shevrin, Chau; Thorpe, Lorna; Islam, Nadia

2017-12-06

The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.

Evaluation of the implementation of an intervention to improve the street environment and promote walking for transport in deprived neighbourhoods.

PubMed

Adams, Emma J; Cavill, Nick; Sherar, Lauren B

2017-08-14

Levels of physical activity remain low, particularly in deprived areas. Improving the street environment to promote walking for transport using a community engagement approach is a potential strategy to increase physical activity. An understanding of the implementation of this intervention approach is needed to facilitate further research, replication and scale-up. The aim of this study was to evaluate the implementation of the Fitter for Walking (FFW) intervention in deprived neighbourhoods. FFW was delivered in five regions of England between August 2008 and March 2012 and aimed to use a community engagement approach to improve the street environment to promote walking for transport. Implementation was assessed in relation to reach; dosage; implementation processes and adaptation; and factors influencing implementation. Three data sources were used: focus groups and face-to-face interviews with coordinators; implementation logs; and participation records. Reach: 155 community groups participated in FFW engaging 30,230 local residents. Dosage: A wide variety of environmental improvements were implemented by local authorities (LAs) (42 projects) and by communities (46 projects). Examples of LA-led improvements included removal of encroaching vegetation, new/improved pedestrian signage, new dropped kerbs/kerb improvements and new, repaired or improved footpaths. Examples of community-led improvements included planting bulbs, shrubs or bedding plants, clean-up days and litter pick-ups. In 32 projects, no environmental improvements were implemented. Promotional and awareness-raising activities were undertaken in 81 projects. Examples included led walks, themed walks, development of maps/resources to promote improved routes and community events. Processes and adaptation: The need for a planning phase, a preparatory phase, and a delivery phase with a four step process were identified. Adaptability to local context was important. Factors influencing implementation: Five key themes were identified in relation to the barriers and facilitators of implementing FFW: local knowledge and contacts; intervention delivery; coordinator role; working with LAs and other partners; and working with communities. FFW is one of few reported interventions which have used a community engagement approach to change the street environment to promote walking for transport in deprived neighbourhoods. Delivering these types of interventions is complex and requires considerable resource and time. A set of recommendations and an implementation framework are proposed for future delivery of this and similar types of programme.

Using logic models to enhance the methodological quality of primary health-care interventions: guidance from an intervention to promote nutrition care by general practitioners and practice nurses.

PubMed

Ball, Lauren; Ball, Dianne; Leveritt, Michael; Ray, Sumantra; Collins, Clare; Patterson, Elizabeth; Ambrosini, Gina; Lee, Patricia; Chaboyer, Wendy

2017-04-01

The methodological designs underpinning many primary health-care interventions are not rigorous. Logic models can be used to support intervention planning, implementation and evaluation in the primary health-care setting. Logic models provide a systematic and visual way of facilitating shared understanding of the rationale for the intervention, the planned activities, expected outcomes, evaluation strategy and required resources. This article provides guidance for primary health-care practitioners and researchers on the use of logic models for enhancing methodological rigour of interventions. The article outlines the recommended steps in developing a logic model using the 'NutriCare' intervention as an example. The 'NutriCare' intervention is based in the Australian primary health-care setting and promotes nutrition care by general practitioners and practice nurses. The recommended approach involves canvassing the views of all stakeholders who have valuable and informed opinions about the planned project. The following four targeted, iterative steps are recommended: (1) confirm situation, intervention aim and target population; (2) document expected outcomes and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Over a period of 2 months, three primary health-care researchers and one health-services consultant led the collaborative development of the 'NutriCare' logic model. Primary health-care practitioners and researchers are encouraged to develop a logic model when planning interventions to maximise the methodological rigour of studies, confirm that data required to answer the question are captured and ensure that the intervention meets the project goals.

The Health Intervention Project: HIV risk reduction among African American women drug users.

PubMed Central

Sterk, Claire E.

2002-01-01

OBJECTIVE: This article describes the Health Intervention Project, an intervention for African American women in Atlanta, Georgia, who are crack cocaine users. METHODS:A formative phase involved ethnographic mapping of the physical and social infrastructure of the study communities and in-depth interviews with women crack cocaine users. Key findings that were incorporated into the intervention program included the exchange of sex for money or drugs, the women's experience with trauma and abuse, the role of men and male partners, the women's roles as mothers and members of extended families, their identity as African Americans, and their desire to reduce their risk for HIV/AIDS related to their drug use and sexual behavior. Individualized intervention sessions were designed to meet the women's needs. The motivation intervention emphasized self-motivation for behavioral change with the assistance of the interventionist, who facilitated the women's goal identification, action plan, and problem-solving skills. The negotiation intervention focused on improving technical and assertive communication skills. An action plan was developed, and the women worked on negotiation skills, self-control regarding sexual and drug-use encounters, assertiveness in sexual and drug-use interactions, and conflict resolution. CONCLUSION: Effective prevention and intervention programs must be framed within an appropriate racial, ethnic, and cultural context. Future research is needed to better understand risk in its social context, including the impact of community factors. PMID:12435832

Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda.

PubMed

Leerlooijer, Joanne N; Kok, Gerjo; Weyusya, Joseph; Bos, Arjan E R; Ruiter, Robert A C; Rijsdijk, Liesbeth E; Nshakira, Nathan; Bartholomew, Leona K

2014-08-01

Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

The Health Intervention Project: HIV risk reduction among African American women drug users.

PubMed

Sterk, Claire E

2002-01-01

This article describes the Health Intervention Project, an intervention for African American women in Atlanta, Georgia, who are crack cocaine users. A formative phase involved ethnographic mapping of the physical and social infrastructure of the study communities and in-depth interviews with women crack cocaine users. Key findings that were incorporated into the intervention program included the exchange of sex for money or drugs, the women's experience with trauma and abuse, the role of men and male partners, the women's roles as mothers and members of extended families, their identity as African Americans, and their desire to reduce their risk for HIV/AIDS related to their drug use and sexual behavior. Individualized intervention sessions were designed to meet the women's needs. The motivation intervention emphasized self-motivation for behavioral change with the assistance of the interventionist, who facilitated the women's goal identification, action plan, and problem-solving skills. The negotiation intervention focused on improving technical and assertive communication skills. An action plan was developed, and the women worked on negotiation skills, self-control regarding sexual and drug-use encounters, assertiveness in sexual and drug-use interactions, and conflict resolution. Effective prevention and intervention programs must be framed within an appropriate racial, ethnic, and cultural context. Future research is needed to better understand risk in its social context, including the impact of community factors.

Reducing Falls After Electroconvulsive Therapy: A Quality Improvement Project.

PubMed

Brown, Allana Marie

2017-07-01

Falls after electroconvulsive therapy (ECT) in patients 60 and older have been long recognized as a major clinical care issue across many mental health care settings. The evidence base for fall prevention strategies after receiving ECT is sparse. The risk factors for falls after ECT are vast and complex in nature, especially considering existing comorbid medical conditions. The dearth of research in guiding practitioners on fall reduction interventions for this patient population illuminates a gap in mental health care quality and safety. The purpose of the current nurse-led quality improvement project was to reduce falls in patients undergoing ECT by enhancing safety measures through education and a post-ECT treatment protocol. The project did not prove to be as efficacious as anticipated as measured by fall rate outcomes. Several factors that may account for the project's findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 20-29.]. Copyright 2017, SLACK Incorporated.

The students for peace project: a comprehensive violence-prevention program for middle school students.

PubMed

Kelder, S H; Orpinas, P; McAlister, A; Frankowski, R; Parcel, G S; Friday, J

1996-01-01

Students for Peace is a three-year project (October 1993- September 1996) designed to evaluate a comprehensive, school-based intervention that seeks to prevent violence among sixth-, seventh-, and eighth-grade students in a large urban school district in Texas. This study examines the hypothesis that students exposed to a two-year multiple-component intervention will reduce aggressive behavior compared to students who receive the district's "usual care" of violence prevention activities. Students for Peace is based largely on Social Learning. Theory (SLT), which addresses both the psychosocial dynamics underlying health behavior and the methods of promoting behavior change, while emphasizing cognitive processes and their effect on behavior. SLT explains human behavior in terms of a model in which three factors-behavior, social-environmental influences, and personal factors (such as personality, perceptions and expectations, and affect)-all interact. Theoretically, an individual's behavior is uniquely determined by a combination of these factors; thus, these factors become the elements for intervention strategies. The intervention program includes four main components: (1) modification of the school environment, (2) a violence-prevention curriculum, (3) peer leadership, and (4) parent education. Students for Peace is using a nested cross-sectional and cohort design in which school is the unit of design, allocation, and analysis. Eight schools, four intervention and four control, are participating. In May 1994, a questionnaire was administered to all students in school the day of the survey. A posttest evaluation was taken in the spring of 1995 and will be followed by a final posttest in spring 1996. A total of 8,865 students responded to the baseline survey. Nearly all variables indicated comparability between treatment and control conditions. As a population, Students for Peace participants are largely Hispanic (65%) or African American (19%). Violence-related variables indicated 30-day fighting prevalence, 23%; 12-month prevalence of injuries due to fighting, 14%; 30-day hand-gun carrying prevalence, 11%; 30-day prevalence of taunts and threats at school, 27%, and threats going to and from school, 26%. Overall, the data from Year 1 activities indicate a population in need of violence-prevention intervention. The challenge is to mold existing district resources into a theoretically sound program of interventions. If that program is found effective, the district will already have the necessary documentation, personnel, and skills for broader dissemination.

Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project.

PubMed

Gil, Andrés G; Wagner, Eric F; Tubman, Jonathan G

2004-11-01

This study presents preliminary analyses examining the effects of an alcohol and other drug use (AOD) intervention with minority juvenile offenders. Furthermore, the study investigates the impact of cultural factors on baseline AOD use among Hispanic and African American youth, as well as on treatment outcome. Participants were 213 juvenile offenders referred for treatment (mean age = 15.7 years), 97 of whom have completed treatment to date. The intervention was carried out in clinics placed within the neighborhoods in which the participants resided. Intervention Alcohol Treatment Targeting Adolescents in Need (ATTAIN) is a controlled clinical trial evaluating the effectiveness of a brief motivational, cognitive behavioral intervention, guided self-change (GSC). Participants are assigned randomly to the individual format of guided self-change (I-GSC), the family involved format of guided self-Change (F-GSC), choice of one of these two, or a waiting list control condition. Only participants involved in active intervention are included in the present report. Data were collected via structured face-to-face interviews. Alcohol and marijuana use measures were collected using the Time-line Follow-back interview (TLFB). There were significant reductions in alcohol and marijuana use for all ethnic groups from baseline to post-intervention. Cultural factors (discrimination, acculturation, ethnic pride and cultural mistrust) were associated with pre-intervention levels of alcohol and marijuana use. Among Hispanics, pre-intervention level of substance use were higher among foreign-born than US-born youth. Analyses conducted with the US-born Hispanic group showed that ethnic orientation and ethnic pride were associated positively with greater reductions in alcohol use. The intervention provided through ATTAIN appears to be effective with a multi-ethnic population of juvenile delinquents. Cultural factors, such as ethnic orientation and ethnic mistrust, appear to constitute amenability to treatment factors, with US-born Hispanic youth lower in acculturation responding better to the intervention.

Evaluating large-scale health programmes at a district level in resource-limited countries.

PubMed

Svoronos, Theodore; Mate, Kedar S

2011-11-01

Recent experience in evaluating large-scale global health programmes has highlighted the need to consider contextual differences between sites implementing the same intervention. Traditional randomized controlled trials are ill-suited for this purpose, as they are designed to identify whether an intervention works, not how, when and why it works. In this paper we review several evaluation designs that attempt to account for contextual factors that contribute to intervention effectiveness. Using these designs as a base, we propose a set of principles that may help to capture information on context. Finally, we propose a tool, called a driver diagram, traditionally used in implementation that would allow evaluators to systematically monitor changing dynamics in project implementation and identify contextual variation across sites. We describe an implementation-related example from South Africa to underline the strengths of the tool. If used across multiple sites and multiple projects, the resulting driver diagrams could be pooled together to form a generalized theory for how, when and why a widely-used intervention works. Mechanisms similar to the driver diagram are urgently needed to complement existing evaluations of large-scale implementation efforts.

Weight reduction among people with severe and persistent mental illness after health behavior counseling and monitoring.

PubMed

Katekaru, Matthew; Minn, Carol E; Pobutsky, Ann M

2015-04-01

The high prevalence of obesity and associated chronic conditions in persons with severe and persistent mental illness has contributed to a mortality rate that is nearly two times higher than the overall population. In 2008, the Central O'ahu Community Mental Health Center of the Hawai'i State Department of Health, Adult Mental Health Division began an unfunded, health counseling intervention pilot project to address such concerns for the health of persons with severe and persistent mental illness. This article reviews the results of this intervention. Forty-seven persons with schizophrenia or related disorders were included in the intervention which involved health counseling and monitoring of weight as a risk factor for chronic disease. After five years of counseling and monitoring, medical chart reviews were conducted for each person for data on weight change. Analysis showed weight loss and improvements in body mass index. The results of this project show potential for long-term counseling and monitoring as an intervention for obesity in persons with severe and persistent mental illness.

Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: the IDEFICS intervention

PubMed Central

2011-01-01

Background The prevalence of childhood obesity has increased during the past decades and is now considered an urgent public health problem. Although stabilizing trends in obesity prevalence have been identified in parts of Europe, preventive efforts in children are still needed. Using the socio-ecological approach as the underlying theoretical perspective, the IDEFICS project aimed to develop, implement and evaluate a community-based intervention for the prevention of childhood obesity in eight European countries. The aim of the present manuscript was to describe the content and developmental process of the IDEFICS intervention. Methods The intervention mapping protocol (IMP) was used to develop the community-based intervention for the prevention of childhood obesity in 3 to 10 years old children. It is a theory- and evidence-based tool for the structured planning and development of health promotion programs that requires the completion of six different steps. These steps were elaborated by two coordinating centers and discussed with the other participating centers until agreement was reached. Focus group research was performed in all participating centers to provide an informed basis for intervention development. Results The application of the IMP resulted in an overall intervention framework with ten intervention modules targeting environmental and personal factors through the family, the school and the community. The summary results of the focus group research were used to inform the development of the overall intervention. The cultural adaptation of the overall intervention was realised by using country specific focus group results. The need for cultural adaptation was considered during the entire process to improve program adoption and implementation. A plan was developed to evaluate program effectiveness and quality of implementation. Conclusions The IDEFICS project developed a community-based intervention for the prevention of childhood obesity by using to the intervention mapping heuristic. The IDEFICS intervention consists of a general and standardized intervention framework that allows for cultural adaptation to make the intervention feasible and to enhance deliverability in all participating countries. The present manuscript demonstrates that the development of an intervention is a long process that needs to be done systematically. Time, human resources and finances need to be planned beforehand to make interventions evidence-based and culturally relevant. PMID:21806806

Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: the IDEFICS intervention.

PubMed

Verbestel, Vera; De Henauw, Stefaan; Maes, Lea; Haerens, Leen; Mårild, Staffan; Eiben, Gabriele; Lissner, Lauren; Moreno, Luis A; Frauca, Natalia Lascorz; Barba, Gianvincenzo; Kovács, Eva; Konstabel, Kenn; Tornaritis, Michael; Gallois, Katharina; Hassel, Holger; De Bourdeaudhuij, Ilse

2011-08-01

The prevalence of childhood obesity has increased during the past decades and is now considered an urgent public health problem. Although stabilizing trends in obesity prevalence have been identified in parts of Europe, preventive efforts in children are still needed. Using the socio-ecological approach as the underlying theoretical perspective, the IDEFICS project aimed to develop, implement and evaluate a community-based intervention for the prevention of childhood obesity in eight European countries. The aim of the present manuscript was to describe the content and developmental process of the IDEFICS intervention. The intervention mapping protocol (IMP) was used to develop the community-based intervention for the prevention of childhood obesity in 3 to 10 years old children. It is a theory- and evidence-based tool for the structured planning and development of health promotion programs that requires the completion of six different steps. These steps were elaborated by two coordinating centers and discussed with the other participating centers until agreement was reached. Focus group research was performed in all participating centers to provide an informed basis for intervention development. The application of the IMP resulted in an overall intervention framework with ten intervention modules targeting environmental and personal factors through the family, the school and the community. The summary results of the focus group research were used to inform the development of the overall intervention. The cultural adaptation of the overall intervention was realised by using country specific focus group results. The need for cultural adaptation was considered during the entire process to improve program adoption and implementation. A plan was developed to evaluate program effectiveness and quality of implementation. The IDEFICS project developed a community-based intervention for the prevention of childhood obesity by using to the intervention mapping heuristic. The IDEFICS intervention consists of a general and standardized intervention framework that allows for cultural adaptation to make the intervention feasible and to enhance deliverability in all participating countries. The present manuscript demonstrates that the development of an intervention is a long process that needs to be done systematically. Time, human resources and finances need to be planned beforehand to make interventions evidence-based and culturally relevant.

The multisite violence prevention project: impact of a universal school-based violence prevention program on social-cognitive outcomes.

PubMed

2008-12-01

This study evaluated the impact of a universal school-based violence prevention program on social-cognitive factors associated with aggression and nonviolent behavior in early adolescence. The effects of the universal intervention were evaluated within the context of a design in which two cohorts of students at 37 schools from four sites (N = 5,581) were randomized to four conditions: (a) a universal intervention that involved implementing a student curriculum and teacher training with sixth grade students and teachers; (b) a selective intervention in which a family intervention was implemented with a subset of sixth grade students exhibiting high levels of aggression and social influence; (c) a combined intervention condition; and (d) a no-intervention control condition. Short-term and long-term (i.e., 2-year post-intervention) universal intervention effects on social-cognitive factors targeted by the intervention varied as a function of students' pre-intervention level of risk. High-risk students benefited from the intervention in terms of decreases in beliefs and attitudes supporting aggression, and increases in self-efficacy, beliefs and attitudes supporting nonviolent behavior. Effects on low-risk students were in the opposite direction. The differential pattern of intervention effects for low- and high-risk students may account for the absence of main effects in many previous evaluations of universal interventions for middle school youth. These findings have important research and policy implications for efforts to develop effective violence prevention programs.

The Multisite Violence Prevention Project: Impact of a Universal School-Based Violence Prevention Program on Social-Cognitive Outcomes

PubMed Central

Simon, Thomas R.; Ikeda, Robin M.; Smith, Emilie Phillips; Reese, Le'Roy E.; Rabiner, David L.; Miller-Johnson, Shari; Winn, Donna-Marie; Dodge, Kenneth A.; Asher, Steven R.; Home, Arthur M.; Orpinas, Pamela; Martin, Roy; Quinn, William H.; Tolan, Patrick H.; Gorman-Smith, Deborah; Henry, David B.; Gay, Franklin N.; Schoeny, Michael; Farrell, Albert D.; Meyer, Aleta L.; Sullivan, Terri N.; Allison, Kevin W.

2009-01-01

This study evaluated the impact of a universal school-based violence prevention program on social-cognitive factors associated with aggression and nonviolent behavior in early adolescence. The effects of the universal intervention were evaluated within the context of a design in which two cohorts of students at 37 schools from four sites (N=5,581) were randomized to four conditions: (a) a universal intervention that involved implementing a student curriculum and teacher training with sixth grade students and teachers; (b) a selective intervention in which a family intervention was implemented with a subset of sixth grade students exhibiting high levels of aggression and social influence; (c) a combined intervention condition; and (d) a no-intervention control condition. Short-term and long-term (i.e., 2-year post-intervention) universal intervention effects on social-cognitive factors targeted by the intervention varied as a function of students' pre-intervention level of risk. High-risk students benefited from the intervention in terms of decreases in beliefs and attitudes supporting aggression, and increases in self-efficacy, beliefs and attitudes supporting nonviolent behavior. Effects on low-risk students were in the opposite direction. The differential pattern of intervention effects for low- and high-risk students may account for the absence of main effects in many previous evaluations of universal interventions for middle school youth. These findings have important research and policy implications for efforts to develop effective violence prevention programs. PMID:18780181

The use of process mapping in healthcare quality improvement projects.

PubMed

Antonacci, Grazia; Reed, Julie E; Lennox, Laura; Barlow, James

2018-05-01

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

Developing culturally adapted lifestyle interventions for South Asian migrant populations: a qualitative study of the key success factors and main challenges.

PubMed

Terragni, L; Beune, E; Stronks, K; Davidson, E; Qureshi, S; Kumar, B; Diaz, E

2018-06-11

South Asian migrant populations have a high risk of non-communicable diseases, such as type 2 diabetes (T2D). The aim of this study is to provide in-depth insight into key success factors and challenges in developing culturally adapted lifestyle interventions to prevent T2D within South Asian migrant populations. The study has a qualitative research design. In-depth interviews, using a semi-structured interview guide, were conducted with eight researchers and project leaders from five studies of culturally adapted lifestyle interventions for South Asian migrant populations. Data were analysed using a grounded theory approach. Four main themes emerged as key factors for success: 'approaching the community in the right way', 'the intervention as a space for social relations', 'support from public authorities' and 'being reflexive and flexible'. Two themes emerged as challenges: 'struggling with time' and 'overemphasising cultural differences'. Our findings augment existing research by establishing the importance of cooperation at the organisational and institutional levels, of fostering the creation of social networks through interventions and of acknowledging the multiplicity of identities and resources among individuals of the same ethnic origin. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Brief Behavioral Therapy for Pediatric Anxiety and Depression: Piloting an Integrated Treatment Approach

ERIC Educational Resources Information Center

Weersing, V. Robin; Gonzalez, Araceli; Campo, John V.; Lucas, Amanda N.

2008-01-01

Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral…

Examining Individual and Ecological Predictors of the Self-Determination of Students with Disabilities

ERIC Educational Resources Information Center

Shogren, Karrie A.; Wehmeyer, Michael L.; Palmer, Susan B.; Soukup, Jane Helen; Little, Todd D.; Garner, Nancy; Lawrence, Margaret

2007-01-01

This article examines the impact of multiple individual and ecological factors on the self-determination of students with learning disabilities, mild and moderate mental retardation, and other health impairments. Baseline data from a multistate, longitudinal research project evaluating interventions to promote self-determination were examined…

The effectiveness of individual placement and support for people with mental illness new on social benefits: a study protocol

PubMed Central

2013-01-01

Background In Switzerland, people with a severe mental illness and unable to work receive disability benefits (‘IV-pension’). Once they are granted these benefits, the chances to regain competitive employment are usually small. However, previous studies have shown that individual placement and support (IPS) supports a successful reintegration into competitive employment. This study focuses on the integration of newly appointed IV-pensioners, who have received an IV-pension for less than a year. Method/design The present pilot project ZHEPP (Zürcher Eingliederungs-Pilot Projekt; engl.: Zurich integration pilot project) is a randomized controlled trial (RCT). The 250 participants will be randomized to either the intervention or the control group. The intervention group receives support of a job coach according to the approach of IPS. Participants in the control group do not receive IPS support. Participation takes a total of two years for each participant. Each group is interviewed every six months (T0-T4). A two-factor analysis of variance will be conducted with the two factors group (intervention versus control group) and outcome (employment yes/no). The main criterion of the two-factor analysis will be the number of competitive employment contracts in each group. Discussion This study will focus on the impact of IPS on new IV-pensioners and aims to identify predictors for a successful integration. Furthermore, we will examine the effect of IPS on stigma variables and recovery orientation. Trial registration ISRCTN54951166 PMID:23883137

An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT)

PubMed Central

2014-01-01

Background In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life. Discussion Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community. Trial registration ISRCTN11674947 PMID:24951180

Healthy Start: a comprehensive health education program for preschool children.

PubMed

Williams, C L; Squillace, M M; Bollella, M C; Brotanek, J; Campanaro, L; D'Agostino, C; Pfau, J; Sprance, L; Strobino, B A; Spark, A; Boccio, L

1998-01-01

Healthy Start is a 3-year demonstration and education research project designed to evaluate the effectiveness of a multidimensional cardiovascular (CV) risk reduction intervention in preschool centers over a 3-year period of time. Two primary interventions are employed. The first is the preschool food service intervention program designed to reduce the total fat in preschool meals and snacks to less than 30% of calories and reduce the saturated fat to less than 10% of calories. The second major intervention is a comprehensive preschool health education curriculum, focused heavily on nutrition. Effectiveness of the intervention will be determined through evaluation of changes in dietary intake of preschool children at school meals and snacks, especially with respect to intake of total and saturated fat. Evaluation of the education component will include assessment of program implementation by teachers, assessment of changes in nutrition knowledge by preschool children, and assessment of changes in home meals that children consume (total and saturated fat content). Blood cholesterol will be evaluated semiannually to evaluate changes that may be due to modification of dietary intake. Growth and body fatness will also be assessed. While substantial efforts have targeted CV risk reduction and health education for elementary school children, similar efforts aimed at preschool children have been lacking. The rationale for beginning CV risk reduction programs for preschool children is based upon the premise that risk factors for heart disease are prevalent by 3 years of age and tend to track over time, most commonly hypercholesterolemia and obesity, both related to nutrition. Since the behavioral antecedents for nutritional risk factors begin to be established very early in life, it is important to develop and evaluate new educational initiatives such as Healthy Start, aimed at the primary prevention of cardiovascular risk factors in preschool children. The purpose of this publication is to describe the rationale and methods for the Healthy Start project.

Implementing person-environment approaches to prevent falls: a qualitative inquiry in applying the Westmead approach to occupational therapy home visits.

PubMed

Clemson, Lindy; Donaldson, Alex; Hill, Keith; Day, Lesley

2014-10-01

Despite evidence of the effectiveness of home safety interventions for preventing falls, there is limited uptake of such interventions within community services. Therefore, as part of a broader translational project, we explored issues underlying the implementation of an evidence-based home safety fall prevention intervention. We conducted in-depth interviews with eight occupational therapists and two programme coordinators engaged to deliver a home safety fall prevention intervention. Six community health centres within two metropolitan regions of Melbourne, Australia participated. The RE-AIM framework and Diffusion of Innovations theory underpinned the interviews which examine the enablers and barriers to implementing a home safety fall prevention intervention and integrating it into routine community preventive practice. Analysis involved thematic and content analysis. Investment in the home safety for fall prevention intervention was supported and valued by coordinators and therapists alike, and a number of themes emerged which influenced implementation of this intervention. These included issues of: compatibility with organisational processes, individual practitioner practices and skills, a prevention approach, and client expectations; relative advantage in terms of flexibility of the process, client engagement and regional capacity building; complexity of implementing the intervention; and observability related to the invisible nature of fall prevention outcomes. Implementation of this home safety fall prevention intervention was influenced by a range of interrelated organisational, practitioner and client related factors. The findings from this project provide insights into, and opportunities to increase the sustainable implementation of the home safety fall prevention intervention into practice. © 2014 Occupational Therapy Australia.

Project Northland: long-term outcomes of community action to reduce adolescent alcohol use.

PubMed

Perry, Cheryl L; Williams, Carolyn L; Komro, Kelli A; Veblen-Mortenson, Sara; Stigler, Melissa H; Munson, Karen A; Farbakhsh, Kian; Jones, Resa M; Forster, Jean L

2002-02-01

Project Northland was a randomized trial to reduce alcohol use among adolescents in 24 school districts in northeastern Minnesota. Phase 1 (1991-1994), when the targeted cohort was in grades 6-8, included school curricula, parent involvement, peer leadership and community task forces. The Interim Phase (1994-1996) involved minimal intervention. Phase 2 (1996-1998), when the cohort was in grades 11 and 12, included a classroom curriculum, parent education, print media, youth development and community organizing. Outcomes of these interventions were assessed by annual student surveys from 1991 to 1998, alcohol purchase attempts by young-looking buyers in 1991, 1994 and 1998, and parent telephone surveys in 1996 and 1998. Growth curve analysis was used to examine the student survey data over time. Project Northland was most successful when the students were young adolescents. The lack of intervention in the Interim Phase when the students were in grades 9 and 10 had a significant and negative impact on alcohol use. The intervention used with the high school students as those in grades 11 and 12 made a positive impact on their tendency to use alcohol use, binge drinking and ability to obtain alcohol. There was no impact in Phase 2 on other student-level behavioral and psychosocial factors. Developmentally appropriate, multi-component, community-wide programs throughout adolescence appear to be needed to reduce alcohol use.

Thirst distress and interdialytic weight gain: how do they relate?

PubMed

Jacob, Sheena; Locking-Cusolito, Heather

2004-01-01

Thirst is a frequent and stressful symptom experienced by hemodialysis patients. Several studies have noted a positive relationship between thirst and interdialytic weight gain (IDWG). These factors prompted us to consider ways that we could intervene to reduce thirst and IDWG through an educative, supportive nursing intervention. This paper presents the results of a pilot research project, the purpose of which was to: examine the relationship between thirst distress (the negative symptoms associated with thirst) and IDWG in a sample of our patients, describe patients' strategies for management of thirst, and establish the necessary sample size for the planned intervention study. The pilot research project results showed that in a small sample of 20, there was a mildly positive, though not statistically significant, correlation between thirst distress and IDWG (r = 0.117). Subjects shared a wide variety of thirst management strategies including: limiting salt intake, using ice chips, measuring daily allotment, performing mouth care, eating raw fruits and vegetables, sucking on hard candy and chewing gum. This pilot research project showed that given an alpha of 0.05 and a power of 80%, we will require a sample of 39 subjects to detect a 20% change in IDWG. We will employ these results to plan our intervention study, first by establishing the appropriate sample size and second by incorporating identified patient strategies into an educational pamphlet that will form the basis of our intervention.

A 12-week multidomain intervention versus active control to reduce risk of Alzheimer’s disease: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Disappointing results from clinical trials of disease-modifying interventions for Alzheimer’s dementia (AD), along with reliable identification of modifiable risk factors in mid life from epidemiological studies, have contributed to calls to invest in risk-reduction interventions. It is also well known that AD-related pathological processes begin more than a decade before the development of clinical signs. These observations suggest that lifestyle interventions might be most effective when targeting non-symptomatic adults at risk of AD. To date, however, the few dementia risk-reduction programs available have targeted individual risk factors and/or were restricted to clinical settings. The current study describes the development of an evidence-based, theoretically-driven multidomain intervention to reduce AD risk in adults at risk. Method The design of Body Brain Life (BBL) is a randomized controlled trial (RCT) to evaluate a 12-week online AD risk-reduction intervention. Eligible participants with several modifiable risk factors on the Australian National University (ANU) AD Risk Index (ANU-ADRI) are randomly allocated to an online only group, an online and face-to-face group, or an active control group. We aim to recruit 180 participants, to undergo a comprehensive cognitive and physical assessment at baseline, post-intervention, and 6-month follow-up assessment. The intervention comprises seven online modules (dementia literacy, risk factor education, engagement in physical, social, and cognitive lifestyles, nutrition, and health monitoring) designed using contemporary models of health behavior change. Discussion The BBL program is a novel online intervention to reduce the risk of AD in middle-aged adults at risk. The trial is currently under way. It is hypothesized that participants in the intervention arms will make lifestyle changes in several domains, and that this will lead to a reduction in their AD risk profile. We also expect to show that health behavior change is underpinned by changes in psychological determinants of behavior. If successful, the findings will contribute to the development of further dementia risk reduction interventions, and thus contribute to the urgent need to lower dementia risk factors in the population to alter future projections of disease prevalence. Longer follow-up of BBL participants and replications using large samples are required to examine whether reduction in AD risk factors will be associated with reduced prevalence. Trial registration Reg. no. ACTRN12612000147886 PMID:23442574

Evaluation of a Multicomponent Psychosocial Skill Training Program for Junior Physicians in Their First Year at Work: A Pilot Study.

PubMed

Mache, Stefanie; Vitzthum, Karin; Klapp, Burghard F; Groneberg, David A

2015-10-01

The present study was designed to gather preliminary information regarding the feasibility of implementing a psychosocial resilience program and to assess if the program would potentially promote protective factors (such as resiliency, self-efficacy) and job satisfaction as well as decreasing perceived stress among a sample of German junior physicians. Eighty-two junior physicians in their first year after graduation took part in the project and were randomized in a controlled trial to either an intervention or a control group for 3 months. The intervention group was offered resilience training combined with cognitive behavioral and solution-focused counseling. Primary outcome measures included scales of the PSQ, BRCS, SWOPE, and COPSOQ. Two post-intervention follow-up measurements proved the effectiveness of the intervention. There was a significant improvement between baseline and follow-up intervention scores on measures of resilience, self-efficacy, optimism, and perceived stress observed in the intervention group compared to the control group. Job satisfaction did not significantly differ between baseline and follow-ups. These results indicate that the program to enhance resilience and decrease stress among physicians is feasible to implement as a group training program in a workplace setting. Further, the intervention provides statistically significant improvement in perceptions of distress and strengthens protective factors (such as resiliency).

Providing oxygen to children in hospitals: a realist review

PubMed Central

Tosif, Shidan; Gray, Amy; Qazi, Shamim; Campbell, Harry; Peel, David; McPake, Barbara; Duke, Trevor

2017-01-01

Abstract Objective To identify and describe interventions to improve oxygen therapy in hospitals in low-resource settings, and to determine the factors that contribute to success and failure in different contexts. Methods Using realist review methods, we scanned the literature and contacted experts in the field to identify possible mechanistic theories of how interventions to improve oxygen therapy systems might work. Then we systematically searched online databases for evaluations of improved oxygen systems in hospitals in low- or middle-income countries. We extracted data on the effectiveness, processes and underlying theory of selected projects, and used these data to test the candidate theories and identify the features of successful projects. Findings We included 20 improved oxygen therapy projects (45 papers) from 15 countries. These used various approaches to improving oxygen therapy, and reported clinical, quality of care and technical outcomes. Four effectiveness studies demonstrated positive clinical outcomes for childhood pneumonia, with large variation between programmes and hospitals. We identified factors that help or hinder success, and proposed a practical framework depicting the key requirements for hospitals to effectively provide oxygen therapy to children. To improve clinical outcomes, oxygen improvement programmes must achieve good access to oxygen and good use of oxygen, which should be facilitated by a broad quality improvement capacity, by a strong managerial and policy support and multidisciplinary teamwork. Conclusion Our findings can inform practitioners and policy-makers about how to improve oxygen therapy in low-resource settings, and may be relevant for other interventions involving the introduction of health technologies. PMID:28479624

Household survey analysis of the impact of comprehensive strategies to improve the expanded programme on immunisation at the county level in western China, 2006–2010

PubMed Central

Zhou, Yuqing; Xing, Yi; Liang, Xiaofeng; Yue, Chenyan; Zhu, Xu; Hipgrave, David

2016-01-01

Objective To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. Design Prospective pre–post (2006–2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties. Setting Four project counties and one non-project county in each of four provinces. Participants 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention. Intervention Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement. Data collection Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline. Primary outcome measures Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010. Analysis Crude (χ2) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage. Results Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01). Conclusions Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions. PMID:26966053

Analyzing the effect of selected control policy measures and sociodemographic factors on alcoholic beverage consumption in Europe within the AMPHORA project: statistical methods.

PubMed

Baccini, Michela; Carreras, Giulia

2014-10-01

This paper describes the methods used to investigate variations in total alcoholic beverage consumption as related to selected control intervention policies and other socioeconomic factors (unplanned factors) within 12 European countries involved in the AMPHORA project. The analysis presented several critical points: presence of missing values, strong correlation among the unplanned factors, long-term waves or trends in both the time series of alcohol consumption and the time series of the main explanatory variables. These difficulties were addressed by implementing a multiple imputation procedure for filling in missing values, then specifying for each country a multiple regression model which accounted for time trend, policy measures and a limited set of unplanned factors, selected in advance on the basis of sociological and statistical considerations are addressed. This approach allowed estimating the "net" effect of the selected control policies on alcohol consumption, but not the association between each unplanned factor and the outcome.

Effectiveness and implementation of a community-based prevention programme targeting anabolic androgenic steroid use in gyms: study protocol of a quasi-experimental control group study.

PubMed

Molero, Yasmina; Gripenberg, Johanna; Bakshi, Ann-Sofie

2016-01-01

During the past decades, concerns about increased anabolic androgenic steroid (AAS) use among recreational sportspeople have been raised, yet there is a paucity of AAS prevention efforts targeting this group. Accordingly, doping prevention efforts aimed at gyms have been recommended. The overall objective of the present project is to examine a prevention programme named 100% Pure Hard Training (100% PHT), which targets AAS use among recreational sportspeople training in gyms. Specifically, the project aims to: 1) assess the prevalence of AAS, and its associations with alcohol, illicit drugs, and nutritional supplements use; 2) examine whether 100% PHT can decrease AAS use in gyms, and 3) provide insights into which factors facilitate and/or impede implementation of the programme. The intervention group consists of 27 gyms, and 27 gyms serve as controls. Intervention gyms take part in 100% PHT, a community-based programme involving several components: (a) training of key stakeholders (i.e., gym staff, gym owners, local police, and municipal prevention coordinators) regarding AAS use; (b) developing an action plan for AAS prevention for each gym; (c) certification of gyms that follow 100% PHT; (d) cooperative relationship between stakeholders; (e) annual follow-up of gyms. The project consists of two studies: Study A will examine the prevalence of AAS use and the effectiveness of 100% PHT (aims 1 and 2), and data for Study A will be collected using questionnaires distributed to gym attendees at two assessment points: baseline (pre-intervention) and follow-up (post-intervention). Study B will evaluate the implementation of 100% PHT (aim 3), and semi-structured interviews with participating stakeholders will be carried out post-intervention. Knowledge gained from the present project can be used to develop community-based doping prevention efforts aimed at recreational sportspeople training in gyms. Furthermore, it can provide insights into which factors are important for successful implementation of AAS prevention programmes that target gyms. Results are also expected to yield information on the prevalence of AAS use as well as associations between the use of AAS and other licit and illicit substances, including nutritional supplements, among recreational sportspeople. The study was registered retrospectively at isrctn.com (Identifier: ISRCTN11655041; Registration date: 3 November 2016;).

Operational challenges in conducting a community-based technology-enabled mental health services delivery model for rural India: Experiences from the SMART Mental Health Project.

PubMed

Maulik, Pallab K; Kallakuri, Sudha; Devarapalli, Siddhardha

2018-01-01

Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention. Method: Key components of the SMART Mental Health Project included delivering an anti-stigma campaign, training of primary health workers in screening, diagnosing and managing stress, depression and increased suicide risk and task sharing of responsibilities in delivering care; and using mobile technology based electronic decision support systems to support delivery of algorithm based care for such disorders. The intervention was conducted in 42 villages across two sites in the state of Andhra Pradesh in south India. A pre-post mixed methods evaluation was done, and in this paper operational challenges are reported. Results: Both quantitative and qualitative results from the evaluation from one site covering about 5000 adults showed that the intervention was feasible and acceptable, and initial results indicated that it was beneficial in increasing access to mental health care and reducing depression and anxiety symptoms. A number of strategies were initiated in response to operational challenges to ensure smoother conduct of the project and facilitated the project to be delivered as envisaged. Conclusions: The operational strategies initiated for this project were successful in ensuring the delivery of the intervention. Those, coupled with other more systematic processes have informed the researchers to understand key processes that need to be in place to develop a more robust study, that could eventually be scaled up.

Predictive Factors for Verbal Memory Performance Over Decades of Aging: Data from the Women's Healthy Ageing Project.

PubMed

Szoeke, Cassandra; Lehert, Philippe; Henderson, Victor W; Dennerstein, Lorraine; Desmond, Patricia; Campbell, Stephen

2016-10-01

Abnormalities in brain structure and function can occur several decades prior to the onset of cognitive decline. It is in the preceding decades that an intervention is most likely to be effective, when informed by an understanding of factors contributing to the disease prodrome. Few studies, however, have sufficient longitudinal data on relevant risks to determine the optimum targets for interventions to improve cognition in aging. In this article we examine the timing and exposure of factors contributing to verbal memory performance in later life. 387 participants from the population-based Women's Healthy Ageing Project, mean age at baseline of 49.6 years (range: 45-55 years), had complete neuropsychiatric assessments, clinical information, physical measures, and biomarkers collected at baseline, with at least three follow-up visits that included at least one cognitive reassessment. Mixed linear models were conducted to assess the significance of risk factors on later-life verbal memory. We explored the influence of early, contemporaneous, and cumulative exposures. Younger age and better education were associated with baseline memory test performance (CERAD). Over the 20 years of study follow-up, cumulative mid- to late-life physical activity had the strongest effect on better later life verbal memory (0.136 [0.058, 0.214]). The next most likely contributors to verbal memory in late life were the negative effect of cumulative hypertension (-0.033 [-0.047, -0.0.18] and the beneficial effect of HDL cholesterol (0.818 [0.042, 1.593]). Findings suggest that midlife interventions focused on physical activity, hypertension control, and achieving optimal levels of HDL cholesterol will help maintain later-life verbal memory skills. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Predictors of completing a primary health care diabetes prevention intervention programme in people at high risk of type 2 diabetes: Experiences of the DE-PLAN project.

PubMed

Gilis-Januszewska, Aleksandra; Lindström, Jaana; Barengo, Noël C; Tuomilehto, Jaakko; Schwarz, Peter Eh; Wójtowicz, Ewa; Piwońska-Solska, Beata; Szybiński, Zbigniew; Windak, Adam; Hubalewska-Dydejczyk, Alicja

2018-02-01

It has been shown that real-life implementation studies for the prevention of type 2 diabetes (DM2) performed in different settings and populations can be effective. However, not enough information is available on factors influencing the reach of DM2 prevention programmes. This study examines the predictors of completing an intervention programme targeted at people at high risk of DM2 in Krakow, Poland as part of the DE-PLAN project.A total of 262 middle-aged people, everyday patients of 9 general practitioners' (GP) practices, at high risk of DM2 (Finnish Diabetes Risk Score (FINDRISK) >14) agreed to participate in the lifestyle intervention to prevent DM2. Intervention consisted of 11 lifestyle counseling sessions, organized physical activity sessions followed by motivational phone calls and letters. Measurements were performed at baseline and 1 year after the initiation of the intervention.Seventy percent of the study participants enrolled completed the core curriculum (n = 184), 22% were men. When compared to noncompleters, completers had a healthier baseline diabetes risk profile (P <.05). People who completed the intervention were less frequently employed versus noncompleters (P = .037), less often had hypertension (P = .043), and more frequently consumed vegetables and fruit daily (P = .055).In multiple logistic regression model, employment reduced the likelihood of completing the intervention 2 times (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81). Higher glucose 2 hours after glucose load and hypertension were the independent factors decreasing the chance to participate in the intervention (OR 0.79, 95% 0.69-0.92 and OR 0.52, 95% CI 0.27-0.99, respectively). Daily consumption of vegetables and fruits increased the likelihood of completing the intervention (OR 1.86, 95% 1.01-3.41).In conclusion, people with healthier behavior and risk profile are more predisposed to complete diabetes prevention interventions. Male, those who work and those with a worse health profile, are less likely to participate and complete interventions. Targeted strategies are needed in real-life diabetes prevention interventions to improve male participation and to reach those who are working as well as people with a higher risk profile.

A novel, bottom-up approach to promote evidence-based HIV prevention for people who inject drugs in Ukraine: protocol for the MICT (‘Bridge’) HIV prevention exchange project

PubMed Central

2014-01-01

Background Ukraine has one of the most severe HIV epidemics in Eastern Europe, with an estimated 1.6% of the adult population living with the virus. Injection drug use accounts for 36% of new HIV cases. Nongovernmental organizations in Ukraine have little experience with effective, theory-based behavioral risk reduction interventions necessary to reduce the scope of the HIV epidemic among Ukrainians who inject drugs. This study seeks to promote the use of evidence-based HIV prevention strategies among Ukrainian organizations working with drug users. Methods/design This study combines qualitative and quantitative methods to explore a model of HIV prevention intervention development and implementation that disseminates common factors of effective behavioral risk reduction interventions and enables service providers to develop programs that reflect their specific organizational contexts. Eight agencies, located in regions of Ukraine with the highest HIV and drug use rates and selected to represent key organizational context criteria (e.g., agency size, target population, experience with HIV prevention), will be taught common factors as the basis for intervention development. We will use qualitative methods, including interviews and observations, to document the process of intervention development and implementation at each agency. Using risk assessments with intervention participants, we will also assess intervention effectiveness. The primary outcome analyses will determine the extent to which agencies develop and implement an intervention for drug users that incorporates common factors of effective behavioral interventions. Effectiveness analyses will be conducted, and effect size of each intervention will be compared to that of published HIV prevention interventions for drug users with demonstrated effectiveness. This study will explore the role of organizational context on intervention development and implementation, including resource allocation decisions, problem-solving around intervention development, and barriers and facilitators to inclusion of common factors and delivery of a high quality intervention. Discussion This innovative approach to HIV prevention science dissemination and intervention development draws on providers’ ability to quickly develop innovative programs and reach populations in greatest need of services. It has the potential to enhance providers’ ability to use HIV prevention science to develop sustainable interventions in response to a rapidly changing epidemic. PMID:24491185

Developing, implementing and evaluating a model for an outpatient self-harm service.

PubMed

Brand, Fiona; Lascelles, Karen

2017-05-10

Aim To reduce the incidence of self-harming behaviour and improve well-being and experience of care for individuals who present regularly to the emergency department in one hospital following self-harm, by providing outpatient care. Method This was a 12-month nurse-led practice development project to develop, implement and evaluate a brief-intervention outpatient service for individuals who presented to the emergency department following self-harm and who were identified as being at risk of further self-harm. The service improvement was informed by an action research process and the principles of appreciative inquiry. Findings The project provided a short-term outpatient follow-up service, known as Brief Interventions in Repeat Self Harm (BIRSH), to patients who presented to the emergency department following self-harm, and who were considered at risk of further self-harm. The intervention enabled the clinician to validate the patient's distress and offer them short-term outpatient follow-up care. The BIRSH sessions were offered to 38 patients. A total of 26 patients attended one or more BIRSH session, and all of these individuals showed a reduction in the number of presentations to the emergency department following self-harm in the six months following the intervention, compared to the six months before the intervention. Conclusion The BIRSH outpatient service appears to have been a contributory factor in reducing self-harm for patients who engaged with the service. The service improvement was informed by an action research process and the principles of appreciative inquiry, which provided a positive, focused approach to the practice development project.

Factors affecting the appreciation generated through applying human factors/ergonomics (HFE) principles to systems of work.

PubMed

So, R H Y; Lam, S T

2014-01-01

This retrospective study examined the levels of appreciation (applause) given by clients to Human Factors/Ergonomic (HFE) specialists after they have modified the systems of work. Thirteen non-academic projects were chosen because the HFE interventions involved changed the way workers work at their workplaces. Companies involved range from multi-national corporations and military organizations with thousands of employees to small trading companies with less than 10 employees. In 5 cases the HFE recommendations were fully adopted and well appreciated. In 4 they were largely ignored and not appreciated, with partial adoption and some appreciation in the other 4 cases. Three factors that predict appreciation were identified: (i) alignment between the benefits HFE can provide and the project's key performance indices; (ii) awareness of HFE among the client's senior management; and (iii) a team organization appropriate for applying HFE recommendations. Having an HFE specialist on the client's side can greatly increase levels of appreciation, but lack of such a specialist will not affect levels of appreciation. A clear contractual requirement for HFE intervention does not promote appreciation significantly, but its absence can greatly reduce levels of appreciation. These relationships are discussed using the Kano's model of quality. Means to generate greater appreciation of the benefits of HFE are discussed. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Merging universal and indicated prevention programs: the Fast Track model. Conduct Problems Prevention Research Group.

PubMed

2000-01-01

Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, this intervention includes a universal-level classroom program plus social-skill training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. The theoretical principles and clinical strategies utilized in the Fast Track Project are described to illustrate the interplay between basic developmental research, the understanding of risk and protective factors, and a research-based model of preventive intervention that integrates universal and indicated models of prevention.

High rates of obesity and non-communicable diseases predicted across Latin America.

PubMed

Webber, Laura; Kilpi, Fanny; Marsh, Tim; Rtveladze, Ketevan; Brown, Martin; McPherson, Klim

2012-01-01

Non-communicable diseases (NCDs) such as cardiovascular disease and stroke are a major public health concern across Latin America. A key modifiable risk factor for NCDs is overweight and obesity highlighting the need for policy to reduce prevalence rates and ameliorate rising levels of NCDs. A cross-sectional regression analysis was used to project BMI and related disease trends to 2050. We tested the extent to which interventions that decrease body mass index (BMI) have an effect upon the number of incidence cases avoided for each disease. Without intervention obesity trends will continue to rise across much of Latin America. Effective interventions are necessary if rates of obesity and related diseases are to be reduced.

The role of family-related factors in the effects of the UP4FUN school-based family-focused intervention targeting screen time in 10- to 12-year-old children: the ENERGY project.

PubMed

Van Lippevelde, Wendy; Bere, Elling; Verloigne, Maïté; van Stralen, Maartje M; De Bourdeaudhuij, Ilse; Lien, Nanna; Vik, Frøydis Nordgård; Manios, Yannis; Grillenberger, Monika; Kovács, Eva; ChinAPaw, Mai J M; Brug, Johannes; Maes, Lea

2014-08-18

Screen-related behaviours are highly prevalent in schoolchildren. Considering the adverse health effects and the relation of obesity and screen time in childhood, efforts to affect screen use in children are warranted. Parents have been identified as an important influence on children's screen time and therefore should be involved in prevention programmes. The aim was to examine the mediating role of family-related factors on the effects of the school-based family-focused UP4FUN intervention aimed at screen time in 10- to 12-year-old European children (n child-parent dyads = 1940). A randomised controlled trial was conducted to test the six-week UP4FUN intervention in 10- to 12-year-old children and one of their parents in five European countries in 2011 (n child-parent dyads = 1940). Self-reported data of children were used to assess their TV and computer/game console time per day, and parents reported their physical activity, screen time and family-related factors associated with screen behaviours (availability, permissiveness, monitoring, negotiation, rules, avoiding negative role modeling, and frequency of physically active family excursions). Mediation analyses were performed using multi-level regression analyses (child-school-country). Almost all TV-specific and half of the computer-specific family-related factors were associated with children's screen time. However, the measured family-related factors did not mediate intervention effects on children's TV and computer/game console use, because the intervention was not successful in changing these family-related factors. Future screen-related interventions should aim to effectively target the home environment and parents' practices related to children's use of TV and computers to decrease children's screen time. The study is registered in the International Standard Randomised Controlled Trial Number Register (registration number: ISRCTN34562078).

Impact analysis of government investment on water projects in the arid Gansu Province of China

NASA Astrophysics Data System (ADS)

Wang, Zhan; Deng, Xiangzheng; Li, Xiubin; Zhou, Qing; Yan, Haiming

In this paper, we introduced three-nested Constant Elasticity of Substitution (CES) production function into a static Computable General Equilibrium (CGE) Model. Through four levels of factor productivity, we constructed three nested production function of land use productivity in the conceptual modeling frameworks. The first level of factor productivity is generated by the basic value-added land. On the second level, factor productivity in each sector is generated by human activities that presents human intervention to the first level of factor productivity. On the third level of factor productivity, water allocation reshapes the non-linear structure of transaction among first and second levels. From the perspective of resource utilization, we examined the economic efficiency of water allocation. The scenario-based empirical analysis results show that the three-nested CES production function within CGE model is well-behaved to present the economy system of the case study area. Firstly, water scarcity harmed economic production. Government investment on water projects in Gansu thereby had impacts on economic outcomes. Secondly, huge governmental financing on water projects bring depreciation of present value of social welfare. Moreover, water use for environment adaptation pressures on water supply. The theoretical water price can be sharply increased due to the increasing costs of factor inputs. Thirdly, water use efficiency can be improved by water projects, typically can be benefited from the expansion of water-saving irrigation areas even in those expanding dry area in Gansu. Therefore, increasing governmental financing on water projects can depreciate present value of social welfare but benefit economic efficiency for future generation.

TU-H-CAMPUS-IeP1-03: Comparison of Monte Carlo Simulation and Conversion Factor Based Method On Estimation of Effective Dose in Pediatric Patients Undergoing Interventional Cardiac Procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leung, K; Wong, M; Ng, Y

Purpose: Interventional cardiac procedures utilize frequent fluoroscopy and cineangiography, which impose considerable radiation risk to patients, especially pediatric patients. Accurate calculation of effective dose is important in order to estimate cancer risk over the rest of their lifetime. This study evaluates the difference in effective dose calculated by Monte Carlo simulation with those estimated by locally-derived conversion factors (CF-local) and by commonly quoted conversion factors from Karambatsakidou et al (CF-K). Methods: Effective dose (E),of 12 pediatric patients, age between 2.5–19 years old, who had undergone interventional cardiac procedures, were calculated using PCXMC-2.0 software. Tube spectrum, irradiation geometry, exposure parameters andmore » dose-area product (DAP) of each projection were included in the software calculation. Effective doses for each patient were also estimated by two Methods: 1) CF-local: conversion factor derived locally by generalizing results of 12 patients, multiplied by DAP of each patient gives E-local. 2) CF-K: selected factor from above-mentioned literature, multiplied by DAP of each patient gives E-K. Results: Mean of E, E-local and E-K were 16.01 mSv, 16.80 mSv and 22.25 mSv respectively. A deviation of −29.35% to +34.85% between E and E-local, while a greater deviation of −28.96% to +60.86% between E and EK were observed. E-K overestimated the effective dose for patients at age 7.5–19. Conclusion: Effective dose obtained by conversion factors is simple and quick to estimate radiation risk of pediatric patients. This study showed that estimation by CF-local may bear an error of 35% when compared with Monte Carlo calculation. If using conversion factors derived by other studies may result in an even greater error, of up to 60%, due to factors that are not catered for in the estimation, including patient size, projection angles, exposure parameters, tube filtration, etc. Users must be aware of these potential inaccuracies when simple conversion method is employed.« less

Therapeutic landscapes of home: Exploring Indigenous peoples' experiences of a Housing First intervention in Winnipeg.

PubMed

Alaazi, Dominic A; Masuda, Jeffrey R; Evans, Joshua; Distasio, Jino

2015-12-01

In this paper, we explore Indigenous perspectives of culture, place, and health among participants in a landmark Canadian Housing First initiative: At Home/Chez Soi (AHCS) project. Implemented from 2009 to 2013 in Winnipeg and four other Canadian cities, AHCS was a multi-city randomized control trial that sought to test the effectiveness of Housing First as a model for addressing chronic homelessness among people living with mental illnesses. As Winnipeg's homeless population is over 70% Indigenous, significant efforts were made to accommodate the culturally specific health, spiritual, and lifestyle preferences of the project's Indigenous participants. While a daunting challenge from an intervention perspective, Winnipeg's experience also provides a unique opportunity to examine how Indigenous participants' experiences can inform improved housing and mental health policy in Canada. In our study, conducted independently from, but with endorsement of the AHCS project, we utilized a case study approach to explore the experiences of the project's Indigenous participants. Data were collected by means of in-depth qualitative interviews with Indigenous participants (N = 14) and key informant project staff and investigators (N = 6). Our exploratory work demonstrates that despite relative satisfaction with the AHCS intervention, Indigenous peoples' sense of place in the city remains largely disconnected from their housing experiences. We found that structural factors, particularly the shortage of affordable housing and systemic erasure of Indigeneity from the urban sociocultural and political landscape, have adversely impacted Indigenous peoples' sense of place and home. Copyright © 2015 Elsevier Ltd. All rights reserved.

Developing and Implementing a Positive Behavioral Reinforcement Intervention in Prison-Based Drug Treatment: Project BRITE

PubMed Central

Burdon, William M.; De Lore, Jef St.; Prendergast, Michael L.

2012-01-01

Within prison settings, the reliance on punishment for controlling inappropriate or non-compliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention. PMID:22185038

Developing and implementing a positive behavioral reinforcement intervention in prison-based drug treatment: Project BRITE.

PubMed

Burdon, William M; St De Lore, Jef; Prendergast, Michael L

2011-09-01

Within prison settings, the reliance on punishment for controlling inappropriate or noncompliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention.

[Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience].

PubMed

Calderón, Carlos; Balagué, Laura; Iruin, Álvaro; Retolaza, Ander; Belaunzaran, Jon; Basterrechea, Javier; Mosquera, Isabel

2016-01-01

To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetza registers of prevalences, referrals and treatments. Follow-up meetings. Improvement in the 4 axes of intervention in the participant centres compared with the controls. Identification of factors to be considered in the development and sustainability of PC-MH collaborative care. The pilot experience confirms that collaborative projects promoted by PC and MH can improve depression care and the satisfaction of professionals. They are complex projects that need simultaneous interventions adjusted to the particularities of the health services. Multidisciplinary and continuous participation and management and information system support are necessary for their implementation. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

How to study improvement interventions: a brief overview of possible study types

PubMed Central

Portela, Margareth Crisóstomo; Pronovost, Peter J; Woodcock, Thomas; Carter, Pam; Dixon-Woods, Mary

2015-01-01

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. PMID:25810415

Republished: How to study improvement interventions: a brief overview of possible study types

PubMed Central

Portela, Margareth Crisóstomo; Pronovost, Peter J; Woodcock, Thomas; Carter, Pam; Dixon-Woods, Mary

2015-01-01

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. PMID:26045562

Associations Between Tobacco Marketing and Use Among Urban Youth in India

ERIC Educational Resources Information Center

Arora, Monika; Reddy, K. Srinath; Stigler, Melissa H.; Perry, Cheryl L.

2008-01-01

Objectives: To study if receptivity and exposure to tobacco marketing are correlated with tobacco use and psychosocial risk factors for tobacco use among a sample of urban Indian youth. Methods: Analysis of cross-sectional survey data from Project MYTRI, a group randomized intervention trial, in Delhi and Chennai, India, collected from sixth and…

The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study

PubMed Central

Webber, Laura; Divajeva, Diana; Marsh, Tim; McPherson, Klim; Brown, Martin; Galea, Gauden; Breda, Joao

2014-01-01

Objective Non-communicable diseases (NCDs) are the biggest cause of death in Europe putting an unsustainable burden on already struggling health systems. Increases in obesity are a major cause of NCDs. This paper projects the future burden of coronary heart disease (CHD), stroke, type 2 diabetes and seven cancers by 2030 in 53 WHO European Region countries based on current and past body mass index (BMI) trends. It also tests the impact of obesity interventions on the future disease burden. Setting and participants Secondary data analysis of country-specific epidemiological data using a microsimulation modelling process. Interventions The effect of three hypothetical scenarios on the future burden of disease in 2030 was tested: baseline scenario, BMI trends go unchecked; intervention 1, population BMI decreases by 1%; intervention 2, BMI decreases by 5%. Primary and secondary outcome measures Quantifying the future burden of major NCDs and the impact of interventions on this future disease burden. Results By 2030 in the whole of the European region, the prevalence of diabetes, CHD and stroke and cancers was projected to reach an average of 3990, 4672 and 2046 cases/100 000, respectively. The highest prevalence of diabetes was predicted in Slovakia (10 870), CHD and stroke—in Greece (11 292) and cancers—in Finland (5615 cases/100 000). A 5% fall in population BMI was projected to significantly reduce cumulative incidence of diseases. The largest reduction in diabetes and CHD and stroke was observed in Slovakia (3054 and 3369 cases/100 000, respectively), and in cancers was predicted in Germany (331/100 000). Conclusions Modelling future disease trends is a useful tool for policymakers so that they can allocate resources effectively and implement policies to prevent NCDs. Future research will allow real policy interventions to be tested; however, better surveillance data on NCDs and their risk factors are essential for research and policy. PMID:25063459

Social value of a nutritional counselling and support program for breastfeeding in urban poor settings, Nairobi.

PubMed

Goudet, Sophie; Griffiths, Paula L; Wainaina, Caroline W; Macharia, Teresia N; Wekesah, Frederick M; Wanjohi, Milka; Muriuki, Peter; Kimani-Murage, Elizabeth

2018-04-02

In Kenya, poor maternal nutrition, suboptimal infant and young child feeding practices and high levels of malnutrition have been shown among the urban poor. An intervention aimed at promoting optimal maternal infant and young child nutrition (MIYCN) practices in urban poor settings in Nairobi, Kenya was implemented. The intervention involved home-based counselling of pregnant and breastfeeding women and mothers of young children by community health volunteers (CHVs) on optimal MIYCN practices. This study assesses the social impact of the intervention using a Social Return on Investment (SROI) approach. Data collection was based on SROI methods and used a mixed methods approach (focus group discussions, key informant interviews, in-depth interviews, quantitative stakeholder surveys, and revealed preference approach for outcomes using value games). The SROI analysis revealed that the MIYCN intervention was assessed to be highly effective and created social value, particularly for mothers and their children. Positive changes that participants experienced included mothers being more confident in child care and children and mothers being healthier. Overall, the intervention had a negative social impact on daycare centers and on health care providers, by putting too much pressure on them to provide care without providing extra support. The study calculated that, after accounting for discounting factors, the input ($USD 419,716) generated $USD 8 million of social value at the end of the project. The net present value created by the project was estimated at $USD 29.5 million. $USD 1 invested in the project was estimated to bring USD$ 71 (sensitivity analysis: USD$ 34-136) of social value for the stakeholders. The MIYCN intervention showed an important social impact in which mothers and children benefited the most. The intervention resulted in better perceived health of mothers and children and increased confidence of mothers to provide care for their children, while it resulted in negative impacts for day care center owners and health care providers.

Evaluation of changes in equine care and limb-related abnormalities in working horses in Jaipur, India, as part of a two year participatory intervention study.

PubMed

Whay, Helen R; Dikshit, Amit K; Hockenhull, Jo; Parker, Richard M A; Banerjee, Anindo; Hughes, Sue I; Pritchard, Joy C; Reix, Christine E

2015-01-01

Previous studies have found the prevalence of lameness in working horses to be 90-100%. Risk factors for lameness in this important equine population, together with risk-reduction strategies adopted by their owners, are poorly understood. The objective was to uncover risk factors for lameness and limb abnormalities in working horses, by associating clinical lameness examination findings on three occasions over two years with owner reported changes in equine management and work practices over this period. Twenty-one communities of horse owners in Jaipur, India, took part in a participatory intervention (PI) project aiming to reduce risk factors for poor welfare, particularly lameness and limb problems. Associations between quantitative measures of equine lameness/limb abnormalities and reported changes in management and work practices were compared with 21 control (C) communities of owners where no intervention had taken place. Key findings from 'complete cases', where the same horse stayed with the same owner for the whole study period (PI group = 73 owners of 83 horses, C group = 58 owners of 66 horses), were that more positive statements of change in equine management and work practices were made by PI group owners than C group owners. A mixed picture of potential risk factors emerged: some reported management improvements, for example reducing the weight of the load for cart animals, were associated with improved limbs and lameness, and others, such as making improvements in shoeing and increasing the age at which their animals started work, with negative outcomes. This study illustrates the complexity and interacting nature of risk factors for lameness in working horses, and highlights the importance of longitudinal investigations that recognise and address this. PI group owners found the project useful and requested similar inputs in future. Our findings demonstrate the value of exploratory and participatory research methodology in the field of working horse welfare.

Design of the Bottom-up Innovation project--a participatory, primary preventive, organizational level intervention on work-related stress and well-being for workers in Dutch vocational education.

PubMed

Schelvis, Roosmarijn M C; Oude Hengel, Karen M; Wiezer, Noortje M; Blatter, Birgitte M; van Genabeek, Joost A G M; Bohlmeijer, Ernst T; van der Beek, Allard J

2013-08-15

In the educational sector job demands have intensified, while job resources remained the same. A prolonged disbalance between demands and resources contributes to lowered vitality and heightened need for recovery, eventually resulting in burnout, sickness absence and retention problems. Until now stress management interventions in education focused mostly on strengthening the individual capacity to cope with stress, instead of altering the sources of stress at work at the organizational level. These interventions have been only partly effective in influencing burnout and well-being. Therefore, the "Bottom-up Innovation" project tests a two-phased participatory, primary preventive organizational level intervention (i.e. a participatory action approach) that targets and engages all workers in the primary process of schools. It is hypothesized that participating in the project results in increased occupational self-efficacy and organizational efficacy. The central research question: is an organization focused stress management intervention based on participatory action effective in reducing the need for recovery and enhancing vitality in school employees in comparison to business as usual? The study is designed as a controlled trial with mixed methods and three measurement moments: baseline (quantitative measures), six months and 18 months (quantitative and qualitative measures). At first follow-up short term effects of taking part in the needs assessment (phase 1) will be determined. At second follow-up the long term effects of taking part in the needs assessment will be determined as well as the effects of implemented tailored workplace solutions (phase 2). A process evaluation based on quantitative and qualitative data will shed light on whether, how and why the intervention (does not) work(s). "Bottom-up Innovation" is a combined effort of the educational sector, intervention providers and researchers. Results will provide insight into (1) the relation between participating in the intervention and occupational and organizational self-efficacy, (2) how an improved balance between job demands and job resources might affect need for recovery and vitality, in the short and long term, from an organizational perspective, and (3) success and fail factors for implementation of an organizational intervention. Netherlands Trial Register NTR3284.

Developing community-based preventive interventions in Hong Kong: a description of the first phase of the family project.

PubMed

Stewart, Sunita M; Fabrizio, Cecilia S; Hirschmann, Malia R; Lam, Tai Hing

2012-02-07

This paper describes the development of culturally-appropriate family-based interventions and their relevant measures, to promote family health, happiness and harmony in Hong Kong. Programs were developed in the community, using a collaborative approach with community partners. The development process, challenges, and the lessons learned are described. This experience may be of interest to the scientific community as there is little information currently available about community-based development of brief interventions with local validity in cultures outside the West. The academic-community collaborative team each brought strengths to the development process and determined the targets for intervention (parent-child relationships). Information from expert advisors and stakeholder discussion groups was collected and utilized to define the sources of stress in parent-child relationships. Themes emerged from the literature and discussion groups that guided the content of the intervention. Projects emphasized features that were appropriate for this cultural group and promoted potential for sustainability, so that the programs might eventually be implemented at a population-wide level. Challenges included ensuring local direction, relevance and acceptability for the intervention content, engaging participants and enhancing motivation to make behavior changes after a brief program, measurement of behavior changes, and developing an equal partner relationship between academic and community staff. This work has public health significance because of the global importance of parent-child relationships as a risk-factor for many outcomes in adulthood, the need to develop interventions with strong evidence of effectiveness to populations outside the West, the potential application of our interventions to universal populations, and characteristics of the interventions that promote dissemination, including minimal additional costs for delivery by community agencies, and high acceptability to participants.

Early impact of a national multi-faceted road safety intervention program in Mexico: results of a time-series analysis.

PubMed

Chandran, Aruna; Pérez-Núñez, Ricardo; Bachani, Abdulgafoor M; Híjar, Martha; Salinas-Rodríguez, Aarón; Hyder, Adnan A

2014-01-01

In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León. An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999-2011 with dummy variables representing each intervention phase. In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city. These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.

Early Impact of a National Multi-Faceted Road Safety Intervention Program in Mexico: Results of a Time-Series Analysis

PubMed Central

Chandran, Aruna; Pérez-Núñez, Ricardo; Bachani, Abdulgafoor M.; Híjar, Martha; Salinas-Rodríguez, Aarón; Hyder, Adnan A.

2014-01-01

Background In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León. Methods An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999–2011 with dummy variables representing each intervention phase. Results In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city. Conclusion These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change. PMID:24498114

Case Management to Reduce Cardiovascular Disease Risk in American Indians and Alaska Natives With Diabetes: Results From the Special Diabetes Program for Indians Healthy Heart Demonstration Project

PubMed Central

Jiang, Luohua; Manson, Spero M.; Beals, Janette; Henderson, William; Pratte, Katherine; Acton, Kelly J.; Roubideaux, Yvette

2014-01-01

Objectives. We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. Methods. Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. Results. A1c levels decreased an average of 0.2% (P < .001). Systolic and diastolic blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels decreased, with the largest significant reduction in LDL cholesterol (∆ = −5.29 mg/dL; P < .001). Average Framingham CHD risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. Conclusions. SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts. PMID:25211728

An exploratory analysis of the model for understanding success in quality.

PubMed

Kaplan, Heather C; Froehle, Craig M; Cassedy, Amy; Provost, Lloyd P; Margolis, Peter A

2013-01-01

Experience suggests that differences in context produce variability in the effectiveness of quality improvement (QI) interventions. However, little is known about which contextual factors affect success or how they exert influence. Using the Model for Understanding Success in Quality (MUSIQ), we perform exploratory quantitative tests of the role of context in QI success. We used a cross-sectional design to survey individuals participating in QI projects in three settings: a pediatric hospital, hospitals affiliated with a state QI collaborative, and organizations sponsoring participants in an improvement advisor training program. Individuals participating in QI projects completed a questionnaire assessing contextual factors included in MUSIQ and measures of perceived success. Path analysis was used to test the direct, indirect, and total effects of context variables on QI success as hypothesized in MUSIQ. In the 74 projects studied, most contextual factors in MUSIQ were found to be significantly related to at least one QI project performance outcome. Contextual factors exhibiting significant effects on two measures of perceived QI success included resource availability, QI team leadership, team QI skills, microsystem motivation, microsystem QI culture, and microsystem QI capability. There was weaker evidence for effects of senior leader project sponsors, organizational QI culture, QI team decision-making, and microsystem QI leadership. These initial tests add to the validity of MUSIQ as a tool for identifying which contextual factors affect improvement success and understanding how they exert influence. Using MUSIQ, managers and QI practitioners can begin to identify aspects of context that must be addressed before or during the execution of QI projects and plan strategies to modify context for increased success. Additional work by QI researchers to improve the theory, refine measurement approaches, and validate MUSIQ as a predictive tool in a wider range of QI efforts is necessary.

Community violence and youth: affect, behavior, substance use, and academics.

PubMed

Cooley-Strickland, Michele; Quille, Tanya J; Griffin, Robert S; Stuart, Elizabeth A; Bradshaw, Catherine P; Furr-Holden, Debra

2009-06-01

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health, 2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children's chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.

Tailoring an Alcohol Intervention for American Indian Alaska Native Women of Childbearing Age: Listening to the Community.

PubMed

Montag, Annika C; Dusek, Marlené L; Ortega, Marina L; Camp-Mazzetti, Alexandrea; Calac, Dan J; Chambers, Christina D

2017-11-01

Reduction of risky drinking in women of childbearing age is 1 strategy that may be employed to prevent fetal alcohol spectrum disorder, a sequela of prenatal alcohol exposure. Communities differ in risk and protective factors, necessitating culturally informed interventions for maximal efficacy. This article describes the modification of an existing web-based screening, brief intervention, and referral to treatment intervention to reduce risky drinking among American Indian Alaska Native (AIAN) women of childbearing age in Southern California into a peer-to-peer-based intervention using motivational interviewing (MI). The modification process was iterative and included various community focus groups, interviews, and a final review. Intervention modification was required for cultural congruence. Components of the peer-to-peer intervention designed by this project included a flip chart used to guide the motivational interviewing, charts of the financial and physical costs of alcohol consumption, revised baseline and follow-up questionnaires, and guidance regarding the application of MI techniques. This study may inform the modification of future interventions among AIAN communities. Copyright © 2017 by the Research Society on Alcoholism.

Intervention Mapping as a Participatory Approach to Developing an HIV prevention Intervention in Rural African American Communities

PubMed Central

Corbie-Smith, Giselle; Akers, Aletha; Blumenthal, Connie; Council, Barbara; Wynn, Mysha; Muhammad, Melvin; Stith, Doris

2011-01-01

Southeastern states are among the hardest hit by the HIV epidemic in this country, and racial disparities in HIV rates are high in this region. This is particularly true in our communities of interest in rural eastern North Carolina. Although most recent efforts to prevent HIV attempt to address multiple contributing factors, we have found few multilevel HIV interventions that have been developed, tailored or tested in rural communities for African Americans. We describe how Project GRACE integrated Intervention Mapping (IM) methodology with community based participatory research (CBPR) principles to develop a multi-level, multi-generational HIV prevention intervention. IM was carried out in a series of steps from review of relevant data through producing program components. Through the IM process, all collaborators agreed that we needed a family-based intervention involving youth and their caregivers. We found that the structured approach of IM can be adapted to incorporate the principles of CBPR. PMID:20528128

Allowing for MSD prevention during facilities planning for a public service: an a posteriori analysis of 10 library design projects.

PubMed

Bellemare, Marie; Trudel, Louis; Ledoux, Elise; Montreuil, Sylvie; Marier, Micheline; Laberge, Marie; Vincent, Patrick

2006-01-01

Research was conducted to identify an ergonomics-based intervention model designed to factor in musculoskeletal disorder (MSD) prevention when library projects are being designed. The first stage of the research involved an a posteriori analysis of 10 recent redesign projects. The purpose of the analysis was to document perceptions about the attention given to MSD prevention measures over the course of a project on the part of 2 categories of employees: librarians responsible for such projects and personnel working in the libraries before and after changes. Subjects were interviewed in focus groups. Outcomes of the analysis can guide our ergonomic assessment of current situations and contribute to a better understanding of the way inclusion or improvement of prevention measures can support the workplace design process.

Individual, employment and psychosocial factors influencing walking to work: Implications for intervention design

PubMed Central

Esliger, Dale W.; Taylor, Ian M.; Sherar, Lauren B.

2017-01-01

Background Promoting walking for the journey to and from work (commuter walking) is a potential strategy for increasing physical activity. Understanding the factors influencing commuter walking is important for identifying target groups and designing effective interventions. This study aimed to examine individual, employment-related and psychosocial factors associated with commuter walking and to discuss the implications for targeting and future design of interventions. Methods 1,544 employees completed a baseline survey as part of the ‘Walking Works’ intervention project (33.4% male; 36.3% aged <30 years). Multivariate logistic regression was used to examine the associations of individual (age, ethnic group, educational qualifications, number of children <16 and car ownership), employment-related (distance lived from work, free car parking at work, working hours, working pattern and occupation) and psychosocial factors (perceived behavioural control, intention, social norms and social support from work colleagues) with commuter walking. Results Almost half of respondents (n = 587, 49%) were classified as commuter walkers. Those who were aged <30 years, did not have a car, had no free car parking at work, were confident of including some walking or intended to walk to or from work on a regular basis, and had support from colleagues for walking were more likely to be commuter walkers. Those who perceived they lived too far away from work to walk, thought walking was less convenient than using a car for commuting, did not have time to walk, needed a car for work or had always travelled the same way were less likely to be commuter walkers. Conclusions A number of individual, employment-related and psychosocial factors were associated with commuter walking. Target groups for interventions to promote walking to and from work may include those in older age groups and those who own or have access to a car. Multi-level interventions targeting individual level behaviour change, social support within the workplace and organisational level travel policies may be required in order to promote commuter walking. PMID:28182714

Individual, employment and psychosocial factors influencing walking to work: Implications for intervention design.

PubMed

Adams, Emma J; Esliger, Dale W; Taylor, Ian M; Sherar, Lauren B

2017-01-01

Promoting walking for the journey to and from work (commuter walking) is a potential strategy for increasing physical activity. Understanding the factors influencing commuter walking is important for identifying target groups and designing effective interventions. This study aimed to examine individual, employment-related and psychosocial factors associated with commuter walking and to discuss the implications for targeting and future design of interventions. 1,544 employees completed a baseline survey as part of the 'Walking Works' intervention project (33.4% male; 36.3% aged <30 years). Multivariate logistic regression was used to examine the associations of individual (age, ethnic group, educational qualifications, number of children <16 and car ownership), employment-related (distance lived from work, free car parking at work, working hours, working pattern and occupation) and psychosocial factors (perceived behavioural control, intention, social norms and social support from work colleagues) with commuter walking. Almost half of respondents (n = 587, 49%) were classified as commuter walkers. Those who were aged <30 years, did not have a car, had no free car parking at work, were confident of including some walking or intended to walk to or from work on a regular basis, and had support from colleagues for walking were more likely to be commuter walkers. Those who perceived they lived too far away from work to walk, thought walking was less convenient than using a car for commuting, did not have time to walk, needed a car for work or had always travelled the same way were less likely to be commuter walkers. A number of individual, employment-related and psychosocial factors were associated with commuter walking. Target groups for interventions to promote walking to and from work may include those in older age groups and those who own or have access to a car. Multi-level interventions targeting individual level behaviour change, social support within the workplace and organisational level travel policies may be required in order to promote commuter walking.

Considerations for the design of safe and effective consumer health IT applications in the home.

PubMed

Zayas-Cabán, Teresa; Dixon, Brian E

2010-10-01

Consumer health IT applications have the potential to improve quality, safety and efficiency of consumers' interactions with the healthcare system. Yet little attention has been paid to human factors and ergonomics in the design of consumer health IT, potentially limiting the ability of health IT to achieve these goals. This paper presents the results of an analysis of human factors and ergonomics issues encountered by five projects during the design and implementation of home-based consumer health IT applications. Agency for Healthcare Research and Quality-funded consumer health IT research projects, where patients used the IT applications in their homes, were reviewed. Project documents and discussions with project teams were analysed to identify human factors and ergonomic issues considered or addressed by project teams. The analysis focused on system design and design processes used as well as training, implementation and use of the IT intervention. A broad range of consumer health IT applications and diverse set of human factors and ergonomics issues were identified. The design and implementation processes used resulted in poor fit with some patients' healthcare tasks and the home environment and, in some cases, resulted in lack of use. Clinician interaction with patients and the information provided through health IT applications appeared to positively influence adoption and use. Consumer health IT application design would benefit from the use of human factors and ergonomics design and evaluation methods. Considering the context in which home-based consumer health IT applications are used will likely affect the ability of these applications to positively impact the quality, safety and efficiency of patient care.

Increasing the treatment of hypertension through primary intervention

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fair, M.D.

1994-12-31

South Carolina is one of the leading states in stroke mortality. Hypertension is one of the major risk factors that lead to strokes. Unfortunately, many people who are hypertensive do not treat their disease properly due to lack of medical education. The specific objectives of this project are to access geographic areas to determine the level of medical representation available; to identify areas of medical needs based on race, income and health status; and, to structure an intervention plan to target areas that are in the highest hypertension at-risk category. The methods used are to identify medical coverage by geographicmore » areas. Health in poor areas is identified and mapped. Implementation of intervention strategies is prioritized based on areas of need.« less

High Rates of Obesity and Non-Communicable Diseases Predicted across Latin America

PubMed Central

Webber, Laura; Kilpi, Fanny; Marsh, Tim; Rtveladze, Ketevan; Brown, Martin; McPherson, Klim

2012-01-01

Non-communicable diseases (NCDs) such as cardiovascular disease and stroke are a major public health concern across Latin America. A key modifiable risk factor for NCDs is overweight and obesity highlighting the need for policy to reduce prevalence rates and ameliorate rising levels of NCDs. A cross-sectional regression analysis was used to project BMI and related disease trends to 2050. We tested the extent to which interventions that decrease body mass index (BMI) have an effect upon the number of incidence cases avoided for each disease. Without intervention obesity trends will continue to rise across much of Latin America. Effective interventions are necessary if rates of obesity and related diseases are to be reduced. PMID:22912663

Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country.

PubMed

Wajid, Abdul; White, Franklin; Karim, Mehtab S

2013-01-01

As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.

Community Health Workers and Health Care Delivery: Evaluation of a Women's Reproductive Health Care Project in a Developing Country

PubMed Central

Wajid, Abdul; White, Franklin; Karim, Mehtab S.

2013-01-01

Background As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. Methods A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. Results The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. Conclusions Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress. PMID:24086541

Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases.

PubMed

Swendeman, Dallas; Basu, Ishika; Das, Sankari; Jana, Smarajit; Rotheram-Borus, Mary Jane

2009-10-01

The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women's empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n=110) compared to a control community (n=106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (Basu et al., 2004). This article examines the intervention's impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000-2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study's results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs.

Finding ergonomic solutions--participatory approaches.

PubMed

Hignett, Sue; Wilson, John R; Morris, Wendy

2005-05-01

This paper gives an overview of the theory of participatory ergonomics interventions and summary examples from a range of industries, including health care, military, manufacturing, production and processing, services, construction and transport. The definition of participatory approaches includes interventions at macro (organizational, systems) levels as well as micro (individual), where workers are given the opportunity and power to use their knowledge to address ergonomic problems relating to their own working activities. Examples are given where a cost-effective benefit has been measured using musculoskeletal sickness absence and compensation costs. Other examples, using different outcome measures, also showed improvements, for example, an increase in productivity, improved communication between staff and management, reduction in risk factors, the development of new processes and new designs for work environments and activities. Three cases are described from Canada and Japan where the participatory project was led by occupational health teams, suggesting that occupational health practitioners can have an important role to play in participatory ergonomics projects.

Redesigning mental healthcare delivery: is there an effect on organizational climate?

PubMed

Joosten, T C M; Bongers, I M B; Janssen, R T J M

2014-02-01

Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place. Two Dutch child- and adolescent-mental healthcare providers. Professionals that worked at one of the units at the start and/or the end of the intervention period. The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series). Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

China's community-based strategy of universal preconception care in rural areas at a population level using a novel risk classification system for stratifying couples´ preconception health status.

PubMed

Zhou, Qiongjie; Zhang, Shikun; Wang, Qiaomei; Shen, Haiping; Tian, Weidong; Chen, Jingqi; Acharya, Ganesh; Li, Xiaotian

2016-12-28

Preconception care (PCC) is recommended for optimizing a woman's health prior to pregnancy to minimize the risk of adverse pregnancy and birth outcomes. We aimed to evaluate the impact of strategy and a novel risk classification model of China´s "National Preconception Health Care Project" (NPHCP) in identifying risk factors and stratifying couples' preconception health status. We performed a secondary analysis of data collected by NPHCP during April 2010 to December 2012 in 220 selected counties in China. All couples enrolled in the project accepted free preconception health examination, risk evaluation, health education and medical advice. Risk factors were categorized into five preconception risk classes based on their amenability to prevention and treatment: A-avoidable risk factors, B- benefiting from targeted medical intervention, C-controllable but requiring close monitoring and treatment during pregnancy, D-diagnosable prenatally but not modifiable preconceptionally, X-pregnancy not advisable. Information on each couple´s socio-demographic and health status was recorded and further analyzed. Among the 2,142,849 couples who were enrolled to this study, the majority (92.36%) were from rural areas with low education levels (89.2% women and 88.3% men had education below university level). A total of 1463266 (68.29%) couples had one or more preconception risk factors mainly of category A, B and C, among which 46.25% were women and 51.92% were men. Category A risk factors were more common among men compared with women (38.13% versus 11.24%; P = 0.000). This project provided new insights into preconception health of Chinese couples of reproductive age. More than half of the male partners planning to father a child, were exposed to risk factors during the preconception period, suggesting that an integrated approach to PCC including both women and men is justified. Stratification based on the new risk classification model demonstrated that a majority of the risk factors are avoidable, or preventable by medical intervention. Therefore, universal free PCC can be expected to improve pregnancy outcomes in rural China.

Social Support Perspectives on Programs for Parents: Lessons from the Child Survival/Fair Start Home Visiting Programs.

ERIC Educational Resources Information Center

Larner, Mary

This paper discusses home visiting programs for low income parents and infants and describes five such programs known collectively as the Child Survival/Fair Start (CS/FS) projects, funded by the Ford Foundation. It describes a conceptual model which links risk factors and intervention activities to effects on mothers and children and explains how…

Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

ERIC Educational Resources Information Center

Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

2005-01-01

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

Mental health service users' experiences of an education intervention based on a European Union project: A comparison between nine European countries.

PubMed

Nieminen, Irja; Kaunonen, Marja

2018-06-19

Mental health service users (MHSUs) often face difficulties in achieving successful participation in education; however, the tools that could help them succeed are rarely investigated. This study aimed to illuminate the experiences of MHSUs in an education intervention based on a European Union (EU) project. Their experiences are compared across nine EU countries. The data were collected through individual interviews with MHSUs (n = 47) at day activity centres that provide mental health services. An inductive content analysis was used as the method of analysis. Three main categories, which include seven subcategories, are revealed by the analysis. The main categories are as follows: (i) the factors related to MHSUs' educational preparedness, (ii) the dimensions of the learning environment, and (iii) the effects of training intervention. The MHSUs' experiences with the education intervention were similar across all countries. The findings showed that this education intervention is a multidimensional process. It contains social, mental, and physical dimensions linked to a learner and learning environment. These dimensions influence the MHSUs' ability to participate in the education process. At its best, the education intervention supports the personal growth of MHSUs and prepares them for social integration. An education intervention can be a usable tool in the rehabilitation of MHSUs if the multidimensional nature of education is taken into consideration. Therefore, designing and executing education interventions requires the attendance of the MHSUs in cooperation with mental health and education professionals. Our findings suggest a tentative framework that can be used in designing and executing education for MHSUs. © 2018 Australian College of Mental Health Nurses Inc.

Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective.

PubMed

Amutah-Onukagha, Ndidiamaka; Mahadevan, Meena; Opara, Ijeoma; Rodriguez, Monica; Trusdell, Megan; Kelly, Jessica

2018-04-01

Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.

Evaluation protocol to assess an integrated framework for the implementation of the Childhood Obesity Research Demonstration project at the California (CA-CORD) and Massachusetts (MA-CORD) sites.

PubMed

Chuang, Emmeline; Ayala, Guadalupe X; Schmied, Emily; Ganter, Claudia; Gittelsohn, Joel; Davison, Kirsten K

2015-02-01

The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project. A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF. Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.

The Australian Prevention Partnership Centre: systems thinking to prevent lifestyle-related chronic illness.

PubMed

Wilson, Andrew; Wutzke, Sonia; Overs, Marge

2014-11-28

Chronic diseases are the major cause of death in Australia and the biggest contributor to premature death and disability. Although prevention of chronic disease can be effective and cost-effective, it has proven difficult to systematically implement interventions that target important lifestyle-related risk factors for chronic disease such as poor nutrition, physical inactivity and harmful alcohol use. Prevention efforts targeting these lifestyle-related risk factors have had mixed success due to issues around designing and implementing effective interventions that address the complexity of risk factors, and incorporating evidence and implementing interventions at a scale, duration, intensity and quality required to achieve population effects. There is increasing recognition that multilevel, multisector approaches are required for the effective and sustained prevention of complex chronic disease. The Australian Prevention Partnership Centre, one of two National Health and Medical Research Council Partnership Centres established in 2013, is researching and developing systems perspectives to prevent lifestyle-related chronic disease in Australia. The Centre's collaborative approach is providing opportunities for researchers to work with policy makers and practitioners to develop research questions, conduct research, and analyse, interpret and disseminate the findings. As such, it is the model of interaction that is being tested as much as the specific projects. With its funding partners, the Centre has developed plans for more than 30 projects. It has also established four capacity units that will improve the gathering, sharing and use of evidence to build a prevention system in Australia. The Centre is exploring new ways to advance prevention by bringing together researchers, policy makers and practitioners to determine the information and actions needed for an effective prevention system for Australia.

A faith-based community partnership to address HIV/AIDS in the southern United States: implementation, challenges, and lessons learned.

PubMed

Abara, Winston; Coleman, Jason D; Fairchild, Amanda; Gaddist, Bambi; White, Jacob

2015-02-01

Though race and region are not by themselves risk factors for HIV infection, regional and racial disparities exist in the burden of HIV/AIDS in the US. Specifically, African Americans in the southern US appear to bear the brunt of this burden due to a complex set of upstream factors like structural and cultural influences that do not facilitate HIV/AIDS awareness, HIV testing, or sexual risk-reduction techniques while perpetuating HIV/AIDS-related stigma. Strategies proposed to mitigate the burden among this population have included establishing partnerships and collaborations with non-traditional entities like African American churches and other faith-based organizations. Though efforts to partner with the African American church are not necessarily novel, most of these efforts do not present a model that focuses on building the capacity of the African American church to address these upstream factors and sustain these interventions. This article will describe Project Fostering AIDS Initiatives That Heal (F.A.I.T.H), a faith-based model for successfully developing, implementing, and sustaining locally developed HIV/AIDS prevention interventions in African American churches in South Carolina. This was achieved by engaging the faith community and the provision of technical assistance, grant funding and training for project personnel. Elements of success, challenges, and lessons learned during this process will also be discussed.

Human Health Impacts of and Public Health Adaptation to Climate Variability and Change

NASA Astrophysics Data System (ADS)

Ebi, K. L.

2007-12-01

Weather and climate are among the factors that determine the geographic range and incidence of several major causes of ill health, including undernutrition, diarrheal diseases and other conditions due to unsafe water and lack of basic sanitation, and malaria. The Human Health chapter in the Fourth Assessment Report of the Intergovernmental Panel on Climate Change concluded that climate change has begun to negatively affect human health, and that projected climate change will increase the risks of climate-sensitive health outcomes, particularly in lower-income populations, predominantly within tropical/subtropical countries. Those at greatest risk include the urban poor, older adults, children, traditional societies, subsistence farmers, and coastal populations, particularly in low income countries. The cause-and-effect chain from climate change to changing patterns of health determinants and outcomes is complex and includes socioeconomic, institutional, and other factors. The severity of future impacts will be determined by changes in climate as well as by concurrent changes in nonclimatic factors and by the adaptation measures implemented to reduce negative impacts. Public health has a long history of effectively intervening to reduce risks to the health of individuals and communities. Lessons learned from more than 150 years of research and intervention can provide insights to guide the design and implementation of effective and efficient interventions to reduce the current and projected impacts of climate variability and change.

Impact of Safety Training and Interventions on Training-Transfer: Targeting Migrant Construction Workers.

PubMed

Hussain, Rahat; Pedro, Akeem; Lee, Do Yeop; Pham, Hai Chien; Park, Chan Sik

2018-05-01

Despite substantial efforts to improve construction safety training, the accident rate of migrant workers is still high. One of the primary factors contributing to the inefficacy of training includes information delivery gaps during training sessions (knowledge-transfer). In addition, there is insufficient evidence that these training programs alone are effective enough to enable migrant workers to transfer their skills to jobsite (training-transfer). This research attempts to identify and evaluate additional interventions to improve the transfer of acquired knowledge to workplace. For this purpose, this study presents the first known experimental effort to assess the effect of interventions on migrant work groups in a multinational construction project in Qatar. Data analysis reveals that the adoption of training programs with the inclusion of interventions significantly improves training-transfer. Construction safety experts can leverage the findings of this study to enhance training-transfer by increasing worker's safety performance and hazard identification ability.

IMPlementation of A Relatives' Toolkit (IMPART study): an iterative case study to identify key factors impacting on the implementation of a web-based supported self-management intervention for relatives of people with psychosis or bipolar experiences in a National Health Service: a study protocol.

PubMed

Lobban, Fiona; Appleton, Victoria; Appelbe, Duncan; Barraclough, Johanna; Bowland, Julie; Fisher, Naomi R; Foster, Sheena; Johnson, Sonia; Lewis, Elizabeth; Mateus, Céu; Mezes, Barbara; Murray, Elizabeth; O'Hanlon, Puffin; Pinfold, Vanessa; Rycroft-Malone, Jo; Siddle, Ron; Smith, Jo; Sutton, Chris J; Walker, Andrew; Jones, Steven H

2017-12-28

Web-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions. A multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives' Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives' distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored. Observation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project. ISCTRN 16267685 (09/03/2016).

Getting to social action: the Youth Empowerment Strategies (YES!) project.

PubMed

Wilson, Nance; Minkler, Meredith; Dasho, Stefan; Wallerstein, Nina; Martin, Anna C

2008-10-01

This article describes the social action component of the Youth Empowerment Strategies (YES!) project funded by the Centers for Disease Control and Prevention through its community-based prevention research (CBPR) initiative. YES! is designed to promote problem-solving skills, social action, and civic participation among underserved elementary and middle school youth. The after-school program focuses on identifying and building youths' capacities and strengths as a means of ultimately decreasing rates of alcohol, tobacco, and other drug use and other risky behaviors. The article discusses the conceptual models of risk and intervention and factors contributing to successful social action work, including group dynamics, intragroup leadership, facilitator skills, and school-community contexts. Attention is focused on how the nature of the projects themselves played a key role in determining the likelihood of experiencing success. Implications and recommendations for other youth-focused empowerment education projects are discussed, including the effective use of Photovoice in such projects.

Methods for the cultural adaptation of a diabetes lifestyle intervention for Latinas: an illustrative project.

PubMed

Osuna, Diego; Barrera, Manuel; Strycker, Lisa A; Toobert, Deborah J; Glasgow, Russell E; Geno, Cristy R; Almeida, Fabio; Perdomo, Malena; King, Diane; Doty, Alyssa Tinley

2011-05-01

Because Latinas experience a high prevalence of type 2 diabetes and its complications, there is an urgent need to reach them with interventions that promote healthful lifestyles. This article illustrates a sequential approach that took an effective multiple-risk-factor behavior-change program and adapted it for Latinas with type 2 diabetes. Adaptation stages include (a) information gathering from literature and focus groups, (b) preliminary adaptation design, and (c) preliminary adaptation test. In this third stage, a pilot study finds that participants were highly satisfied with the intervention and showed improvement across diverse outcomes. Key implications for applications include the importance of a model for guiding cultural adaptations, and the value of procedures for obtaining continuous feedback from staff and participants during the preliminary adaptation test.

A multi-site evaluation of innovative approaches to increase tuberculosis case notification: summary results.

PubMed

Creswell, Jacob; Sahu, Suvanand; Blok, Lucie; Bakker, Mirjam I; Stevens, Robert; Ditiu, Lucica

2014-01-01

Globally, TB notifications have stagnated since 2007, and sputum smear positive notifications have been declining despite policies to improve case detection. We evaluate results of 28 interventions focused on improving TB case detection. We measured additional sputum smear positive cases treated, defined as the intervention area's increase in case notification during the project compared to the previous year. Projects were encouraged to select control areas and collect historical notification data. We used time series negative binomial regression for over-dispersed cross-sectional data accounting for fixed and random effects to test the individual projects' effects on TB notification while controlling for trend and control populations. Twenty-eight projects, 19 with control populations, completed at least four quarters of case finding activities, covering a population of 89.2 million. Among all projects sputum smear positive (SS+) TB notifications increased 24.9% and annualized notification rates increased from 69.1 to 86.2/100,000 (p = 0.0209) during interventions. Among the 19 projects with control populations, SS+TB case notifications increased 36.9% increase while in the control populations a 3.6% decrease was observed. Fourteen (74%) of the 19 projects' SS+TB notification rates in intervention areas increased from the baseline to intervention period when controlling for historical trends and notifications in control areas. Interventions were associated with large increases in TB notifications across many settings, using an array of interventions. Many people with TB are not reached using current approaches. Different methods and interventions tailored to local realities are urgently needed.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

PubMed

Williams, Allison M; Tompa, Emile; Lero, Donna S; Fast, Janet; Yazdani, Amin; Zeytinoglu, Isik U

2017-09-20

Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and; other nuances at play. It is hypothesized that the benefits of the caregiver-friendly workplace policy intervention(s) will include improvements in caregiver-employees' mental, psychosocial and physical health, as well as evidence of cost-benefit and cost-effectiveness for the employer. The expected project results will provide the research evidence for extensive knowledge translation work, to be carried out in collaboration with our knowledge transition partners, to the employer/human resources and occupational health/safety target populations. ISRCTN16187974 Registered August 25, 2016.

In Service Training of Head Start Teachers to Overcome Early Risks of Mathematics Failure: The Mathstaar Program

ERIC Educational Resources Information Center

Geist, Eugene A.; Geist, Kamile

2009-01-01

This action research project is designed as a music-based intervention to address and overcome some of the risk factors for low achievement in mathematics that research has linked to poverty level. The National Assessment of Educational Progress found that children who are eligible for school lunch programs in 4th grade score on average 13 points…

Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.

PubMed

Shediac-Rizkallah, M C; Bone, L R

1998-03-01

Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

A Multicomponent Behavioral Intervention to Reduce Stroke Risk Factor Behaviors: The Stroke Health and Risk Education Cluster-Randomized Controlled Trial.

PubMed

Brown, Devin L; Conley, Kathleen M; Sánchez, Brisa N; Resnicow, Kenneth; Cowdery, Joan E; Sais, Emma; Murphy, Jillian; Skolarus, Lesli E; Lisabeth, Lynda D; Morgenstern, Lewis B

2015-10-01

The Stroke Health and Risk Education Project was a cluster-randomized, faith-based, culturally sensitive, theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans. Ten Catholic churches were randomized to intervention or control group. The intervention group received a 1-year multicomponent intervention (with poor adherence) that included self-help materials, tailored newsletters, and motivational interviewing counseling calls. Multilevel modeling, accounting for clustering within subject pairs and parishes, was used to test treatment differences in the average change since baseline (ascertained at 6 and 12 months) in dietary sodium, fruit and vegetable intake, and physical activity, measured using standardized questionnaires. A priori, the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level. Of 801 subjects who consented, 760 completed baseline data assessments, and of these, 86% completed at least one outcome assessment. The median age was 53 years; 84% subjects were Hispanic/Latino; and 64% subjects were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 cups per day [95% confidence interval: 0.08, 0.42], P=0.002), a greater decrease in sodium intake (-123.17 mg/d [-194.76, -51.59], P=0.04), but no difference in change in moderate- or greater-intensity physical activity (-27 metabolic equivalent-minutes per week [-526, 471], P=0.56). This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake, reaching its primary end point. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01378780. © 2015 American Heart Association, Inc.

Associations Between Tobacco Marketing and Use Among Urban Youth in India

PubMed Central

Arora, Monika; Reddy, K. Srinath; Stigler, Melissa H.; Perry, Cheryl L.

2010-01-01

Objectives To study if receptivity and exposure to tobacco marketing are correlated with tobacco use and psychosocial risk factors for tobacco use among a sample of urban Indian youth. Methods Analysis of cross sectional survey data from Project MYTRI, a group randomized intervention trial, in Delhi and Chennai, India collected from 6th and 8th graders (n=11642), in 32 schools in 2004. Results Exposure to tobacco advertisements and receptivity to tobacco marketing were significantly related to increased tobacco use among students. Conclusion This association suggests the need to strengthen policy and program-based interventions in India to reduce the influence of such exposures. PMID:18067468

Behavioural informatics for improving water hygiene practice based on IoT environment.

PubMed

Fu, Yang; Wu, Wenyan

2018-02-01

The development of Internet of Things (IoT) and latest Information and Communication Technologies (ICT) have changed the nature of healthcare monitoring and health behaviour intervention in many applications. Water hygiene and water conservation behaviour intervention as important influence factors to human health are gaining much attentions for improving sustained sanitation practice. Based on face-to-face delivery, typical behaviour intervention method is costly and hardly to provide all day access to personalised intervention guidance and feedbacks. In this study, we presented a behavioural information system and water use behaviour model using IoT platform. Using Expanded Theory of Planned Behaviour (ETPB) and adopted structure equation model, this study offers a solution for understanding the behaviour intervention mechanism and methodology for developing empirical model. A case study of behaviour intervention model is presented by utilising residential water conservation behaviour data collected in China. Results suggested that cultural differences have significant influences on the understanding of intervention drivers, promoting projects and increasing awareness, which could improve the behaviour intervention efficiency and further facilitate the improvement of water hygiene practice. The performance evaluation of water saving dimension is discussed as well in the paper. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards canine rabies elimination: Economic comparisons of three project sites.

PubMed

Elser, J L; Hatch, B G; Taylor, L H; Nel, L H; Shwiff, S A

2018-02-01

An appreciation of the costs of implementing canine rabies control in different settings is important for those planning new or expanded interventions. Here we compare the costs of three canine rabies control projects in South Africa, the Philippines and Tanzania to identify factors that influence the overall costs of rabies control efforts. There was considerable variation in the cost of vaccinating each dog, but across the sites these were lower where population density was higher, and later in the projects when dog vaccination coverage was increased. Transportation costs comprised a much higher proportion of total costs in rural areas and where house-to-house vaccination campaigns were necessary. The association between the cost of providing PEP and human population density was less clear. The presence of a pre-existing national rabies management programme had a marked effect on keeping infrastructure and equipment costs for the project low. Finally, the proportion of the total costs of the project provided by the external donor was found to be low for the projects in the Philippines and South Africa, but likely covered close to the complete costs of the project in Tanzania. The detailed economic evaluation of three recent large-scale rabies control pilot projects provides the opportunity to examine economic costs across these different settings and to identify factors influencing rabies control costs that could be applied to future projects. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study.

PubMed

Cleland, Claire L; Hunter, Ruth F; Tully, Mark A; Scott, David; Kee, Frank; Donnelly, Michael; Prior, Lindsay; Cupples, Margaret E

2014-05-23

There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such 'hard-to-reach' population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents' and community leaders' perceptions of physical activity (PA) interventions and issues regarding their implementation, in order to improve understanding of needs, expectations, and social/environmental factors relevant to future interventions. Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n = 113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n = 14) in local facilities. Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework. Three main themes were identified: awareness of PA interventions; factors contributing to intervention effectiveness; and barriers to participation in PA interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an 'exit strategy' were perceived as important factors related to intervention effectiveness. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating in interventions. These findings illustrate the complexity of influences on a community's participation in PA interventions and support a social-ecological approach to promoting PA. They highlight the need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population's perspectives is of key importance in translating PA behaviour change theories into practice.

Reframing the concept of alternative livelihoods

PubMed Central

Wright, Juliet H.; Hill, Nicholas A. O.; Roe, Dilys; Rowcliffe, J. Marcus; Kümpel, Noëlle F.; Day, Mike; Booker, Francesca; Milner‐Gulland, E. J.

2015-01-01

Abstract Alternative livelihood project (ALP) is a widely used term for interventions that aim to reduce the prevalence of activities deemed to be environmentally damaging by substituting them with lower impact livelihood activities that provide at least equivalent benefits. ALPs are widely implemented in conservation, but in 2012, an International Union for Conservation of Nature resolution called for a critical review of such projects based on concern that their effectiveness was unproven. We focused on the conceptual design of ALPs by considering their underlying assumptions. We placed ALPs within a broad category of livelihood‐focused interventions to better understand their role in conservation and their intended impacts. We dissected 3 flawed assumptions about ALPs based on the notions of substitution, the homogenous community, and impact scalability. Interventions based on flawed assumptions about people's needs, aspirations, and the factors that influence livelihood choice are unlikely to achieve conservation objectives. We therefore recommend use of a sustainable livelihoods approach to understand the role and function of environmentally damaging behaviors within livelihood strategies; differentiate between households in a community that have the greatest environmental impact and those most vulnerable to resource access restrictions to improve intervention targeting; and learn more about the social–ecological system within which household livelihood strategies are embedded. Rather than using livelihood‐focused interventions as a direct behavior‐change tool, it may be more appropriate to focus on either enhancing the existing livelihood strategies of those most vulnerable to conservation‐imposed resource access restrictions or on use of livelihood‐focused interventions that establish a clear link to conservation as a means of building good community relations. However, we recommend that the term ALP be replaced by the broader term livelihood‐focused intervention. This avoids the implicit assumption that alternatives can fully substitute for natural resource‐based livelihood activities. PMID:26310510

Dietary change through African American churches: baseline results and program description of the eat for life trial.

PubMed

Resnicow, K; Wallace, D C; Jackson, A; Digirolamo, A; Odom, E; Wang, T; Dudley, W N; Davis, M; Mitchell, D; Baranowski, T

2000-01-01

Eat for Life, a multicomponent intervention to increase fruit and vegetable (F & V) consumption among African Americans, is delivered through African American churches. Fourteen churches were randomly assigned to one of three treatment conditions: 1) comparison; 2) culturally-sensitive multicomponent intervention with one phone call; and 3) culturally-sensitive multicomponent intervention with four phone calls. The intervention included an 18-minute video, a project cookbook, printed health education materials, and several "cues" imprinted with the project logo and a 5 A Day message. A key element of the telephone intervention was the use of motivational interviewing, a counseling technique originally developed for addictive behaviors. Major outcomes for the trial included total F & V intake, assessed by food-frequency questionnaires (FFQs) and 24-hour recalls, and serum carotenoids. Psychosocial variables assessed included outcome expectations, barriers to F & V intake, preference for meat meals, neophobia, social support to eat more F & V, self-efficacy to eat more F & V, and nutrition knowledge. Baseline mean F & V intakes across the three FFQs ranged from 3.45 to 4.28 servings per day. Intake based on a single 24-hour recall was 3.0 servings. Variables positively correlated with F & V intake included self-efficacy, outcome expectations, and a belief that F & V contain vitamins. Factors negatively correlated with intake include perceived barriers, meat preference, neophobia, and high-fat cooking practices. The completion rate for the first telephone counseling call was 90%. Completion rates for the remaining three calls ranged from 79% to 86%. The recruitment and intervention methods of the Eat for Life study appear promising. The telephone intervention based on motivational interviewing is potentially useful for delivering dietary counseling.

Monetary conversion factors for economic evaluations of substance use disorders.

PubMed

McCollister, Kathryn; Yang, Xuan; Sayed, Bisma; French, Michael T; Leff, Jared A; Schackman, Bruce R

2017-10-01

Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

A Study of Child Variance, Volume 2: Interventions; Conceptual Project in Emotional Disturbance.

ERIC Educational Resources Information Center

Rhodes, William C.; Tracy, Michael L.

Presented in the second volume of a series emanating from a conceptual project on emotional disturbance are six papers on general aspects of interventions as well as biophysical, behavioral, psychodynamic, environmental, and counter theoretical interventions. In an "Overview of Interventions", W. Rhodes discusses a framework for viewing…

Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence

PubMed Central

2010-01-01

Background People with diabetes can suffer from diverse complications that seriously erode quality of life. Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years. Accurate projections of diabetes burden are essential to policymakers planning for future health care needs and costs. Methods Using data on prediabetes and diabetes prevalence in the United States, forecasted incidence, and current US Census projections of mortality and migration, the authors constructed a series of dynamic models employing systems of difference equations to project the future burden of diabetes among US adults. A three-state model partitions the US population into no diabetes, undiagnosed diabetes, and diagnosed diabetes. A four-state model divides the state of "no diabetes" into high-risk (prediabetes) and low-risk (normal glucose) states. A five-state model incorporates an intervention designed to prevent or delay diabetes in adults at high risk. Results The authors project that annual diagnosed diabetes incidence (new cases) will increase from about 8 cases per 1,000 in 2008 to about 15 in 2050. Assuming low incidence and relatively high diabetes mortality, total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the US adult population by 2050. However, if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050. A middle-ground scenario projects a prevalence of 25% to 28% by 2050. Intervention can reduce, but not eliminate, increases in diabetes prevalence. Conclusions These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Effective strategies will need to be undertaken to moderate the impact of these factors on national diabetes burden. Our analysis suggests that widespread implementation of reasonably effective preventive interventions focused on high-risk subgroups of the population can considerably reduce, but not eliminate, future increases in diabetes prevalence. PMID:20969750

Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

PubMed

Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

2018-01-01

To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.

Using the missed opportunity tool as an application of the Lives Saved Tool (LiST) for intervention prioritization.

PubMed

Tam, Yvonne; Pearson, Luwei

2017-11-07

The Missed Opportunity tool was developed as an application in the Lives Saved Tool (LiST) to allow users to quickly compare the relative impact of interventions. Global Financing Facility (GFF) investment cases have been identified as a potential application of the Missed Opportunity analyses in Democratic Republic of the Congo (DRC), Ethiopia, Kenya, and Tanzania, to use 'lives saved' as a normative factor to set priorities. The Missed Opportunity analysis draws on data and methods in LiST to project maternal, stillbirth, and child deaths averted based on changes in interventions' coverage. Coverage of each individual intervention in LiST was automated to be scaled up from current coverage to 90% in the next year, to simulate a scenario where almost every mother and child receive proven interventions that they need. The main outcome of the Missed Opportunity analysis is deaths averted due to each intervention. When reducing unmet need for contraception is included in the analysis, it ranks as the top missed opportunity across the four countries. When it is not included in the analysis, top interventions with the most total deaths averted are hospital-based interventions such as labor and delivery management in the CEmOC and BEmOC level, and full treatment and supportive care for premature babies, and for sepsis/pneumonia. The Missed Opportunity tool can be used to provide a quick, first look at missed opportunities in a country or geographic region, and help identify interventions for prioritization. While it is a useful advocate for evidence-based priority setting, decision makers need to consider other factors that influence decision making, and also discuss how to implement, deliver, and sustain programs to achieve high coverage.

Design of the Bottom-up Innovation project - a participatory, primary preventive, organizational level intervention on work-related stress and well-being for workers in Dutch vocational education

PubMed Central

2013-01-01

Background In the educational sector job demands have intensified, while job resources remained the same. A prolonged disbalance between demands and resources contributes to lowered vitality and heightened need for recovery, eventually resulting in burnout, sickness absence and retention problems. Until now stress management interventions in education focused mostly on strengthening the individual capacity to cope with stress, instead of altering the sources of stress at work at the organizational level. These interventions have been only partly effective in influencing burnout and well-being. Therefore, the “Bottom-up Innovation” project tests a two-phased participatory, primary preventive organizational level intervention (i.e. a participatory action approach) that targets and engages all workers in the primary process of schools. It is hypothesized that participating in the project results in increased occupational self-efficacy and organizational efficacy. The central research question: is an organization focused stress management intervention based on participatory action effective in reducing the need for recovery and enhancing vitality in school employees in comparison to business as usual? Methods/Design The study is designed as a controlled trial with mixed methods and three measurement moments: baseline (quantitative measures), six months and 18 months (quantitative and qualitative measures). At first follow-up short term effects of taking part in the needs assessment (phase 1) will be determined. At second follow-up the long term effects of taking part in the needs assessment will be determined as well as the effects of implemented tailored workplace solutions (phase 2). A process evaluation based on quantitative and qualitative data will shed light on whether, how and why the intervention (does not) work(s). Discussion “Bottom-up Innovation” is a combined effort of the educational sector, intervention providers and researchers. Results will provide insight into (1) the relation between participating in the intervention and occupational and organizational self-efficacy, (2) how an improved balance between job demands and job resources might affect need for recovery and vitality, in the short and long term, from an organizational perspective, and (3) success and fail factors for implementation of an organizational intervention. Trial registration number Netherlands Trial Register NTR3284 PMID:23947538

Ergonomics intervention in an Iranian television manufacturing industry.

PubMed

Motamedzade, M; Mohseni, M; Golmohammadi, R; Mahjoob, H

2011-01-01

The primary goal of this study was to use the Strain Index (SI) to assess the risk of developing upper extremity musculoskeletal disorders in a television (TV) manufacturing industry and evaluate the effectiveness of an educational intervention. The project was designed and implemented in two stages. In first stage, the SI score was calculated and the Nordic Musculoskeletal Questionnaire (NMQ) was completed. Following this, hazardous jobs were identified and existing risk factors in these jobs were studied. Based on these data, an educational intervention was designed and implemented. In the second stage, three months after implementing the interventions, the SI score was re-calculated and the Nordic Musculoskeletal Questionnaire (NMQ) completed again. 80 assembly workers of an Iranian TV manufacturing industry were randomly selected using simple random sampling approach. The results showed that the SI score had a good correlation with the symptoms of musculoskeletal disorders. It was also observed that the difference between prevalence of signs and symptoms of musculoskeletal disorders, before and after intervention, was significantly reduced. A well conducted implementation of an interventional program with total participation of all stakeholders can lead to a decrease in musculoskeletal disorders.

Validation of the European Cyberbullying Intervention Project Questionnaire for Colombian Adolescents.

PubMed

Herrera-López, Mauricio; Casas, José A; Romera, Eva M; Ortega-Ruiz, Rosario; Del Rey, Rosario

2017-02-01

Cyberbullying is the act of using unjustified aggression to harm or harass via digital devices. Currently regarded as a widespread problem, the phenomenon has attracted growing research interest in different measures of cyberbullying and the similarities and differences across countries and cultures. This article presents the Colombian validation of the European Cyberbullying Intervention Project Questionnaire (ECIPQ) involving 3,830 high school students (M = 13.9 years old, standard deviation = 1.61; 48.9 percent male), of which 1,931 were Colombian and 1,899 Spanish. Confirmatory factor analysis (CFA), content validation, and multigroup analysis were performed with each of the sample subgroups. The optimal fits and psychometric properties obtained confirm the robustness and suitability of the assessment instrument to jointly measure cyber-aggression and cyber-victimization. The results corroborated the theoretical construct and the two-dimensional and universal nature of cyberbullying. The multigroup analysis showed that cyberbullying dynamics are similar in both countries. The comparative analyses of prevalence revealed that Colombian students are less involved in cyberbullying. The results indicate the suitability of the instrument and the advantages of using such a tool to evaluate and guide psychoeducational interventions aimed at preventing cyberbullying in countries where few studies have been performed.

Sustainable prevention of obesity through integrated strategies: The SPOTLIGHT project's conceptual framework and design.

PubMed

Lakerveld, Jeroen; Brug, Johannes; Bot, Sandra; Teixeira, Pedro J; Rutter, Harry; Woodward, Euan; Samdal, Oddrun; Stockley, Lynn; De Bourdeaudhuij, Ilse; van Assema, Patricia; Robertson, Aileen; Lobstein, Tim; Oppert, Jean-Michel; Adány, Róza; Nijpels, Giel

2012-09-17

The prevalence of overweight and obesity in Europe is high. It is a major cause of the overall rates of many of the main chronic (or non communicable) diseases in this region and is characterized by an unequal socio-economic distribution within the population. Obesity is largely determined by modifiable lifestyle behaviours such as low physical activity levels, sedentary behaviour and consumption of energy dense diets. It is increasingly being recognised that effective responses must go beyond interventions that only focus on a specific individual, social or environmental level and instead embrace system-based multi-level intervention approaches that address both the individual and environment. The EU-funded project "sustainable prevention of obesity through integrated strategies" (SPOTLIGHT) aims to increase and combine knowledge on the wide range of determinants of obesity in a systematic way, and to identify multi-level intervention approaches that are strong in terms of Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM). SPOTLIGHT comprises a series of systematic reviews on: individual-level predictors of success in behaviour change obesity interventions; social and physical environmental determinants of obesity; and on the RE-AIM of multi-level interventions. An interactive web-atlas of currently running multi-level interventions will be developed, and enhancing and impeding factors for implementation will be described. At the neighbourhood level, these elements will inform the development of methods to assess obesogenicity of diverse environments, using remote imaging techniques linked to geographic information systems. The validity of these methods will be evaluated using data from surveys of health and lifestyles of adults residing in the neighbourhoods surveyed. At both the micro- and macro-levels (national and international) the different physical, economical, political and socio-cultural elements will be assessed. SPOTLIGHT offers the potential to develop approaches that combine an understanding of the obesogenicity of environments in Europe, and thus how they can be improved, with an appreciation of the individual factors that explain why people respond differently to such environments. Its findings will inform governmental authorities and professionals, academics, NGOs and private sector stakeholders engaged in the development and implementation of policies to tackle the obesity epidemic in Europe.

A critical examination of the U.S. nursing shortage: contributing factors, public policy implications.

PubMed

Fox, Rebekah L; Abrahamson, Kathleen

2009-01-01

BACKGROUND. Despite short-lived periods of adequacy in nurse availability, the nursing shortage has endured. In order to better understand the myriad factors that influence the current shortage of nurses, as well as possible solutions, this project addresses the influence of social factors and government policy on nurse staffing inadequacy. When the government intervenes in a philosophically free-market economy, the assumption is that a problem, such as the current nursing shortage, could not be solved without such intervention. PURPOSE. Nursing care arguably falls into the realm of protecting the common good, and therefore requires government oversight. We provide a critical analysis of policy intervention efforts into the nursing shortage debate by examining the passage of legislation, the provision of educational assistance, and the establishment of minimum staffing requirements and minimum quality standards for reimbursement, which all impact nursing supply and demand. RESULTS. Arguments supporting and opposing policy intervention in general, and its impact on the overall provision of nursing care in the United States, were examined. Without policy incentive to place financial value on the quality of care provided by nurses, a simple increase in the number of available nurses is unlikely to solve the current problem. IMPLICATIONS. Important considerations that should be factored into policy creation include measurement and compensation for quality care, the nature of recruitment efforts of new nurses, and the complex nature of a nursing work.

Evaluation of risk factor reduction in a European City Network.

PubMed

Farrington, Jill L; Faskunger, Johan; Mackiewicz, Karolina

2015-06-01

There is a substantial and growing burden of premature mortality caused by non-communicable diseases (NCDs) globally. This paper evaluates the preventive efforts of the WHO European Healthy Cities Network during its fifth phase (2009-13), specifically for four behavioural risk factors (tobacco use, alcohol abuse, unhealthy diet and physical inactivity). Drawing on case studies, questionnaire responses and other materials, it notes which cities were involved, what worked and did not, the triggers for action, challenges met and lessons learnt. Few cities appeared to have taken comprehensive approaches to NCD prevention across multiple risk factors, or have combined population- and individual-level interventions. Work on healthy food and diet predominantly focused on children in educational or care settings, and few cities appeared to take a comprehensive approach to tackling obesity. Partnerships were a strong feature for all the NCD risk factor work, and were frequently extensive, being most diverse for the Healthy Diet and Food work. There were strong examples of engagement with communities, also involved in co-designing and shaping projects. Equity also featured strongly and there were multiple examples of how attention had been paid to the social determinants of health. There was evidence that cities continue to be significant innovative forces within their countries and drivers of change, and the mutual dependency of the national and local levels was highlighted. Interventions to promote physical activity have shifted focus from specific events and projects to being more integrated with other policy areas and based on intersectoral collaboration. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Theoretical rationale of community intervention for the prevention and control of cardiovascular disease.

PubMed

MacLean, D R

1994-01-01

Cardiovascular disease is the leading cause of death and disability in the developed world, accounting for slightly more than 40% of all mortality. Along with the resultant disability of those who survive with the disease it costs the health care system in Canada approximately $17 billion on an annual basis. The known risk factors for cardiovascular disease are widespread within the population; in Canada, approximately 70% of individuals have one or more of the major risk factors. Research over the past 25 years has disclosed that a significant proportion of the cause of heart disease and its risk factors are rooted in the unhealthy habits of average living in conjunction with unfavorable physical, economic and psychosocial environments. The primary prevention of cardiovascular disease has focused on individual risk factor change combined with approaches to community organization in an effort to produce a more conducive environment for behavior change to be carried out. First-generation community programs for cardiovascular disease prevention, as illustrated by the North Karelia Project, Stanford Five City Project and others in the United States, have relied heavily on social learning theory as advanced by Bandura, from Stanford University. Second-generation prevention programs, such as the Nova Scotia Heart Health Program, have relied on these theories as well as theories of participation and community development in the prevention of major noncommunicable diseases. This paper gives an overview of the theoretical basis of community intervention programs for cardiovascular disease. Included will be a discussion of some of the various theoretical approaches used in Canada and the United States and elsewhere over the past 25 years.

Retention of female volunteer community health workers in Dhaka urban slums: a prospective cohort study.

PubMed

Alam, Khurshid; Oliveras, Elizabeth

2014-05-20

Volunteer community health workers (CHWs) are a key approach to improving community-based maternal and child health services in developing countries. BRAC, a large Bangladeshi non-governmental organization (NGO), has employed female volunteer CHWs in its community-based health programs since 1977, recently including its Manoshi project, a community-based maternal and child health intervention in the urban slums of Bangladesh. A case-control study conducted in response to high dropout rates in the first year of the project showed that financial incentives, social prestige, community approval and household responsibilities were related to early retention in the project. In our present prospective cohort study, we aimed to better understand the factors associated with retention of volunteer CHWs once the project was more mature. We used a prospective cohort study design to examine the factors affecting retention of volunteer CHWs who remained in the project after the initial start-up period. We surveyed a random sample of 542 CHWs who were working for BRAC Manoshi in December 2008. In December 2009, we revisited this cohort of CHWs and interviewed those who had dropped out about the main reasons for their dropping out. We used a multivariable generalized linear model regression analysis with a log link to estimate the relative risk (RR) of independent factors on retention. Of the 542 CHWs originally enrolled, 120 had dropped out by the end of one year, mainly because they left the slums. CHWs who received positive community appraisal (adjusted RR = 1.45, 95% confidence interval (CI) = 1.10 to 1.91) or were associated with other NGOs (adjusted RR = 1.13, 95% CI = 1.04 to 1.23) were more likely to have been retained in the project. Although refresher training was also associated with increased retention (adjusted RR = 2.25, 95% CI = 1.08 to 4.71) in this study, too few CHWs had not attended refresher training regularly to make it a meaningful predictor of retention that could be applied in the project setting. Factors that affect retention of CHWs may change over time, with some factors that are important in the early years of a project losing importance as the project matures. Community health programs operating in fragile urban slums should consider changing factors over program duration for better retention of volunteer CHWs.

The development of peer educator-based harm reduction programmes in Northern Vietnam.

PubMed

Walsh, Nick; Gibbie, Tania M; Higgs, Peter

2008-03-01

Injecting drug use remains an important risk factor for transmission in Vietnam, with an estimated 50% of the 290 000 people living with HIV/AIDS reporting injecting drug use as a risk factor. Despite this, effective harm reduction interventions are generally lacking. This paper describes the implementation of peer-based harm reduction programmes in two rural provinces of Vietnam. Peer educators were trained in basic HIV prevention, including harm reduction. After significant preparation work with the Provincial AIDS Committees of Bac Giang and Thanh Hoa and other relevant national, provincial and local authorities, the interventions were commenced. Harm reduction interventions were delivered through outreach as well as on-site. This included needle and syringe distribution and collection. Community advocacy occurred throughout the life of the project. Local authorities and peers believed that while there was a general reduction in stigma and discrimination, legal barriers associated particularly with the carrying of injecting equipment remained. This impacted upon the ability of peer educators to work with their clients. Peer-based delivery of harm reduction intervention is acceptable. Harm reduction interventions, including needle and syringe programmes, are feasible and acceptable in these two rural Vietnamese provinces. Community acceptance and uptake of these interventions is key to successful expansion across the region. Active participation by families of drug users seems crucial. This initiative demonstrates that despite a difficult policy environment, peer-delivered needle and syringe programmes are feasible within a rural Asian environment as long as there is adequate local political and community support.

[Producing know-how and making recommendations for promoting high blood pressure management in Colombia , 1998-2005].

PubMed

Ortega-Bolaños, Jesús

2008-01-01

Producing know-how and making recommendations concerning the most effective health promotion community interventions for managing high blood pressure in Colombia. A systematic review was made of the Cochrane, Lilacs, Ovid, Proquest and Pubmed databases, the main interest of the study lying within the framework of the most effective community interventions around the world for managing high blood pressure. The following search words were used: systematic review, community intervention, cost effectiveness, health promotion and high blood pressure. Studies published in Spanish, English and Portuguese were reviewed. The research strategies used were derived from defining the most pertinent methodological approach for involving individual, interpersonal and community levels in developing the project. 1,041 articles were obtained from the systematic review of the literature: 246 abstracts, 197 articles about educational interventions for preventing and controlling high blood pressure and 53 articles adopting different approaches regarding informative interventions and communication. Only 11 complete referenced articles from this world of information fulfilled the levels of evidence and evaluation criteria necessary for producing recommendations. The available evidence concerning effective, culturally-suitable programmes and for promoting a reduction in these risk factors is limited. Greater evidence regarding community interventions is required for reducing risk factors directed towards special population groups adapted to the cultural characteristics of the participating population. This must involve determinants of the social and physical context related to social practices, these being developed on a large scale within the daily settings in which the subjects and their families are living.

Probabilistic Causal Analysis for System Safety Risk Assessments in Commercial Air Transport

NASA Technical Reports Server (NTRS)

Luxhoj, James T.

2003-01-01

Aviation is one of the critical modes of our national transportation system. As such, it is essential that new technologies be continually developed to ensure that a safe mode of transportation becomes even safer in the future. The NASA Aviation Safety Program (AvSP) is managing the development of new technologies and interventions aimed at reducing the fatal aviation accident rate by a factor of 5 by year 2007 and by a factor of 10 by year 2022. A portfolio assessment is currently being conducted to determine the projected impact that the new technologies and/or interventions may have on reducing aviation safety system risk. This paper reports on advanced risk analytics that combine the use of a human error taxonomy, probabilistic Bayesian Belief Networks, and case-based scenarios to assess a relative risk intensity metric. A sample case is used for illustrative purposes.

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

PubMed

Jortberg, Bonnie T; Rosen, Raquel; Roth, Sarah; Casias, Luke; Dickinson, L Miriam; Coombs, Letoynia; Awadallah, Nida S; Bernardy, Meaghann K; Dickinson, W Perry

2016-01-01

Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P < .01). A primary care-based childhood obesity intervention may result in significant clinical and lifestyle changes. © Copyright 2016 by the American Board of Family Medicine.

Challenging logics of complex intervention trials: community perspectives of a health care improvement intervention in rural Uganda.

PubMed

Okwaro, Ferdinand M; Chandler, Clare I R; Hutchinson, Eleanor; Nabirye, Christine; Taaka, Lilian; Kayendeke, Miriam; Nayiga, Susan; Staedke, Sarah G

2015-04-01

Health systems in many African countries are failing to provide populations with access to good quality health care. Morbidity and mortality from curable diseases such as malaria remain high. The PRIME trial in Tororo, rural Uganda, designed and tested an intervention to improve care at health centres, with the aim of reducing ill-health due to malaria in surrounding communities. This paper presents the impact and context of this trial from the perspective of community members in the study area. Fieldwork was carried out for a year from the start of the intervention in June 2011, and involved informal observation and discussions as well as 13 focus group discussions with community members, 10 in-depth interviews with local stakeholders, and 162 context descriptions recorded through quarterly interviews with community members, health workers and district officials. Community members observed a small improvement in quality of care at most, but not all, intervention health centres. However, this was diluted by other shortfalls in health services beyond the scope of the intervention. Patients continued to seek care at health centres they considered inadequate as well as positioning themselves and their children to access care through other sources such as research and nongovernmental organization (NGO) projects. These findings point to challenges of designing and delivering interventions within a paradigm that requires factorial (reduced to predictable factors) problem definition with easily actionable and evaluable solutions by small-scale projects. Such requirements mean that interventions often work on the periphery of a health system rather than tackling the murky political and economic realities that shape access to care but are harder to change or evaluate with randomized controlled trials. Highly projectified settings further reduce the ability to genuinely 'control' for different health care access scenarios. We argue for a raised consciousness of how evaluation paradigms impact on intervention choices. Copyright © 2015 Elsevier Ltd. All rights reserved.

Transitions in Loneliness Among Older Adults: A 5-Year Follow-Up in the National Social Life, Health, and Aging Project.

PubMed

Hawkley, Louise C; Kocherginsky, Masha

2018-04-01

A substantial portion of the older adult population suffers from frequent feelings of loneliness, but a large proportion remains relatively unscathed by loneliness. To date, research examining both protective and risk factors for loneliness has not included data from the United States. The present study used the first two waves of data from the National Social Life, Health, and Aging Project to examine sociodemographic, structural, and functional factors thought to be associated with loneliness in older adults. Functional limitations and low family support were associated with an increase in loneliness frequency (as were more strained friendships) and with transitioning from nonlonely to lonely status. Better self-rated health, higher levels of socializing frequency, and lower family strain were associated with transitioning from lonely to nonlonely status. Interventions that target these factors may be effective in preventing and reducing loneliness and its effects on health and well-being in older adults.

The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

PubMed Central

Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

2015-01-01

Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project.

PubMed

Evans, Elizabeth; Aiking, Harry; Edwards, Adrian

2011-01-01

General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals. Service development project. Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009. GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services. Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished. This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.

Effect of Visual Art School-Based Stroke Intervention for Middle School Students.

PubMed

Johnson, Ashleigh B; Montgomery, Chelsea M; Dillard, Wesley A; Morrill, Kenneth; Hoesli, Coral; Gillette, Wesley M; Johnson, Brandon K; Nathaniel, Thomas I

2017-08-01

Community stroke awareness initiatives have traditionally been used to expand knowledge of stroke signs and risk factors to high-risk adult populations. Here, we use a novel unfettered, visual art-based approach for an elementary school initiative to raise stroke awareness. Seventh graders in a middle school art class received stroke awareness training during the course of the 2015 to 2016 school year through their teacher in the visual arts class. In turn, they used this training to develop their own artistic interpretations of key stroke awareness concepts via project-based learning and then present their projects to raise awareness about stroke. We evaluated our predata and postdata to determine whether the visual art school-based stroke intervention was effective in both educating students about stroke and enabling them to effectively disseminate this information to parents and other adults in their community. The pretest evaluation indicates a fair or good knowledge about stroke, and no student indicated an "outstanding" or "excellent" knowledge. The posttest evaluation indicated a higher degree of stroke awareness because students were rated as having an "outstanding," "excellent," or "very good" performance especially in the ability to translate knowledge of stroke awareness lessons learned in their art class into a well-articulated stroke-related project and presentation. Pearson χ test reveals significant difference (P < .001) between the pretest and posttest evaluations. Our results indicate that our school-based stroke intervention was effective in both educating students about stroke and enabling them to effectively disseminate this information to parents and other adults in their community. The use of a visual art teacher to lead the educational component in the intervention indicates that expertise in neurology or stroke is not necessary to facilitate understanding of stroke and highlights the importance of creativeness in stroke education for children.

Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project.

PubMed

Trief, Paula M; Teresi, Jeanne A; Eimicke, Joseph P; Shea, Steven; Weinstock, Ruth S

2009-03-01

with increasing prevalence of diabetes in older people, it is important to understand factors that affect their outcomes. The Informatics for Diabetes Education and Telemedicine (IDEATel) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse, medically underserved, older diabetes patients. Subjects were randomised to telemedicine case management or usual care. This intervention has been shown to result in improved medical outcomes and self-efficacy. Self-efficacy refers to one's belief that (s)he can successfully engage in a behaviour. Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals, but not studied in older individuals. to assess whether (a) diabetes self-efficacy relates to the primary medical outcome of glycaemic control, and to secondary outcomes (blood pressure and cholesterol), and (b) whether, after an intervention, change in diabetes self-efficacy relates to change in these medical outcomes in a group of older, ethnically diverse individuals. three waves of longitudinal data from participants in IDEATel were analysed. diabetes self-efficacy at baseline correlated with glycaemic control, blood pressure and cholesterol. An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control (P < 0.0001), but not in blood pressure and lipid levels. The intervention was significantly related to improved self-efficacy over time (P < 0.0001), and both directly (P = 0.022) and indirectly through self-efficacy (P < 0.001) to improved glycaemic control. The mediation effect of self-efficacy was also significant (P< 0.004). diabetes self-efficacy is a relevant construct for older diabetes patients. Thus, interventions that target enhanced self-efficacy may also result in improved glycaemic control.

How to study improvement interventions: a brief overview of possible study types.

PubMed

Portela, Margareth Crisóstomo; Pronovost, Peter J; Woodcock, Thomas; Carter, Pam; Dixon-Woods, Mary

2015-05-01

Improvement (defined broadly as purposive efforts to secure positive change) has become an increasingly important activity and field of inquiry within healthcare. This article offers an overview of possible methods for the study of improvement interventions. The choice of available designs is wide, but debates continue about how far improvement efforts can be simultaneously practical (aimed at producing change) and scientific (aimed at producing new knowledge), and whether the distinction between the practical and the scientific is a real and useful one. Quality improvement projects tend to be applied and, in some senses, self-evaluating. They are not necessarily directed at generating new knowledge, but reports of such projects if well conducted and cautious in their inferences may be of considerable value. They can be distinguished heuristically from research studies, which are motivated by and set out explicitly to test a hypothesis, or otherwise generate new knowledge, and from formal evaluations of improvement projects. We discuss variants of trial designs, quasi-experimental designs, systematic reviews, programme evaluations, process evaluations, qualitative studies, and economic evaluations. We note that designs that are better suited to the evaluation of clearly defined and static interventions may be adopted without giving sufficient attention to the challenges associated with the dynamic nature of improvement interventions and their interactions with contextual factors. Reconciling pragmatism and research rigour is highly desirable in the study of improvement. Trade-offs need to be made wisely, taking into account the objectives involved and inferences to be made. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The School Adjustment of Students in Distinct Risk Configurations: Considerations for the Development of Selected and Indicated Interventions

ERIC Educational Resources Information Center

Petrin, Robert A.

2011-01-01

As indicated in papers 2 and 3 of this symposium and in published research from Project REAL, there is clear evidence that the SEALS model has a general positive impact on the school context during the early adolescent years. The purpose of this study was to identify key process factors that support gains to academic outcomes in general, but…

Practice points in utilizing local volunteers in community health projects.

PubMed

Muula, Adamson S; Theu, Joe; Hofman, Jan J

2004-07-01

Community volunteers are recruited for many health intervention projects. There are various motivations for the use of the volunteers and these include: the desire to reduce financial costs of projects/programmes; to encourage community ownership; ensure long-term sustainability of the health intervention; and to empower local communities through training offered the project. Health intervention measures working with community volunteers should not be implemented without due consideration of issues regarding mobilization and engagement, skills and motivation of the volunteers and their effectiveness and efficiency towards the attainment of the project goals. This paper discusses some tips that should be considered when community volunteers are used in resource-limited situations.

Group diabetes self-management education in a primary care setting: a quality improvement project.

PubMed

Harris, Tara; Silva, Susan; Intini, Ronald; Smith, Tommy; Vorderstrasse, Allison

2014-01-01

This quality improvement project evaluated the effectiveness of a monthly diabetes self-management education intervention on HbA1C and knowledge levels in patients with type 2 diabetes mellitus. A retrospective analysis evaluating 51 patients found no significant improvement in HbA1C levels; however, there was a significant improvement in knowledge levels. Race was an influential factor on HbA1C levels showing a significant elevation in mean HbA1C in African Americans, while there was a decrease in mean HbA1c in Caucasians over the 6-month evaluation period.

Project SOAR: a training program to increase school counselors' knowledge and confidence regarding suicide prevention and intervention.

PubMed

King, K A; Smith, J

2000-12-01

School counselors are often the lead individuals in school suicide prevention programs. All school counselors in Dallas, Texas, receive training through Project SOAR (Suicide, Options, Awareness, and Relief), a suicide prevention program. This study assessed Dallas school counselors' knowledge of suicidal risk factors and perceived ability to initiate appropriate steps when confronted with a suicidal student. A two-page, 44-item survey was distributed to all Dallas school counselors attending a mandatory meeting in spring 1999. A total of 186 school counselors (75%) responded. Most had been a school counselor for less than 10 years and one-half received initial SOAR training less than four years ago. The majority strongly agreed that they could recognize suicidal warning signs, assess a student's risk for suicide, and offer support to a suicidal student. In addition, most knew the intervention steps to take when a student assessed at high suicidal risk. When compared to school counselors nationwide, these counselors reported increased confidence in identifying students at suicidal risk.

Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project

PubMed Central

Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, Maria Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

2017-01-01

Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems–strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality. PMID:27378199

[Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project].

PubMed

Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, María Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

2017-06-08

Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

Project GRACE: a staged approach to development of a community-academic partnership to address HIV in rural African American communities.

PubMed

Corbie-Smith, Giselle; Adimora, Adaora A; Youmans, Selena; Muhammad, Melvin; Blumenthal, Connie; Ellison, Arlinda; Akers, Aletha; Council, Barbara; Thigpen, Yolanda; Wynn, Mysha; Lloyd, Stacey W

2011-03-01

The HIV epidemic is a health crisis in rural African American communities in the Southeast United States; however, to date little attention has been paid to community-academic collaborations to address HIV in these communities. Interventions that use a community-based participatory research (CBPR) approach to address individual, social, and physical environmental factors have great potential for improving community health. Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) uses a CBPR approach to develop culturally sensitive, feasible, and sustainable interventions to prevent the spread of HIV in rural African American communities. This article describes a staged approach to community-academic partnership: initial mobilization, establishment of organizational structure, capacity building for action, and planning for action. Strategies for engaging rural community members at each stage are discussed; challenges faced and lessons learned are also described. Careful attention to partnership development has resulted in a collaborative approach that has mutually benefited both the academic and community partners.

A reanalysis of a behavioral intervention to prevent incident HIV infections: Including indirect effects in modeling outcomes of Project EXPLORE

PubMed Central

Eaton, Lisa A.; Kalichman, Seth C.; Kenny, David A.; Harel, Ofer

2013-01-01

Background Project EXPLORE -- a large-scale, behavioral intervention tested among men who have sex with men (MSM) at-risk for HIV infection --was generally deemed as ineffective in reducing HIV incidence. Using novel and more precise data analytic techniques we reanalyzed Project EXPLORE by including both direct and indirect paths of intervention effects. Methods Data from 4,296 HIV negative MSM who participated in Project EXPLORE, which included ten sessions of behavioral risk reduction counseling completed from 1999-2005, were included in the analysis. We reanalyzed the data to include parameters that estimate the overtime effects of the intervention on unprotected anal sex and the over-time effects of the intervention on HIV status mediated by unprotected anal sex simultaneously in a single model. Results We found the indirect effect of intervention on HIV infection through unprotected anal sex to be statistically significant up through 12 months post-intervention, OR=.83, 95% CI=.72-.95. Furthermore, the intervention significantly reduced unprotected anal sex up through 18 months post-intervention, OR=.79, 95% CI=.63-.99. Discussion Our results reveal effects not tested in the original model that offer new insight into the effectiveness of a behavioral intervention for reducing HIV incidence. Project EXPLORE demonstrated that when tested against an evidence-based, effective control condition can result in reductions in rates of HIV acquisition at one year follow-up. Findings highlight the critical role of addressing behavioral risk reduction counseling in HIV prevention. PMID:23245226

Screening Experiments and the Use of Fractional Factorial Designs in Behavioral Intervention Research

PubMed Central

Nair, Vijay; Strecher, Victor; Fagerlin, Angela; Ubel, Peter; Resnicow, Kenneth; Murphy, Susan; Little, Roderick; Chakraborty, Bibhas; Zhang, Aijun

2008-01-01

Health behavior intervention studies have focused primarily on comparing new programs and existing programs via randomized controlled trials. However, numbers of possible components (factors) are increasing dramatically as a result of developments in science and technology (e.g., Web-based surveys). These changes dictate the need for alternative methods that can screen and quickly identify a large set of potentially important treatment components. We have developed and implemented a multiphase experimentation strategy for accomplishing this goal. We describe the screening phase of this strategy and the use of fractional factorial designs (FFDs) in studying several components economically. We then use 2 ongoing behavioral intervention projects to illustrate the usefulness of FFDs. FFDs should be supplemented with follow-up experiments in the refining phase so any critical assumptions about interactions can be verified. PMID:18556602

Evaluating the sustainability, scalability, and replicability of an STH transmission interruption intervention: The DeWorm3 implementation science protocol.

PubMed

Means, Arianna Rubin; Ajjampur, Sitara S R; Bailey, Robin; Galactionova, Katya; Gwayi-Chore, Marie-Claire; Halliday, Katherine; Ibikounle, Moudachirou; Juvekar, Sanjay; Kalua, Khumbo; Kang, Gagandeep; Lele, Pallavi; Luty, Adrian J F; Pullan, Rachel; Sarkar, Rajiv; Schär, Fabian; Tediosi, Fabrizio; Weiner, Bryan J; Yard, Elodie; Walson, Judd

2018-01-01

Hybrid trials that include both clinical and implementation science outcomes are increasingly relevant for public health researchers that aim to rapidly translate study findings into evidence-based practice. The DeWorm3 Project is a series of hybrid trials testing the feasibility of interrupting the transmission of soil transmitted helminths (STH), while conducting implementation science research that contextualizes clinical research findings and provides guidance on opportunities to optimize delivery of STH interventions. The purpose of DeWorm3 implementation science studies is to ensure rapid and efficient translation of evidence into practice. DeWorm3 will use stakeholder mapping to identify individuals who influence or are influenced by school-based or community-wide mass drug administration (MDA) for STH and to evaluate network dynamics that may affect study outcomes and future policy development. Individual interviews and focus groups will generate the qualitative data needed to identify factors that shape, contextualize, and explain DeWorm3 trial outputs and outcomes. Structural readiness surveys will be used to evaluate the factors that drive health system readiness to implement novel interventions, such as community-wide MDA for STH, in order to target change management activities and identify opportunities for sustaining or scaling the intervention. Process mapping will be used to understand what aspects of the intervention are adaptable across heterogeneous implementation settings and to identify contextually-relevant modifiable bottlenecks that may be addressed to improve the intervention delivery process and to achieve intervention outputs. Lastly, intervention costs and incremental cost-effectiveness will be evaluated to compare the efficiency of community-wide MDA to standard-of-care targeted MDA both over the duration of the trial and over a longer elimination time horizon.

[Cardiovascular risk reduction: impact of an international project].

PubMed

Colle, B; Brusaferro, S

2008-01-01

The Euroaction project, promoted by European Society of Cardiology, aims to determine whether a nurse co-ordinated, multidisciplinary, family based preventive cardiology programme could help more patients and their families achieve the recommended European lifestyle, risk factor and therapeutic goals for cardiovascular disease prevention. EUROACTION was evaluated in a paired cluster randomized controlled trial, and the primary care branch included 6 European countries. Consecutive patients > 50 years and < 80 years, with no history of cardiovascular disease, were prospectively identified by the general practitioners with one of the following: (i) high total cardiovascular risk (HeartScore > or = 5% over 10 years, either now or when projected to age 60 years) and on no medical treatment for blood pressure, lipids or diabetes; (ii) on treatment with anti-hypertensive and/or lipid-lowering drug therapies started in the last year but with no diabetes; (iii) diagnosed with diabetes mellitus (treated by diet alone or with oral hypoglycaemic drug therapy and/or insulin) within the last three years in both intervention and usual care practices. All eligible high risk individuals and their partners were then invited by the nurse for an assessment of their lifestyle, risk factors and therapeutic management as soon as possible after identification. In the primary care intervention branch 1019 patients have been enrolled with no differences by sex and mean age 62, while in the control branch 1005 patients were recruited with mean age 63, female were 43%. The main results show that Intervention group (I) had a statistically significant improvement compared to Usual Care (UC) in the assumption of recommended quantity of fruit and vegetables (78.4% I vs 38.8% UC p=0.005), in the weight loss (weight loss > al 5% in subjects with BMI > 25 kg/m2) (16.5% I vs 6.8% UC p=0.005), in blood pressure control both in people specifically treated with drugs and untreated (respectively 52% I vs 35% UC p=0.04 and 65% Ivs 45% UC p=0.02), in reaching the European target for total cholesterol (Total Cholesterol < 5.0 mmol/l) during the study year (from 21.9% to 35.8% (I) absolute increase 12.7% (p=0.025) vs from 33% to 32.2% (UC)). No significant differences were found about change of smoking habits. The experimented intervention model based on a multidisciplinary approach and nurses leaded showed a good one year impact in reducing cardiovascular risk factors in high risk people. This model should be further tested in local contexts.

Constructing common cohorts from trials with overlapping eligibility criteria: implications for comparing effect sizes between trials.

PubMed

Mount, David L; Feeney, Patricia; Fabricatore, Anthony N; Coday, Mace; Bahnson, Judy; Byington, Robert; Phelan, Suzanne; Wilmoth, Sharon; Knowler, William C; Hramiak, Irene; Osei, Kwame; Sweeney, Mary Ellen; Espeland, Mark A

2009-10-01

Comparing findings from separate trials is necessary to choose among treatment options, however differences among study cohorts may impede these comparisons. As a case study, to examine the overlap of study cohorts in two large randomized controlled clinical trials that assess interventions to reduce risk of major cardiovascular disease events in adults with type 2 diabetes in order to explore the feasibility of cross-trial comparisons The Action for Health in Diabetes (Look AHEAD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials enrolled 5145 and 10,251 adults with type 2 diabetes, respectively. Look AHEAD assesses the efficacy of an intensive lifestyle intervention designed to produce weight loss; ACCORD tests pharmacological therapies for control of glycemia, hyperlipidemia, and hypertension. Incidence of major cardiovascular disease events is the primary outcome for both trials. A sample was constructed to include participants from each trial who appeared to meet eligibility criteria and be appropriate candidates for the other trial's interventions. Demographic characteristics, health status, and outcomes of members and nonmembers of this constructed sample were compared. Nearly 80% of Look AHEAD participants were projected to be ineligible for ACCORD; ineligibility was primarily due to better glycemic control or no early history of cardiovascular disease. Approximately 30% of ACCORD participants were projected to be ineligible for Look AHEAD, often for reasons linked to poorer health. The characteristics of participants projected to be jointly eligible for both trials continued to reflect differences between trials according to factors likely linked to retention, adherence, and study outcomes. Accurate ascertainment of cross-trial eligibility was hampered by differences between protocols. Despite several similarities, the Look AHEAD and ACCORD cohorts represent distinct populations. Even within the subsets of participants who appear to be eligible and appropriate candidates for trials of both modes of intervention, differences remained. Direct comparisons of results from separate trials of lifestyle and pharmacologic interventions are compromised by marked differences in enrolled cohorts.

14. Implementation, execution, and completion of projects.

PubMed

2014-05-01

Once an intervention has been selected for implementation, it becomes a project. Implementation of a project is a complex process and requires completion of a host of tasks. The implementation process has been deconstructed into its components so that it can be analysed and evaluated. A prerequisite for implementation is an operational plan. The tasks that require completion include: (1) reassessing current status and verifying the needs; (2) activating the operational plan; (3) setting-up and operating an administrative structure; (4) identifying, acquiring, and organising resources (including human resources); (5) assigning roles and responsibilities; (6) educating and training personnel (including mission-specific); (7) briefing staff; (8) preparing/readying resources for transport; (9) assuring project self-sufficiency; (10) arranging for personal necessities; (11) ensuring the safety of personnel and the security of equipment and supplies; (12) insuring personnel; (13) coordinating with other projects/actors; (14) coordinating with other BSF systems (role of the coordination and control centre); (15) communicating with community leaders; (16) initiating the use of standardised progress reports; (17) deploying personnel, equipment, and supplies; (18) initiating the intervention(s); (19) executing the intervention(s); (20) reporting start of interventions; (21) completing the project; and (22) completing and submitting a formal report. This deconstruction is essential in order to study the process and identify critical points of success and failure. It also is recognised that many interventions consist of many components (subfunctions), each of which may be considered a production process.

Knowledge-exchange in the Pacific: outcomes of the TROPIC (translational research for obesity prevention in communities) project.

PubMed

Kremer, Peter; Mavoa, Helen; Waqa, Gade; Moodie, Marjory; McCabe, Marita; Swinburn, Boyd

2017-04-26

The Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aimed to design, implement and evaluate a knowledge-broking approach to evidence-informed policy making to address obesity in Fiji. This paper reports on the quantitative evaluation of the knowledge-broking intervention through assessment of participants' perceptions of evidence use and development of policy/advocacy briefs. Selected staff from six organizations - four government Ministries and two nongovernment organizations (NGOs) - participated in the project. The intervention comprised workshops and supported development of policy/advocacy briefs. Workshops addressed obesity and policy cycles and developing participants' skills in accessing, assessing, adapting and applying relevant evidence. A knowledge-broking team supported participants individually and/or in small groups to develop evidence-informed policy/advocacy briefs. A questionnaire survey that included workplace and demographic items and the self-assessment tool "Is Research Working for You?" (IRWFY) was administered pre- and post-intervention. Forty nine individuals (55% female, 69% 21-40 years, 69% middle-senior managers) participated in the study. The duration and level of participant engagement with the intervention activities varied - just over half participated for 10+ months, just under half attended most workshops and approximately one third produced one or more policy briefs. There were few reliable changes on the IRWFY scales following the intervention; while positive changes were found on several scales, these effects were small (d < .2) and only one individual scale (assess) was statistically significant (p < .05). Follow up (N = 1) analyses of individual-level change indicated that while 63% of participants reported increased research utilization post-intervention, this proportion was not different to chance levels. Similar analysis using scores aggregated by organization also revealed no organizational-level change post-intervention. This study empirically evaluated a knowledge-broking program that aimed to extend evidence-informed policy making skills and development of a suite of national policy briefs designed to increase the enactment of obesity-related policies. The findings failed to indicate reliable improvements in research utilization at either the individual or organizational level. Factors associated with fidelity and intervention dose as well as challenges related to organizational support and the measurement of research utilization, are discussed and recommendations for future research presented.

Strengths and weaknesses of the Young Black Men, Masculinities, and Mental Health (YBMen) Facebook project.

PubMed

Watkins, Daphne C; Allen, Julie Ober; Goodwill, Janelle R; Noel, Blake

2017-01-01

The Young Black Men, Masculinities, and Mental Health (YBMen) project is a Facebook-based intervention that provides mental health education and social support to young Black men. The YBMen project was created to better understand and address the pressures and needs of young Black men, particularly with regard to issues related to their conceptualization of masculinity and mental health. Black men from a 2-year liberal arts college in the Midwest (United States) enrolled in the YBMen pilot project. The purpose of this study is to report what participants in the YBMen pilot project liked and disliked about the intervention, along with their suggestions for improvement. Qualitative results from the 8 Black men who actively participated in the YBMen Facebook intervention and completed the postintervention interview are reported. A systematic analysis identified 9 subthemes that described participants' reactions to different components and characteristics of the Facebook intervention. Results indicated that opportunities for relationship building and connectivity, coupled with engaging popular culture references used in the intervention encouraged young Black men to actively participate in the YBMen Facebook intervention. The YBMen project has potential to improve the health and well-being of young Black men by providing nontraditional resources that are easily accessible, culturally sensitive, and gender-specific. Implications of the YBMen project as an effective Internet-based program that promotes mental health and increases social support among young Black men are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Creation of a crystalline lens radiation exposure defense cover and the effect of radiation exposure decrease on neuro-interventions].

PubMed

Take, Toshio; Sato, Kaori; Kiuchi, Katsunori; Nakazawa, Yasuo

2007-11-20

A variety of radiation hazards resulting from interventional radiology (IVR) have been reported in recent years. Particularly affected are the skin and the crystalline lens, with their high radiation sensitivity. During neurological interventions, the radiological technologist should consider decreasing radiation exposure. We found exposure projections where the exposure dose became a radiation hazard for the crystalline lens, and examined an efficient method of cover for the exposure projections used for neurological interventions. The exposure projection for maximum crystalline lens radiation exposure was a lateral projection. In the crystalline lens the maximum exposure to radiation was on the X-ray tube side. The method of defense adopted was that of installing a lead plate of the appropriate shape on the surface of the X-ray tube collimator. In other exposure projections, this cover did not become a redundant shadow. With the cover that was created, the X-ray side crystalline lens lateral projection could be defended effectively.

[Risk factors for the spine: nursing assessment and care].

PubMed

Bringuente, M E; de Castro, I S; de Jesus, J C; Luciano, L dos S

1997-01-01

The present work aimed at studying risk factor that affect people with back pain, identifying them and implementing an intervention proposal of a health education program based on self-care teaching, existential humanist philosophical projects and stress equalization approach line, skeletal-muscle reintegration activities, basic techniques on stress equalization and massage. It has been developed for a population of 42 (forty-two) clients. Two instruments which integrate nursing consultation protocol have been used in data collection. The results showed the existence of associated risk factors which are changeable according to health education programs. The assessment process has contributed for therapeutic measures focus, using non-conventional care methods for this approach providing an improvement to these clients life quality.

Project power: Adapting an evidence-based HIV/STI prevention intervention for incarcerated women.

PubMed

Fasula, Amy M; Fogel, Catherine I; Gelaude, Deborah; Carry, Monique; Gaiter, Juarlyn; Parker, Sharon

2013-06-01

Incarcerated women are a critical population for targeted HIV/STI prevention programming; however, there is a dearth of evidence-based, genderspecific behavioral interventions for this population. Systematically adapting existing evidence-based interventions (EBIs) can help fill this gap. We illustrate the adaptation of the HIV/STI prevention EBI, Project Safe, for use among incarcerated women and delivery in prisons. Project POWER, the final adapted intervention, was developed using formative research with prison staff and administration, incarcerated and previously incarcerated women, and input of community advisory boards. Intervention delivery adaptations included: shorter, more frequent intervention sessions; booster sessions prior to and just after release; facilitator experience in prisons and counseling; and new videos. Intervention content adaptations addressed issues of empowerment, substance use, gender and power inequity in relationships, interpersonal violence, mental health, reentry, and social support. This illustration of the adaption process provides information to inform additional efforts to adapt EBIs for this underserved population.

Kā-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians.

PubMed

Kaholokula, Joseph Keawe'aimoku; Look, Mele A; Wills, Thomas A; de Silva, Māpuana; Mabellos, Tricia; Seto, Todd B; Ahn, Hyeong Jun; Sinclair, Ka'imi A; Buchwald, Dedra

2017-04-17

As a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Kā-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk. A 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only. This trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities. ClinicalTrials.gov: NCT02620709 , registration date November 23, 2015.

Teen Intervention Project--Cherokee (TIP-C).

PubMed

Lowe, John

2006-01-01

To test the feasibility of providing a cultural school-based substance abuse intervention for Cherokee adolescents and to examine the relationship between Cherokee self-reliance, substance abuse, and stress. A 10-week group intervention was implemented over a 3-year period for Cherokee adolescent substance abusers. Pre-intervention, immediate post-intervention, and 90-day post-intervention measures of Cherokee self-reliance, substance abuse, and stress were administered to 108 Cherokee adolescent high school students who participated in the intervention. Immediate and 90-day post-intervention substance abuse rates were significantly lower than pre-intervention rates. Cherokee self-reliance scores were significantly increased. Perceived stress scores were significantly lower immediately post-intervention but increased 90-day post-intervention. The Teen Intervention Project--Cherokee is an effective and culturally appropriate school-based intervention for Cherokee adolescent substance abusers.

Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

PubMed Central

Wallace, Carolyn M; Legro, Marcia W

2008-01-01

Background Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project. Methods This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers. Results Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers. Conclusion Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions. PMID:18430201

High mobility, low access thwarts interventions among seasonal workers in the Greater Mekong Sub-region: lessons from the malaria containment project.

PubMed

Canavati, Sara E; Quintero, Cesia E; Lawford, Harriet L S; Yok, Sovann; Lek, Dysoley; Richards, Jack S; Whittaker, Maxine Anne

2016-08-26

During the process of malaria elimination in the Greater Mekong Sub-region, mobile and migrant populations (MMPs) have been identified as the most at-risk demographic. An important sub-group of MMPs are seasonal workers, and this paper presents an evaluation of the reach and effectiveness of interventions tailored towards this group and was carried out as part of the Containment Project from 2009-11. A mixed-methods study was conducted in Pailin Province in Western Cambodia. Three-hundred-and-four seasonal workers were surveyed using a structured questionnaire. Qualitative data were gathered through a total of eight focus group discussions and 14 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. High mobility and low access of the target population to the interventions, as well as lack of social and anthropological research that led to implementation oversights, resulted in under-exposure of seasonal workers to interventions. Consequently, their reach and impact were severely limited. Some services, particularly Mobile Malaria Workers, had the ability to significantly impact key factors, such as risky behaviours among those they did reach. Others, like Listening and Viewing Clubs and mass media campaigns, showed little impact. There is potential in two of the interventions assessed, but high mobility and inadequate exposure of seasonal workers to these interventions must be considered in the development and planning of future interventions to avoid investing in low-impact activities and ensure that all interventions perform according to their maximum potential. This will be critical in order for Cambodia to achieve its aim of malaria elimination. The lessons learned from this study can be extrapolated to other areas of health care in Cambodia and other countries in order to reduce the gap between healthcare provided to MMPs, especially seasonal workers, and to the general population.

A Benefit-Cost Structure for PACE I.D.: An Early Identification and Intervention Project. Management Systems Programs.

ERIC Educational Resources Information Center

Keenan, J. M.; And Others

This report attempts to assess the economic benefits and costs of the PACE (Projects to Advance Creativity in Education) Early Identification and Intervention Project. The report is structured to provide an indication of impacts generated by the Project, with some estimates of its direction and relative magnitude. The first section on impact…

A quality improvement project to improve the effectiveness and patient-centredness of management of people with mild-to-moderate kidney disease in primary care.

PubMed

Thomas, Nicola; Gallagher, Hugh; Jain, Neerja

2014-01-01

Chronic kidney disease (CKD) stages 3 to 5, affects 6-7% of the adult population and is an important risk factor for both advanced kidney disease and cardiovascular disease. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3-5 kidney disease who were managed in primary care. The intervention was a Care Bundle for CKD. The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element. 29 GP Practices in England and Wales began the study. They undertook training in clinical management of CKD and in facilitation of self-management, with the self-management content designed and led by patients. Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices. Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered CKD stage 3 to 5 population in 5 Practices, 20-29% in 3 Practices, 30-49% in 2 Practices and ≥50% in 3 Practices (998 patients in total). Of these, 671 patients (75%) agreed to the self-management component of the intervention. The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 patients in the six Practices who completed the project but did not submit regular practice-level monthly data. In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in people with CKD stage 3-5 and no diabetes and 48% in people with CKD stage 3-5 and diabetes. At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more patients with CKD on the Practice CKD Register). In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in patients seen infrequently are significant challenges to generalisation and sustainability.

Organizational and community approaches to community-wide prevention of heart disease: the first two years of the Pawtucket Heart Health Program.

PubMed

Elder, J P; McGraw, S A; Abrams, D B; Ferreira, A; Lasater, T M; Longpre, H; Peterson, G S; Schwertfeger, R; Carleton, R A

1986-03-01

The Pawtucket Heart Health program (PHHP) is a federally funded research and demonstration project for the primary prevention of coronary heart disease (CHD) in a community. This article presents a discussion of the first 26 months of this intervention, divided into its three phases. PHHP staff initially approached the intervention city through local organizations to accomplish risk-factor behavior change in the population. After 11 months, PHHP complemented its programs in organizations with activities open to all city residents, in order to accelerate participation by the population. Seven months into this phase, it was decided that community activities should be the major focus of the intervention approach to assure a level of participation adequate to make a measurable impact. The third has shown the greatest percentage of public participation, demonstrating the complementary nature of organization and community interventions and of the translation of social learning theory into principles for primary prevention in a community.

Understanding knowledge transfer in an ergonomics intervention at a poultry processing plant.

PubMed

Antle, David M; MacKinnon, Scott N; Molgaard, John; Vézina, Nicole; Parent, Robert; Bornstein, Stephen; Leclerc, Louise

2011-01-01

This case study reviews the knowledge transfer (KT) process of implementing a knife sharpening and steeling program into a poultry processing plant via a participatory ergonomics intervention. This ergonomics intervention required stakeholder participation at the company level to move a 'train-the-trainer' program, developed in Québec, Canada, into action on the plant's deboning line. Communications and exchanges with key stakeholders, as well as changes in steeling and production behaviours were recorded. The intervention was assumed to be at least partially successful because positive changes in work operations occurred. Ergonomic-related changes such as those documented have been cited in the academic literature as beneficial to worker health. However, several components cited in literature that are associated with a successful participatory ergonomics intervention were not attained during the project. A Dynamic Knowledge Transfer Model was used to identify KT issues that impacted on the success of train-the-trainer program. A debriefing analysis reveals that a failure to consider key participatory ergonomics factors necessary for success were related to capacity deficits in the knowledge dissemination strategy.

The application of an industry level participatory ergonomics approach in developing MSD interventions.

PubMed

Tappin, D C; Vitalis, A; Bentley, T A

2016-01-01

Participatory ergonomics projects are traditionally applied within one organisation. In this study, a participative approach was applied across the New Zealand meat processing industry, involving multiple organisations and geographical regions. The purpose was to develop interventions to reduce musculoskeletal disorder (MSD) risk. This paper considers the value of an industry level participatory ergonomics approach in achieving this. The main rationale for a participative approach included the need for industry credibility, and to generate MSD interventions that address industry level MSD risk factors. An industry key stakeholder group became the primary vehicle for formal participation. The study resulted in an intervention plan that included the wider work system and industry practices. These interventions were championed across the industry by the key stakeholder group and have extended beyond the life of the study. While this approach helped to meet the study aim, the existence of an industry-supported key stakeholder group and a mandate for the initiative are important prerequisites for success. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Using rap music to promote adolescent health: pilot study of VoxBox.

PubMed

Paukste, Ernesta; Harris, Neil

2015-04-01

Alcohol, tobacco and other drugs (ATODs) usage among adolescents, particularly those living in lower socioeconomic communities, is a population health problem in Australia that requires innovative health promotion strategies. There is a growing recognition of the potential of arts-based approaches to engage youth in health promoting activities. This paper presents the process evaluation of the pilot VoxBox intervention that used rap to build adolescents' awareness of risks associated with ATODs. The VoxBox intervention was piloted in Logan, Queensland, at five high schools with 18 adolescents completing the intervention. Data collection methods included observation, focus groups, semi-structured interviews and a survey of adolescent participants. The intervention was well received by participants and stakeholders. Three factors characterising the project's successful engagement of adolescents were: participate - go with the flow, learning from the real deal and resourced to make some noise. In VoxBox, the emphasis on engaging adolescents in an activity of real interest that was appropriately resourced and delivered was central to credibility and success. SO WHAT?: The findings highlight the importance of interventions matching the interests of the targeted population group.

The economic impact of project MARS (motivating adolescents to reduce sexual risk).

PubMed

Dealy, Bern C; Horn, Brady P; Callahan, Tiffany J; Bryan, Angela D

2013-09-01

The purpose of this study was to economically evaluate Project MARS (Motivating Adolescents to Reduce Sexual Risk; T. J. Callahan, E. A. Montanaro, R. E. Magnan, & A. D. Bryan, 2013, "Project MARS: Design of a multi-behavior intervention trial for justice-involved youth," Translational Behavioral Medicine, Vol. 3, pp. 122-130), an ongoing, randomized, sexual-risk-reduction intervention for justice-involved youth. We consider the effect of including viral STIs in the economic analysis, and explore the impact of the MARS intervention on the perceived cost of acquiring STIs to justice-involved youth. 206 participants, ages 14 to 18, participated in a sexual-risk-reduction intervention that included screening and treatment for chlamydia and gonorrhea. A Bernoulli probability model was used to estimate averted STIs attributable to the MARS intervention. The economic benefit of averted STIs was monetized using the direct medical cost of treatment. In addition, we used a contingent valuation (willingness-to-pay) model to investigate the impact of the Project MARS on participants' perceived cost of acquiring an STI. Using the standard outcome domains typically used to evaluate STI interventions, Project MARS resulted in a reduction of $2.08 in direct medical costs for every $1 spent. When viral STIs were added to the economic model, a considerable increase in averted direct medical costs ($2.68 for every $1 spent) was found. Preliminary contingent valuation estimates suggest that participants' willingness-to-pay for averted STIs significantly increased after receiving the MARS intervention. From an economic perspective, Project MARS is a worthwhile program to adopt. Future attention should be given to the impact of behavioral interventions on viral infections. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings.

PubMed

Loosier, Penny S; Doll, Shelli; Lepar, Danielle; Ward, Kristin; Gamble, Ginger; Dittus, Patricia J

2016-08-01

The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage indicated Project Connect was successful with sexually experienced female youth, where it increased rates of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) testing and receipt of contraception. This adaption of Project Connect examined its effectiveness in a new context and via collection of clinic encounter-level data. Project Connect was implemented in 3 high schools. (only 2 schools remained open throughout the entire project period). Participant recruitment and data collection occurred in 5 of 8 participating health clinics. Students completed Youth Surveys (N = 608) and a Clinic Survey (paired with medical data abstraction in 2 clinics [N = 305]). Students were more likely than nonstudents to report having reached a clinic via Project Connect. Nearly 40% of students attended a Project Connect school, with 32.7% using Project Connect to reach the clinic. Students were most likely to have been referred by a school nurse or coach. Project Connect is a low-cost, sustainable structural intervention with multiple applications within schools, either as a standalone intervention or in combination with ongoing efforts. © 2016, American School Health Association.

Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions.

PubMed

Wheeler, Stephanie B; Leeman, Jennifer; Hassmiller Lich, Kristen; Tangka, Florence K L; Davis, Melinda M; Richardson, Lisa C

A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.

[Exposition of the operator's eye lens and efficacy of radiation shielding in fluoroscopically guided interventions].

PubMed

Galster, M; Guhl, C; Uder, M; Adamus, R

2013-05-01

Efficacy of radiation protection tools for the eye lens dose of the radiologist in fluoroscopic interventions. A patient phantom was exposed using a fluoroscopic system. Dose measurements were made at the eye location of the radiologist using an ionization chamber. The setting followed typical fluoroscopic interventions. The reduction of scattered radiation by the equipment-mounted shielding (undercouch drapes and overcouch top) was evaluated. The ceiling-suspended lead acrylic glass screen was tested in scattered radiation generated by a slab phantom. The protective properties of different lead glass goggles and lead acrylic visors were evaluated by thermoluminescence measurements on a head phantom in the primary beam. The exposition of the lens of about 110 to 550 μSv during radiologic interventions is only slightly reduced by the undercouch drapes. Applying the top in addition to the drapes reduces the lens dose by a factor of 2 for PA projections. In 25°LAO the dose is reduced by a factor between 1.2 and 5. The highest doses were measured for AP angulations furthermore the efficacy of the equipment-mounted shielding is minimal. The ceiling-suspended lead screen reduced scatter by a factor of about 30. The lead glass goggles and visors reduced the lens dose up to a factor of 8 to 10. Depending on the specific design, the tested models are less effective especially for radiation from lateral with cranial angulation of the beam. Occasionally the visors even caused an increase of dose. The exposition of the eye lens can be kept below the new occupational limit recommended by the ICRP if the radiation shielding equipment is used consistently. © Georg Thieme Verlag KG Stuttgart · New York.

Supporting families in challenging contexts: the CAPEDP project.

PubMed

Saïas, Thomas; Greacen, Tim; Tubach, Florence; Dugravier, Romain; Marcault, Estelle; Tereno, Susana; Tremblay, Richard E; Guédeney, Antoine

2013-06-01

Although France has one of the most generous health and social care systems for infant and maternal well-being in the Western world, professionals have been increasingly concerned by the rising number of children being referred for mental health problems. The present article describes the first home-visiting program in France to specifically target mental health questions in families living in vulnerable contexts. The CAPEDP project, involving 440 women and their families, took place in Paris and its inner suburbs from 2006 to 2011. To be eligible for inclusion, women had to be (i) under 26 years old, (ii) less that 27 weeks pregnant, (iii) sufficiently fluent in French to give truly informed consent to participate in the study and benefit from the intervention and (iv) presenting with one or more of the following social vulnerability factors: low income, low educational level, and/or intending to bring up the child without the child's father. The intervention consisted of 44 home visits from the third trimester of pregnancy through to the child's second birthday. The aim of the intervention was to promote infant mental health and reduce the incidence of infant mental health problems at the age of two years. The intervention paid particular attention to postnatal maternal depression and promoting parenting skills and attachment security, particularly through the use of video during home-visits. A major issue was that of adapting international best practice recommendations with regard to home-visiting programs to the particularities of the existing French social and health care system. An original aspect of the intervention was to use trained clinical psychologists to conduct all home visits.

Cost and threshold analysis of an HIV/STI/hepatitis prevention intervention for young men leaving prison: Project START.

PubMed

Johnson, A P; Macgowan, R J; Eldridge, G D; Morrow, K M; Sosman, J; Zack, B; Margolis, A

2013-10-01

The objectives of this study were to: (a) estimate the costs of providing a single-session HIV prevention intervention and a multi-session intervention, and (b) estimate the number of HIV transmissions that would need to be prevented for the intervention to be cost-saving or cost-effective (threshold analysis). Project START was evaluated with 522 young men aged 18-29 years released from eight prisons located in California, Mississippi, Rhode Island, and Wisconsin. Cost data were collected prospectively. Costs per participant were $689 for the single-session comparison intervention, and ranged from $1,823 to 1,836 for the Project START multi-session intervention. From the incremental threshold analysis, the multi-session intervention would be cost-effective if it prevented one HIV transmission for every 753 participants compared to the single-session intervention. Costs are comparable with other HIV prevention programs. Program managers can use these data to gauge costs of initiating these HIV prevention programs in correctional facilities.

Multilevel perspectives on community intervention: an example from an Indo-US HIV prevention project in Mumbai, India.

PubMed

Schensul, Stephen L; Saggurti, Niranjan; Singh, Rajendra; Verma, Ravi K; Nastasi, Bonnie K; Mazumder, Papiya Guha

2009-06-01

This paper explores the meaning and applicability of multilevel interventions and the role of ethnography in identifying intervention opportunities and accounting for research design limitations. It utilizes as a case example the data and experiences from a 6-year, NIMH-funded, intervention to prevent HIV/STI among married men in urban poor communities in Mumbai, India. The experiences generated by this project illustrate the need for multilevel interventions to include: (1) ethnographically driven formative research to delineate appropriate levels, stakeholders and collaborators; (2) identification of ways to link interventions to the local culture and community context; (3) the development of a model of intervention that is sufficiently flexible to be consistently applied to different intervention levels using comparable culturally congruent concepts and approaches; (4) mechanisms to involve community residents, community based organizations and community-based institutions; and (5) approaches to data collection that can evaluate the impact of the project on multiple intersecting levels.

Intervention to decrease glyburide use in elderly patients with renal insufficiency.

PubMed

Aspinall, Sherrie L; Zhao, Xinhua; Good, Chester B; Stone, Roslyn A; Boresi, Joy; Cox, Sarah; Bartholomew, Chad; Jansen, David; Guterman, Sarah; Patino, Mauricio; Rivera-Miranda, Giselle; Burlingame, Mark; Frazer, Justin; Sellers, Janelle; Stanard Steele, Valerie; Witt, Lauri; Cunningham, Francesca E

2011-02-01

The objectives of this study were to describe changes in glyburide prescribing in cohorts that were and were not targeted by a risk reduction project, assess factors associated with glyburide discontinuation, and evaluate changes in glycated hemoglobin (ie, HbA(1c)) levels and rates of serious hypoglycemia. This historical cohort study included a targeted cohort of 4368 outpatient veterans aged ≥65 years with active prescriptions for glyburide between April 1, 2007 and June 30, 2007 and serum creatinine (SCr) ≥2 mg/dL and a nontargeted cohort of 1886 outpatients meeting these same criteria between July 1, 2007 and September 3, 2007. The intervention in the risk reduction project took place on September 4, 2007 and entailed giving regional pharmacy leaders information about the increased risk of hypoglycemia with glyburide and the list of targeted patients for follow up with providers. For each patient, the study period was the time between the date they first met the eligibility criteria and March 31, 2008. All data were obtained from Veterans Affairs (VA) administrative databases. The primary outcome was the discontinuation of glyburide. Secondary outcomes were the change in HbA(1c) after stopping glyburide and the rate of serious hypoglycemia after intervention. Incidence rate ratios (IRRs) for glyburide discontinuation in targeted versus nontargeted cohorts were statistically significantly elevated in September (IRR 2.1; 95% CI 1.7-2.5), October (IRR 1.3; 95% CI 1.1-1.6), and November 2007 (IRR 1.4; 95% CI 1.1-1.7). The intervention, black race, SCr, Charlson comorbidity score, new glyburide use, and VA region were independently associated with discontinuation. Among patients in the targeted cohort who discontinued glyburide, mean (SD) HbA(1c) at baseline and after discontinuation were 7.17% (1.35%), and 7.22% (1.34%), respectively (P = 0.36). The hypoglycemia rates/1000 person-days were 0.093 before the intervention and 0.070 afterwards (P = 0.10). A one-time intervention in a risk reduction project decreased glyburide use over a 3-month period in elderly outpatients with renal insufficiency without compromising glucose control. Published by EM Inc USA.

A multi-phase telepsychiatry programme in Michigan: organizational factors affecting utilization and user perceptions.

PubMed

Whitten, Pamela; Kuwahara, Emily

2004-01-01

Over the last few years, telepsychiatry services in Michigan have been developed by LifeWays, a Medicaid-managed behavioural health-care organization. The project had four phases, involving the introduction of telepsychiatry services between a rural and an urban clinic, to a crisis intervention centre, to a youth detention centre and to patients' homes. The role of organizational issues in the success of the programme was examined through patient interviews, provider interviews, patient and provider pre- and post-project focus groups, and service documents. Utilization data were obtained from activity logs and patient charts. During the study, 297 clients received 578 teleconsultations. Almost 97% of the telepsychiatry visits were scheduled. Telemedicine usage varied between the four project phases. The reasons for its variation in use included provider roles, existing organizational strategic goals and resources, the inherent organizational culture and quirks, and leadership and managerial factors. The major difficulties stemmed from the providers and the organization itself. There is tremendous potential for telepsychiatry and the ways in which organizational variables can be managed to influence the success of telepsychiatry programmes deserve further study.

Communication for Development Interventions in Fragile States: A Systematic Review

PubMed Central

Skuse, Andrew; Rodger, Dianne; Power, Gerry; Mbus, Domenic Friguglietti; Brimacombe, Tait

2013-01-01

Executive summary Background A wide range of contextual and programmatic factors frame, affect and constrain communication for development (C4D) interventions undertaken in fragile or conflict affected states. For the purposes of this review, contextual factors include culture, poverty, different stages of conflict (such as latent, open or post-conflict scenarios), policy, legislation and so on, while programmatic factors include the type of intervention, formative and summative evaluation, project design and management, human and financial resources and so on. Understanding the various factors that influence C4D interventions in fragile states is important to improving practice, implementation and evaluation, as well as to the future development of methodologies and frameworks that can be utilised in conflict or crisis situations. Objective The objective of this review is to assess the contextual and programmatic factors that influence communication for development interventions in fragile states. Types of participants Persons regardless of age, gender and ethnicity – living in fragile states. Phenomena of interest The contextual and programmatic factors that influence communication for development (C4D) interventions in fragile states. Types of studies Qualitative peer reviewed studies, expert opinion, discussion papers, project reports, policy papers, position papers and other text. Search strategy Searches were conducted for published and unpublished material (between January 2001 – September 2011), including grey literature, in the English language. Databases searched were: Academic Search Premier; African Women's Bibliographic Database; Anthropology Plus; Bibliography of Asian Studies; Educational Resources Information Centre; Ingenta Connect; JSTOR; Scopus; and Sociological Abstracts; Communication for Social Change Consortium; DevComm (World Bank); Eldis; Search for Common Ground; The Communication Initiative; United Nations Development Programme; United Nations Educational, Scientific and Cultural Organization; and United Nations High Commissioner for Refugees. Methodological quality Each identified source was critically appraised by two independent reviewers for methodological quality and thematic relevance prior to inclusion in the review. The appraisal process employed the System for the Unified Management, Assessment and Review of Information (SUMARI) software developed by the Joanna Briggs Institute. Data collection Data was extracted using the standardised extraction tools. Data synthesis Data were categorised and synthesised using standardised SUMARI extraction tools. This involved the identification of a set of analytical findings, followed by the allocation of specific categories representative of each, i.e. digital divide. A process of aggregation followed via which these initial categories were (where possible) collated into broader synthesised findings. The results of this process are set out in the form of a series of statements that represent a wider trend informed by the data. Results A total of 239 sources were retrieved for detailed examination. 156 of these sources were excluded after review of the full paper/publication leaving 83 sources that were assessed for methodological quality using the SUMARI system. A total of 26 papers (19 qualitative papers and 7 textual/opinion pieces) were included in the review for appraisal and data extraction. A further 57 papers were assessed and excluded. Following extraction, a discussion was developed that examined the relevance of the findings from a realist perspective. Conclusions This review identifies that while different initiatives can be pursued in different conflict situations, their direction and content needs to be driven by a close understanding of context, which in turn is driven by a range of influencing factors (contextual and programmatic), which in turn reflect and build upon existing C4D practice principles. While identifying influencing factors that affect C4D implementation is critical to effective practice, this systematic review also highlights a need for early, more thorough and longer-term C4D interventions within fragile states (especially those that can be characterised by latent conflict and chronic instability). Early communication intervention can help reduce tension and promote reconciliation, but also enable development and humanitarian agencies to be better placed to address situations that may escalate into open conflict. Implications for policy and practice A wide range of contextual and programmatic factors combine to both constrain and provide opportunities for C4D initiatives in fragile states. Such factors need to be recognised, negotiated and addressed by practitioners in design, implementation and evaluation in order to enhance the overall effectiveness of C4D initiatives. Implications for research The quality of the evidence base relating to C4D interventions in fragile states is relatively weak. The difficultly of conducting rigorous evaluation and research in conflict-affected contexts should not be underestimated. This highlights a need to improve our understanding of communications environments within fragile states and the related need to develop appropriate methodological frameworks and tools that enable effective mapping and the identification of appropriate communication interventions to occur.

Project INSPIRE-HBCU Undergraduate Collaborative Summer Training Program to Inspire Students in Prostate Cancer Research

DTIC Science & Technology

2007-02-01

rate – Factors impacting these disparities – Cancer Education/Awareness /Interventions Health Literacy Community Health Fairs Faith-based...approaches that have been developed to address cancer health disparities. One approach considers increasing health literacy as a measure to lessen the...lead to a decreased mortality rate because the cancers would be caught earlier when they are less aggressive and more treatable. The health literacy approach

Developing and piloting a peer mentoring intervention to reduce teenage pregnancy in looked-after children and care leavers: an exploratory randomised controlled trial.

PubMed

Mezey, Gillian; Meyer, Deborah; Robinson, Fiona; Bonell, Chris; Campbell, Rona; Gillard, Steve; Jordan, Peter; Mantovani, Nadia; Wellings, Kaye; White, Sarah

2015-10-01

Looked-after children (LAC) are at greater risk of teenage pregnancy than non-LAC, which is associated with adverse health and social consequences. Existing interventions have failed to reduce rates of teenage pregnancy in LAC. Peer mentoring is proposed as a means of addressing many of the factors associated with the increased risk of teenage pregnancy in this group. To develop a peer mentoring intervention to reduce teenage pregnancy in LAC. Phase I and II randomised controlled trial of a peer mentoring intervention for LAC; scoping exercise and literature search; national surveys of social care professionals and LAC; and focus groups and interviews with social care professionals, mentors and mentees. Three local authorities (LAs) in England. LAC aged 14-18 years (mentees/care as usual) and 19-25 years (mentors). Recruitment and training of mentors; randomisation and matching of mentors to mentees; and 1-year individual peer mentoring. pregnancy in LAC aged 14-18 years. sexual attitudes, behaviour and knowledge; psychological health; help-seeking behaviour; locus of control; and attachment style. A health economic evaluation was also carried out. In total, 54% of target recruitment was reached for the exploratory trial and 13 out of 20 mentors (65%) and 19 out of 30 LAC aged 14-18 years (63%) (recruited during Phases I and II) were retained in the research. The training programme was acceptable and could be manualised and replicated. Recruitment and retention difficulties were attributed to systemic problems and LA lack of research infrastructure and lack of additional funding to support and sustain such an intervention. Mentees appeared to value the intervention but had difficulty in meeting weekly as required. Only one in four of the relationships continued for the full year. A future Phase III trial would require the intervention to be modified to include provision of group and individual peer mentoring; internal management of the project, with support from an external agency such as a charity or the voluntary sector; funds to cover LA research costs, including the appointment of a dedicated project co-ordinator; a reduction in the lower age for mentee recruitment and an increase in the mentor recruitment age to 21 years; and the introduction of a more formal recruitment and support structure for mentors. Given the problems identified and described in mounting this intervention, a new development phase followed by a small-scale exploratory trial incorporating these changes would be necessary before proceeding to a Phase III trial. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 85. See the NIHR Journals Library website for further project information.

From Project to Program: Tupange's Experience with Scaling Up Family Planning Interventions in Urban Kenya.

PubMed

Keyonzo, Nelson; Nyachae, Paul; Kagwe, Peter; Kilonzo, Margaret; Mumba, Feddis; Owino, Kenneth; Kichamu, George; Kigen, Bartilol; Fajans, Peter; Ghiron, Laura; Simmons, Ruth

2015-05-01

This paper describes how the Urban Reproductive Health Initiative in Kenya, the Tupange Project (2010-2015), successfully applied the ExpandNet approach to sustainably scale up family planning interventions, first in Machakos and Kakamega, and subsequently also in its three core cities, Nairobi, Kisumu and Mombasa. This new focus meant shifting from a "project" to a "program" approach, which required paying attention to government leadership and ownership, limiting external inputs, institutionalizing interventions in existing structures and emphasizing sustainability. The paper also highlights the project's efforts to prepare for the future scale up of Tupange's interventions in other counties to support continuing and improved access to family planning services in the new context of devolution (decentralization) in Kenya. Copyright © 2015. Published by Elsevier Ltd.

A cross-sectional, randomized cluster sample survey of household vulnerability to extreme heat among slum dwellers in ahmedabad, india.

PubMed

Tran, Kathy V; Azhar, Gulrez S; Nair, Rajesh; Knowlton, Kim; Jaiswal, Anjali; Sheffield, Perry; Mavalankar, Dileep; Hess, Jeremy

2013-06-18

Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile.

A youth-led social marketing intervention to encourage healthy lifestyles, the EYTO (European Youth Tackling Obesity) project: a cluster randomised controlled0 trial in Catalonia, Spain.

PubMed

Llauradó, Elisabet; Aceves-Martins, Magaly; Tarro, Lucia; Papell-Garcia, Ignasi; Puiggròs, Francesc; Arola, Lluís; Prades-Tena, Jordi; Montagut, Marta; Moragas-Fernández, Carlota M; Solà, Rosa; Giralt, Montse

2015-07-03

The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical activity practice, and to prevent obesity in socioeconomically disadvantaged and vulnerable adolescents. The EYTO project works through a peer-led social marketing intervention that is designed and implemented by the adolescents of each participating country. Each country involved in the project acts independently. This paper describes the "Som la Pera" intervention Spanish study that is part of the EYTO project. In Spain, the research team performed a cluster randomised controlled intervention over 2 academic years (2013-2015) in which 2 high-schools were designated as the control group and 2 high-schools were designated as the intervention group, with a minimum of 121 schoolchildren per group. From the intervention group, 5 adolescents with leadership characteristics, called "Adolescent Challenge Creators" (ACCs), were recruited. These 5 ACCs received an initial 4 h training session about social marketing principles and healthy lifestyle theory, followed by 24 sessions (1.30 h/session) divided in two academic years to design and implement activities presented as challenges to encourage healthy lifestyles among their peers, the approximately 180-200 high-school students in the intervention group. During the design of the intervention, it was essential that the ACCs used the 8 social marketing criteria (customer orientation, behaviour, theory, insight, exchange, competition, segmentation and methods mix). The expected primary outcomes from the Spanish intervention will be as follows: increases in the consumption of fruits and vegetables and physical activity practice along with reductions in TV/computer/game console use. The secondary outcomes will be as follows: increased breakfast consumption, engagement with local recreation and reduced obesity prevalence. The outcomes will be measured by the Health Behaviour in School-aged Children Study (HBSC) survey at baseline and at the end of the intervention. In the control group, no intervention was implemented, but the outcome measurements were collected in parallel with the intervention group. This study described a new methodology to improve lifestyles and to address adolescent obesity. ClinicalTrials.gov: NCT02157402. Registered 03 June 2014.

Project Crossroads as Pre-Trial Intervention. A Program Evaluation.

ERIC Educational Resources Information Center

Rovner-Pieczenik, Roberta

This report describes and evaluates Project Crossroads, a manpower approach to the rehabilitation of accused offenders prior to adjudication. In order to demonstrate the feasibility of working with the court and its personnel to provide a pretrial intervention alternative for youthful first-time offenders, Project Crossroads provided a…

Project BLEND: An Inclusive Model of Early Intervention Services.

ERIC Educational Resources Information Center

Brown, William; Horn, Eva M.; Heiser, JoAnn G.; Odom, Samuel L.

1996-01-01

This paper describes a model demonstration project to provide inclusive early intervention services to young children with developmental delays and their families. It notes the importance of collaborative partnerships among the significant adults in a child's life as a basis for effective program implementation. The project has three major…

Services for Children with Deaf-Blindness Pilot Project. Final Report.

ERIC Educational Resources Information Center

Stremel, Kathleen

This final report describes a pilot project, "Quality Service Provision for Infants and Young Children with Deaf-Blindness: A Mechanism for State Intervention Teams," developed and implemented at the University of Southern Mississippi. The project developed a model of an intervention team that provides intensive training and technical…

A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT)

PubMed Central

Shand, Fiona; Morley, Kirsten; Batterham, Philip J; Petrie, Katherine; Reda, Bill; Berrouiguet, Sofian; Haber, Paul S; Carter, Gregory; Christensen, Helen

2017-01-01

Background Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. Objective The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. Methods To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Results Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. Conclusions The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway. PMID:29237584

Development of Web-Based Computer-Tailored Advice to Promote Physical Activity Among People Older Than 50 Years

PubMed Central

van Stralen, Maartje M; Bolman, Catherine; Golsteijn, Rianne HJ; de Vries, Hein; Mudde, Aart N; Lechner, Lilian

2012-01-01

Background The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Objective To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project. Methods We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial. Results Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions. Conclusions Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience. Trial Registration Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp). PMID:22390878

Development of web-based computer-tailored advice to promote physical activity among people older than 50 years.

PubMed

Peels, Denise A; van Stralen, Maartje M; Bolman, Catherine; Golsteijn, Rianne Hj; de Vries, Hein; Mudde, Aart N; Lechner, Lilian

2012-03-02

The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance. To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project. We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial. Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions. Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience. Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp).

Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact.

PubMed

Ricca, Jim; Kureshy, Nazo; LeBan, Karen; Prosnitz, Debra; Ryan, Leo

2014-03-01

Evidence exists that community-based intervention packages can have substantial child and newborn mortality impact, and may help more countries meet Millennium Development Goal 4 (MDG 4) targets. A non-governmental organization (NGO) project using such programming in Mozambique documented an annual decline in under-five mortality rate (U5MR) of 9.3% in a province in which Demographic and Health Survey (DHS) data showed a 4.2% U5MR decline during the same period. To test the generalizability of this finding, the same analysis was applied to a group of projects funded by the US Agency for International Development. Projects supported implementation of community-based intervention packages aimed at increasing use of health services while improving preventive and home-care practices for children under five. All projects collect baseline and endline population coverage data for key child health interventions. Twelve projects fitted the inclusion criteria. U5MR decline was estimated by modelling these coverage changes in the Lives Saved Tool (LiST) and comparing with concurrent measured DHS mortality data. Average coverage changes for all interventions exceeded average concurrent trends. When population coverage changes were modelled in LiST, they were estimated to give a child mortality improvement in the project area that exceeded concurrent secular trend in the subnational DHS region in 11 of 12 cases. The average improvement in modelled U5MR (5.8%) was more than twice the concurrent directly measured average decline (2.5%). NGO projects implementing community-based intervention packages appear to be effective in reducing child mortality in diverse settings. There is plausible evidence that they raised coverage for a variety of high-impact interventions and improved U5MR by more than twice the concurrent secular trend. All projects used community-based strategies that achieved frequent interpersonal contact for health behaviour change. Further study of the effectiveness and scalability of similar packages should be part of the effort to accelerate progress towards MDG 4.

Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases⋆

PubMed Central

Swendeman, Dallas; Basu, Ishika; Das, Sankari; Jana, Smarajit; Rotheram-Borus, Mary Jane

2010-01-01

The Sonagachi Project was initiated in Kolkata, India in 1992 as a STD/HIV intervention for sex workers. The project evolved to adopt strategies common to women’s empowerment programs globally (i.e., community mobilization, rights-based framing, advocacy, micro-finance) to address common factors that support effective, evidence-based HIV/STD prevention. The Sonagachi model is now a broadly diffused evidence-based empowerment program. We previously demonstrated significant condom use increases among female sex workers in a 16 month replication trial of the Sonagachi empowerment intervention (n = 110) compared to a control community (n = 106) receiving standard care of STD clinic, condom promotion, and peer education in two randomly assigned rural towns in West Bengal, India (Basu et al., 2004). This article examines the intervention’s impacts on 21 measured variables reflecting five common factors of effective HIV/STD prevention programs to estimate the impact of empowerment strategies on HIV/STD prevention program goals. The intervention which was conducted in 2000–2001 significantly: 1) improved knowledge of STDs and condom protection from STD and HIV, and maintained STD/HIV risk perceptions despite treatment; 2) provided a frame to motivate change based on reframing sex work as valid work, increasing disclosure of profession, and instilling a hopeful future orientation reflected in desire for more education or training; 3) improved skills in sexual and workplace negotiations reflected in increased refusal, condom decision-making, and ability to change work contract, but not ability to take leave; 4) built social support by increasing social interactions outside work, social function participation, and helping other sex workers; and 5) addressed environmental barriers of economic vulnerabilities by increasing savings and alternative income, but not working in other locations, nor reduced loan taking, and did not increase voting to build social capital. This study’s results demonstrate that, compared to narrowcast clinical and prevention services alone, empowerment strategies can significantly impact a broader range of factors to reduce vulnerability to HIV/STDs. PMID:19716639

Psychosocial factors associated with failure to use contraception among adolescents with repeat pregnancies in Puerto Rico.

PubMed

Colón, Malieri; Martínez, Rosa; Tulla, Michelle; Pérez, José; Santaella, Yadiris; Laras, Linda

2014-01-01

Social, medical, psychological and economic problems are often associated to teen pregnancy. This is a reality worldwide; Puerto Rico is not an exception, documented in statistics and previous research projects. There are many risks associated with pregnancies among adolescents, including increased maternal morbidity and infant morbidity. In Puerto Rico, the adolescent repeat births reed are 22% for a second child and 6% for a third child. Repeated teen pregnancy has a higher than expected incidence; therefore the investigation of psychosocial factors associated with failure to use contraception is needed,especially to address the intervention at clinics with this population of different needs, mainly when these patients with repeated teen pregnancies have been through the health care system already. The project is a cross sectional survey study, seventy articipants between 12-19 years of age who attended obstetrics or postpartum clinics at an adult University Hospital. A self-administered questionnaire included some psychosocial factors that have been associated withthe failure to use contraceptives as well as demographics tion, education, socioeconomic status and support system. Their partner's age ranged from 15 to 38 years of age. Most participants lived with their partner. Their main activity at the time of the study was housework. Most had left school beforebecoming pregnant and received government help. Of all participants, a small number was legally married. The lack of use of contraceptive was found to be significantly associated to partner (p < 0.05). The lack of contraceptive use is a key factor in adolescent pregnancy. It is expected that this data can be helpful for documentation and intervention measurements something canbe done at an educational level, family planning and medical care.

A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008.

PubMed

Balcázar, Héctor G; de Heer, Hendrik; Rosenthal, Lee; Aguirre, Melissa; Flores, Leticia; Puentes, Flor A; Cardenas, Victor M; Duarte, Maria O; Ortiz, Melchor; Schulz, Leslie O

2010-03-01

The high prevalence of cardiovascular disease (CVD) in the Hispanic population of the United States, together with low rates of health insurance coverage, suggest a potential cardiovascular health crisis. The objective of Project HEART (Health Education Awareness Research Team) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population. Project HEART took place from 2005 through 2008 as a randomized community trial with a community-based participatory research framework using promotores de salud (community health workers). A total of 328 participants with at least 1 CVD risk factor were selected by randomizing 10 US Census tracts in El Paso, Texas, to either the experimental or the control group. The experimental group (n = 192) was assigned to a series of 8 health classes using the Su Corazón, Su Vida curriculum. After 2 months of educational sessions, the group was followed for 2 months. The control group (n = 136) was given basic educational materials at baseline, and no other intervention was used. Main outcomes of interest included changes in health behaviors and clinical measures. Participants in the experimental group showed more awareness of CVD risk factors, more confidence in the control of these factors, and improved dietary habits (ie, lower salt and cholesterol intake, better weight-control practices) compared with the control group. Total cholesterol was 3% lower in the experimental than in the control participants, and nonhigh-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5% lower. The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community.

Through our eyes: exploring African-American men's perspective on factors affecting transition to manhood.

PubMed

Bharmal, Nazleen; Kennedy, David; Jones, Loretta; Lee-Johnson, Charles; Morris, D'Ann; Caldwell, Ben; Brown, Anthony; Houston, Tina; Meeks, Charlene; Vargas, Roberto; Franco, Idalid; Razzak, A Rab; Brown, Arleen F

2012-02-01

Premature mortality and disparities in morbidity observed in African-American men may be associated with factors in their social, economic, and built environments that may be especially influential during the transition to adulthood. To have young, African-American men from Los Angeles County identify and prioritize factors associated with their transition to manhood using photovoice methodology and pile-sorting exercises. Qualitative study using community-based participatory research (CBPR) and photovoice Twelve African-American men, ages 16-26 years, from Los Angeles County, California. We used CBPR principles to form a community advisory board (CAB) whose members defined goals for the partnered project, developed the protocols, and participated in data collection and analysis. Participants were given digital cameras to take 50-300 photographs over three months. Pile-sorting techniques were used to facilitate participants' identification and discussion of the themes in their photos and selected photos of the group. Pile-sorts of group photographs were analyzed using multidimensional scaling and hierarchical cluster analysis to systematically compare participants' themes and identify patterns of associations between sorted photographs. Sub-themes and related quotes were also elicited from the pile-sorting transcripts. The CAB and several study participants met periodically to develop dissemination strategies and design interventions informed by study findings. Four dominant themes emerged during analysis: 1) Struggles face during the transition to manhood, 2) Sources of social support, 3) Role of sports, and 4) Views on Los Angeles lifestyle. The project led to the formation of a young men's group and community events featuring participants. CBPR and photovoice are effective methods to engage young, African-American men to identify and discuss factors affecting their transition to manhood, contextualize research findings, and participate in intervention development.

The DEBT Project: Early Intervention for Handicapped Children and Their Parents.

ERIC Educational Resources Information Center

Macy, Daniel J.; And Others

Project DEBT (Developmental Education Birth through Two), an early identification and intervention program for handicapped and at risk children and their parents, is described. The Koontz Child Developmental Program, the core curriculum for instructional planning and intervention in DEBT, is reviewed, and new data are presented. It is explained…

Fighting Fires in Early Intervention Supervision: Trading the Axe for Mr. Rogers's Slippers

ERIC Educational Resources Information Center

Alexander, Laura; Gallen, Robert T.; Salazar, Ruby; Shahmoon-Shanok, Rebecca

2012-01-01

When Pennsylvania's Early Intervention system implemented an early intervention-reflective supervision project, modest expectations for change were anticipated, given the limited amount of time and funding for the project. In this article, one participant tells the story of her professional development, which enabled her to augment her skills as…

Toddler Research and Intervention Project Report-Year II. IMRID Behavioral Science Monograph No. 21.

ERIC Educational Resources Information Center

Bricker, Diane; Bricker, William

The report summarizes the second year of the Toddler Research and Intervention Project, which uses experimental research to devise and evaluate educational intervention techniques with approximately 28 normal or developmentally delayed children 1- to 4-years-old and their families. Described are researchers/teachers relationships, behavioral…

A gesture-controlled projection display for CT-guided interventions.

PubMed

Mewes, A; Saalfeld, P; Riabikin, O; Skalej, M; Hansen, C

2016-01-01

The interaction with interventional imaging systems within a sterile environment is a challenging task for physicians. Direct physician-machine interaction during an intervention is rather limited because of sterility and workspace restrictions. We present a gesture-controlled projection display that enables a direct and natural physician-machine interaction during computed tomography (CT)-based interventions. Therefore, a graphical user interface is projected on a radiation shield located in front of the physician. Hand gestures in front of this display are captured and classified using a leap motion controller. We propose a gesture set to control basic functions of intervention software such as gestures for 2D image exploration, 3D object manipulation and selection. Our methods were evaluated in a clinically oriented user study with 12 participants. The results of the performed user study confirm that the display and the underlying interaction concept are accepted by clinical users. The recognition of the gestures is robust, although there is potential for improvements. The gesture training times are less than 10 min, but vary heavily between the participants of the study. The developed gestures are connected logically to the intervention software and intuitive to use. The proposed gesture-controlled projection display counters current thinking, namely it gives the radiologist complete control of the intervention software. It opens new possibilities for direct physician-machine interaction during CT-based interventions and is well suited to become an integral part of future interventional suites.

A pilot controlled trial of a cognitive dissonance-based body dissatisfaction intervention with young British men.

PubMed

Jankowski, Glen S; Diedrichs, Phillippa C; Atkinson, Melissa J; Fawkner, Helen; Gough, Brendan; Halliwell, Emma

2017-12-01

This pilot study evaluated a body image intervention for men, Body Project M. Seventy-four British undergraduate men took part in two 90-min intervention sessions, and completed standardised assessments of body image, bulimic pathology, and related outcomes at baseline, post-intervention, and 3-month follow-up. Fifty-three other men completed the questionnaires as an assessment-only control group. Per-protocol analysis showed that Body Project M improved men's dissatisfaction with body fat and muscularity, body appreciation, muscularity enhancing behaviours, appearance comparisons, and internalization (ds=0.46-0.80) at post-intervention. All except dissatisfaction with muscularity and internalization were sustained at 3-month follow-up. No effects were found for bulimic pathology. Post-intervention effects for dissatisfaction with muscularity and internalization only were retained under intention-to-treat analysis. Participants were favourable towards the intervention. This study provides preliminary evidence for the acceptability and post-intervention efficacy of Body Project M. Further development of the intervention is required to improve and sustain effects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis.

PubMed

Guerrero-Torrelles, Mariona; Monforte-Royo, Cristina; Rodríguez-Prat, Andrea; Porta-Sales, Josep; Balaguer, Albert

2017-10-01

Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre-post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.

Lessons learnt from the Bristol Girls Dance Project cluster RCT: implications for designing and implementing after-school physical activity interventions

PubMed Central

Edwards, Mark J; May, Thomas; Kesten, Joanna M; Banfield, Kate; Bird, Emma L; Powell, Jane E; Sebire, Simon J; Jago, Russell

2016-01-01

Objective To consider implementation issues associated with the delivery of Bristol Girls Dance Project (BGDP) and to identify improvements that may aid the design of after-school physical activity (PA) interventions. Design Two-armed cluster randomised control trial. The BGDP was a 20-week school-based intervention, consisting of two 75 min after-school dance sessions per week, which aimed to support Year 7 girls to be more physically active. Setting 18 secondary schools (nine intervention, nine control) in the Greater Bristol area (as an indication of deprivation, children eligible for the pupil premium in participant schools ranged from 6.9 to 53.3%). Participants 571 Year 7 girls. This article reports on qualitative data collected from 59 girls in the intervention arm of the trial, 10 dance instructors and 9 school contacts involved in the delivering of the BGDP. Methods Data were obtained from nine focus groups with girls (one per intervention school), and interviews with dance instructors and school contacts. Focus groups sought views of girls’ motivation to participate, teaching styles and experiences of the intervention. Interviews explored views on implementation and dissemination. Framework analysis was used to analyse data. Results Qualitative data elicited three themes associated with the delivery of BGDP that affected implementation: project design, session content and project organisation. ‘Project design’ found issues associated with recruitment, timetabling and session quantity to influence the effectiveness of BGDP. ‘Session content’ found that dance instructors delivered a range of content and that girls enjoyed a variety of dance. Themes within ‘project organisation’ suggested an ‘open enrolment’ policy and greater parental involvement may facilitate better attendance. Conclusions After-school PA interventions have potential for increasing PA levels among adolescent girls. There is a need to consider the context in which interventions are delivered and implement them in ways that are appropriate to the needs of participants. Trial registration number ISRCTN52882523. PMID:26747038

Low dose tomographic fluoroscopy: 4D intervention guidance with running prior

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flach, Barbara; Kuntz, Jan; Brehm, Marcus

Purpose: Today's standard imaging technique in interventional radiology is the single- or biplane x-ray fluoroscopy which delivers 2D projection images as a function of time (2D+T). This state-of-the-art technology, however, suffers from its projective nature and is limited by the superposition of the patient's anatomy. Temporally resolved tomographic volumes (3D+T) would significantly improve the visualization of complex structures. A continuous tomographic data acquisition, if carried out with today's technology, would yield an excessive patient dose. Recently the authors proposed a method that enables tomographic fluoroscopy at the same dose level as projective fluoroscopy which means that if scanning time ofmore » an intervention guided by projective fluoroscopy is the same as that of an intervention guided by tomographic fluoroscopy, almost the same dose is administered to the patient. The purpose of this work is to extend authors' previous work and allow for patient motion during the intervention.Methods: The authors propose the running prior technique for adaptation of a prior image. This adaptation is realized by a combination of registration and projection replacement. In a first step the prior is deformed to the current position via affine and deformable registration. Then the information from outdated projections is replaced by newly acquired projections using forward and backprojection steps. The thus adapted volume is the running prior. The proposed method is validated by simulated as well as measured data. To investigate motion during intervention a moving head phantom was simulated. Real in vivo data of a pig are acquired by a prototype CT system consisting of a flat detector and a continuously rotating clinical gantry.Results: With the running prior technique it is possible to correct for motion without additional dose. For an application in intervention guidance both steps of the running prior technique, registration and replacement, are necessary. Reconstructed volumes based on the running prior show high image quality without introducing new artifacts and the interventional materials are displayed at the correct position.Conclusions: The running prior improves the robustness of low dose 3D+T intervention guidance toward intended or unintended patient motion.« less

Evaluating clinic and community-based lifestyle interventions for obesity reduction in a low-income Latino neighborhood: Vivamos Activos Fair Oaks Program.

PubMed

Drieling, Rebecca L; Ma, Jun; Stafford, Randall S

2011-02-14

Obesity exerts an enormous health impact through its effect on coronary heart disease and its risk factors. Primary care-based and community-based intensive lifestyle counseling may effectively promote weight loss. There has been limited implementation and evaluation of these strategies, particularly the added benefit of community-based intervention, in low-income Latino populations. The Vivamos Activos Fair Oaks project is a randomized clinical trial designed to evaluate the clinical and cost-effectiveness of two obesity reduction lifestyle interventions: clinic-based intensive lifestyle counseling, either alone (n = 80) or combined with community health worker support (n = 80), in comparison to usual primary care (n = 40). Clinic-based counseling consists of 15 group and four individual lifestyle counseling sessions provided by health educators targeting behavior change in physical activity and dietary practices. Community health worker support includes seven home visits aimed at practical implementation of weight loss strategies within the person's home and neighborhood. The interventions use a framework based on Social Cognitive Theory, the Transtheoretical Model of behavior change, and techniques from previously tested lifestyle interventions. Application of the framework was culturally tailored based on past interventions in the same community and elsewhere, as well as a community needs and assets assessment. The interventions include a 12-month intensive phase followed by a 12-month maintenance phase. Participants are obese Spanish-speaking adults with at least one cardiovascular risk factor recruited from a community health center in a low-income neighborhood of San Mateo County, California. Follow-up assessments occur at 6, 12, and 24 months for the primary outcome of percent change in body mass index at 24 months. Secondary outcomes include specific cardiovascular risk factors, particularly blood pressure and fasting glucose levels. If successful, this study will provide evidence for broad implementation of obesity interventions in minority populations and guidance about the selection of strategies involving clinic-based case management and community-based community health worker support. ClinicalTrials.gov: NCT01242683.

Factors associated with staff development processes and the creation of innovative science courses in higher education

NASA Astrophysics Data System (ADS)

Hodges, Jeanelle Bland

1999-11-01

The purpose of the study was to determine factors associated with staff development processes and the creation of innovative science courses by higher education faculty who have participated in a model staff development project. The staff development program was designed for college faculty interested in creating interdisciplinary, constructivist-based science, mathematics, or engineering courses designed for non-majors. The program includes workshops on incorporating constructivist pedagogy, alternative assessment, and technology into interdisciplinary courses. Staff development interventions used in the program include grant opportunities, distribution of resource materials, and peer mentoring. University teams attending the workshops are comprised of faculty from the sciences, mathematics, or engineering, as well as education, and administration. A purposeful and convenient sample of three university teams were subjects for this qualitative study. Each team had attended a NASA Opportunities for Visionary Academics (NOVA) workshop, received funding for course development, and offered innovative courses. Five questions were addressed in this study: (a) What methods were used by faculty teams in planning the courses? (b) What changes occurred in existing science courses? (c) What factors affected the team collaboration process? (d) What personal characteristics of faculty members were important in successful course development? and (e) What barriers existed for faculty in the course development process? Data was collected at each site through individual faculty interviews (N = 11), student focus group interviews (N = 15), and classroom observations. Secondary data included original funding proposals. The NOVA staff development model incorporated effective K--12 interventions with higher education interventions. Analysis of data revealed that there were four factors of staff development processes that were most beneficial. First, the team collaborative processes were crucial in successful course development. Second, the use of instructional grants to fund course development gave credibility to the faculty involved in course development. Third, the faculty members taking the lead in creating teams actively sought out faculty members in the sciences who had previous experience teaching at the K--12 level or in informal education. In addition, college environments were found to have an impact on the success of the innovative course development projects.

Sustainability of water, sanitation and hygiene interventions in Central America

PubMed Central

Medlin, Elizabeth; Aquino, Gonzalo; Gelting, Richard J.

2015-01-01

The American Red Cross and U.S. Centers for Disease Control and Prevention collaborated on a sustainability evaluation of post-hurricane water, sanitation and hygiene (WASH) interventions in Central America. In 2006 and 2009, we revisited six study areas in rural El Salvador, Guatemala, Honduras and Nicaragua to assess sustainability of WASH interventions finalized in 2002, after 1998’s Hurricane Mitch. We used surveys to collect data, calculate indicators and identify factors that influence sustainability. Regional sustainability indicator results showed there was a statistically significant decline in access to water. The presence of sanitation facilities had not changed since the beginning of the project; however, maintenance and use of latrines declined but continued to meet the goal of 75% use after 7 years. The hygiene indicator, hand washing, initially declined and then increased. Declines in water access were due to operational problems related to storm events and population changes. Sanitation facilities were still present and sometimes used even though they reached or surpassed their original design life. Changes in hygiene practices appeared related to ongoing hygiene promotion from outside organizations. These results provide useful input for making WASH programs more sustainable and informing future, more in-depth research into factors influencing sustainability. PMID:26413262

Sustainability of water, sanitation and hygiene interventions in Central America.

PubMed

Sabogal, Raquel I; Medlin, Elizabeth; Aquino, Gonzalo; Gelting, Richard J

The American Red Cross and U.S. Centers for Disease Control and Prevention collaborated on a sustainability evaluation of post-hurricane water, sanitation and hygiene (WASH) interventions in Central America. In 2006 and 2009, we revisited six study areas in rural El Salvador, Guatemala, Honduras and Nicaragua to assess sustainability of WASH interventions finalized in 2002, after 1998's Hurricane Mitch. We used surveys to collect data, calculate indicators and identify factors that influence sustainability. Regional sustainability indicator results showed there was a statistically significant decline in access to water. The presence of sanitation facilities had not changed since the beginning of the project; however, maintenance and use of latrines declined but continued to meet the goal of 75% use after 7 years. The hygiene indicator, hand washing, initially declined and then increased. Declines in water access were due to operational problems related to storm events and population changes. Sanitation facilities were still present and sometimes used even though they reached or surpassed their original design life. Changes in hygiene practices appeared related to ongoing hygiene promotion from outside organizations. These results provide useful input for making WASH programs more sustainable and informing future, more in-depth research into factors influencing sustainability.

Retention of female volunteer community health workers in Dhaka urban slums: a prospective cohort study

PubMed Central

2014-01-01

Background Volunteer community health workers (CHWs) are a key approach to improving community-based maternal and child health services in developing countries. BRAC, a large Bangladeshi non-governmental organization (NGO), has employed female volunteer CHWs in its community-based health programs since 1977, recently including its Manoshi project, a community-based maternal and child health intervention in the urban slums of Bangladesh. A case–control study conducted in response to high dropout rates in the first year of the project showed that financial incentives, social prestige, community approval and household responsibilities were related to early retention in the project. In our present prospective cohort study, we aimed to better understand the factors associated with retention of volunteer CHWs once the project was more mature. Methods We used a prospective cohort study design to examine the factors affecting retention of volunteer CHWs who remained in the project after the initial start-up period. We surveyed a random sample of 542 CHWs who were working for BRAC Manoshi in December 2008. In December 2009, we revisited this cohort of CHWs and interviewed those who had dropped out about the main reasons for their dropping out. We used a multivariable generalized linear model regression analysis with a log link to estimate the relative risk (RR) of independent factors on retention. Results Of the 542 CHWs originally enrolled, 120 had dropped out by the end of one year, mainly because they left the slums. CHWs who received positive community appraisal (adjusted RR = 1.45, 95% confidence interval (CI) = 1.10 to 1.91) or were associated with other NGOs (adjusted RR = 1.13, 95% CI = 1.04 to 1.23) were more likely to have been retained in the project. Although refresher training was also associated with increased retention (adjusted RR = 2.25, 95% CI = 1.08 to 4.71) in this study, too few CHWs had not attended refresher training regularly to make it a meaningful predictor of retention that could be applied in the project setting. Conclusion Factors that affect retention of CHWs may change over time, with some factors that are important in the early years of a project losing importance as the project matures. Community health programs operating in fragile urban slums should consider changing factors over program duration for better retention of volunteer CHWs. PMID:24886046

Effectiveness of an Adaptation of the Project Connect Health Systems Intervention: Youth and Clinic-Level Findings

ERIC Educational Resources Information Center

Loosier, Penny S.; Doll, Shelli; Lepar, Danielle; Ward, Kristin; Gamble, Ginger; Dittus, Patricia J.

2016-01-01

Background: The Project Connect Health Systems Intervention (Project Connect) uses a systematic process of collecting community and healthcare infrastructure information to craft a referral guide highlighting local healthcare providers who provide high quality sexual and reproductive healthcare. Previous self-report data on healthcare usage…

By Design: Family-Centered, Interdisciplinary Preservice Training in Early Intervention.

ERIC Educational Resources Information Center

Whitehead, Amy; Ulanski, Betty; Swedeen, Beth; Sprague, Rae; Yellen-Shiring, Gail; Fruchtman, Amy; Pomije, Carrie; Rosin, Peggy

This training guide is a product of the Family-Centered Interdisciplinary Training Project in Early Intervention (Wisconsin), a project that is addressing the need for preservice training of professionals to serve infants, toddlers, and preschool children with disabilities and their families. The project is focused on students from the disciplines…

Using Sociotransformative Constructivism to Create Multicultural and Gender-Inclusive Classrooms: An Intervention Project for Teacher Professional Development

ERIC Educational Resources Information Center

Zozakiewicz, Cathy; Rodriguez, Alberto J.

2007-01-01

Maxima was an intervention project that focused on assisting teachers to establish more inquiry-based, gender-inclusive, and culturally relevant learning environments. The authors grounded the project by using sociotransformative constructivism as a theoretical framework to steer the implementation of three guiding concepts for professional…

K-6 Early Intervention Project: Evaluation of the First Year of Implementation.

ERIC Educational Resources Information Center

McDaid, Janet L.

California's K-6 Early Intervention Project was established in 1986 under the authority of California Assembly Bill 1535, Pilot Project on Hyperactivity, to provide a system of early identification and assistance to children in kindergarten through grade 6 whose behavior problems interfere with learning. This report contains evaluation findings…

Expert knowledge elicitation using computer simulation: the organization of frail elderly case management as an illustration.

PubMed

Chiêm, Jean-Christophe; Van Durme, Thérèse; Vandendorpe, Florence; Schmitz, Olivier; Speybroeck, Niko; Cès, Sophie; Macq, Jean

2014-08-01

Various elderly case management projects have been implemented in Belgium. This type of long-term health care intervention involves contextual factors and human interactions. These underlying complex mechanisms can be usefully informed with field experts' knowledge, which are hard to make explicit. However, computer simulation has been suggested as one possible method of overcoming the difficulty of articulating such elicited qualitative views. A simulation model of case management was designed using an agent-based methodology, based on the initial qualitative research material. Variables and rules of interaction were formulated into a simple conceptual framework. This model has been implemented and was used as a support for a structured discussion with experts in case management. The rigorous formulation provided by the agent-based methodology clarified the descriptions of the interventions and the problems encountered regarding: the diverse network topologies of health care actors in the project; the adaptation time required by the intervention; the communication between the health care actors; the institutional context; the organization of the care; and the role of the case manager and his or hers personal ability to interpret the informal demands of the frail older person. The simulation model should be seen primarily as a tool for thinking and learning. A number of insights were gained as part of a valuable cognitive process. Computer simulation supporting field experts' elicitation can lead to better-informed decisions in the organization of complex health care interventions. © 2013 John Wiley & Sons, Ltd.

Developing and piloting a peer mentoring intervention to reduce teenage pregnancy in looked-after children and care leavers: an exploratory randomised controlled trial.

PubMed Central

Mezey, Gillian; Meyer, Deborah; Robinson, Fiona; Bonell, Chris; Campbell, Rona; Gillard, Steve; Jordan, Peter; Mantovani, Nadia; Wellings, Kaye; White, Sarah

2015-01-01

BACKGROUND: Looked-after children (LAC) are at greater risk of teenage pregnancy than non-LAC, which is associated with adverse health and social consequences. Existing interventions have failed to reduce rates of teenage pregnancy in LAC. Peer mentoring is proposed as a means of addressing many of the factors associated with the increased risk of teenage pregnancy in this group. OBJECTIVE: To develop a peer mentoring intervention to reduce teenage pregnancy in LAC. DESIGN: Phase I and II randomised controlled trial of a peer mentoring intervention for LAC; scoping exercise and literature search; national surveys of social care professionals and LAC; and focus groups and interviews with social care professionals, mentors and mentees. SETTING: Three local authorities (LAs) in England. PARTICIPANTS: LAC aged 14-18 years (mentees/care as usual) and 19-25 years (mentors). INTERVENTION: Recruitment and training of mentors; randomisation and matching of mentors to mentees; and 1-year individual peer mentoring. MAIN OUTCOME MEASURES: PRIMARY OUTCOME: pregnancy in LAC aged 14-18 years. SECONDARY OUTCOMES: sexual attitudes, behaviour and knowledge; psychological health; help-seeking behaviour; locus of control; and attachment style. A health economic evaluation was also carried out. RESULTS: In total, 54% of target recruitment was reached for the exploratory trial and 13 out of 20 mentors (65%) and 19 out of 30 LAC aged 14-18 years (63%) (recruited during Phases I and II) were retained in the research. The training programme was acceptable and could be manualised and replicated. Recruitment and retention difficulties were attributed to systemic problems and LA lack of research infrastructure and lack of additional funding to support and sustain such an intervention. Mentees appeared to value the intervention but had difficulty in meeting weekly as required. Only one in four of the relationships continued for the full year. A future Phase III trial would require the intervention to be modified to include provision of group and individual peer mentoring; internal management of the project, with support from an external agency such as a charity or the voluntary sector; funds to cover LA research costs, including the appointment of a dedicated project co-ordinator; a reduction in the lower age for mentee recruitment and an increase in the mentor recruitment age to 21 years; and the introduction of a more formal recruitment and support structure for mentors. CONCLUSIONS: Given the problems identified and described in mounting this intervention, a new development phase followed by a small-scale exploratory trial incorporating these changes would be necessary before proceeding to a Phase III trial. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 85. See the NIHR Journals Library website for further project information. PMID:26497730

The Behavior Education Support and Treatment (BEST) school intervention program: pilot project data examining schoolwide, targeted-school, and targeted-home approaches.

PubMed

Waschbusch, Daniel A; Pelham, William E; Massetti, Greta

2005-08-01

As part of a pilot project, four elementary schools were randomly assigned to receive one of four interventions: (a) a schoolwide intervention that incorporated universal and targeted treatment, (b) a targeted-school intervention delivered to individual students in regular and special education classrooms, (c) a targeted-home intervention delivered in home and regular classroom settings, and (d) a control condition that did not receive a designated intervention. Results showed that the behavior of disruptive children in all schools improved during the course of the year, with some evidence that interventions provided complementary effects. These findings support the continued use of behavioral interventions in elementary schools and argue for interventions that combine different methods of delivering interventions.

Use of the Theoretical Domains Framework to evaluate factors driving successful implementation of the Accelerated Chest pain Risk Evaluation (ACRE) project.

PubMed

Skoien, Wade; Page, Katie; Parsonage, William; Ashover, Sarah; Milburn, Tanya; Cullen, Louise

2016-10-12

The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain. The aims of this paper are to describe use of the TDF to determine which factors successfully influenced implementation and to describe use of the TDF as a tool to evaluate implementation efforts and which domains are most relevant to successful implementation. A 30-item questionnaire targeting clinicians was developed using the TDF as a guide. Questions encompassed ten of the domains of the TDF: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Intentions; Memory, attention and decision processes; Environmental context and resources; and Social influences. Sixty-three of 176 stakeholders (36 %) responded to the questionnaire. Responses for all scales showed that respondents were highly favourable to all aspects of the implementation. Scales with the highest mean responses were Intentions, Knowledge, and Optimism, suggesting that initial education and awareness strategies around the ACRE project were effective. Scales with the lowest mean responses were Environmental context and resources, and Social influences, perhaps highlighting that implementation planning could have benefitted from further consideration of the factors underlying these scales. The ACRE project was successful, and therefore, a perfect case study for understanding factors which drive implementation success. The overwhelmingly positive response suggests that it was a successful programme and likely that each of these domains was important for the implementation. However, a lack of variance in the responses hampered us from concluding which factors were most influential in driving the success of the implementation. The TDF offers a useful framework to conceptualise and evaluate factors impacting on implementation success. However, its broad scope makes it necessary to tailor the framework to allow evaluation of specific projects.

Conditions for successfully implementing resident-oriented care in nursing homes.

PubMed

Berkhout, Afke J M B; Boumans, Nicolle P G; Mur, Ingrid; Nijhuis, Frans J N

2009-06-01

This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

Identifying and Evaluating the Therapeutic Strategies Used During a Manualized Self- Advocacy Intervention for Transition-Age Youth.

PubMed

Kramer, Jessica M

2015-01-01

Prior to undertaking randomized control trials, pilot research should ensure that an intervention's active ingredients are operationalized in manuals or protocols. This study identified the strategies facilitators reported to use during the implementation of a problem-solving self-advocacy intervention, Project "Teens making Environment and Activity Modifications" (TEAM), with transition-age youth with developmental disabilities, and evaluated the alignment of strategies with the intervention's hypothesized mechanisms of change. An iterative process was used to conduct a content analysis of 106 field notes completed by six facilitators. Facilitators used 19 strategies. Findings suggest that facilitators used strategies simultaneously to ensure universal design for learning, maximize relevance for individual trainees, and maintain a safe and encouraging environment. Facilitators can individualize Project TEAM in a way that operationalizes the mechanisms of change underlying Project TEAM. The quality of the intervention may improve by explicitly incorporating these strategies into the intervention protocol. The strategies may also be applicable to therapists implementing interventions informed, by similar theoretical propositions.

"Does Hope Change? Testing a Project-Based Health Intervention among Urban Students of Color"

ERIC Educational Resources Information Center

Zusevics, Kaija L.; Johnson, Sheri

2014-01-01

Hope is positively correlated with educational attainment and health. Interventions based on project-based learning (PBL) may increase youth hope. This study examined how a PBL intervention affected hope among urban students of color. Students in health classes were invited to participate. A PBL health class was implemented in four classrooms. The…

Interventions to reduce injuries among older workers in agriculture: A review of evaluated intervention projects.

PubMed

Nilsson, Kerstin

2016-10-17

The number of older workers is increasing throughout the industrialised world and older workers are known to be more frequent in the injury-prone agricultural sector. This paper sought to extend knowledge by reviewing evaluated intervention studies intended to decrease risks and work injuries among older workers in agriculture. A systematic literature review regarding: evaluated intervention projects on injury prevention, including participants aged 55 years and older, and working in agriculture. This review identified evaluated intervention projects regarding: i) intervention in injury prevention; ii) interventions to increase knowledge in health and safety tasks and practice; and iii) interventions to increase the use of safety equipment in work. The evaluations reviewed showed that the interventions were less successful in involving older agricultural workers than their younger counterparts. The evaluations also showed that the outcome of interventions was generally less positive or brought about no significant difference in risk awareness and behaviour change among older agricultural workers. Many articles and statistics describe injuries in agriculture. Especially older farm workers are one of the groups with most work injuries and deaths. Despite this, an important finding in this review was shortage of implemented and evaluated intervention studies orientated toward reduce injuries among older workers in agriculture. This review also found that no intervention project in the evaluations studied had a clear positive effect. Many intervention studies have problems with or lack of evaluation in the study design. Based on the results in this review, important future research tasks are to improve the design of interventions, devise implementation methods and formulate appropriate evaluation methods to measure the outcome of the interventions. Intervention programmes also need to involve older workers specific physical and cognitive age aspects in the design to increases their willingness to participate and to be successful to reduce injuries.

Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana?

PubMed

Singh, Kavita; Brodish, Paul; Speizer, Ilene; Barker, Pierre; Amenga-Etego, Issac; Dasoberi, Ireneous; Kanyoke, Ernest; Boadu, Eric A; Yabang, Elma; Sodzi-Tettey, Sodzi

2016-06-16

Quality improvement (QI) interventions are becoming more common in low- and middle-income countries, yet few studies have presented impact evaluations of these approaches. In this paper, we present an impact evaluation of a scale-up phase of 'Project Fives Alive!', a QI intervention in Ghana that aims to improve maternal and child health outcomes. 'Project Fives Alive!' employed a QI methodology to recognize barriers to care-seeking and care provision at the facility level and then to identify, test and implement simple and low-cost local solutions that address the barriers. A quasi-experimental design, multivariable interrupted time series analysis, with data coming from 744 health facilities and controlling for potential confounding factors, was used to study the effect of the project. The key independent variables were the change categories (interventions implemented) and implementation phase - Wave 2a (early phase) versus Wave 2b (later phase). The outcomes studied were early antenatal care (ANC), skilled delivery, facility-level under-five mortality and attendance of underweight infants at child welfare clinics. We stratified the analysis by facility type, namely health posts, health centres and hospitals. Several of the specific change categories were significantly associated with improved outcomes. For example, three of five change categories (early ANC, four or more ANC visits and skilled delivery/immediate postnatal care (PNC)) for health posts and two of five change categories (health education and triage) for hospitals were associated with increased skilled delivery. These change categories were associated with increases in skilled delivery varying from 28% to 58%. PNC changes for health posts and health centres were associated with greater attendance of underweight infants at child welfare clinics. The triage change category was associated with increased early antenatal care in hospitals. Intensity, the number of change categories tested, was associated with increased skilled delivery in health centres and reduced under-five mortality in hospitals. Using an innovative evaluation technique we determined that 'Project Fives Alive!' demonstrated impact at scale for the outcomes studied. The QI approach used by this project should be considered by other low- and middle-income countries in their efforts to improve maternal and child health.

A Feasibility and Efficacy Randomized Controlled Trial of an Online Preventative Program for Childhood Obesity: Protocol for the EMPOWER Intervention

PubMed Central

Sharma, Manoj

2012-01-01

Background: The home and family environment is a highly influential psychosocial antecedent of pediatric obesity. Implementation of conventional family- and home-based childhood obesity interventions is challenging for parents, often requiring them to attend multiple educational sessions. Attrition rates for traditional interventions are frequently high due to competing demands for parents’ time. Under such constraints, an Internet-based intervention has the potential to modify determinants of childhood obesity while making judicious use of parents’ time. Theory-based interventions offer many advantages over atheoretical interventions, including reduced intervention dosage, increased likelihood of behavioral change, and efficient resource allocation. Social cognitive theory (SCT) is a robust theoretical framework for addressing childhood obesity. SCT is a behavior change model rooted in reciprocal determinism, a causal paradigm that states that human functioning is the product of a dynamic interplay of behavioral, personal, and environmental factors. Objectives: To evaluate the efficacy of the Enabling Mothers to Prevent Childhood Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) program, an Internet-based, theory-driven intervention for preventing childhood overweight and obesity. The project goal is supported by two specific aims: (1) modification of four obesogenic protective factors related to childhood obesity (minutes engaged in physical activity, servings of fruits and vegetables consumed, servings of sugar-sweetened and sugar-free beverages consumed, and minutes engaged in screen time), and (2) reification of five maternal-mediated constructs of SCT (environment, expectations, emotional coping, self-control, and self-efficacy). Methods: We will recruit mothers with children ages 4 to 6 years from childcare centers and randomly assign them to either the theory-based (experimental) or knowledge-based (control) arm of the trial. Data for the intervention will be collected at three intervals: baseline (week 0), posttest (week 4), and follow-up (8 weeks). At each phase of data collection, we will collect from both groups (1) measures of the four obesogenic protective factors, and (2) summated SCT construct scores. Constructs will be measured by a psychometrically valid and reliable SCT-based instrument. Behaviors will be evaluated by a behavior log. We will use a repeated-measures one-between-, one-within-participants design to evaluate intervention results. Constructs will be modified through Web-based learning modules, online interactive worksheets, and mother–child home-based activities. Process evaluation will assess program fidelity. PMID:23611831

An exercise trial for wheelchair users: Project Workout on Wheels

PubMed Central

Froehlich-Grobe, Katherine; Aaronson, Lauren S.; Washburn, Richard A.; Little, Todd D.; Lee, Jaehoon; Nary, Dorothy E.; VanSciver, Angela; Nesbitt, Jill; Norman, Sarah E.

2011-01-01

There is growing interest in promoting health for people with disabilities, yet evidence regarding community-based interventions is sparse. This paper describes the design details of a randomized controlled trial (RCT) that will test the effectiveness of a multi-component behaviorally-based, intervention to promote exercise adoption (over 6 months) and maintenance (up to one year) among wheelchair users and includes descriptive data on participant characteristics at baseline. Participants were randomly assigned to either a staff-supported intervention group or a self-guided comparison group. The primary study aim is to assess the effectiveness of the multi-component behaviorally-based intervention for promoting physical activity adoption and maintenance. The RCT will also assess the physical and psychosocial effects of the intervention and the complex interplay of factors that influence the effectiveness of the intervention. Therefore, the primary outcome derives from participant reports of weekly exercise (type, frequency, duration) over 52 weeks. Secondary outcomes collected on four occasions (baseline, 3 months, 6 months, 12 months) included physiological outcomes (VO2 peak, strength), disability-related outcomes (pain, fatigue, participation), and psychosocial outcomes (exercise self-efficacy, exercise barriers, quality of life, depression, mood). This study will provide evidence regarding the effectiveness of a multi-component behaviorally-based intervention for promoting exercise adoption among people with mobility impairments that necessitate wheelchair use. PMID:22101206

What Were They Thinking? Reducing Sunk-Cost Bias in a Life-Span Sample

PubMed Central

Strough, JoNell; Bruine de Bruin, Wändi; Parker, Andrew M.; Karns, Tara; Lemaster, Philip; Pichayayothin, Nipat; Delaney, Rebecca; Stoiko, Rachel

2016-01-01

We tested interventions to reduce “sunk-cost bias,” the tendency to continue investing in failing plans even when those plans have soured and are no longer rewarding. We showed members of a national U.S. life-span panel a hypothetical scenario about a failing plan that was halfway complete. Participants were randomly assigned to an intervention to focus on how to improve the situation, an intervention to focus on thoughts and feelings, or a no-intervention control group. First, we found that the thoughts and feelings intervention reduced sunk-cost bias in decisions about project completion, as compared to the improvement intervention and the no-intervention control. Second, older age was associated with greater willingness to cancel the failing plan across all three groups. Third, we found that introspection processes helped to explain the effectiveness of the interventions. Specifically, the larger reduction in sunk-cost bias as observed in the thoughts and feelings intervention (vs. the improvement intervention) was associated with suppression of future-oriented thoughts of eventual success, and with suppression of augmentations of the scenario that could make it seem reasonable to continue the plan. Fourth, we found that introspection processes were related to age differences in decisions. Older people were less likely to mention future-oriented thoughts of eventual success associated with greater willingness to continue the failing plan. We discuss factors to consider when designing interventions for reducing sunk-cost bias. PMID:27831712

Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji.

PubMed

Waqa, Gade; Moodie, Marj; Schultz, Jimaima; Swinburn, Boyd

2013-12-01

Nearly one-half of the adult population in Fiji between the ages of 15-64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13-18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.

Mujeres felices por ser saludables: a breast cancer risk reduction program for Latino women.

PubMed

Fitzgibbon, Marian L; Gapstur, Susan M; Knight, Sara J

2003-05-01

Breast cancer is the most commonly diagnosed cancer and the most common cause of cancer mortality among Latino women. Several behavioral factors such as early detection and dietary practices could help decrease morbidity and mortality associated with breast cancer in this population. Unfortunately, there are few data regarding the efficacy of health-related interventions for young Latino women. Mujeres Felices por ser Saludables is a randomized intervention project designed to assess breast cancer risk reduction behavior among Latino women ages 20-40 years. The primary objectives of the project were to determine whether an 8-month integrated dietary/breast health intervention could lead to a greater reduction in dietary fat, increase in dietary fiber, increase in the frequency and proficiency of breast self examination (BSE), and reduction in anxiety related to BSE compared to controls. Herein we describe the overall design of the project and present baseline characteristics of the 256 randomized women. Our results suggest that the average daily intake of dietary fat (percentage of total energy) was slightly below 30% (percentage of total energy) among the women randomized. While over half of these women reported that they practice BSE, and few reported anxiety related to BSE, less than 27% of women were proficient in the recommended BSE technique. There are few data on the dietary and breast health behaviors of young low-acculturated Latino women. This study documents the feasibility of recruiting, randomizing, and obtaining both baseline dietary and breast health data on this unique and underserved population.

An evidence-based public health approach to climate change adaptation.

PubMed

Hess, Jeremy J; Eidson, Millicent; Tlumak, Jennifer E; Raab, Kristin K; Luber, George

2014-11-01

Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

Reframing the concept of alternative livelihoods.

PubMed

Wright, Juliet H; Hill, Nicholas A O; Roe, Dilys; Rowcliffe, J Marcus; Kümpel, Noëlle F; Day, Mike; Booker, Francesca; Milner-Gulland, E J

2016-02-01

Alternative livelihood project (ALP) is a widely used term for interventions that aim to reduce the prevalence of activities deemed to be environmentally damaging by substituting them with lower impact livelihood activities that provide at least equivalent benefits. ALPs are widely implemented in conservation, but in 2012, an International Union for Conservation of Nature resolution called for a critical review of such projects based on concern that their effectiveness was unproven. We focused on the conceptual design of ALPs by considering their underlying assumptions. We placed ALPs within a broad category of livelihood-focused interventions to better understand their role in conservation and their intended impacts. We dissected 3 flawed assumptions about ALPs based on the notions of substitution, the homogenous community, and impact scalability. Interventions based on flawed assumptions about people's needs, aspirations, and the factors that influence livelihood choice are unlikely to achieve conservation objectives. We therefore recommend use of a sustainable livelihoods approach to understand the role and function of environmentally damaging behaviors within livelihood strategies; differentiate between households in a community that have the greatest environmental impact and those most vulnerable to resource access restrictions to improve intervention targeting; and learn more about the social-ecological system within which household livelihood strategies are embedded. Rather than using livelihood-focused interventions as a direct behavior-change tool, it may be more appropriate to focus on either enhancing the existing livelihood strategies of those most vulnerable to conservation-imposed resource access restrictions or on use of livelihood-focused interventions that establish a clear link to conservation as a means of building good community relations. However, we recommend that the term ALP be replaced by the broader term livelihood-focused intervention. This avoids the implicit assumption that alternatives can fully substitute for natural resource-based livelihood activities. © 2015 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

Sandy Lake Health and Diabetes Project: A Community-Based Intervention Targeting Type 2 Diabetes and Its Risk Factors in a First Nations Community

PubMed Central

Kakekagumick, Kara E.; Naqshbandi Hayward, Mariam; Harris, Stewart B.; Saksvig, Brit; Gittelsohn, Joel; Manokeesic, Gary; Goodman, Starsky; Hanley, Anthony J.

2013-01-01

The Sandy Lake Health and Diabetes Project (SLHDP) was initiated in 1991 as a partnership between Sandy Lake First Nation and researchers interested in addressing the high rates of type 2 diabetes mellitus (T2DM) in the community. Following the expressed wishes of the community, the SLHDP has encompassed a variety of community-wide interventions and activities including: community surveys to document T2DM prevalence and risk factors, the Northern Store program aimed at increasing the availability and knowledge of healthy food options, a home visit program for the prevention and management of T2DM, a local diabetes radio show, a school diabetes curriculum for grades 3 and 4, a community-wide walking trail to encourage increased physical activity, youth diabetes summer camps, and a variety of community events focusing on nutrition and physical activity. Over the 22 year existence of the SLHDP, the community has taken ownership of the program and activities have evolved in alignment with community needs and priorities. This paper discusses the history, implementation, evaluation, and outcomes of the SLHDP and describes its sustainability. The SLHDP is a model of culturally appropriate participatory research that is iterative, with reciprocal capacity building for both key community stakeholders and academic partners. PMID:24302919

Community-based breast cancer intervention program for older African American women in beauty salons.

PubMed Central

Forte, D A

1995-01-01

African American women are at high risk for morbidity and mortality from breast cancer. African American women ages 50 and older have been a difficult group to reach through conventional breast cancer intervention programs. Cultural and health beliefs that differ from mainstream society are reported to be factors contributing to the low rates of breast screening among this group. In addition to these attitudinal factors, older African American women are disproportionately represented among uninsured and under-insured Americans. As a result, cost becomes a barrier to mammography screening for many of these women. This project proposes to increase breast cancer screening awareness and provide a referral or free breast screening, or both, for African American women ages 50 and older. This information will be offered in the culturally familiar setting of local beauty salons. The culturally sensitive educational pamphlets developed by the National Cancer Institute (NCI) and video developed by the NCI-funded project, Cancer Prevention Research Unit, will be used to promote mammography, clinical breast examinations, and breast self-examination. Providers staffing a mobile mammography van provided by Dr. Anitha Mitchell of the Association of Black Women Physicians through a grant from the Breast and Cervical Cancer Control Program, funded by the Centers for Disease Control and Prevention, will perform mammograms for women on site during scheduled intervals. A followup telephone survey will be conducted. PMID:7630996

The Impact of Acculturation, Motivation and the Therapeutic Alliance on Treatment Retention and Outcomes for Hispanic Drug Involved Probationers

PubMed Central

Brocato, Jo

2013-01-01

Factors associated with retention and outcomes for Hispanic offenders mandated to treatment for substance use disorders have been overlooked in the literature resulting in an impediment to providing evidence-based, culturally relevant treatment services. This project examined the roles of motivational factors, the therapeutic relationship, and acculturation in predicting treatment retention and recidivism among Hispanic male probationers mandated to residential treatment. By following a treatment cohort over one hundred and twenty days, this research identifies factors that may be targeted to improve interventions and policies. The following conclusions are supported: among Hispanic offenders, the number of days in treatment is positively related to motivation to change and level of acculturation. PMID:23976877

Case-Control Study of Injury Intervention for Preschool Children in Henggang, Shenzhen.

PubMed

Wang, Hong; Liu, Yi-Xin; Deng, Wen-Jiao; Yang, Wei-Jian; Wang, Fang

2015-10-01

To explore effective interventions for child accidental injury prevention and to reduce the incidence of injury. Cluster random sampling method was adopted, and children in 19 kindergartens in Henggang, Shenzhen and their parents were selected as the objects of study. Nineteen kindergartens were randomly divided into intervention group and control group to carry out the injury intervention case-control study. Through a series of interventions, there were certain effects. After the end of the project, the injury incidence rates of the intervention group and the control group were 4.91%, 10.64%, and the difference was significant; the average costs of treatment for injuries of the intervention group and the control group were 168.4 Yuan and 206.8 Yuan, and the difference was statistically significant; compared with before the implementation of the project, the rate of various types of injuries after the end of the project declined, in which, the rate of mechanical injury, pet bites, accidental falls, burns, and traffic accidents decreased significantly. The differences were significant. Injury interventions can effectively prevent and control the occurrence of injury.

THE ADDED VALUE OF INTEGRATE-HTA GUIDANCE IN THE WORK PROCESSES OF HEALTH TECHNOLOGY ASSESSMENT AGENCIES.

PubMed

van der Wilt, Gert Jan; Kievit, Wietske; Oortwijn, Wija

2017-01-01

A central idea underlying the INTEGRATE-HTA project is that many of the interventions that are being used in health care are quite complex. By this, we mean that the relation between the delivery of the intervention on the one hand, and the onset of (desired and undesired) changes may be less straightforward than hoped for. There may be all sorts of reasons for this, varying from a lack of resources, lack of skills, perverse incentives, organizational problems, etc. Not identifying such factors and their potential impact may seriously compromise the policy relevance of a health technology assessment (HTA) (1). However, current approaches and methods in HTA do not seem to be adequately geared to deal with this complexity.

Women-Centered and Culturally Responsive Heart Health Promotion Among Indigenous Women in Canada.

PubMed

Ziabakhsh, Shabnam; Pederson, Ann; Prodan-Bhalla, Natasha; Middagh, Diane; Jinkerson-Brass, Sharon

2016-11-01

Most women in Canada confront a combination of bio-psychosocial factors that put them at risk for cardiovascular disease. The challenge for health planners is to address these factors while contextualizing interventions that meet the specific needs of particular social and cultural groupings. The article will discuss a women-centered, group-based heart health pilot initiative designed to engage with indigenous approaches to healing. The nurse practitioners co-led the group with a representative from the indigenous community to balance women-centered practices with more traditional and culturally appropriate ones. In particular, indigenous processes, such as a Talking Circle, combined with indigenous knowledge/content were integrated into the pilot program. The project was evaluated to investigate its outcomes (how the intervention impacted the participants) and processes (how participants perceived the intervention). Evaluation involved analysis of the Talking Circle's content, a focus group, field observations, and self-completed surveys. Most women made changes regarding their diet, some began physical activities, and others focused on better managing their emotional health. Women viewed the group as successful because it embraced both women-centered and culturally appropriate health promotion practices. The intervention created a culturally safe space for learning and transformation. The findings confirm the need for employing culturally relevant, gender-specific approaches to heart health promotion that are situated in and responsive to community needs. © 2016 Society for Public Health Education.

Tracking the mutual shaping of the technical and social dimensions of solar-powered mosquito trapping systems (SMoTS) for malaria control on Rusinga Island, western Kenya.

PubMed

Oria, Prisca A; Hiscox, Alexandra; Alaii, Jane; Ayugi, Margaret; Mukabana, Wolfgang Richard; Takken, Willem; Leeuwis, Cees

2014-11-18

There has been increasing effort in recent years to incorporate user needs in technology design and re-design. This project employed a bottom-up approach that engaged end users from the outset. Bottom-up approaches have the potential to bolster novel interventions and move them towards adaptive and evidence-based strategies. The present study concerns an innovative use of solar-powered mosquito trapping systems (SMoTS) to control malaria in western Kenya. Our paper highlights the co-dependence of research associated with the development of the SMoTS technology on one hand and research for enhancing the sustainable uptake of that very same intervention within the community on the other. During the pre-intervention year, we examined the design, re-design and piloting of a novel technology to generate lessons for malaria elimination on Rusinga Island. Initial ideas about many technological necessities were evaluated and re-designed following feedback from various sources, including technical and social research as well as broader interactions with the social environment. We documented the interlocking of the multiple processes and activities that took place through process observation and document reviews. We analysed the data within the conceptual framework of system innovation by identifying mutual shaping between technical and social factors. Our findings illustrate how various project stakeholders including project staff, collaborators, donor, and community members simultaneously pursued interdependent technological transformations and social interests. In the ongoing process, we observed how partial outcomes in the technological domain influenced social events at a later phase and vice versa. Looking at malaria intervention projects employing novel technologies as niches that may evolve towards system innovation, helps to reveal interrelations between the various technical and social aspects. Revealing these interrelations requires a different role for research and different perspective on innovation where innovation is more than the technical aspects. This approach therefore requires that research is designed in a way that enables obtaining feedback from both aspects.

Using a modified intervention mapping approach to develop and refine a single-session motivational intervention for methamphetamine-using men who have sex with men.

PubMed

Zule, William A; Coomes, Curtis M; Karg, Rhonda; Harris, Jennie L; Orr, Alex; Wechsberg, Wendee M

2010-05-14

There is an ongoing need for the development and adaptation of behavioral interventions to address behaviors related to acquisition and transmission of infectious diseases and for preventing the onset of chronic diseases. This paper describes the application of an established systematic approach to the development of a behavioral intervention to reduce sexual risk behaviors for HIV among men who have sex with men and who use methamphetamine. The approach includes six steps: (1) a needs assessment; (2) preparing matrices of proximal program objectives; (3) selecting theory-based methods and practical strategies; (4) producing program components and materials; (5) planning for program adoption, implementation, and sustainability; and (6) planning for evaluation. The focus of this article is on the intervention development process; therefore the article does not describe steps 5 and 6. Overall the process worked well, although it had to be adapted to fit the sequence of events associated with a funded research project. This project demonstrates that systematic approaches to intervention development can be applied even in research projects where some of the steps occur during the proposal writing process rather than during the actual project. However, intervention developers must remain flexible and be prepared to adapt the process to the situation. This includes being ready to make choices regarding intervention efficacy versus feasibility and being willing to select the best intervention that is likely to be delivered with available resources rather than an ideal intervention that may not be practical.

Skills-Based Residency Training in Alcohol Screening and Brief Intervention: Results from the Georgia-Texas "Improving Brief Intervention" Project

ERIC Educational Resources Information Center

Seale, J. Paul; Velasquez, Mary M.; Johnson, J. Aaron; Shellenberger, Sylvia; von Sternberg, Kirk; Dodrill, Carrie; Boltri, John M.; Takei, Roy; Clark, Denice; Grace, Daniel

2012-01-01

Alcohol screening and brief intervention (SBI) is recommended for all primary care patients but is underutilized. This project trained 111 residents and faculty in 8 family medicine residencies to conduct SBI and implement SBI protocols in residency clinics, then assessed changes in self-reported importance and confidence in performing SBI and…

The utility of Geographical Information Systems (GIS) in systems-oriented obesity intervention projects: The selection of comparable study sites for a quasi-experimental intervention design--TX CORD

USDA-ARS?s Scientific Manuscript database

The Texas Childhood Obesity Research Demonstration project (TX CORD) uses a systems-oriented approach to address obesity that includes individual and family interventions, community-level action, as well as environmental and policy initiatives. Given that randomization is seldom possible in communit...

Developing and Evaluating Interventions Aimed at Increasing Retention of Special Education Teachers (Teacher Support & Retention Project). Final Report.

ERIC Educational Resources Information Center

Cooley, Elizabeth

This final report describes the activities and outcomes of a 3-year federally funded project that developed and evaluated interventions aimed at increasing retention of special education teachers. The interventions developed and evaluated consisted of: (1) a series of stress management workshops aimed at preventing or alleviating teacher burnout,…

Effects of an Employer-Based Intervention on Employment Outcomes for Youth with Significant Support Needs Due to Autism

ERIC Educational Resources Information Center

Wehman, Paul; Schall, Carol M.; McDonough, Jennifer; Graham, Carolyn; Brooke, Valerie; Riehle, J. Erin; Brooke, Alissa; Ham, Whitney; Lau, Stephanie; Allen, Jaclyn; Avellone, Lauren

2017-01-01

The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism…

34 CFR 694.2 - Which students must a Partnership, or a State that chooses to use the cohort approach in its...

Code of Federal Regulations, 2010 CFR

2010-07-01

... chooses to use the cohort approach in its project, serve under the program's early intervention component... cohort approach in its project, serve under the program's early intervention component? A Partnership, or a State that chooses to use a cohort approach in its GEAR UP early intervention component, must...

34 CFR 694.2 - Which students must a Partnership, or a State that chooses to use the cohort approach in its...

Code of Federal Regulations, 2013 CFR

2013-07-01

... chooses to use the cohort approach in its project, serve under the program's early intervention component... chooses to use the cohort approach in its project, serve under the program's early intervention component? A Partnership, or a State that chooses to use a cohort approach in its GEAR UP early intervention...

34 CFR 694.2 - Which students must a Partnership, or a State that chooses to use the cohort approach in its...

Code of Federal Regulations, 2012 CFR

2012-07-01

... chooses to use the cohort approach in its project, serve under the program's early intervention component... chooses to use the cohort approach in its project, serve under the program's early intervention component? A Partnership, or a State that chooses to use a cohort approach in its GEAR UP early intervention...

34 CFR 694.2 - Which students must a Partnership, or a State that chooses to use the cohort approach in its...

Code of Federal Regulations, 2014 CFR

2014-07-01

... chooses to use the cohort approach in its project, serve under the program's early intervention component... chooses to use the cohort approach in its project, serve under the program's early intervention component? A Partnership, or a State that chooses to use a cohort approach in its GEAR UP early intervention...

34 CFR 694.2 - Which students must a Partnership, or a State that chooses to use the cohort approach in its...

Code of Federal Regulations, 2011 CFR

2011-07-01

... chooses to use the cohort approach in its project, serve under the program's early intervention component... chooses to use the cohort approach in its project, serve under the program's early intervention component? A Partnership, or a State that chooses to use a cohort approach in its GEAR UP early intervention...

School Staff Perceptions of Well-Being and Experience of an Intervention to Promote Well-Being

ERIC Educational Resources Information Center

Sharrocks, Louise

2014-01-01

An intervention was carried out with primary school staff to promote well-being with weekly sessions of a project which became known as Chill and Chat. Data were gathered via questionnaires completed before and after the project and from three focus groups (before, during and after the intervention), and were analysed using thematic analysis.…

Drug abuse prevention for high-risk African American children and their families: a review and model program.

PubMed

Van Hasselt, V B; Hersen, M; Null, J A; Ammerman, R T; Bukstein, O G; McGillivray, J; Hunter, A

1993-01-01

In this article we are specifically concerned with the familial and socioeconomic factors that contribute to the exceedingly high prevalence rates of drug abuse in African-American children. In addition to detailing the impact of drug abuse in African-American children and their families, we consider how this critical health problem can be prevented using existing knowledge and strategies known to mental health professionals. A model program entitled Project for a Substance Abuse-Free Environment (SAFE) is outlined. Its objectives are to implement: (a) a broad-spectrum family intervention to empower disadvantaged and high-risk families in their communities: (b) a competency-based skills intervention to increase resilience and decrease drug use and other maladaptive behaviors in at-risk children; (c) alternative activities that will promote self-efficacy, achievement, and self-esteem; (d) a culturally-relevant evaluation plan that includes both formative (process) and summative (outcome) evaluation; (e) a comprehensive approach for assessing project impact; (e) systematic procedures for enhancing the maintenance and generalization of gains in participating children and families.

An exercise-based randomized controlled trial on brain, cognition, physical health and mental health in overweight/obese children (ActiveBrains project): Rationale, design and methods.

PubMed

Cadenas-Sánchez, Cristina; Mora-González, José; Migueles, Jairo H; Martín-Matillas, Miguel; Gómez-Vida, José; Escolano-Margarit, María Victoria; Maldonado, José; Enriquez, Gala María; Pastor-Villaescusa, Belén; de Teresa, Carlos; Navarrete, Socorro; Lozano, Rosa María; de Dios Beas-Jiménez, Juan; Estévez-López, Fernando; Mena-Molina, Alejandra; Heras, María José; Chillón, Palma; Campoy, Cristina; Muñoz-Hernández, Victoria; Martínez-Ávila, Wendy Daniela; Merchan, María Elisa; Perales, José C; Gil, Ángel; Verdejo-García, Antonio; Aguilera, Concepción M; Ruiz, Jonatan R; Labayen, Idoia; Catena, Andrés; Ortega, Francisco B

2016-03-01

The new and recent advances in neuroelectric and neuroimaging technologies provide a new era for further exploring and understanding how brain and cognition function can be stimulated by environmental factors, such as exercise, and particularly to study whether physical exercise influences brain development in early ages. The present study, namely the ActiveBrains project, aims to examine the effects of a physical exercise programme on brain and cognition, as well as on selected physical and mental health outcomes in overweight/obese children. A total of 100 participants aged 8 to 11 years are randomized into an exercise group (N=50) or a control group (N=50). The intervention lasts 20-weeks, with 3-5 sessions per week of 90 min each, and is mainly focused on high-intensity aerobic exercise yet also includes muscle-strengthening exercises. The extent to what the intervention effect remains 8-months after the exercise programme finishes is also studied in a subsample. Brain structure and function and cognitive performance are assessed using structural and functional magnetic resonance imaging and electroencephalographic recordings. Secondary outcomes include physical health outcomes (e.g. physical fitness, body fatness, bone mass and lipid-metabolic factors) and mental health outcomes (e.g. chronic stress indicators and overall behavioural and personality measurements such as anxiety or depression). This project will substantially contribute to the existing knowledge and will have an impact on societies, since early stimulation of brain development might have long lasting consequences on cognitive performance, academic achievement and in the prevention of behavioural problems and the promotion of psychological adjustment and mental health. Clinical trials. Gov identifier: NCT02295072. Copyright © 2016 Elsevier Inc. All rights reserved.

Understanding the trends in HIV and hepatitis C prevalence amongst injecting drug users in different settings--implications for intervention impact.

PubMed

Vickerman, Peter; Martin, Natasha K; Hickman, Matthew

2012-06-01

A recent systematic review observed that HIV prevalence amongst injectors is negligible (<1%) below a threshold HCV prevalence of 30%, but thereafter increases with HCV prevalence. We explore whether a model can reproduce these trends, what determines different epidemiological profiles and how this affects intervention impact. An HIV/HCV transmission model was developed. Univariate sensitivity analyses determined whether the model projected a HCV prevalence threshold below which HIV is negligible, and how different behavioural and epidemiological factors affect the threshold. Multivariate uncertainty analyses considered whether the model could reproduce the observed breadth of HIV/HCV epidemics, how specific behavioural patterns produce different epidemic profiles, and how this affects an intervention's impact (reduces injecting risk by 30%). The model projected a HCV prevalence threshold, which varied depending on the heterogeneity in risk, mixing, and injecting duration in a setting. Multivariate uncertainty analyses showed the model could produce the same range of observed HIV/HCV epidemics. Variability in injecting transmission risk, degree of heterogeneity and injecting duration mainly determined different epidemic profiles. The intervention resulted in 50%/28% reduction in HIV incidence/prevalence and 37%/10% reduction in HCV incidence/prevalence over five years. For either infection, greater impact occurred in settings with lower prevalence of that infection and higher prevalence of the other infection. There are threshold levels of HCV prevalence below which HIV risk is negligible but these thresholds are likely to vary by setting. A setting's HIV and HCV prevalence may give insights into IDU risk behaviour and intervention impact. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit.

PubMed

Fields, Lorraine B

2008-10-01

Ventilator-associated pneumonia (VAP) is a preventable secondary consequence of intubation and mechanical ventilation. VAP is pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilator support. Mechanically ventilated patients in neurologic and other intensive care units (ICUs) are at an increased risk of VAP due to factors such as decreased level of consciousness; dry, open mouth; and microaspiration of secretions. VAP can be prevented by initiating interventions from the Institute of Healthcare Improvement's VAP bundle, including (a) elevating the head of the bed of ventilated patients to 30 degrees, (b) preventing venous thromboembolism through use of sequential compression devices or anticoagulation, (c) administering gastric acid histamine2 blockers, (d) practicing good hand hygiene, (e) initiating early mobilization, and (f) performing daily sedation interruption at 10 am to evaluate neurologic status. The one intervention not included in the IHI bundle is oral hygiene. The purpose of this project is to support the premise that oral care, including timed toothbrushing, combined with the VAP bundle can mitigate and prevent the occurrence of VAP. Our project specifically addressed timed oral care of mechanically ventilated patients on a 24-bed stroke, neurologic, and medical ICU. Patients were randomized into a control group that performed usual oral care or an intervention group that brushed teeth every 8 hours. The results were immediate and startling, as the VAP rate dropped to zero within a week of beginning the every-8-hours toothbrushing regimen in the intervention group. The study was so successful that the control group was dropped after 6 months, and all intubated patients' teeth were brushed every 8 hours, maintaining the zero rate until the end of the study.

Exploring the value of mixed methods within the At Home/Chez Soi housing first project: a strategy to evaluate the implementation of a complex population health intervention for people with mental illness who have been homeless.

PubMed

Macnaughton, Eric L; Goering, Paula N; Nelson, Geoffrey B

2012-05-02

This paper is a methodological case study that describes the At Home/Chez Soi (Housing First) Initiative's mixed-methods strategy for implementation evaluation and discusses the value of these methods in evaluating the implementation of such complex population health interventions. The Housing First (HF) model is being implemented in five cities: Vancouver, Winnipeg, Toronto, Montréal and Moncton. At Home/Chez Soi is an intervention trial that aims to address the issue of homelessness in people with mental health issues. The HF model emphasizes choices, hopefulness and connecting people with resources that make a difference to their quality of life. A component of HF is supported housing, which provides a rent subsidy and rapid access to housing of choice in private apartments; a second component is support. Quantitative and qualitative methods were used to evaluate HF implementation. The findings of this case study illustrate how the critical ingredients of complex interventions, such as HF, can be adapted to different contexts while implementation fidelity is maintained at a theoretical level. The findings also illustrate how the project's mixed methods approach helped to facilitate the adaptation process. Another value of this approach is that it identifies systemic and organizational factors (e.g., housing supply, discrimination, housing procurement strategy) that affect implementation of key elements of HF. In general, the approach provides information about both whether and how key aspects of the intervention are implemented effectively across different settings. It thus provides implementation data that are rigorous, contextually relevant and practical.

A developmental evaluation to enhance stakeholder engagement in a wide-scale interactive project disseminating quality improvement data: study protocol for a mixed-methods study

PubMed Central

Laycock, Alison; Bailie, Jodie; Matthews, Veronica; Cunningham, Frances; Harvey, Gillian; Percival, Nikki; Bailie, Ross

2017-01-01

Introduction Bringing together continuous quality improvement (CQI) data from multiple health services offers opportunities to identify common improvement priorities and to develop interventions at various system levels to achieve large-scale improvement in care. An important principle of CQI is practitioner participation in interpreting data and planning evidence-based change. This study will contribute knowledge about engaging diverse stakeholders in collaborative and theoretically informed processes to identify and address priority evidence-practice gaps in care delivery. This paper describes a developmental evaluation to support and refine a novel interactive dissemination project using aggregated CQI data from Aboriginal and Torres Strait Islander primary healthcare centres in Australia. The project aims to effect multilevel system improvement in Aboriginal and Torres Strait Islander primary healthcare. Methods and analysis Data will be gathered using document analysis, online surveys, interviews with participants and iterative analytical processes with the research team. These methods will enable real-time feedback to guide refinements to the design, reports, tools and processes as the interactive dissemination project is implemented. Qualitative data from interviews and surveys will be analysed and interpreted to provide in-depth understanding of factors that influence engagement and stakeholder perspectives about use of the aggregated data and generated improvement strategies. Sources of data will be triangulated to build up a comprehensive, contextualised perspective and integrated understanding of the project's development, implementation and findings. Ethics and dissemination The Human Research Ethics Committee (HREC) of the Northern Territory Department of Health and Menzies School of Health Research (Project 2015-2329), the Central Australian HREC (Project 15-288) and the Charles Darwin University HREC (Project H15030) approved the study. Dissemination will include articles in peer-reviewed journals, policy and research briefs. Results will be presented at conferences and quality improvement network meetings. Researchers, clinicians, policymakers and managers developing evidence-based system and policy interventions should benefit from this research. PMID:28710222

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study

PubMed Central

Verloigne, Maïté; Altenburg, Teatske Maria; Chinapaw, Mai Jeanette Maidy; Chastin, Sebastien; Cardon, Greet

2017-01-01

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September–October 2014) and post (April–May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach. PMID:28763041

Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study.

PubMed

Verloigne, Maïté; Altenburg, Teatske Maria; Chinapaw, Mai Jeanette Maidy; Chastin, Sebastien; Cardon, Greet; De Bourdeaudhuij, Ilse

2017-08-01

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September-October 2014) and post (April-May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach.

The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

PubMed

Howard, N; Mounier-Jack, S; Gallagher, K E; Kabakama, S; Griffiths, U K; Feletto, M; LaMontagne, D S; Burchett, H E D; Watson-Jones, D

2016-09-01

Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.

Outcomes of The BODY Project: A Program to Halt Obesity and Its Medical Consequences in High School Students.

PubMed

Sweat, Victoria; Bruzzese, Jean-Marie; Fierman, Arthur; Mangone, Alexander; Siegel, Carole; Laska, Eugene; Convit, Antonio

2015-12-01

Adolescent obesity continues to be a major public health issue with a third of American adolescents being overweight or obese. Excess weight is associated with cardiovascular risk factors and pre-diabetes. High school students identified as carrying excess weight [body mass index (BMI) ≥25 kg/m(2), or BMI percentile ≥85 %] were invited to participate in The BODY Project, an intervention that included a medical evaluation and a personalized medical report of the results of that evaluation sent to the parent/guardian at home. The medical evaluation and report was repeated 12 months later. The reports also contained advice on how the individual student could modify their lifestyle to improve the specific medical parameters showing abnormalities. Outcomes were change in BMI, blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting glucose, and fasting insulin. Students participating in The BODY Project intervention demonstrated modest, yet significant, reductions in BMI (p < 0.001) 1 year later, and also had significant improvements in systolic blood pressure (p < 0.001) and cholesterol profile (HDL p = 0.002; LDL p < 0.001) at follow-up. The BODY Project, by means of a minimal educational program anchored on the principle of teachable moments around the students' increased perception of their own risk for disease from the medical abnormalities uncovered, demonstrates evidence of potential effectiveness in addressing adolescent obesity.

Comparing estimates of child mortality reduction modelled in LiST with pregnancy history survey data for a community-based NGO project in Mozambique

PubMed Central

2011-01-01

Background There is a growing body of evidence that integrated packages of community-based interventions, a form of programming often implemented by NGOs, can have substantial child mortality impact. More countries may be able to meet Millennium Development Goal (MDG) 4 targets by leveraging such programming. Analysis of the mortality effect of this type of programming is hampered by the cost and complexity of direct mortality measurement. The Lives Saved Tool (LiST) produces an estimate of mortality reduction by modelling the mortality effect of changes in population coverage of individual child health interventions. However, few studies to date have compared the LiST estimates of mortality reduction with those produced by direct measurement. Methods Using results of a recent review of evidence for community-based child health programming, a search was conducted for NGO child health projects implementing community-based interventions that had independently verified child mortality reduction estimates, as well as population coverage data for modelling in LiST. One child survival project fit inclusion criteria. Subsequent searches of the USAID Development Experience Clearinghouse and Child Survival Grants databases and interviews of staff from NGOs identified no additional projects. Eight coverage indicators, covering all the project’s technical interventions were modelled in LiST, along with indicator values for most other non-project interventions in LiST, mainly from DHS data from 1997 and 2003. Results The project studied was implemented by World Relief from 1999 to 2003 in Gaza Province, Mozambique. An independent evaluation collecting pregnancy history data estimated that under-five mortality declined 37% and infant mortality 48%. Using project-collected coverage data, LiST produced estimates of 39% and 34% decline, respectively. Conclusions LiST gives reasonably accurate estimates of infant and child mortality decline in an area where a package of community-based interventions was implemented. This and other validation exercises support use of LiST as an aid for program planning to tailor packages of community-based interventions to the epidemiological context and for project evaluation. Such targeted planning and assessments will be useful to accelerate progress in reaching MDG4 targets. PMID:21501454

Analysing pseudoephedrine/methamphetamine policy options in Australia using multi-criteria decision modelling.

PubMed

Manning, Matthew; Wong, Gabriel T W; Ransley, Janet; Smith, Christine

2016-06-01

In this paper we capture and synthesize the unique knowledge of experts so that choices regarding policy measures to address methamphetamine consumption and dependency in Australia can be strengthened. We examine perceptions of the: (1) influence of underlying factors that impact on the methamphetamine problem; (2) importance of various models of intervention that have the potential to affect the success of policies; and (3) efficacy of alternative pseudoephedrine policy options. We adopt a multi-criteria decision model to unpack factors that affect decisions made by experts and examine potential variations on weight/preference among groups. Seventy experts from five groups (i.e. academia (18.6%), government and policy (27.1%), health (18.6%), pharmaceutical (17.1%) and police (18.6%)) in Australia participated in the survey. Social characteristics are considered the most important underlying factor, prevention the most effective strategy and Project STOP the most preferred policy option with respect to reducing methamphetamine consumption and dependency in Australia. One-way repeated ANOVAs indicate a statistically significant difference with regards to the influence of underlying factors (F(2.3, 144.5)=11.256, p<.001), effectiveness of interventions (F(2.4, 153.1)=28.738, p<.001) and policy options (F(2.8, 175.5)=70.854, p<.001). A majority of respondents believed that genetic, biological, emotional, cognitive and social factors are the most influential explanatory variables in terms of methamphetamine consumption and dependency. Most experts support the use of preventative mechanisms to inhibit drug initiation and delayed drug uptake. Compared to other policies, Project STOP (which aims to disrupt the initial diversion of pseudoephedrine) appears to be a more preferable preventative mechanism to control the production and subsequent sale and use of methamphetamine. This regulatory civil law lever engages third parties in controlling drug-related crime. The literature supports third-party partnerships as it engages experts who have knowledge and expertise with respect to prevention and harm minimization. Copyright © 2016 Elsevier B.V. All rights reserved.

Implementing Brief Interventions in Health Care: Lessons Learned from the Swedish Risk Drinking Project

PubMed Central

Nilsen, Per; Wåhlin, Sven; Heather, Nick

2011-01-01

The Risk Drinking Project was a national implementation endeavour in Sweden, carried out from 2004 to 2010, based on a government initiative to give alcohol issues a more prominent place in routine primary, child, maternity and occupational health care. The article describes and analyses the project. Critical factors that were important for the results are identified. The magnitude of the project contributed to its reach and impact in terms of providers’ awareness of the project goals and key messages. The timing of the project was appropriate. The increase in alcohol consumption in Sweden and diminished opportunities for primary prevention strategies since entry to the European Union in 1995 have led to increased expectations for health care providers to become more actively involved in alcohol prevention. This awareness provided favourable conditions for this project. A multifaceted approach was used in the project. Most educational courses were held in workshops and seminars to encourage learning-by-doing. Motivational interviewing was an integral aspect. The concept of risk drinking was promoted in all the activities. Subprojects were tailored to the specific conditions of each respective setting, building on the skills the providers already had to modify existing work practices. Nurses were afforded a key role in the project. PMID:22016706

Implementing brief interventions in health care: lessons learned from the Swedish Risk Drinking Project.

PubMed

Nilsen, Per; Wåhlin, Sven; Heather, Nick

2011-09-01

The Risk Drinking Project was a national implementation endeavour in Sweden, carried out from 2004 to 2010, based on a government initiative to give alcohol issues a more prominent place in routine primary, child, maternity and occupational health care. The article describes and analyses the project. Critical factors that were important for the results are identified. The magnitude of the project contributed to its reach and impact in terms of providers' awareness of the project goals and key messages. The timing of the project was appropriate. The increase in alcohol consumption in Sweden and diminished opportunities for primary prevention strategies since entry to the European Union in 1995 have led to increased expectations for health care providers to become more actively involved in alcohol prevention. This awareness provided favourable conditions for this project. A multifaceted approach was used in the project. Most educational courses were held in workshops and seminars to encourage learning-by-doing. Motivational interviewing was an integral aspect. The concept of risk drinking was promoted in all the activities. Subprojects were tailored to the specific conditions of each respective setting, building on the skills the providers already had to modify existing work practices. Nurses were afforded a key role in the project.

Evaluation of the implementation of the Montreal At Home/Chez Soi project.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine

2014-11-28

Homelessness and mental disorders constitute a major problem in Canada. The purpose of the At Home/Chez Soi pilot project was to house and provide supports to marginalised groups. Policymakers are in a better position to nurture new, complex interventions if they know which key factors hinder or enable their implementation. This paper evaluates the implementation process for the Montreal site of this project. We collected data from 62 individuals, through individual interviews, focus groups, questionnaires, observations and documentation. The implementation process was analysed using a conceptual framework with five constructs: Intervention Characteristics (IC), Context of Implementation (CI), Implementation Process (IP), Organizational Characteristics (OC) and Strategies of Implementation (SI). The most serious obstacle to the project came from the CI construct, i.e., lack of support from provincial authorities and key local resources in the homelessness field. The second was within the OC construct. The chief hindrances were numerous structures, divergent values among stakeholders, frequent turnover of personnel and team leaders; lacking staff supervision and miscommunication. The third is related to IC: the complex, unyielding nature of the project undermined its chances of success. The greatest challenges from IP were the pressure to perform, along with stress caused by planning, deadlines and tension between teams. Conversely, SI construct conditions (e.g., effective governing structures, comprehensive training initiatives and toolkits) were generally very positive even with problems in power sharing and local leadership. For the four other constructs, the following proved useful: evidence of the project's scope and quality, great needs of services consolidation, generous financing and status as a research pilot project, enthusiasm and commitment toward the project, substantially improved services, and overall user satisfaction. This study demonstrated the difficulty of implementing a complex project in the healthcare system. While the project faced many barriers, minimal conditions were also achieved. At the end of the study period, major tensions between organizations and teams were significantly reduced, supporting its full implementation. However, in late 2013, the project was unsustainable, calling into question the relevance of achieving a significant number of positive conditions in each area of the framework.

One on One Numeracy Intervention: A Pilot Project in Low SES Communities

ERIC Educational Resources Information Center

Thornton, Steve; Quinane, Mary; Galluzzo, Gina; Taylor, Debbie

2010-01-01

This paper reports on the structure and impact of a one on one numeracy intervention project conducted during 2009 with students in years 1, 4 and 8. The project was built on a Reading Recovery model, using research into how the brain learns mathematics and ideas of threshold concepts. Teachers were provided time to work individually with students…

Supporting workers with mental health problems to retain employment: users' experiences of a UK job retention project.

PubMed

Cameron, Josh; Walker, Carl; Hart, Angie; Sadlo, Gaynor; Haslam, Imogen; Retain Support Group

2012-01-01

To understand experiences and perspectives of job retention project users in relation to challenges faced and support received; to develop explanatory insight into effective interventions. 14 employed users of a United Kingdom job retention project, with a range of mental health problems. Semi-structured individual interviews which were collaboratively designed with service users. Data analysis involved deductive & inductive thematic analysis, constant comparative analysis, and service user collaboration. Participants' feelings of guilt and self blame were a major obstacle to job retention. The project helped them address these by supporting a reappraisal of their situation. This assisted identification of job accommodations and adjustments and confidence in self advocacy. Thus an important basis for improved dialogue with their employer was established. A peer support group provided an important adjunct to individual project worker interventions. 10 participants retained employment; three of those who did not were helped to retain work aspirations. The project effectively used a multi-faceted approach involving a person - environment-occupation focus on the worker, their work, and workplace. Such complex interventions may offer more promise than those interventions (such as cognitive behavioural therapy) which have a primary focus on the individual worker.

Project on Academic Striving: The Moderation of Stress in the Lives of the Students of an Urban Intermediate School. A Project to Coordinate Research and Environmental Intervention. Final Report. Executive Summary.

ERIC Educational Resources Information Center

Grannis, Joseph C.; Fahs, Mary Ellen

This document summarizes the evaluation of a project that studied social, physical, and academic stress in the lives of students in an inner-city intermediate school and developed interventions to reduce that stress. Over 242 students, most of whom were from low-income families and almost all of whom were black, participated in the project. The…

Sepsis in general surgery: a deadly complication.

PubMed

Moore, Laura J; Moore, Frederick A; Jones, Stephen L; Xu, Jiaqiong; Bass, Barbara L

2009-12-01

Sepsis is a deadly and potentially preventable complication. A better understanding of sepsis in general surgery patients is needed to help direct resources to those patients at highest risk for death from sepsis. We identified risk factors for sepsis in general surgery patients by using the National Surgical Quality Improvement Project database. Analysis of the database identified 3 major risk factors for both the development of sepsis and death from sepsis in general surgery patients. These risk factors are age older than 60 years, need for emergency surgery, and the presence of comorbid conditions. Risk factors for death from sepsis or septic shock in general surgery patients include age older than 60 years, need for emergency surgery, and the presence of preexisting comorbidities. These findings emphasize the need for early recognition through aggressive sepsis screening and rapid implementation of evidence-based interventions for sepsis and septic shock in general surgery patients with these risk factors.

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction.

PubMed

Kruk, Margaret E; Vail, Daniel; Austin-Evelyn, Katherine; Atuyambe, Lynn; Greeson, Dana; Grépin, Karen Ann; Kibira, Simon P S; Macwan'gi, Mubiana; Masvawure, Tsitsi B; Rabkin, Miriam; Sacks, Emma; Simbaya, Joseph; Galea, Sandro

2016-03-01

Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients' receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers' knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers' clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers' knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program. Project HOPE—The People-to-People Health Foundation, Inc.

The NIHR Public Health Research Programme: responding to local authority research needs in the United Kingdom.

PubMed

Dorling, Hannah; Cook, Andrew; Ollerhead, Liz; Westmore, Matt

2015-12-11

The remit of the National Institute for Health Research Public Health Research (PHR) Programme is to evaluate public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of interventions, set outside of the National Health Service, intended to improve the health of the public and reduce inequalities. This paper illustrates how the PHR Programme is providing new knowledge for public health decision makers, based on the nine key areas for local authority public health action, described by the King's Fund. Many funded PHR projects are evaluating interventions, applied in a range of settings, across the identified key areas for local authority influence. For example, research has been funded on children and young people, and for some of the wider determinants of health, such as housing and travel. Other factors, such as spatial planning, or open and green spaces and leisure, are less represented in the PHR Programme. Further opportunities in research include interventions to improve the health of adolescents, adults in workplaces, and communities. Building evidence for public health interventions at local authority level is important to prioritise and implement effective changes to improve population health.

Improving prediction of fall risk among nursing home residents using electronic medical records.

PubMed

Marier, Allison; Olsho, Lauren E W; Rhodes, William; Spector, William D

2016-03-01

Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The foundation of NCVD PCI Registry: the Malaysia's first multi-centre interventional cardiology project.

PubMed

Liew, H B; Rosli, M A; Wan Azman, W A; Robaayah, Z; Sim, K H

2008-09-01

The National Cardiovascular Database for Percutaneous Coronary Intervention (NCVD PCI) Registry is the first multicentre interventional cardiology project, involving the main cardiac centres in the country. The ultimate goal of NCVD PCI is to provide a contemporary appraisal of PCI in Malaysia. This article introduces the foundation, the aims, methodology, database collection and preliminary results of the first six-month database.

Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial

PubMed Central

Wall, Martin; Hayes, Richard; Moore, Derek; Petticrew, Mark; Clow, Angela; Schmidt, Elena; Draper, Alizon; Lock, Karen; Lynch, Rebecca; Renton, Adrian

2009-01-01

Background In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. Methods/Design The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. Discussion The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. Trial Registration Current Controlled Trials ISRCTN68175121 PMID:19558712

Institutionalization of community action projects to reduce alcohol-use related problems: systematic facilitators.

PubMed

Holder, H D; Moore, R S

2000-01-01

This article reviews papers from a recent conference on community action research in order to identify factors that contribute to long-term maintenance, sustainability, or institutionalization of community project interventions. The descriptions of long-term outcomes and aftereffects of projects that emerged in the conference are valuable because relatively few instances of institutionalization have been documented in the scientific literature. After a general theoretical discussion of institutionalization in communities, the article identifies characteristics of successful community action programs that outlived their original funding. These characteristics include honoring community values and cultural relevance, cultivating key leader support, and utilizing indigenous staff. They also include developing local resources, maintaining flexibility, and leveraging prior success. The paper concludes by noting that aiming for policy and structural changes is a goal for an institutionalization of measures positively affecting desired health outcomes, even if the programs which created them are not themselves sustained.

Successful Up-Scaled Population Interventions to Reduce Risk Factors for Non-Communicable Disease in Adults: Results from the International Community Interventions for Health (CIH) Project in China, India and Mexico

PubMed Central

Dyson, Pamela A.; Anthony, Denis; Fenton, Brenda; Stevens, Denise E.; Champagne, Beatriz; Li, Li-Ming; Lv, Jun; Ramírez Hernández, Jorge; Thankappan, K. R.; Matthews, David R.

2015-01-01

Background Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC. Methods The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up. Results A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014) Conclusions Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity. PMID:25875825

Community Stakeholders' Perceptions of Major Factors Influencing Childhood Obesity, the Feasibility of Programs Addressing Childhood Obesity, and Persisting Gaps.

PubMed

Ganter, Claudia; Aftosmes-Tobio, Alyssa; Chuang, Emmeline; Blaine, Rachel E; Land, Thomas; Davison, Kirsten K

2016-04-01

Prior research has identified numerous factors contributing to increased rates of childhood obesity. However, few studies have focused explicitly on the experience of community stakeholders in low-income communities. This study sought to capture the perspectives of these on-the-ground experts regarding major factors contributing to childhood obesity as well as gaps in current prevention and control efforts. We conducted semi-structured interviews with 39 stakeholders from different community sectors (e.g., healthcare providers, childcare providers, teachers). Data were drawn from the Massachusetts Childhood Obesity Research Demonstration project, a multi-level, multi-sector intervention designed to reduce childhood obesity being implemented in two low-income communities in Massachusetts. Interviews were conducted at baseline, transcribed, coded using grounded theory approach, and analyzed in NVivo 10.0. The vast majority of stakeholders had recently participated in obesity prevention strategies, and nearly all of them identified gaps in prevention efforts either within their organizations or in the broader community. In addition to factors previously identified in the literature, several themes emerged including the need to change policies to increase physical activity during school, offer healthier snacks in schools and afterschool programs, and increase communication and collaboration within the community in prevention efforts. Community stakeholders can impact the success of interventions by bridging the gap between science and lived experience. The results of this study can guide future research by highlighting the importance of including stakeholders' frontline experiences with target populations, and using information on identified gaps to augment intervention planning efforts.

The Childhood Obesity Research Demonstration project: a team approach for supporting a multisite, multisector intervention.

PubMed

Williams, Nancy; Dooyema, Carrie A; Foltz, Jennifer L; Belay, Brook; Blanck, Heidi M

2015-02-01

Comprehensive multisector, multilevel approaches are needed to address childhood obesity. This article introduces the structure of a multidisciplinary team approach used to support and guide the multisite, multisector interventions implemented as part of the Childhood Obesity Research Demonstration (CORD) project. This article will describe the function, roles, and lessons learned from the CDC-CORD approach to project management. The CORD project works across multisectors and multilevels in three demonstration communities. Working with principal investigators and their research teams who are engaging multiple stakeholder groups, including community organizations, schools and child care centers, health departments, and healthcare providers, can be a complex endeavor. To best support the community-based research project, scientific and programmatic expertise in a wide range of areas was required. The team was configured based on the skill sets needed to interact with the various levels of staff working with the project. By thoughtful development of the team and processes, an efficient system for supporting the multisite, multisector intervention project sites was developed. The team approach will be formally evaluated at the end of the project period.

EMPRESS: A European Project to Enhance Process Control Through Improved Temperature Measurement

NASA Astrophysics Data System (ADS)

Pearce, J. V.; Edler, F.; Elliott, C. J.; Rosso, L.; Sutton, G.; Andreu, A.; Machin, G.

2017-08-01

A new European project called EMPRESS, funded by the EURAMET program `European Metrology Program for Innovation and Research,' is described. The 3 year project, which started in the summer of 2015, is intended to substantially augment the efficiency of high-value manufacturing processes by improving temperature measurement techniques at the point of use. The project consortium has 18 partners and 5 external collaborators, from the metrology sector, high-value manufacturing, sensor manufacturing, and academia. Accurate control of temperature is key to ensuring process efficiency and product consistency and is often not achieved to the level required for modern processes. Enhanced efficiency of processes may take several forms including reduced product rejection/waste; improved energy efficiency; increased intervals between sensor recalibration/maintenance; and increased sensor reliability, i.e., reduced amount of operator intervention. Traceability of temperature measurements to the International Temperature Scale of 1990 (ITS-90) is a critical factor in establishing low measurement uncertainty and reproducible, consistent process control. Introducing such traceability in situ (i.e., within the industrial process) is a theme running through this project.

The Health and Sport Engagement (HASE) Intervention and Evaluation Project: protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity.

PubMed

Mansfield, Louise; Anokye, Nana; Fox-Rushby, Julia; Kay, Tess

2015-10-26

Sport is being promoted to raise population levels of physical activity for health. National sport participation policy focuses on complex community provision tailored to diverse local users. Few quality research studies exist that examine the role of community sport interventions in raising physical activity levels and no research to date has examined the costs and cost-effectiveness of such provision. This study is a protocol for the design, outcome, process and economic evaluation of a complex community sport intervention to increase levels of physical activity, the Health and Sport Engagement (HASE) project part of the national Get Healthy Get Active programme led by Sport England. The HASE study is a collaborative partnership between local community sport deliverers and sport and public health researchers. It involves designing, delivering and evaluating community sport interventions. The aim is to engage previously inactive people in sustained sporting activity for 1×30 min a week and to examine associated health and well-being outcomes. The study uses mixed methods. Outcomes (physical activity, health, well-being costs to individuals) will be measured by a series of self-report questionnaires and attendance data and evaluated using interrupted time series analysis controlling for a range of sociodemographic factors. Resource use will be identified and measured using diaries, interviews and records and presented alongside effectiveness data as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. A longitudinal process evaluation (focus groups, structured observations, in-depth interview methods) will examine the efficacy of the project for achieving its aim using the principles of thematic analysis. The results of this study will be disseminated through peer-reviewed publications, academic conference presentations, Sport England and national public health organisation policy conferences, and practice-based case studies. Ethical approval was obtained through Brunel University London's research ethics committee (reference number RE33-12). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A successful intervention program for high ability minority students

NASA Technical Reports Server (NTRS)

Coleman, Winson R.

1989-01-01

Among professional occupations in the United States, non-Asian minorities are least represented in science and engineering fields. The Bureau of Labor Statistics predicts that over the next decade, civilian employment of scientists and engineers has the potential to grow by 40 percent. Furthermore, projections for the year 2000 indicate that 100,000 fewer B.S. and B.A. degrees will be awarded than were awarded in 1984. The latter projection takes into consideration the overall declining proportion of all 18 year old college students. Within this shrinking pool of 18 year old potential college students will be an increasing proportion of Blacks and Hispanics. In order to change the educational patterns for minority youth, an intense look at the factors that affect the science and mathematics performance of minorities. Furthermore, the work of programs that are successful at producing minority scientists and engineers must be examined and documented with the intent of replicating these programs. The fundamental concern at this time appears to be the quality of precollege experience because research has shown that lack of precollege preparation is the single most important cause of underrepresentation of minorities in science and engineering careers. For many years, intervention programs have attempted to improve the quality of the minority precollege experience by latter year intervention in grades eleven and twelve. Later efforts, such as this one, have concentrated on earlier years. The effectiveness of intervention programs is widely accepted but not rigorously documented. The mechanisms these programs have developed need to be identified and their potential for broader use evaluated. The ultimate goal of such studies would be to provide the different educational communities with a set of proven cost-effective state of the art mechanisms designed to increase participation and success of minority students in science and mathematics-related courses. One such intervention program is the Saturday Academy program for high ability minority students in the Washington, D.C. area. A description of the Saturday Academy is provided with the intent of making it available to personnel who are considering the development of similar projects. The effect of participation in the program on high school graduate rates, college enrollment, and choice of quantitative major is examined.

Childhood Obesity Prevention and Treatment Research (COPTR): Interventions Addressing Multiple Influences in Childhood and Adolescent Obesity

PubMed Central

Pratt, Charlotte A.; Boyington, Josephine; Esposito, Layla; Pemberton, Victoria L.; Bonds, Denise; Kelley, Melinda; Yang, Song; Murray, David; Stevens, June

2018-01-01

Obesity is a major public health problem affecting more than 12 million (~17%)U.S. children. The scientific community agrees that tackling this problem must begin in childhood to reduce risk of subsequent development of cardiovascular diseases and other chronic diseases. The Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, initiated by the National Institutes of Health (NIH), is conducting intervention studies to prevent obesity in pre-schoolers and treat overweight or obese 7–13 year olds. Four randomized controlled trials plan to enroll a total of 1,700 children and adolescents (~ 50% female, 70% minorities), and are testing innovative multi-level and multi-component interventions in multiple settings involving primary care physicians, parks and recreational centers, family advocates, and schools. For all the studies, the primary outcome measure is body mass index; secondary outcomes, moderators and mediators of intervention include diet, physical activity, home and neighborhood influences, and psychosocial factors. COPTR is being conducted collaboratively among four participating field centers, a coordinating center, and NIH project offices. PMID:23999502

Effectiveness, efficiency and efficacy in the multidimensional treatment of schizophrenia: Rethinking project.

PubMed

Crespo-Facorro, Benedicto; Bernardo, Miguel; Argimon, Josep Maria; Arrojo, Manuel; Bravo-Ortiz, Maria Fe; Cabrera-Cifuentes, Ana; Carretero-Román, Julián; Franco-Martín, Manuel A; García-Portilla, Paz; Haro, Josep Maria; Olivares, José Manuel; Penadés, Rafael; Del Pino-Montes, Javier; Sanjuán, Julio; Arango, Celso

Schizophrenia is a clinically heterogeneous syndrome affecting multiple dimensions of patients' life. Therefore, its treatment might require a multidimensional approach that should take into account the efficacy (the ability of an intervention to get the desired result under ideal conditions), the effectiveness (the degree to which the intended effect is obtained under routine clinical practice conditions or settings) and the efficiency (value of the intervention as relative to its cost to the individual or society) of any therapeutic intervention. In a first step of the process, a group of 90 national experts from different areas of health-care and with a multidimensional and multidisciplinary perspective of the disease, defined the concepts of efficacy, effectiveness and efficiency of established therapeutic interventions within 7 key dimensions of the illness: symptomatology; comorbidity; relapse and adherence; insight and subjective experience; cognition; quality of life, autonomy and functional capacity; and social inclusion and associated factors. The main conclusions and recommendations of this stage of the work are presented herein. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

Automatic cable artifact removal for cardiac C-arm CT imaging

NASA Astrophysics Data System (ADS)

Haase, C.; Schäfer, D.; Kim, M.; Chen, S. J.; Carroll, J.; Eshuis, P.; Dössel, O.; Grass, M.

2014-03-01

Cardiac C-arm computed tomography (CT) imaging using interventional C-arm systems can be applied in various areas of interventional cardiology ranging from structural heart disease and electrophysiology interventions to valve procedures in hybrid operating rooms. In contrast to conventional CT systems, the reconstruction field of view (FOV) of C-arm systems is limited to a region of interest in cone-beam (along the patient axis) and fan-beam (in the transaxial plane) direction. Hence, highly X-ray opaque objects (e.g. cables from the interventional setup) outside the reconstruction field of view, yield streak artifacts in the reconstruction volume. To decrease the impact of these streaks a cable tracking approach on the 2D projection sequences with subsequent interpolation is applied. The proposed approach uses the fact that the projected position of objects outside the reconstruction volume depends strongly on the projection perspective. By tracking candidate points over multiple projections only objects outside the reconstruction volume are segmented in the projections. The method is quantitatively evaluated based on 30 simulated CT data sets. The 3D root mean square deviation to a reference image could be reduced for all cases by an average of 50 % (min 16 %, max 76 %). Image quality improvement is shown for clinical whole heart data sets acquired on an interventional C-arm system.

Inspiring health worker motivation with supportive supervision: a survey of lady health supervisor motivating factors in rural Pakistan.

PubMed

Rabbani, Fauziah; Shipton, Leah; Aftab, Wafa; Sangrasi, Kashif; Perveen, Shagufta; Zahidie, Aysha

2016-08-17

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision. Twenty-nine lady health supervisors enrolled in Nigraan completed open-ended structured surveys with questions exploring factors that affect their motivation. Thematic analysis was conducted using a conceptual framework categorizing motivating factors at individual, community, and health system levels. Supportive supervision, recognition, training, logistics, and salaries are community and health system motivating factors for lady health supervisors. Lady health supervisors are motivated by both their role in providing supportive supervision to lady health workers and by the supervisory support received from their coordinators and managers. Family support, autonomy, and altruism are individual level motivating factors. Health system factors, including supportive supervision, are crucial to improving lady health supervisor motivation. As health worker motivation influences their performance, evaluating the impact of health system interventions on community health worker motivation is important to improving the effectiveness of community health worker programs.

Evaluation of a tuberculosis active case finding project in peri-urban areas, Myanmar: 2014-2016.

PubMed

Aye, Sandar; Majumdar, Suman S; Oo, Myo Minn; Tripathy, Jaya Prasad; Satyanarayana, S; Kyaw, Nang Thu Thu; Kyaw, Khine Wut Yee; Oo, Nay Lynn; Thein, Saw; Thu, Myat Kyaw; Soe, Kyaw Thu; Aung, Si Thu

2018-05-01

We assessed the effect of an active case finding (ACF) project on tuberculosis (TB) case notification and the yields from a household and neigbourhood intervention (screening contacts of historical index TB patients diagnosed >24months ago) and a community intervention (screening attendants of health education sessions/mobile clinics). Cross-sectional analysis of project records, township TB registers and annual TB reports. In the household and neigbourhood intervention, of 56,709 people screened, 1,076 were presumptive TB and 74 patients were treated for active TB with a screening yield of 0.1% and a yield from presumptive cases of 6.9%. In the community intervention, of 162,881 people screened, 4,497 were presumptive TB and 984 were treated for active TB with a screening yield of 0.6% and yield from presumptive cases of 21.9%. Of active TB cases, 94% were new, 89% were pulmonary, 44% were bacteriologically-confirmed and 5% had HIV. Case notification rates per 100,000 in project townships increased from 142 during baseline (2011-2013) to 148 during intervention (2014-2016) periods. The yield from household and neigbourhood intervention was lower than community intervention. This finding highlights reconsidering the strategy of screening of contacts from historical index cases. Strategies to reach high-risk groups should be explored for future ACF interventions to increase yield of TB. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

The Urban Context: A Place to Eliminate Health Disparities and Build Organizational Capacity

PubMed Central

GILBERT, KEON L.; QUINN, SANDRA CROUSE; FORD, ANGELA F.; THOMAS, STEPHEN B.

2011-01-01

This study seeks to examine the process of building the capacity to address health disparities in several urban African American neighborhoods. An inter-organizational network consisting of a research university, community members, community organizations, media partners, and foundations was formed to develop a community-based intervention designed to provide health promotion and disease prevention strategies for type 2 diabetes and hypertension. In-depth qualitative interviews (n = 18) with foundation executives and project directors, civic organization leadership, community leaders, county epidemiologist, and university partners were conducted. Our study contextualizes a process to build a public health partnership using cultural, community, organizational, and societal factors necessary to address health disparities. Results showed 5 important factors to build organizational capacity: leadership, institutional commitment, trust, credibility, and inter-organizational networks. These factors reflected other important organizational and community capacity indicators such as: community context, organizational policies, practices and structures, and the establishment of new commitments and partnerships important to comprehensively address urban health disparities. Understanding these factors to address African American health disparities will provide lessons learned for health educators, researchers, practitioners, foundations, and communities interested in building and sustaining capacity efforts through the design, implementation, and maintenance of a community-based health promotion intervention. PMID:21271434

Implementation of standardized nomenclature in the electronic medical record.

PubMed

Klehr, Joan; Hafner, Jennifer; Spelz, Leah Mylrea; Steen, Sara; Weaver, Kathy

2009-01-01

To describe a customized electronic medical record documentation system which provides an electronic health record, Epic, which was implemented in December 2006 using standardized taxonomies for nursing documentation. Descriptive data is provided regarding the development, implementation, and evaluation processes for the electronic medical record system. Nurses used standardized nursing nomenclature including NANDA-I diagnoses, Nursing Interventions Classification, and Nursing Outcomes Classification in a measurable and user-friendly format using the care plan activity. Key factors in the success of the project included close collaboration among staff nurses and information technology staff, ongoing support and encouragement from the vice president/chief nursing officer, the ready availability of expert resources, and nursing ownership of the project. Use of this evidence-based documentation enhanced institutional leadership in clinical documentation.

Lessons learned from a lateral violence and team-building intervention.

PubMed

Barrett, Ann; Piatek, Carolyn; Korber, Susan; Padula, Cynthia

2009-01-01

Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. Key to a cohesive environment is an effective nurse manager able to drive and sustain change.

Small, medium, large or supersize? The development and evaluation of interventions targeted at portion size

PubMed Central

Vermeer, W M; Steenhuis, I H M; Poelman, M P

2014-01-01

In the past decades, portion sizes of high-caloric foods and drinks have increased and can be considered an important environmental obesogenic factor. This paper describes a research project in which the feasibility and effectiveness of environmental interventions targeted at portion size was evaluated. The studies that we conducted revealed that portion size labeling, offering a larger variety of portion sizes, and proportional pricing (that is, a comparable price per unit regardless of the size) were considered feasible to implement according to both consumers and point-of-purchase representatives. Studies into the effectiveness of these interventions demonstrated that the impact of portion size labeling on the (intended) consumption of soft drinks was, at most, modest. Furthermore, the introduction of smaller portion sizes of hot meals in worksite cafeterias in addition to the existing size stimulated a moderate number of consumers to replace their large meals by a small meal. Elaborating on these findings, we advocate further research into communication and marketing strategies related to portion size interventions; the development of environmental portion size interventions as well as educational interventions that improve people's ability to deal with a ‘super-sized' environment; the implementation of regulation with respect to portion size labeling, and the use of nudges to stimulate consumers to select healthier portion sizes. PMID:25033959

Small, medium, large or supersize? The development and evaluation of interventions targeted at portion size.

PubMed

Vermeer, W M; Steenhuis, I H M; Poelman, M P

2014-07-01

In the past decades, portion sizes of high-caloric foods and drinks have increased and can be considered an important environmental obesogenic factor. This paper describes a research project in which the feasibility and effectiveness of environmental interventions targeted at portion size was evaluated. The studies that we conducted revealed that portion size labeling, offering a larger variety of portion sizes, and proportional pricing (that is, a comparable price per unit regardless of the size) were considered feasible to implement according to both consumers and point-of-purchase representatives. Studies into the effectiveness of these interventions demonstrated that the impact of portion size labeling on the (intended) consumption of soft drinks was, at most, modest. Furthermore, the introduction of smaller portion sizes of hot meals in worksite cafeterias in addition to the existing size stimulated a moderate number of consumers to replace their large meals by a small meal. Elaborating on these findings, we advocate further research into communication and marketing strategies related to portion size interventions; the development of environmental portion size interventions as well as educational interventions that improve people's ability to deal with a 'super-sized' environment; the implementation of regulation with respect to portion size labeling, and the use of nudges to stimulate consumers to select healthier portion sizes.

Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD).

PubMed

Ayala, Guadalupe X; Ibarra, Leticia; Binggeli-Vallarta, Amy; Moody, Jamie; McKenzie, Thomas L; Angulo, Janette; Hoyt, Helina; Chuang, Emmeline; Ganiats, Theodore G; Gahagan, Sheila; Ji, Ming; Zive, Michelle; Schmied, Emily; Arredondo, Elva M; Elder, John P

2015-02-01

Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

Exercise intervention and cardiovascular risk factors in obese children. Comparison between obese youngsters taking part in a physical activity school-based programme with and without individualised diet counselling: the ACORDA project.

PubMed

Aires, Luísa; Silva, Gustavo; Martins, Clarice; Marques, Elisa; Lagoa, Maria João; Ribeiro, José Carlos; Rêgo, Carla; Nascimento, Henrique; Pereira, Petronila Rocha; Santos-Silva, Alice; Belo, Luís; Mota, Jorge

2016-05-01

To determine the effects of a school-based exercise intervention programme on cardiovascular risk factors, including body fat (BF), metabolic profile and physical activity (PA) in children with and without individualised dietary counselling approach (IDC and WIDC). Forty-six overweight children from 6-16 years old (25 girls, 54.3%; age = 10.3 ± 2.8) of six schools took part in an 8-month interdisciplinary, school-based intervention programme. All children were engaged in PA classes, but only one group was exposed to individualised counselling. Blood pressure (BP), lipids and lipoproteins, accelerometer-based PA, percentage of body fat (%BF) and trunk fat (%TF) measures were taken before and after intervention. General Linear Model (Repeated Measures ANOVA) adjusted for age, maturation and height change was used to analyse the longitudinal effect of individualised counselling between two evaluations in each group. Favourable changes were observed for %BF, %TF, systolic BP and total cholesterol in the IDC group. Subjects WIDC only increased light and moderate-vigorous PA. In IDC, significant effects for time * group interactions were found for systolic BP, total cholesterol and LDL-cholesterol, indicating that counselling might add favourable changes in these markers, beyond those explained by PA and growth. School-based interventions can contribute to counteracting obesity in youth, particularly when individualised dietary counselling is provided. Therefore, the link between schools and professional counselling should be strengthened to ensure consolidated changes towards healthy behaviours.

Our Choice/Nuestra Opción: The Imperial County, California, Childhood Obesity Research Demonstration Study (CA-CORD)

PubMed Central

Ibarra, Leticia; Binggeli-Vallarta, Amy; Moody, Jamie; McKenzie, Thomas L.; Angulo, Janette; Hoyt, Helina; Chuang, Emmeline; Ganiats, Theodore G.; Gahagan, Sheila; Ji, Ming; Zive, Michelle; Schmied, Emily; Arredondo, Elva M.; Elder, John P.

2015-01-01

Abstract Background: Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. Methods: CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. Conclusions: Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status. PMID:25584664

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

PubMed Central

Engels, Yvonne; van den Hombergh, Pieter; Mokkink, Henk; van den Hoogen, Henk; van den Bosch, Wil; Grol, Richard

2006-01-01

Aim To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. Design of study Randomised controlled trial. Setting Twenty-six intervention and 23 control primary care practices in the Netherlands. Method Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. Results Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. Conclusion The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument. PMID:17007709

Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India.

PubMed

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Gupta, Madhu; Thakur, Jarnail Singh

2017-07-01

To raise the quality of counselling by community health volunteers resulting in improved uptake of maternal, neonatal and child health services (MNCH), an m-health application was introduced under a project named 'Reducing Maternal and Newborn Deaths (ReMiND)' in district Kaushambi in India. We report the impact of this project on coverage of key MNCH services. A pre- and post-quasi-experimental design was undertaken to assess the impact of intervention. This project was introduced in two community development blocks in Kaushambi district in 2012. Two other blocks from the same district were selected as controls after matching for coverage of two indicators at baseline - antenatal care and institutional deliveries. The Annual Health Survey conducted by the Ministry of Health and Family Welfare in 2011 served as pre-intervention data, whereas a household survey in four blocks of Kaushambi district in 2015 provided post-intervention coverage of key services. Propensity score matched samples from intervention and control areas in pre-intervention and post-intervention periods were analysed using difference-in-difference method to estimate the impact of ReMiND project. We found a statistically significant increase in coverage of iron-folic acid supplementation (12.58%), self-reporting of complication during pregnancy (13.11%) and after delivery (19.6%) in the intervention area. The coverage of three or more antenatal care visits, tetanus toxoid vaccination, full antenatal care and ambulance usage increased in intervention area by 10.3%, 4.28%, 1.1% and 2.06%, respectively; however, the changes were statistically insignificant. Three of eight services which were targeted for improvement under ReMiND project registered a significant improvement as result of m-health intervention. © 2017 John Wiley & Sons Ltd.

Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

PubMed

Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

2013-01-01

Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual involvement in research activities (χ(2)=5.23, p=0.019), consultation with colleagues from other EDs (χ(2)=6.37, p=0.01) and perception of organizational expectations to use research evidence to guide practice (χ(2)=5.52, p=0.015). Most clinicians (95/105 or 92%) reported relying on colleagues from their own ED as a primary knowledge source. Urban clinicians were more likely than their rural counterparts to perceive that use of research evidence to guide practice was an expectation. Rural clinicians were more likely to rely on physicians from their own ED as a preferred knowledge source. The decision made by emergency clinicians to participate in a Web-based knowledge exchange intervention was influenced by a number of individual and contextual factors. Differences in these factors and preferences for knowledge sources require further characterization to enhance engagement of rural ED clinicians in online knowledge exchange interventions.

SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

PubMed

Cranley, Lisa A; Hoben, Matthias; Yeung, Jasper; Estabrooks, Carole A; Norton, Peter G; Wagg, Adrian

2018-03-12

Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.

Investigating shadows: a pedagogical intervention project with primary school children

NASA Astrophysics Data System (ADS)

Noversa, Silvana; Abreu, Cátia; Varela, Paulo; Costa, Manuel F. M.

2014-07-01

This communication results from a pedagogical intervention project, carried out at a primary school in the district of Braga - Portugal. The intervention took place in a class of the 3rd year, composed of 16 students, and it incorporated the practice of inquiry-based science teaching addressing the theme "Light Experiments", which is part of the "Environmental Studies" curricular area. Various class activities were planned and implemented concerning some of the factors that influence the shadow of an object, in order to find answers to the following three questions: a) will 3rd year students, aged 7/8 years, be able to construct and execute an investigation strategy that involves manipulating and controlling variables? b) what are the main difficulties experienced by students in the designing and execution of such a strategy? c) how will students, in interaction with the teacher and with their peers, gradually design and execute their investigation strategy in order to respond to the problem formulated? The project adopted an action research methodology. A careful record was kept of the events most relevant to the questions under study in each class. This data was used to prepare the class diaries - descriptive and reflective narratives prepared based on recorded audio and field notes made during participant observation in the context of the classroom. A content analysis of the diaries has identified a few elements that provide answers to the research questions raised. In order to plan and implement a research project with children in the 7/8 years old range require a high level of scaffolding to allow students to gradually build a coherent strategy to tackle the research problem. Teacher's role is crucial. The teacher, by questioning and inducing reasoning and discussion, promotes encourages and regulates the cognitive activity of students. Some level of autonomy should be given to the students in large group collaborative work.

PEPFAR support of alcohol-HIV prevention activities in Namibia and Botswana: a framework for investigation, implementation and evaluation.

PubMed

Glenshaw, M; Deluca, N; Adams, R; Parry, C; Fritz, K; Du Preez, V; Voetsch, K; Lekone, P; Seth, P; Bachanas, P; Grillo, M; Kresina, T F; Pick, B; Ryan, C; Bock, N

2016-01-01

The association between harmful use of alcohol and HIV infection is well documented. To address this dual epidemic, the US President's Emergency Plan for AIDS Relief (PEPFAR) developed and implemented a multi-pronged approach primarily in Namibia and Botswana. We present the approach and preliminary results of the public health investigative and programmatic activities designed, initiated and supported by PEPFAR to combat the harmful use of alcohol and its association as a driver of HIV morbidity and mortality from 2008 to 2013. PEPFAR supported comprehensive alcohol programming using a matrix model approach that combined the socio-ecological framework and the Alcohol Misuse Prevention and Intervention Continuum. This structure enabled seven component objectives: (1) to quantify harmful use of alcohol through rapid assessments; (2) to develop and evaluate alcohol-based interventions; (3) to promote screening programs and alcohol abuse resource services; (4) to support stakeholder networks; (5) to support policy interventions and (6) structural interventions; and (7) to institutionalize universal prevention messages. Targeted PEPFAR support for alcohol activities resulted in several projects to address harmful alcohol use and HIV. Components are graphically conceptualized within the matrix model, demonstrating the intersections between primary, secondary and tertiary prevention activities and individual, interpersonal, community, and societal factors. Key initiative successes included leveraging alcohol harm prevention activities that enabled projects to be piloted in healthcare settings, schools, communities, and alcohol outlets. Primary challenges included the complexity of multi-sectorial programming, varying degrees of political will, and difficulties monitoring outcomes over the short duration of the program.

Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial.

PubMed

Norlund, Fredrika; Olsson, Erik Mg; Pingel, Ronnie; Held, Claes; Svärdsudd, Kurt; Gulliksson, Mats; Burell, Gunilla

2017-06-01

Background The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aim of this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vital exhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events. Methods A total of 362 patients were randomly assigned to intervention or usual care groups. The psychological outcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of the outcomes were analysed using joint modelling of the longitudinal and time to event data. Results The intervention had a positive effect on somatic anxiety ( p < 0.05), reflecting a beneficial development over time compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time. Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events. Conclusions The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustion or depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardiovascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, the mechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

Rationale and design of Mi-CARE: The mile square colorectal cancer screening, awareness and referral and education project.

PubMed

Buscemi, Joanna; Miguel, Yazmin San; Tussing-Humphreys, Lisa; Watts, Elizabeth A; Fitzgibbon, Marian L; Watson, Karriem; Winn, Robert A; Matthews, Kameron L; Molina, Yamile

2017-01-01

Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino, low-income and uninsured/underinsured patients. Barriers to screening include cost, access to health care facilities, lack of recommendation to screen, and psychosocial factors such as embarrassment, fear of the test, anxiety about testing preparation and fear of a cancer diagnosis. Various intervention approaches to improve CRC screening rates have been developed. However, comparative effectiveness research (CER) to investigate the relative performance of different approaches has been understudied, especially across different real-life practice settings. Assessment of differential efficacy across diverse vulnerable populations is also lacking. The current paper describes the rationale and design for the Mile Square Colorectal Cancer Screening, Awareness and Referral and Education Project (Mi-CARE), which aims to increase CRC screening rates in 3 clinics of a large Federally Qualified Health Center (FQHC) by reducing prominent barriers to screening for low-income, minority and underserved patients. Patients attending these clinics will receive one of three interventions to increase screening uptake: lay patient navigator (LPN)-based navigation, provider level navigation, or mailed birthday CRC screening reminders. The design of our program allows for comparison of the effectiveness of the tailored interventions across sites and patient populations. Data from Mi-CARE may help to inform the dissemination of tailored interventions across FQHCs to reduce health disparities in CRC. Copyright © 2016 Elsevier Inc. All rights reserved.

[Non transmissible chronic diseases. A preventive approach].

PubMed

Berríos, X

1991-03-01

Non transmissible chronic diseases, accidents and violence cause 70-80% of deaths in developed countries and 40-50% in underdeveloped ones, including Chile. Their relative contribution to mortality in Chile has increased from 34% to 64% in the last 30 years. Prevention is possible by controlling risk factors such as smoking, alcohol, obesity, hypertension and hypercholesterolemia. Preventive programs should be implemented based on available studies of the epidemiology of risk factors in our country. Population intervention to obtain better health habits and special actions for individuals with risks factors must be employed. Local health services, the community and the media must participate, the cornerstone of the program being population education, particularly those of younger age. A model to be followed is the Interhealth Project, sponsored by WHO and led by Finland (North Karelia).

Substance abuse intervention for health care workers: a preliminary report.

PubMed

Lapham, S C; Chang, I; Gregory, C

2000-05-01

The Workplace Managed Care Cooperative Agreement project targets 3,300 health care professionals in hospital, specialty clinic, and primary care settings located in metropolitan New Mexico communities. This project will evaluate whether enhancements to existing substance abuse prevention/early intervention programs can prevent the onset of risky drinking, reduce prevalence of risky drinking, better identify employees who abuse alcohol and drugs, and improve employee wellness. This article describes one such enhancement (Project WISE [Workplace Initiative in Substance Education]), implemented at Lovelace Health Systems. Project WISE includes relatively low-cost elements such as substance abuse awareness training, information on how to reduce drinking, and brief motivational counseling. Evaluation will consist of baseline comparisons of the intervention and comparison sites, a process evaluation, a qualitative analysis using focus groups, and an outcome evaluation using health and work records. Methodological challenges, solutions, and implications for researchers undertaking similar projects are presented.

A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT).

PubMed

Larsen, Mark Erik; Shand, Fiona; Morley, Kirsten; Batterham, Philip J; Petrie, Katherine; Reda, Bill; Berrouiguet, Sofian; Haber, Paul S; Carter, Gregory; Christensen, Helen

2017-12-13

Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway. ©Mark Erik Larsen, Fiona Shand, Kirsten Morley, Philip J. Batterham, Katherine Petrie, Bill Reda, Sofian Berrouiguet, Paul S. Haber, Gregory Carter, Helen Christensen. Originally published in JMIR Mental Health (http://mental.jmir.org), 13.12.2017.

[Improve the accessibility of essential drugs for the populations of one medical region in Burkina Faso].

PubMed

Ridde, Valéry; Nitièma, Abdoulaye P; Dadjoari, Moussa

2005-01-01

Despite the formulation of the Bamako initiative in 1992 in Burkina Faso, not until 2001 and the launching of a project by a nongovernmental organization was the policy really implemented in a region of the country. One of the goals of this policy is to improve access to health care by using generic essential drugs. The objective of this article is to summarize the results of the evaluation of the project's ability to improve the population's access to drugs. The project lasted three years (2001-2003) and the interventions took place in 41 basic health centres of three districts. According to WHO, improving access to drugs requires consideration of four essential factors: rational use, affordable prices, financial viability, and effectiveness of the distribution. The average number of drugs prescribed per prescription sheet (n = 1061) was 2.4; 93% of the drugs were prescribed by their generic name (international non-proprietary names); 44% of infant diarrheas were treated with oral rehydration salt. National drug prices were respected but not the directives aiming at exempting from payment or subsidizing certain population sub-groups (children, indigents). The average annual cash flow of the basic health centres was 1.2 million F CFA and it increased by 854% compared to the beginning of the project. The cost-recovery scheme for administrative expenses was 106%. The average annual availability of the 10 essential drugs was 89%. Utilization rates increased (0.13 in 1999 to 0.21 in 2003) but not significantly differently than in other basic health centres of the area not supported by the project (p = 0.084). The project succeeded in improving access to these drugs for the overall population but not for the worst-off. The drugs are now geographically available for all and financially accessible for those who can afford to pay. The intervention strategy supported the sustainability of the project's activities but much remains to be done to provide the poorest with access to drugs.

Similarities and Differences Matter: Considering the Influence of Gender on HIV Prevention Programs for Young Adults in an Urban HBCU.

PubMed

Lindong, Ian; Edwards, Lorece; Dennis, Sabriya; Fajobi, Olaoluwa

2017-01-29

Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) disproportionately burdens African American youth and young adults. In studies conducted in Historically Black Colleges and Universities (HBCU) settings, African American youth generally perceive themselves as having a low risk of contracting HIV and sexually transmitted diseases (STDs) despite having higher rates of unprotected sexual encounters, multiple sex partners, and particularly low rates of HIV testing and awareness of HIV status. These findings position HBCUs in a pivotal role for theory-based research and practice to modify behaviors in order to decrease HIV acquisition risk. Get Students Mobilized and Retooled to Transform (SMART) is an interventional research project in an urban HBCU in a northeastern metropolitan area in the US. The project is designed to assess and then address irresponsible behavior among students on college campuses that leads to illicit drug use, excessive alcohol consumption and underage drinking, and risky sexual behaviors that increase the likelihood of acquiring HIV and STDs. As gender plays a critical role in interventions, this article explores gender similarities and differences to inform the planning and implementation of Get SMART and any subsequent projects that address substance and alcohol use and HIV in an HBCU setting. Survey research was conducted to find similar and different factors that may be valuable in implementing and tailoring evidence-based interventions in a predominantly African American campus setting. Survey results revealed that more young adult women consume alcohol and use marijuana than young adult men. Young adult men were also more likely to be tested for HIV when compared to young adult women.

An Examination of Participants Who Develop an Eating Disorder Despite Completing an Eating Disorder Prevention Program: Implications for Improving the Yield of Prevention Efforts

PubMed Central

Stice, Eric; Rohde, Paul

2014-01-01

Numerous trials provide support for the Body Project, an eating disorder prevention program wherein young women with body image concerns critique the thin ideal. Despite medium to large effects, some participants subsequently develop an eating disorder, suggesting that intervention or recruitment procedures could be improved. This study investigated baseline and acute intervention predictors of DSM-5 eating disorder development during a 3-year follow-up among Body Project participants. Combined data from two trials compare participants who experienced eating disorder onset during follow-up (n=20) to those who did not (n=216). Participants who did versus did not develop an eating disorder started the intervention with higher eating disorder symptoms (η2=0.08), negative affect (η2=0.06), thin-ideal internalization (η2=0.02), and body dissatisfaction (η2=0.02); the same baseline predictors of eating disorder onset emerged in controls. Attenuated pre–post reductions in eating disorder symptoms (η2=0.01) predicted eating disorder onset but not after controlling for baseline levels. Given that Body Project and control participants who later developed an eating disorder started with initial elevations in risk factors and eating disorder symptoms, it might be useful to develop a more intensive variant of this program for those exhibiting greater risk at baseline and to deliver the prevention program earlier to prevent initial escalation of risk. The fact that nonresponders also showed greater negative affect and eating disorder symptoms suggests that it might be useful to add activities to improve affect and increase dissonance about disordered eating. PMID:25342026

Development of the Oxford Hills Healthy Moms Project using a social marketing process: a community-based physical activity and nutrition intervention for low-socioeconomic-status mothers in a rural area in Maine.

PubMed

Dharod, Jigna M; Drewette-Card, Rebecca; Crawford, David

2011-03-01

A physical activity and nutrition community intervention called the Oxford Hills Healthy Moms (OHHM) Project was developed using a multifaceted social marketing process, including review of state surveillance results, key informant interviews, and a survey and focus group discussions with low-socioeconomic-status (low-SES) mothers. This formative work was used to make key decisions on the selection of the intervention region, segmentation of the audience, and design of intervention strategies addressing multiple levels of the socioecological model. The OHHM Project aims to increase fruit and vegetable consumption and physical activity levels among low-SES mothers in the Oxford Hills region of Maine. The OHHM Project includes five components: (a) physical activity buddy program, (b) cooking club with education, (c) fruit and vegetable discount buying club with education, (d) increased access to produce vendors, and (e) increased access to places for physical activity.

AIDS Community Demonstration Projects for HIV prevention among hard-to-reach groups.

PubMed Central

O'Reilly, K R; Higgins, D L

1991-01-01

The AIDS Community Demonstration Projects are multicenter prevention projects directing community-based interventions to members of hard-to-reach groups at risk of infection from human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The projects are supported by the Centers for Disease Control (CDC). Interventions are derived from theories of behavior change and have as their goal reducing HIV and other sexually transmitted diseases in the communities. The current objectives, intentionally narrow to improve the project's specificity and clarity, are to increase the use of condoms in sexual activity and the use of bleach to clean injecting drug equipment. Additional objectives may be added. The impact of the interventions is seen in increases in the use of HIV counseling and testing services, decreases in all or specific sexual and drug-use risk behaviors, and requests for related social and public health services. A quasi-experimental research design is being used to evaluate the projects. Multiple evaluation measures are used, including a street-based interview with randomly identified respondents in both intervention and control communities. Success in facilitating HIV and AIDS risk reduction is being measured using a model of behavior change describing stages of change. Upon successful completion of these projects in 1994, CDC may be able to offer models of effective, feasible, and easy-to-monitor State and local health departments and community-based organizations. PMID:1659721

New way of working: Professionals' expectations and experiences of the Culture and Health Project for clients with psychiatric disabilities: A focus group study.

PubMed

Wästberg, Birgitta A; Sandström, Boel; Gunnarsson, Anna Birgitta

2018-02-01

There is a need for various types of interventions when meeting needs of clients with psychiatric disabilities and complementary interventions may also influence their well-being. The Culture and Health project, based on complementary interventions with 270 clients, was created in a county in Sweden for clients with psychiatric disabilities and for professionals to carry out the interventions. The aim of this study was to investigate the professionals' expectations regarding the project and their clients' possibilities for participating, and to investigate the professionals' experiences of the project after its completion. Focus group data with a total of 30 professionals participating were collected. A qualitative content analysis revealed four categories of the professionals' expectations before entering the project: "Clients' own possibilities and limitations for their development and independence", "Professionals' possibilities for supporting the clients", "Societal prerequisites", and "Expectations of a new way of working". Furthermore, the analysis regarding professionals' experiences after working with the project revealed three categories: "Adopting the challenges", "Having ways of working that function - prerequisites and possibilities", and "Meeting the future - an ambition to continue". Working in the Culture and Health project together with the clients in group-based activities was perceived as beneficial, although challenges arose. When implementing cultural activities, support from stakeholder organisations is needed. © 2017 Australian College of Mental Health Nurses Inc.

Community-based youth tobacco control interventions: cost effectiveness of the Full Court Press project.

PubMed

Ross, Hana; Powell, Lisa M; Bauer, Joseph E; Levy, David T; Peck, Richard M; Lee, Hye-Ryeon

2006-01-01

We evaluated the impact of a community-based tobacco control project that was implemented in the city of Tucson, Arizona, USA, between 1996 and 2001. The project's goal was to reduce the prevalence of youth smoking through change in social norms at schools and in communities and workplaces. As is often the case, these community-based health promotion interventions were implemented in conjunction with other broader programmes, in this case implemented on the state level. Taking into account state level interventions as well as changes in sociodemographic and economic environment over the course of the project (e.g. increases in cigarette prices), we measure the net effect of the intervention in terms of the number of people who quit or did not initiate smoking and by the discounted life-years gained. To establish the value of investing into community-based intervention, we calculated the real discounted cost per quit and per life-year gained of 3789 US dollars and 3942 US dollars, respectively. These compare favourably with the real cost per quit of 4270 US dollars when implementing the 1996 US Clinical Practice Guideline for smoking cessation but exceed the real cost of 2923 US dollars per discounted life-year gained when following the guideline. A sensitivity analysis that assumed 5% programme persistence (i.e. 5% of the programme's impact would last forever in the absence of future funding for the programme), one-third would relapse and that one-third of those who quit may have quit smoking even without the programme, suggested a lower cost per discounted life-year saved of 3476 US dollars. The cost effectiveness of this project compares favourably with other tobacco control interventions. Despite its relatively small target group, this community-based intervention was cost effective.

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

PubMed Central

Higgins, D L; O'Reilly, K; Tashima, N; Crain, C; Beeker, C; Goldbaum, G; Elifson, C S; Galavotti, C; Guenther-Grey, C

1996-01-01

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations. PMID:8862154

[Research priorities and research topics for cardiovascular nursing: the Swiss Research Agenda for Nursing].

PubMed

Mahrer-Imhof, Romy; Imhof, Lorenz

2008-12-01

Cardiovascular diseases are worldwide a major challenge for the health care system and the number one reason for premature mortality and lost life years. Many accomplishments to reduce risk factors and improve treatment in acute and chronic disease and rehabilitation have been initiated by medical research but were also embraced by nursing research, which provided valuable knowledge about supporting risk factor modification and patients' self-management. Nursing research in the cardiovascular field has a long tradition in the US. In Europe cardiovascular nursing research also developed over the past decade, with increasing participation of Swiss nurse researchers. Efforts in this field of cardiovascular nursing have been made to convey projects in nursing research that help to enhance the health of the population sustainably and improve well-being in patients with acute and chronic courses of cardiovascular disease. Scientific knowledge is pivotal in developing evidence-based nursing interventions. Since both the German and the French speaking part of Switzerland have been lacking a literature-based and expert-supported agenda for nursing research, the aim of the Swiss Research Agenda for Nursing (SRAN) project was to develop an agenda providing researchers, funding agencies, and politics with orientation. This article takes the seven priorities of the SRAN project and links them to the topics of risk factor modification, rehabilitation programs, self-care, and patient education. The article presents the first agenda for cardiovascular nursing for the years 2007 to 2017. The agenda will serve to develop an action plan and to promote nursing research projects in the field of cardiovascular nursing in Switzerland.

[Quality Improvement Project: Increasing the Rate of Proper Use of Infant Transferring Warmers].

PubMed

Huang, Hsiu-Yu; Fann, Guei-Ling

2015-10-01

Infant-transferring warmers provide a warm environment and emergency care facilities such ventilators for high-risk infants during transport. Accurate use of this warmer has been demonstrated to reduce rates of neonatal complications and increase rates of survival. This project found that, despite the complaints of nurses that warmers occasionally malfunctioned during the transfer process, warmer functions nearly always tested normal after use. Therefore, the researchers surveyed ward nurses to better understand the underlying reasons for these complaints. Results found that only 68.4% of those surveyed operated the warmer correctly. The reasons for improper use were analyzed and categorized as: Nurse-related factors - lack of warmer operating knowledge and experience in the clinic; System-related factors - lack of a standard operating procedure (SOP) and monitor/audit practices and an incomplete training protocol; Equipment-related factors - lack of an equipment preparation SOP and difficulties in setting the ventilator properly. The purpose of this project was to achieve a 100% rate of proper warmer use among nurses. Through continuous clinical education, we created a standard operating procedure for warmer operation, created a video and poster for warmer users, simplified the equipment preparation SOP, and periodically monitored and checked results. After the intervention, 100% of the nurses were able to use the warmers correctly. Additionally, the rate of satisfaction for nursing-warmer use among the participating nurses increased from 51.4% to 80.6%. This project effectively increased the rate for correctly using transferring warmers among participating nurses and improved the quality of medical care.

Understanding Angiography-Based Aneurysm Flow Fields through Comparison with Computational Fluid Dynamics.

PubMed

Cebral, J R; Mut, F; Chung, B J; Spelle, L; Moret, J; van Nijnatten, F; Ruijters, D

2017-06-01

Hemodynamics is thought to be an important factor for aneurysm progression and rupture. Our aim was to evaluate whether flow fields reconstructed from dynamic angiography data can be used to realistically represent the main flow structures in intracranial aneurysms. DSA-based flow reconstructions, obtained during interventional treatment, were compared qualitatively with flow fields obtained from patient-specific computational fluid dynamics models and quantitatively with projections of the computational fluid dynamics fields (by computing a directional similarity of the vector fields) in 15 cerebral aneurysms. The average similarity between the DSA and the projected computational fluid dynamics flow fields was 78% in the parent artery, while it was only 30% in the aneurysm region. Qualitatively, both the DSA and projected computational fluid dynamics flow fields captured the location of the inflow jet, the main vortex structure, the intrasaccular flow split, and the main rotation direction in approximately 60% of the cases. Several factors affect the reconstruction of 2D flow fields from dynamic angiography sequences. The most important factors are the 3-dimensionality of the intrasaccular flow patterns and inflow jets, the alignment of the main vortex structure with the line of sight, the overlapping of surrounding vessels, and possibly frame rate undersampling. Flow visualization with DSA from >1 projection is required for understanding of the 3D intrasaccular flow patterns. Although these DSA-based flow quantification techniques do not capture swirling or secondary flows in the parent artery, they still provide a good representation of the mean axial flow and the corresponding flow rate. © 2017 by American Journal of Neuroradiology.

Approaching the Practice Quality Improvement Project in Interventional Radiology.

PubMed

Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

2015-12-01

An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Home intervention as a tool for nursing care: evaluation of the satisfaction of the elderly.

PubMed

Nogueira, Iara Sescon; Previato, Giselle Fernanda; Scolari, Giovana Aparecida de Souza; Gomes, Ana Caroline Oliveira; Carreira, Ligia; Baldissera, Vanessa Denardi Antoniassi

2017-04-06

To evaluate the results of home nursing interventions according to the satisfaction of the elderly users. Ex-post facto evaluative, qualitative and descriptive research, conducted from November 2015 to January 2016 with 12 dependent elderly individuals accompanied by an extension project in the city of Maringá, PR, Brazil. Data were collected after home interventions based on the Single-User Treatment Project, by means of semi-structured interviews subjected to content analysis and the theoretical framework of Donabedian. The following thematic categories emerged: "home nursing intervention: synonymous with joy, distraction and bonding" and" home nursing intervention: health and lifestyle transformations". The home nursing interventions had positive results that signal the quality of the provided care.

Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment.

PubMed

Fehrenbacher, Anne E; Chowdhury, Debasish; Ghose, Toorjo; Swendeman, Dallas

2016-10-01

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

Effect of animal-assisted activity on balance and quality of life in home-dwelling persons with dementia.

PubMed

Olsen, Christine; Pedersen, Ingeborg; Bergland, Astrid; Enders-Slegers, Marie-José; Ihlebæk, Camilla

2016-01-01

Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in home-dwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The project was conducted as a prospective and cluster-randomized multicenter trial with a follow-up. 16 adapted day-care centers recruited respectively 42 (intervention group) and 38 (control group with treatment as usual) home-dwelling PWDs. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3-7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall. ClinicalTrial.gov; NCT02008630. Copyright © 2016 Elsevier Inc. All rights reserved.

The Influence of Social Context on Changes in Fruit and Vegetable Consumption: Results of the Healthy Directions Studies

PubMed Central

Sorensen, Glorian; Stoddard, Anne M.; Dubowitz, Tamara; Barbeau, Elizabeth M.; Bigby, JudyAnn; Emmons, Karen M.; Berkman, Lisa F.; Peterson, Karen E.

2007-01-01

As part of the Harvard Cancer Prevention Program Project, we used a social contextual model of health behavior change to test an intervention targeting multiple risk-related behaviors in working-class, multiethnic populations. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in health centers and small business studies. We analyzed change in fruit and vegetable consumption, measured at baseline and final assessments by self-report, in 2 randomized controlled prevention trials: 1 in small businesses (n = 974) and 1 in health centers (n = 1954). Stronger social networks, social norms that were more supportive, food sufficiency, and less household crowding were associated with greater change in fruit and vegetable intake. We also observed differences between our intervention sites. Social context can play an important role in promoting changes in fruit and vegetable consumption. PMID:17538059

A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States.

PubMed

Seligman, Hilary K; Lyles, Courtney; Marshall, Michelle B; Prendergast, Kimberly; Smith, Morgan C; Headings, Amy; Bradshaw, Georgiana; Rosenmoss, Sophie; Waxman, Elaine

2015-11-01

Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity. Project HOPE—The People-to-People Health Foundation, Inc.

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review.

PubMed

Stead, Martine; Angus, Kathryn; Holme, Ingrid; Cohen, David; Tait, Gayle

2009-09-01

Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be. This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement. Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills. The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation. Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe.

Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study.

PubMed

Scheirer, Mary Ann; Santos, Sherie Lou Z; Tagai, Erin K; Bowie, Janice; Slade, Jimmie; Carter, Roxanne; Holt, Cheryl L

2017-03-28

Sustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL. We examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project's management database; and open-ended comments from CHAs, staff, and community partners. Outcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs. The multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts.

Preliminary Effectiveness of Project Impact: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program

ERIC Educational Resources Information Center

Stadnick, Nicole A.; Stahmer, Aubyn; Brookman-Frazee, Lauren

2015-01-01

This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent…

A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women

PubMed Central

Cornell, C. E.; Littleton, M. A.; Greene, P. G.; Pulley, L.; Brownstein, J. N.; Sanderson, B. K.; Stalker, V. G.; Matson-Koffman, D.; Struempler, B.; Raczynski, J. M.

2009-01-01

The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community’s physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention. PMID:19047648

Knowledge of Cervical Cancer Screening among Women across Different Socio-Economic Regions of China.

PubMed

Di, Jiangli; Rutherford, Shannon; Wu, Jiuling; Song, Bo; Ma, Lan; Chen, Jingyi; Chu, Cordia

2015-01-01

China has a high burden of cervical cancer (CC) and wide disparities in CC burden exist among different socio-economic regions. In order to reduce these disparities, China's government launched the National Cervical Cancer Screening Program in Rural Areas (NCCSPRA) in 2009. Understanding the factors associated with underutilization of CC screening among target populations is important to improve the screening participation rate, and a high participation rate is key to achieving the goals of a screening program. However, data on the knowledge of CC among target populations in program areas is lacking in China. This study will investigate the knowledge of CC prevention and control among women in specific project counties to develop a better understanding of factors that might influence CC screening participation in order to improve the implementation of the NCCSPRA. A cross-sectional survey was conducted and face-to-face interview questionnaires were completed by 308 women who received CC screening services in 6 project counties of NCCSPRA across different socio-economic regions of China. ANOVA and Chi-square tests were used to compare the knowledge rates and scores across the different subgroups. Logistic regression was conducted to examine factors associated with knowledge level. The overall CC knowledge rate of the target population was only 19.5%. Regional socio-economic level, advice from doctors, age, and educational status were strong predictors of knowledge level of CC screening. Significantly lower knowledge rates and scores were identified in older women (55-64 years old), less educated women (with primary school or illiterate), women in less developed regions and women who did not receive any advice about screening results from doctors. The knowledge of CC screening among women in the project counties of NCCSPRA was found to be very poor. Given the importance of knowledge in encouraging women to participate in screening is key to reducing CC burden in rural women in China, it is urgent that a targeted health promotion intervention is developed and implemented in project counties, especially targeting older women, women with less education and women in less developed regions, and focus on improving their CC knowledge and encouraging them to communicate with health care providers. The health promotion intervention targeting health care providers is also important to improve their knowledge of CC and provide best advice to women.

Childhood Obesity Research Demonstration Project: Cross-Site Evaluation Methods

PubMed Central

Lee, Rebecca E.; Mehta, Paras; Thompson, Debbe; Bhargava, Alok; Carlson, Coleen; Kao, Dennis; Layne, Charles S.; Ledoux, Tracey; O'Connor, Teresia; Rifai, Hanadi; Gulley, Lauren; Hallett, Allen M.; Kudia, Ousswa; Joseph, Sitara; Modelska, Maria; Ortega, Dana; Parker, Nathan; Stevens, Andria

2015-01-01

Abstract Introduction: The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2–12 years of age. Design/Methods: The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. Conclusions: The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model. PMID:25679060

Individual and family environmental correlates of television and computer time in 10- to 12-year-old European children: the ENERGY-project.

PubMed

Verloigne, Maïté; Van Lippevelde, Wendy; Bere, Elling; Manios, Yannis; Kovács, Éva; Grillenberger, Monika; Maes, Lea; Brug, Johannes; De Bourdeaudhuij, Ilse

2015-09-18

The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway). Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child-parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age. In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway. Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children's individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country.

Lessons Learned From Dissemination of Evidence-Based Interventions for HIV Prevention.

PubMed

Collins, Charles B; Sapiano, Tobey N

2016-10-01

In 1999, IOM issued a report that recommended that the Centers for Disease Control and Prevention should disseminate evidence-based HIV prevention interventions (EBIs) to be implemented by health departments, community-based organizations, drug treatment centers, and clinics. Based on these recommendations, the Diffusion of Effective Behavioral Interventions Project was initiated in 2000 and began disseminating interventions into public health practice. For 15 years, the Centers for Disease Control and Prevention has disseminated 29 EBIs to more than 11,300 agencies. Lessons were identified during the 15 years of implementation regarding successful methods of dissemination of EBIs. Lessons around selecting interventions for dissemination, developing a dissemination infrastructure including a resource website (https://effectiveinterventions.cdc.gov), and engagement with stakeholders are discussed. A continuous development approach ensured that intervention implementation materials, instructions, and technical assistance were all tailored to the needs of end users, focus populations, and agency capacities. Six follow-up studies demonstrated that adopters of EBIs were able to obtain comparable outcomes to those of the original efficacy research. The Diffusion of Effective Behavioral Interventions Project may offer guidance for other large, national, evidence-based public health dissemination projects. Published by Elsevier Inc.

A framework for addressing implementation gap in global drowning prevention interventions: experiences from Bangladesh.

PubMed

Hyder, Adnan A; Alonge, Olakunle; He, Siran; Wadhwaniya, Shirin; Rahman, Fazlur; El Arifeen, Shams

2014-12-01

Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning-global funding, political will, scale, sustainability, and capacity building; (ii) engaging-coordination, involvement of appropriate individuals; (iii) executing-focused action, multisectoral actions, quality of execution; and (iv) evaluating-rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings.

Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project.

PubMed

Esperato, Alexo; Bishai, David; Hyder, Adnan A

2012-01-01

The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.

Suicide prevention as a community development process: understanding circumpolar youth suicide prevention through community level outcomes.

PubMed

Allen, James; Mohatt, Gerald; Fok, Carlotta Ching Ting; Henry, David

2009-06-01

Community-based models have become increasingly prominent in prevention, and have special relevance for suicide prevention in circumpolar Indigenous communities. It follows that outcomes from circumpolar suicide prevention programs might be more completely understood at the community level. We present here a methodology for analysis at this level. This paper seeks to understand a cultural prevention program for rural Yup'ik youth in Alaska targeting suicide and co-occurring alcohol abuse as a community development process through changes at the community level. Quasi-experimental design with assessment at pre- and post-intervention or at 4 time points. The community development process for this project began in October 2004. The first program baseline assessment began in November 2006, prior to prevention activities with youth and parents, and the post-intervention assessment concluded in March 2008. Five key informants pre- and post-intervention completed a community readiness assessment, which is a structured procedure assessing a community's awareness of suicide as an issue and its, organizational readiness for prevention programming. Forty-three adult caregivers or sponsors of youth in the prevention program completed an assessment of behaviours that contributed to community protective factors from youth suicide and alcohol abuse at 4 time points before, during and after the intervention. The 54 youth who participated in the prevention program completed an assessment of community protective factors, also at 4 time points before, during and after the intervention. The community protective factors from suicide that were assessed included safety, enforcement of alcohol prohibitions, role models, support and opportunities for youth. Community readiness for the prevention efforts increased to new developmental stages of readiness post-intervention, and a trend in the data suggested community protective factors increased in the amount of protective behaviours performed by adults (slope estimate = 0.0162, 95% CI--0.0028-0.0351, d=.55) and in the perceptions of youth (slope estimate=0.0148, 95% CI--0.0004-0.0291, d=.45), in a dose response relationship to the number of prevention program sessions attended by adults and youth. Using data from a feasibility study, this paper demonstrates the feasibility and potential utility of methodological approaches that use community-level variables beyond individual level outcomes in circumpolar suicide prevention research.

High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level

PubMed Central

2013-01-01

Background High risk prescribing can compromise independent wellbeing and quality of life in older adults. The aims of this project are to determine the prevalence, risk factors, clinical consequences, and costs of high risk prescribing, and to assess the impact of interventions on high risk prescribing in older people. Methods The proposed project will utilise data from the 45 and Up Study, a large scale cohort of 267,153 men and women aged 45 and over recruited during 2006–2009 from the state of New South Wales, Australia linked to a range of administrative health datasets. High risk prescribing will be assessed using three indicators: polypharmacy (use of five or more medicines); Beers Criteria (an explicit measure of potentially inappropriate medication use); and Drug Burden Index (a pharmacologic dose-dependent measure of cumulative exposure to anticholinergic and sedative medicines). Individual risk factors from the 45 and Up Study questionnaire, and health system characteristics from health datasets that are associated with the likelihood of high risk prescribing will be identified. The main outcome measures will include hospitalisation (first admission to hospital, total days in hospital, cause-specific hospitalisation); admission to institutionalised care; all-cause mortality, and, where possible, cause-specific mortality. Economic costs to the health care system and implications of high risk prescribing will be also investigated. In addition, changes in high risk prescribing will be evaluated in relation to certain routine medicines-related interventions. The statistical analysis will be conducted using standard pharmaco-epidemiological methods including descriptive analysis, univariate and multivariate regression analysis, controlling for relevant confounding factors, using a number of different approaches. Discussion The availability of large-scale data is useful to identify opportunities for improving prescribing, and health in older adults. The size of the 45 and Up Study, along with linkage to health databases provides an important opportunity to investigate the relationship between high risk prescribing and adverse outcomes in a real-world population of older adults. PMID:23388494

Project on Academic Striving: The Moderation of Stress in the Lives of the Students of an Urban Intermediate School. A Project To Coordinate Research and Environmental Intervention. Final Report to the William T. Grant Foundation. Volume One [and] Volume Two.

ERIC Educational Resources Information Center

Grannis, Joseph C.; Fahs, Mary Ellen

This report evaluates a project that studied social, physical, and academic stress in the lives of students in an inner-city intermediate school and developed interventions to reduce that stress. Over 242 students, most of whom were from low-income families and almost all of whom were black, participated in the project. The following findings are…

Rural Organization of Australian Stroke Teams: Emergency Department project.

PubMed

Wright, A; McGrail, M; Disler, P

2008-08-01

Many junior doctors have poor stroke assessment skills. Although major efforts have gone in to changing the attitudes of clinicians to stroke through the development of guidelines and implementation strategies, the most important step may be to make sure that medical schools include appropriate teaching of this important topic in their curricula. The Rural Organization of Australian Stroke Teams Emergency Department (ROASTED) project sought to determine the effectiveness of a practical intervention to improve the assessment and education of stroke knowledge among our junior emergency department doctors. We used a prospective before and after study of two separate cohorts (intervention vs no intervention) to assess the stroke knowledge of our junior emergency department doctors and to test the effectiveness of an educational intervention. The project took place at five sites in rural Victoria in November 2006. Both cohorts undertook the same two validated quizzes 1 month apart. At the intervention sites two 1-h tutorials were conducted between the quizzes and participants were encouraged to use a web-based educational tool. Pre-project stroke knowledge was shown to be poor at all of the participating sites. At the sites where no intervention took place no improvement in knowledge was shown (z = 0.83, P = 0.41, two-sided Mann-Whitney U-test). The median score for quiz 1 was 8.1 (41%, interquartile range (IQR) 6.5-9.4) and for quiz 2, 7.2 (36%, IQR 5.1-9.3). At the intervention sites, participants significantly improved their stroke knowledge between quiz 1 and quiz 2 (z = 4.75, P < 0.001). The median score for quiz 1 in this cohort was 8.3 (42%, IQR 6.5-10.0) and for quiz 2, 12.8 (64%, IQR 12.0-14.8). This project showed that junior doctors have an inadequate knowledge of stroke and that among our junior emergency department doctors there is a need for the ROASTED intervention and other innovative educational measures.

Increasing High School Student Interest in Science: An Action Research Study

NASA Astrophysics Data System (ADS)

Vartuli, Cindy A.

An action research study was conducted to determine how to increase student interest in learning science and pursuing a STEM career. The study began by exploring 10th-grade student and teacher perceptions of student interest in science in order to design an instructional strategy for stimulating student interest in learning and pursuing science. Data for this study included responses from 270 students to an on-line science survey and interviews with 11 students and eight science teachers. The action research intervention included two iterations of the STEM Career Project. The first iteration introduced four chemistry classes to the intervention. The researcher used student reflections and a post-project survey to determine if the intervention had influence on the students' interest in pursuing science. The second iteration was completed by three science teachers who had implemented the intervention with their chemistry classes, using student reflections and post-project surveys, as a way to make further procedural refinements and improvements to the intervention and measures. Findings from the exploratory phase of the study suggested students generally had interest in learning science but increasing that interest required including personally relevant applications and laboratory experiences. The intervention included a student-directed learning module in which students investigated three STEM careers and presented information on one of their chosen careers. The STEM Career Project enabled students to explore career possibilities in order to increase their awareness of STEM careers. Findings from the first iteration of the intervention suggested a positive influence on student interest in learning and pursuing science. The second iteration included modifications to the intervention resulting in support for the findings of the first iteration. Results of the second iteration provided modifications that would allow the project to be used for different academic levels. Insights from conducting the action research study provided the researcher with effective ways to make positive changes in her own teaching praxis and the tools used to improve student awareness of STEM career options.

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project

PubMed Central

Djellouli, Nehla; Mann, Sue; Nambiar, Bejoy; Meireles, Paula; Miranda, Diana; Barros, Henrique; Bocoum, Fadima Y; Yaméogo, W Maurice E; Yaméogo, Clarisse; Belemkoabga, Sylvie; Tougri, Halima; Coulibaly, Abou; Kouanda, Seni; Mochache, Vernon; Mwakusema, Omar K; Irungu, Eunice; Gichangi, Peter; Dembo, Zione; Kadzakumanja, Angela; Makwenda, Charles Vidonji; Timóteo, Judite; Cossa, Misete G; de Melo, Malica; Griffin, Sally; Osman, Nafissa B; Foia, Severiano; Ogbe, Emilomo; Duysburgh, Els

2017-01-01

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective. PMID:29225949

Rethinking HIV prevention to prepare for oral PrEP implementation for young African women

PubMed Central

Celum, Connie L; Delany-Moretlwe, Sinead; McConnell, Margaret; van Rooyen, Heidi; Bekker, Linda-Gail; Kurth, Ann; Bukusi, Elizabeth; Desmond, Chris; Morton, Jennifer; Baeten, Jared M

2015-01-01

Introduction HIV incidence remains high among young women in sub-Saharan Africa in spite of scale-up of HIV testing, behavioural interventions, antiretroviral treatment and medical male circumcision. There is a critical need to critique past approaches and learn about the most effective implementation of evidence-based HIV prevention strategies, particularly emerging interventions such as pre-exposure prophylaxis (PrEP). Discussion Women in sub-Saharan Africa are at increased risk of HIV during adolescence and into their 20s, in part due to contextual factors including gender norms and relationship dynamics, and limited access to reproductive and sexual health services. We reviewed behavioural, behavioural economic and biomedical approaches to HIV prevention for young African women, with a particular focus on the barriers, opportunities and implications for implementing PrEP in this group. Behavioural interventions have had limited impact in part due to not effectively addressing the context, broader sexual norms and expectations, and structural factors that increase risk and vulnerability. Of biomedical HIV prevention strategies that have been tested, daily oral PrEP has the greatest evidence for protection, although adherence was low in two placebo-controlled trials in young African women. Given high efficacy and effectiveness in other populations, demonstration projects of open-label PrEP in young African women are needed to determine the most effective delivery models and whether women at substantial risk are motivated and able to use oral PrEP with sufficient adherence to achieve HIV prevention benefits. Conclusions Social marketing, adherence support and behavioural economic interventions should be evaluated as part of PrEP demonstration projects among young African women in terms of their effectiveness in increasing demand and optimizing uptake and effective use of PrEP. Lessons learned through evaluations of implementation strategies for delivering oral PrEP, a first-generation biomedical HIV prevention product, will inform development of new and less user-dependent PrEP formulations and delivery of an expanding choice of prevention options in HIV prevention programmes for young African women. PMID:26198350

Design Based Research Methodology for Teaching with Technology in English

ERIC Educational Resources Information Center

Jetnikoff, Anita

2015-01-01

Design based research (DBR) is an appropriate method for small scale educational research projects involving collaboration between teachers, students and researchers. It is particularly useful in collaborative projects where an intervention is implemented and evaluated in a grounded context. The intervention can be technological, or a new program…

Biographies for Artistic and Social Intervention: A Youth-Driven Project

ERIC Educational Resources Information Center

Carvalho, Claudia Pato

2014-01-01

This article discusses how biographical materials may be used in youth arts education projects to develop new methodologies and approaches that can stimulate artistic and social intervention in contemporary urban communities, thus changing the field of arts education policy at the community level. Through their creation of Artistic Society…

IMPACT: An Early Intervention Demonstration Project. Abbreviated Version.

ERIC Educational Resources Information Center

Ungerleider, Steven; Caudill, Barry D.

Project IMPACT is based on an innovative prevention/community intervention model designed to stem the use of drugs and alcohol in an Oregon school district. A total of 74 teachers, administrators, and community leaders participated in a training session which included didactic and experiential sessions informing participants about the nature and…

Cancer Patient and Survivor Research from the Cancer Information Service Research Consortium: A Preview of Three Large Randomized Trials and Initial Lessons Learned

PubMed Central

MARCUS, ALFRED C.; DIEFENBACH, MICHAEL A.; STANTON, ANNETTE L.; MILLER-HALEGOUA, SUZANNE N.; FLEISHER, LINDA; RAICH, PETER C.; MORRA, MARION E.; PEROCCHIA, ROSEMARIE SLEVIN; TRAN, ZUNG VU; BRIGHT, MARY ANNE

2014-01-01

Three large randomized trials are described from the Cancer Information Service Research Consortium (CISRC). Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 is also testing a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the two-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1 = 208, Project 2 = 340, Project 3 = 792). Self-reported use of the multimedia program was 51%, 52% and 67% for Projects 1–3, respectively. Self-reported use of the print materials (read all, most or some) was 90%, 85% and 83% for Projects 1–3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the CISRC interventions, perceived utility and benefit was high, and more than 90% would recommend them to other cancer patients. Five initial lessons learned are presented that may help inform future cancer communications research. PMID:23448232

Cancer patient and survivor research from the cancer information service research consortium: a preview of three large randomized trials and initial lessons learned.

PubMed

Marcus, Alfred C; Diefenbach, Michael A; Stanton, Annette L; Miller, Suzanne M; Fleisher, Linda; Raich, Peter C; Morra, Marion E; Perocchia, Rosemarie Slevin; Tran, Zung Vu; Bright, Mary Anne

2013-01-01

The authors describe 3 large randomized trials from the Cancer Information Service Research Consortium. Three web-based multimedia programs are being tested to help newly diagnosed prostate (Project 1) and breast cancer patients (Project 2) make informed treatment decisions and breast cancer patients prepare for life after treatment (Project 3). Project 3 also tests a telephone callback intervention delivered by a cancer information specialist. All participants receive standard print material specific to each project. Preliminary results from the 2-month follow-up interviews are reported for the initial wave of enrolled participants, most of whom were recruited from the Cancer Information Service (1-800-4-CANCER) telephone information program (Project 1: n =208; Project 2: n =340; Project 3: n =792). Self-reported use of the multimedia program was 51%, 52%, and 67% for Projects 1, 2, and 3, respectively. Self-reported use of the print materials (read all, most, or some) was 90%, 85%, and 83% for Projects 1, 2, and 3, respectively. The callback intervention was completed by 92% of Project 3 participants. Among those using the Cancer Information Service Research Consortium interventions, perceived usefulness and benefit was high, and more than 90% reported that they would recommend them to other cancer patients. The authors present 5 initial lessons learned that may help inform future cancer communications research.

Healthcare Costs Attributable to Hypertension: Canadian Population-Based Cohort Study.

PubMed

Weaver, Colin G; Clement, Fiona M; Campbell, Norm R C; James, Matthew T; Klarenbach, Scott W; Hemmelgarn, Brenda R; Tonelli, Marcello; McBrien, Kerry A

2015-09-01

Accurately documenting the current and future costs of hypertension is required to fully understand the potential economic impact of currently available and future interventions to prevent and treat hypertension. The objective of this work was to calculate the healthcare costs attributable to hypertension in Canada and to project these costs to 2020. Using population-based administrative data for the province of Alberta, Canada (>3 million residents) from 2002 to 2010, we identified individuals with and without diagnosed hypertension. We calculated their total healthcare costs and estimated costs attributable to hypertension using a regression model adjusting for comorbidities and sociodemographic factors. We then extrapolated hypertension-attributable costs to the rest of Canada and projected costs to the year 2020. Twenty-one percent of adults in Alberta had diagnosed hypertension in 2010, with a projected increase to 27% by 2020. The average individual with hypertension had annual healthcare costs of $5768, of which $2341 (41%) were attributed to hypertension. In Alberta, the healthcare costs attributable to hypertension were $1.4 billion in 2010. In Canada, the hypertension-attributable costs were estimated to be $13.9 billion in 2010, rising to $20.5 billion by 2020. The increase was ascribed to demographic changes (52%), increasing prevalence (16%), and increasing per-patient costs (32%). Hypertension accounts for a significant proportion of healthcare spending (10.2% of the Canadian healthcare budget) and is projected to rise even further. Interventions to prevent and treat hypertension may play a role in limiting this cost growth. © 2015 American Heart Association, Inc.

Designing and implementing a socioeconomic intervention to enhance TB control: operational evidence from the CRESIPT project in Peru.

PubMed

Wingfield, Tom; Boccia, Delia; Tovar, Marco A; Huff, Doug; Montoya, Rosario; Lewis, James J; Gilman, Robert H; Evans, Carlton A

2015-08-21

Cash transfers are key interventions in the World Health Organisation's post-2015 global TB policy. However, evidence guiding TB-specific cash transfer implementation is limited. We designed, implemented and refined a novel TB-specific socioeconomic intervention that included cash transfers, which aimed to support TB prevention and cure in resource-constrained shantytowns in Lima, Peru for: the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project. Newly-diagnosed TB patients from study-site healthposts were eligible to receive the intervention consisting of economic and social support. Economic support was provided to patient households through cash transfers on meeting the following conditions: screening for TB in household contacts and MDR TB in patients; adhering to TB treatment and chemoprophylaxis; and engaging with CRESIPT social support (household visits and community meetings). To evaluate project acceptability, quantitative and qualitative feedback was collected using a mixed-methods approach during formative activities. Formative activities included consultations, focus group discussions and questionnaires conducted with the project team, project participants, civil society and stakeholders. Over 7 months, 135 randomly-selected patients and their 647 household contacts were recruited from 32 impoverished shantytown communities. Of 1299 potential cash transfers, 964 (74 %) were achieved, 259 (19 %) were not achieved, and 76 (7 %) were yet to be achieved. Of those achieved, 885/964 (92 %) were achieved optimally and 79/964 (8 %) sub-optimally. Key project successes were identified during 135 formative activities and included: strong multi-sectorial collaboration; generation of new evidence for TB-specific cash transfer; and the project being perceived as patient-centred and empowering. Challenges included: participant confidence being eroded through cash transfer delays, hidden account-charges and stigma; access to the initial bank-provider being limited; and conditions requiring participation of all TB-affected household members (e.g. community meetings) being hard to achieve. Refinements were made to improve project acceptability and future impact: the initial bank-provider was changed; conditional and unconditional cash transfers were combined; cash transfer sums were increased to a locally-appropriate, evidence-based amount; and cash transfer size varied according to patient household size to maximally reduce mitigation of TB-related costs and be more responsive to household needs. A novel TB-specific socioeconomic intervention including conditional cash transfers has been designed, implemented, refined and is ready for impact assessment, including by the CRESIPT project. The lessons learnt during this research will inform policy-makers and decision-makers for future implementation of related interventions.

Results of a Pilot Study to Ameliorate Psychological and Behavioral Outcomes of Minority Stress Among Young Gay and Bisexual Men.

PubMed

Smith, Nathan Grant; Hart, Trevor A; Kidwai, Ammaar; Vernon, Julia R G; Blais, Martin; Adam, Barry

2017-09-01

Project PRIDE (Promoting Resilience In Discriminatory Environments) is an 8-session small group intervention aimed at reducing negative mental and behavioral health outcomes resulting from minority stress. This study reports the results of a one-armed pilot test of Project PRIDE, which aimed to examine the feasibility and potential for efficacy of the intervention in a sample of 33 gay and bisexual men aged 18 to 25. The intervention appeared feasible to administer in two different sites and all participants who completed posttreatment (n = 22) or follow-up (n = 19) assessments reported high satisfaction with the intervention. Small to large effect sizes were observed for increases in self-esteem; small effect sizes were found for decreases in loneliness and decreases in minority stress variables; and small and medium effect sizes were found for reductions in alcohol use and number of sex partners, respectively. Overall, Project PRIDE appears to be a feasible intervention with promise of efficacy. Copyright © 2017. Published by Elsevier Ltd.

Project FIT: A School, Community and Social Marketing Intervention Improves Healthy Eating Among Low-Income Elementary School Children.

PubMed

Alaimo, Katherine; Carlson, Joseph J; Pfeiffer, Karin A; Eisenmann, Joey C; Paek, Hye-Jin; Betz, Heather H; Thompson, Tracy; Wen, Yalu; Norman, Gregory J

2015-08-01

Project FIT was a two-year multi-component nutrition and physical activity intervention delivered in ethnically-diverse low-income elementary schools in Grand Rapids, MI. This paper reports effects on children's nutrition outcomes and process evaluation of the school component. A quasi-experimental design was utilized. 3rd, 4th and 5th-grade students (Yr 1 baseline: N = 410; Yr 2 baseline: N = 405; age range: 7.5-12.6 years) were measured in the fall and spring over the two-year intervention. Ordinal logistic, mixed effect models and generalized estimating equations were fitted, and the robust standard errors were utilized. Primary outcomes favoring the intervention students were found regarding consumption of fruits, vegetables and whole grain bread during year 2. Process evaluation revealed that implementation of most intervention components increased during year 2. Project FIT resulted in small but beneficial effects on consumption of fruits, vegetables, and whole grain bread in ethnically diverse low-income elementary school children.

Development of an Internet-Based Parent Training Intervention for Children with ASD

DTIC Science & Technology

2013-10-01

daily routines and activities. In the second phase of the project (Years 2 and 3), the focus is on pilot testing two delivery methods for the online...evidence-based curriculum that uses a blend of developmental and behavioral intervention strategies during daily routines and activities. In the first...post-treatment during a 10-minute parent-child play session and a snack using the Project ImPACT intervention Fidelity Checklist (n=11). Parents are

Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors?

PubMed

Shaw, William S; Linton, Steven J; Pransky, Glenn

2006-12-01

To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. From 17 recent review articles (2000-2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.

Hydrological Responses of Andean Lakes and Tropical Floodplains to Climate Variability and Human Intervention: an Integrative Modelling Framework

NASA Astrophysics Data System (ADS)

Hoyos, I. C.; González Morales, C.; Serna López, J. P.; Duque, C. L.; Canon Barriga, J. E.; Dominguez, F.

2013-12-01

Andean water bodies in tropical regions are significantly influenced by fluctuations associated with climatic and anthropogenic drivers, which implies long term changes in mountain snow peaks, land covers and ecosystems, among others. Our work aims at providing an integrative framework to realistically assess the possible future of natural water bodies with different degrees of human intervention. We are studying in particular the evolution of three water bodies in Colombia: two Andean lakes and a floodplain wetland. These natural reservoirs represent the accumulated effect of hydrological processes in their respective basins, which exhibit different patterns of climate variability and distinct human intervention and environmental histories. Modelling the hydrological responses of these local water bodies to climate variability and human intervention require an understanding of the strong linkage between geophysical and social factors. From the geophysical perspective, the challenge is how to downscale global climate projections in the local context: complex orography and relative lack of data. To overcome this challenge we combine the correlational and physically based analysis of several sources of spatially distributed biophysical and meteorological information to accurately determine aspects such as moisture sources and sinks and past, present and future local precipitation and temperature regimes. From the social perspective, the challenge is how to adequately represent and incorporate into the models the likely response of social agents whose water-related interests are diverse and usually conflictive. To deal with the complexity of these systems we develop interaction matrices, which are useful tools to holistically discuss and represent each environment as a complex system. Our goal is to assess partially the uncertainties of the hydrological balances in these intervened water bodies we establish climate/social scenarios, using hybrid models that combine the computational power of numerical simulations (of both physical and social components) with interactive responses given by users who define strategies and make decisions in real time, providing valuable information about people's attitudes and choices regarding future climate perspectives. Part of our interest with this project is to effectively transfer the knowledge and scientific information gathered to the communities in a way that is useful and propositive. To this end we developed a website (http://peerlagoscolombia.udea.edu.co) that includes relevant information about the project outcomes. We also developed and installed telemetric hydrologic stations in each site, whose data on water storage levels and basic meteorological variables can be accessed online. Acknowledgement: this project is funded by the USAID-NSF PEER program (First cycle, project 31).

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

PubMed Central

Shaw, Martin; Iwashyna, Theodore J.; Daniel, Malcolm; Devine, Helen; Jarvie, Lyndsey; Kinsella, John; MacTavish, Pamela; Quasim, Tara

2017-01-01

Background Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. Methods Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. Results 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). Conclusions and relevance This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further. PMID:29186177

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention.

PubMed

McPeake, Joanne; Shaw, Martin; Iwashyna, Theodore J; Daniel, Malcolm; Devine, Helen; Jarvie, Lyndsey; Kinsella, John; MacTavish, Pamela; Quasim, Tara

2017-01-01

Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008-2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07-0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment

PubMed Central

Fassier, Jean-Baptiste; Lamort-Bouché, Marion; Broc, Guillaume; Guittard, Laure; Péron, Julien; Rouat, Sabrina; Carretier, Julien; Fervers, Béatrice; Letrilliart, Laurent; Sarnin, Philippe

2018-01-01

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders’ point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of “early intervention.” They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol. PMID:29527521

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment.

PubMed

Fassier, Jean-Baptiste; Lamort-Bouché, Marion; Broc, Guillaume; Guittard, Laure; Péron, Julien; Rouat, Sabrina; Carretier, Julien; Fervers, Béatrice; Letrilliart, Laurent; Sarnin, Philippe

2018-01-01

Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [ FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.

An integrated approach to panic prevention targeting the empirically supported risk factors of smoking and anxiety sensitivity: theoretical basis and evidence from a pilot project evaluating feasibility and short-term efficacy.

PubMed

Feldner, Matthew T; Zvolensky, Michael J; Babson, Kimberly; Leen-Feldner, Ellen W; Schmidt, Norman B

2008-10-01

Consistent with a risk reduction model of targeted prevention, the present investigation piloted and empirically evaluated the feasibility and short-term efficacy of a first-generation panic prevention program that targeted two malleable risk factors for panic development-anxiety sensitivity and daily cigarette smoking. Members of a high risk cohort, defined by high levels of anxiety sensitivity and current daily smoking (n=96), were randomly assigned to either (1) a one session intervention focused on proximally increasing motivation to quit smoking and reducing anxiety sensitivity to distally prevent the development of panic or (2) a health information control condition of comparable length. Participants were followed for 6 months. Consistent with hypotheses, those in the treatment condition showed reduced anxiety sensitivity and this effect was maintained across the follow-up period. Limited evidence also suggested the intervention increased motivation to quit smoking. We discuss how this prevention protocol can be modified in the future to enhance its effects as part of second-generation larger-scale outcome evaluations.

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people.

PubMed

de Vlaming, Rianne; Haveman-Nies, Annemien; Van't Veer, Pieter; de Groot, Lisette Cpgm

2010-09-13

The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity. A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data. Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people

PubMed Central

2010-01-01

Background The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity. Methods/Design A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data. Discussion Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto. PMID:20836840

Bullying and cyberbullying: overlapping and predictive value of the co-occurrence.

PubMed

del Rey, Rosario; Elipe, Paz; Ortega-Ruiz, Rosario

2012-11-01

Several studies show certain co-occurrence of the traditional bullying and the cyberbullying. However, the results about relation and homogeneity among the roles of each of them are not unanimous. The present study intends to advance in the knowledge about the above-mentioned co-occurrence by exploring the dimensions of victimization and traditional aggression and cyber-victimization and cyber-aggression and by identifying its eventual directionality. A short-term longitudinal design was developed. The sample was formed by 274 adolescents, aging 12 to 18 years-old, belonging to 2 schools of Andalusia (South of Spain). In order to value the impact of bullying and cyberbullying the European Cyberbullying Intervention Project Questionnaire (ECIPQ) and the European Bullying Intervention Project Questionnaire (EBIPQ) were used. The results show important simultaneity among both phenomena and suggest that although in cyberbullying -cyber-victimization and cyber-aggression- may be predicted because of previous involvement of the subject in traditional bullying, on the contrary it does not happen. In addition, previous victimization is a risk factor for traditional bullying and for cyberbullying. Results are discussed in relation to the process and socio-group dynamics arising from the bullying and cyberbullying phenomena, and in terms of their prevention.

Toward risk reduction: predicting the future burden of occupational cancer.

PubMed

Hutchings, Sally; Rushton, Lesley

2011-05-01

Interventions to reduce cancers related to certain occupations should be evidence-based. The authors have developed a method for forecasting the future burden of occupational cancer to inform strategies for risk reduction. They project risk exposure periods, accounting for cancer latencies of up to 50 years, forward in time to estimate attributable fractions for a series of forecast target years given past and projected exposure trends and under targeted reduction scenarios. Adjustment factors for changes in exposed numbers and levels are applied in estimation intervals within the risk-exposure periods. The authors illustrate the methods by using a range of scenarios for reducing lung cancer due to occupational exposure to respirable crystalline silica. Attributable fractions for lung cancer due to respirable crystalline silica could be potentially reduced from 2.07% in 2010 to nearly 0% by 2060, depending on the timing and success of interventions. Focusing on achieving compliance with current exposure standards in small industries can be more effective than setting standards at a lower level. The method can be used to highlight high-risk carcinogens, industries, and occupations. It is adaptable for other countries and other exposure situations in the general environment and can be extended to include socioeconomic impact assessment.

Implementation of the NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Rationale and Study Design for Young Hearts, Strong Starts, a Cluster-Randomized Trial Targeting Body Mass Index, Blood Pressure, and Tobacco

PubMed Central

LaBresh, Kenneth A.; Lazorick, Suzanne; Ariza, Adolfo J.; Furberg, Robert D.; Whetstone, Lauren; Hobbs, Connie; de Jesus, Janet; Bender, Randall H.; Salinas, Ilse G.; Binns, Helen J.

2014-01-01

Background Cardiovascular disease (CVD) and the underlying atherosclerosis begin in childhood, and their presence and intensity are related to known cardiovascular disease risk factors. Attention to risk factor control in childhood has the potential to reduce subsequent risk of CVD. Objective The Young Hearts Strong Starts Study was designed to test strategies facilitating adoption of the National, Heart, Lung and Blood Institute supported Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. This study compares guideline-based quality measures for body mass index, blood pressure, and tobacco using two strategies: a multifaceted, practice-directed intervention versus standard dissemination. Study Design Two primary care research networks recruited practices and provided support for the intervention and outcome evaluations. Individual practices were randomly assigned to the intervention or control groups using a cluster randomized design based on network affiliation, number of clinicians per practice, urban versus nonurban location, and practice type. The units of observation are individual children because measure adherence is abstracted from individual patient’s medical records. The units of randomization are physician practices. This results in a multilevel design in which patients are nested within practices. The intervention practices received toolkits and supported guideline implementation including academic detailing, an ongoing e-learning group. This project is aligned with the American Board of Pediatrics Maintenance of Certification requirements including monthly physician self-abstraction, webinars, and other elements of the trial. Significance This trial will provide an opportunity to demonstrate tools and strategies to enhance CV prevention in children by guideline-based interventions. PMID:24295879

Achieving social change on gender-based violence: a report on the impact evaluation of Soul City's fourth series.

PubMed

Usdin, S; Scheepers, E; Goldstein, Susan; Japhet, Garth

2005-12-01

The Soul City Institute for Health and Development Communication--a South African multi-media health promotion project--together with the National Network on Violence Against Women, formulated an intervention to address domestic violence. Recognising that behavioural change interventions aimed solely at individuals have limited impact, the intervention was designed to impact at multiple mutually reinforcing levels; individual, community and socio-political environment. The intervention and its evaluation results are presented. Soul City successfully reached 86%, 25% and 65% of audiences through television, print booklets and radio, respectively. On an individual level there was a shift in knowledge around domestic violence including 41% of respondents hearing about the helpline. Attitude shifts were also associated with the intervention, with a 10% increase in respondents disagreeing that domestic violence was a private affair. There was also a 22% shift in perceptions of social norms on this issue. Qualitative data analysis suggests the intervention played a role in enhancing women's and communities' sense of efficacy, enabling women to make more effective decisions around their health and facilitating community action. The evaluation concluded that implementation of the Domestic Violence Act can largely be attributed to the intervention. While demonstrating actual reductions in levels of domestic violence was not possible, the evaluation shows a strong association between exposure to intervention components and a range of intermediary factors indicative of, and necessary to bring about social change. This paper reports on the evaluation, discusses its limitations and challenges as well as lessons learned regarding multi-level interventions on domestic violence.

Exposure to a community-level HIV prevention intervention: who gets the message.

PubMed

Walls, C T; Lauby, J; Lavelle, K; Derby, T; Bond, L

1998-08-01

As part of the evaluation of a community-level HIV prevention program for women, this study examined predictors of exposure to print media and community outreach and assessed the relationship between exposure to the intervention and condom use behavior. Data from interviews with 479 women randomly selected from the intervention community in 1995 and 1996 were examined. Analysis of demographic and risk characteristics were conducted to identify predictors of exposure to the project's HIV prevention messages. Additionally, logistic regression analyses were conducted to examine the effects of intervention exposure on condom use, controlling for factors related to exposure. The results revealed that the print media campaign reached the largest number of women. However, women at highest risk did not have high rates of exposure to print media, but had greater exposure to outreach. Exposure to print media had an effect on increased communication with a main partner about condom use, but was not significantly related to condom use last time had sex. There were no significant main effects for exposure to outreach on condom use behavior. An important finding of this analysis was that each intervention strategy was successful in reaching a different portion of the target population and that exposure had differential effects on the condom use behavior of particular segments of the target population.

Applying Lean Six Sigma methodologies to improve efficiency, timeliness of care, and quality of care in an internal medicine residency clinic.

PubMed

Fischman, Daniel

2010-01-01

Patients' connectedness to their providers has been shown to influence the success of preventive health and disease management programs. Lean Six Sigma methodologies were employed to study workflow processes, patient-physician familiarity, and appointment compliance to improve continuity of care in an internal medicine residency clinic. We used a rapid-cycle test to evaluate proposed improvements to the baseline-identified factors impeding efficient clinic visits. Time-study, no-show, and patient-physician familiarity data were collected to evaluate the effect of interventions to improve clinic efficiency and continuity of medical care. Forty-seven patients were seen in each of the intervention and control groups. The wait duration between the end of triage and the resident-patient encounter was statistically shorter for the intervention group. Trends toward shorter wait times for medical assistant triage and total encounter were also seen in the intervention group. On all measures of connectedness, both the physicians and patients in the intervention group showed a statistically significant increased familiarity with each other. This study shows that incremental changes in workflow processes in a residency clinic can have a significant impact on practice efficiency and adherence to scheduled visits for preventive health care and chronic disease management. This project used a structured "Plan-Do-Study-Act" approach.

13. Operational planning for a specific intervention.

PubMed

2014-05-01

Every intervention must follow an operational plan. Operational plans delineate actions required to meet an objective that is part of the strategic plan (overarching goal). Operational plans dictate the critical pathways for the interventions that will be followed during and following the implementation of the intervention. Operational plans include: (1) an introduction and brief situation report; (2) an overview of the task(s), objectives, and the overarching goal to be addressed; (3) the methods that will be employed; (4) planning factors; (5) the resources that will be required including personnel, equipment, and supplies; (6) timelines, benchmarks, and milestones including their respective indicators, startup time, end point, and estimates of the time required for completion; (7) the administrative structure to be employed; (8) an operating budget; (9) the strategy for acquiring the funding required; (10) roles and responsibilities of the personnel including position descriptions and the competencies required of the personnel (skill sets); (11) mechanisms for monitoring the progress including the indicators that will be employed, (12) safety, including health of the personnel, required immunisations, accommodations, and reporting structure; (13) self-sufficiency; and (14) reporting and accounting. There are many generic items in an operational plan that can be used in successive plans. Without a detailed operational plan, interventions are doomed to probable failure and can profoundly negatively impact other projects operational in the area.

Project Eban: An HIV/STD Intervention for African American Couples

PubMed Central

2010-01-01

Objective To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention and how the content was shaped by culturally congruent concepts to address the needs of the study target population. Design The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual, interpersonal and community level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. Methods The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couples-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afro-centric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from four urban sites (Atlanta, Los Angeles, New York and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements and content of each session are described and lessons learned from this intervention trial are discussed. Results An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the participants responded very well to both the couple and group sessions. Participant feedback suggests that the cultural congruence of the intervention and use of African American co-facilitators made them feel comfortable disclosing risky behaviors. Participant feedback also suggests that the intervention’s couples-based focus on enhancing dyadic communication and decision-making skills were key to helping the couples work together to overcome barriers to using condoms. Conclusion Participant and facilitator evaluations of the Eban Risk Reduction Intervention suggest that couples responded well to the Afro-centric content and mixed modalities of the intervention sessions. Couple sessions were optimal for enhancing interpersonal and microlevel factors, including communication, problem solving, and decision making. PMID:18724186

Environmental assessment in slum improvement programs: Some evidence from a study on infrastructure projects in two Dhaka slums

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chowdhury, Farhat Jahan; Amin, A.T.M. Nurul

2006-08-15

This paper reports findings from a study on slum improvement projects to show the difference that environmental assessment (EA) can make in such interventions and to suggest mechanisms for its integration into such projects. The findings are based on a field survey that was carried out in two slums of Dhaka where infrastructure projects were implemented. In one slum, the EA process was considered in designing and locating infrastructure and in the other it was not. The survey results traced the severe problems that existed in both slums before the implementation of infrastructure improvement projects and reveal that after themore » intervention the situation has considerably improved in the slum where EA was conducted. In contrast, some problems still persist in the other slum where EA was not considered. To make it worse, the newly built infrastructures have even given rise to a set of new problems. In order to avoid such negative outcomes from development interventions, the paper finally develops the mechanism for integration of EA into slum improvement project.« less

Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS.

PubMed

Doran, Kelly; Resnick, Barbara; Kim, Natalie; Lynn, Donna; McCormick, Tyrell

2017-02-01

Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). The intervention is ongoing, but measures are described. As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

PubMed

Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

2017-01-01

To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002). Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

Development, Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation.

PubMed

Moore, Jennifer L; Carpenter, Julia; Doyle, Anne Marie; Doyle, Laura; Hansen, Piper; Hahn, Bridget; Hornby, T George; Roth, Heidi R; Spoeri, Susan; Tappan, Rachel; Van Der Laan, Krista

2018-01-01

To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years. Successive independent samples study. Large rehabilitation system. Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121). The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care. To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation. Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists. After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans.

PubMed

Sauaia, Angela; Min, Sung-joon; Lack, David; Apodaca, Cecilia; Osuna, Diego; Stowe, Angela; MGinnis, Gretchen F; Latts, Lisa M; Byers, Tim

2007-10-01

The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans. We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998-1999) and during follow-up (2000-2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders. The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [+/-.11], P = .03). For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches.

Qualitative evaluation of the Teenage Mothers Project in Uganda: a community-based empowerment intervention for unmarried teenage mothers

PubMed Central

2013-01-01

Background A large proportion of unmarried teenage mothers in Uganda face physical, psychological, and social problems after pregnancy and childbirth, such as obstetric complications, lack of education, and stigmatisation in their communities. The Teenage Mothers Project (TMP) in Eastern Uganda empowers unmarried teenage mothers to cope with the consequences of early pregnancy and motherhood. Since 2000, 1036 unmarried teenage mothers, their parents, and community leaders participated in economic and social empowerment interventions. The present study explored the changes resulting from the TMP as well as factors that either enabled or inhibited these changes. Methods Semi-structured interviews (N = 23) were conducted with former teenage mothers , community leaders, and project implementers, and lifeline histories were obtained from former teenage mothers (N = 9). Quantitative monitoring data regarding demographic and social characteristics of teenage mother participants (N = 1036) were analysed. Results The findings suggest that, overall, the TMP seems to have contributed to the well-being of unmarried teenage mothers and to a supportive social environment. It appears that the project contributed to supportive community norms towards teenage mothers’ position and future opportunities, increased agency, improved coping with early motherhood and stigma, continued education, and increased income generation by teenage mothers. The study findings also suggest limited change in disapproving community norms regarding out-of-wedlock sex and pregnancy, late active enrolment of teenage mothers in the project (i.e., ten months after delivery of the child), and differences in the extent to which parents provided support. Conclusions It is concluded that strengths of the community-based TMP seem to be its socio-ecological approach, the participatory planning with community leaders and other stakeholders, counselling of parents and unmarried teenage mothers, and the emphasis on education and income generation. The project can improve by earlier active participation of unmarried pregnant adolescents and increased support for parents. PMID:24011141

Can Activity Projects Improve Children's Wellbeing during the Transition to Secondary Education?

ERIC Educational Resources Information Center

Akister, Jane; Guest, Hannah; Burch, Sarah

2016-01-01

Promoting child mental wellbeing is an important part of UK early intervention policy. Children with poor physical or mental health have significantly lower educational attainment and lower social status as adults. "Activity" projects are one form of early intervention used to try and help vulnerable children. Evidence relating to the…

Alabama School for the Blind Fitness and Nutrition Project.

ERIC Educational Resources Information Center

Patterson, Douglas

This project compared the relative physical fitness levels of 30 visually handicapped/blind students (aged 7-18) at a residential school with that of non-handicapped peers, to develop a school-based fitness and nutrition intervention program and determine impact of the intervention. The compounding handicapping nature of fitness deficits and…

Project SuperHeart: An Evaluation of a Heart Disease Intervention Program For Children.

ERIC Educational Resources Information Center

Way, Joyce W.

1981-01-01

An effective way to prevent coronary heart disease in later life is to concentrate on preventive measures in the early years before coronary heart disease becomes established. Project SuperHeart, a heart disease intervention program for young children, includes physical fitness and classroom activities emphasizing basic nutritional habits. (JN)

Classifying Trajectories of Social-Emotional Difficulties through Elementary School: Impacts of the Chicago School Readiness Project

ERIC Educational Resources Information Center

McCoy, Dana Charles; Jones, Stephanie; Roy, Amanda; Raver, C. Cybele

2018-01-01

Although research has shown fade-out of the cognitive benefits of classroom-based preschool interventions, less is known regarding the durability of social-emotional impacts. This study examines the extent to which the multicomponent Chicago School Readiness Project (CSRP) intervention lowered risk of internalizing, externalizing, attention, and…

A Writer-Respondent Intervention as a Means of Developing Academic Literacy

ERIC Educational Resources Information Center

Bharuthram, S.; Mckenna, S.

2006-01-01

This paper discusses the implementation of a project in which a writer-respondent intervention was used to develop the academic literacy practices of students. Writer-respondent projects are based on the idea that detailed developmental comments and questions on students' draft writing can assist them in acquiring the peculiar norms of academic…

Evaluation of the CSEC Community Intervention Project (CCIP) in Five U.S. Cities

ERIC Educational Resources Information Center

Ferguson, Kristin M.; Soydan, Haluk; Lee, Sei-Young; Yamanaka, Alisa; Freer, Adam S.; Xie, Bin

2009-01-01

In response to the commercial sexual exploitation of children (CSEC) within five U.S. cities, the CSEC Community Intervention Project (CCIP) was created to enhance collaboration among nongovernmental organization (NGO) representatives, law enforcement officials and prosecutors in Chicago, Atlantic City, Denver, Washington, D.C., and San Diego. A…

Young Adult Outcomes of the Abecedarian and CARE Early Childhood Educational Interventions

ERIC Educational Resources Information Center

Campbell, Frances A.; Wasik, Barbara H.; Pungello, Elizabeth; Burchinal, Margaret; Barbarin, Oscar; Kainz, Kirsten; Sparling, Joseph J.; Ramey, Craig T.

2008-01-01

Adult benefits for participants in Project CARE were compared with those of the Abecedarian Project, a closely related randomized study of early childhood educational intervention for children from low-income families who were at risk of developmental delays and school failure. CARE replicated Abecedarian's young adult treatment-related…

Inclusive design in the implementation of projects for schools modernization in Portugal - case studies.

PubMed

Lopes, Lígia; Aguiar, Carlos; da Silva, Fernando Moreira

2012-01-01

The Project for Schools Modernization taking place in Portugal, with an estimated total investment of 2450 million for the intervention in the first 205 schools, provide the reclassification of 332 secondary schools by 2015. One of the questions we can pose is if the authorities and the teams of architects selected to design these schools considered fundamental for the correctness of architectural barriers within the school and its accessibility the implementation of standards and principles of inclusion of children/teenagers with special needs within their school environment. As most of the projects are already being implemented, the main aim of this paper is to present the outcomes of a comparative analysis and synthesis of six schools located in the northern part of the country. This analysis occurs from the of Participatory Design perspective which appeals to the experience of the disable children to look (or evaluate) the negative and positive factors in terms of physical space, interpreted by inclusive design rules and orientations. Therefore, the evaluation of schools modernization project, and its discussion, is central for the understanding how these children are addressed in projects which are directed at them.

Promoting CARE: including parents in youth suicide prevention.

PubMed

Hooven, Carole; Walsh, Elaine; Pike, Kenneth C; Herting, Jerald R

2012-01-01

This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an "intervention as usual" (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.

Promoting CARE

PubMed Central

Hooven, Carole; Walsh, Elaine; Pike, Kenneth C.; Herting, Jerald R.

2013-01-01

This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an “intervention as usual” (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group. PMID:22617413

HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya

PubMed Central

Galárraga, Omar; Wamai, Richard G; Sosa-Rubí, Sandra G; Mugo, Mercy G; Contreras-Loya, David; Bautista-Arredondo, Sergio; Nyakundi, Helen; Wang’ombe, Joseph K

2017-01-01

Abstract We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Africa’ (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011–12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. PMID:29029086

A systems approach to college drinking: development of a deterministic model for testing alcohol control policies.

PubMed

Scribner, Richard; Ackleh, Azmy S; Fitzpatrick, Ben G; Jacquez, Geoffrey; Thibodeaux, Jeremy J; Rommel, Robert; Simonsen, Neal

2009-09-01

The misuse and abuse of alcohol among college students remain persistent problems. Using a systems approach to understand the dynamics of student drinking behavior and thus forecasting the impact of campus policy to address the problem represents a novel approach. Toward this end, the successful development of a predictive mathematical model of college drinking would represent a significant advance for prevention efforts. A deterministic, compartmental model of college drinking was developed, incorporating three processes: (1) individual factors, (2) social interactions, and (3) social norms. The model quantifies these processes in terms of the movement of students between drinking compartments characterized by five styles of college drinking: abstainers, light drinkers, moderate drinkers, problem drinkers, and heavy episodic drinkers. Predictions from the model were first compared with actual campus-level data and then used to predict the effects of several simulated interventions to address heavy episodic drinking. First, the model provides a reasonable fit of actual drinking styles of students attending Social Norms Marketing Research Project campuses varying by "wetness" and by drinking styles of matriculating students. Second, the model predicts that a combination of simulated interventions targeting heavy episodic drinkers at a moderately "dry" campus would extinguish heavy episodic drinkers, replacing them with light and moderate drinkers. Instituting the same combination of simulated interventions at a moderately "wet" campus would result in only a moderate reduction in heavy episodic drinkers (i.e., 50% to 35%). A simple, five-state compartmental model adequately predicted the actual drinking patterns of students from a variety of campuses surveyed in the Social Norms Marketing Research Project study. The model predicted the impact on drinking patterns of several simulated interventions to address heavy episodic drinking on various types of campuses.

A Systems Approach to College Drinking: Development of a Deterministic Model for Testing Alcohol Control Policies*

PubMed Central

Scribner, Richard; Ackleh, Azmy S.; Fitzpatrick, Ben G.; Jacquez, Geoffrey; Thibodeaux, Jeremy J.; Rommel, Robert; Simonsen, Neal

2009-01-01

Objective: The misuse and abuse of alcohol among college students remain persistent problems. Using a systems approach to understand the dynamics of student drinking behavior and thus forecasting the impact of campus policy to address the problem represents a novel approach. Toward this end, the successful development of a predictive mathematical model of college drinking would represent a significant advance for prevention efforts. Method: A deterministic, compartmental model of college drinking was developed, incorporating three processes: (1) individual factors, (2) social interactions, and (3) social norms. The model quantifies these processes in terms of the movement of students between drinking compartments characterized by five styles of college drinking: abstainers, light drinkers, moderate drinkers, problem drinkers, and heavy episodic drinkers. Predictions from the model were first compared with actual campus-level data and then used to predict the effects of several simulated interventions to address heavy episodic drinking. Results: First, the model provides a reasonable fit of actual drinking styles of students attending Social Norms Marketing Research Project campuses varying by “wetness” and by drinking styles of matriculating students. Second, the model predicts that a combination of simulated interventions targeting heavy episodic drinkers at a moderately “dry” campus would extinguish heavy episodic drinkers, replacing them with light and moderate drinkers. Instituting the same combination of simulated interventions at a moderately “wet” campus would result in only a moderate reduction in heavy episodic drinkers (i.e., 50% to 35%). Conclusions: A simple, five-state compartmental model adequately predicted the actual drinking patterns of students from a variety of campuses surveyed in the Social Norms Marketing Research Project study. The model predicted the impact on drinking patterns of several simulated interventions to address heavy episodic drinking on various types of campuses. PMID:19737506

Dietary fiber does not displace energy but is associated with decreased serum cholesterol concentrations in healthy children.

PubMed

Ruottinen, Soile; Lagström, Hanna K; Niinikoski, Harri; Rönnemaa, Tapani; Saarinen, Maiju; Pahkala, Katja A; Hakanen, Maarit; Viikari, Jorma Sa; Simell, Olli

2010-03-01

Dietary fiber has health benefits, but fiber recommendations for children are controversial because fiber may displace energy. The objective was to longitudinally evaluate dietary fiber intake in children and to study associations between growth variables, serum cholesterol concentrations, and intakes of fiber, energy, and nutrients. Altogether, 543 children from a prospective randomized atherosclerosis prevention trial (the Special Turku Coronary Risk factor Intervention Project; STRIP) participated in this study between the ages of 8 mo and 9 y. The intervention children (n = 264) were counseled to replace part of saturated fat with unsaturated fat. Nutrient intakes, weight, height, and serum total, HDL-, and LDL-cholesterol and triglyceride concentrations were analyzed. Children were divided into 3 groups according to mean dietary fiber intake in foods: low (lowest 10%), high (highest 10%), and average (middle 80%) fiber intakes. Fiber intake associated positively with energy intake and inversely with fat intake. Children with a high fiber intake received more vitamins and minerals than did children in other groups. In longitudinal growth analyses, weights and heights were similar in all 3 fiber intake groups, and fiber intake (g/d) associated positively with weight gain between 8 mo and 2 y. Serum cholesterol concentrations decreased with increasing fiber intakes. Children in the intervention group had a higher fiber intake than did the control children during the entire follow-up period. Fiber intake did not displace energy or disturb growth between 13 mo and 9 y of age. Serum cholesterol values correlated inversely with fiber intake, which indicated that part of the cholesterol-lowering intervention effect in the STRIP project may have been explained by dietary fiber.

Mold and Endotoxin Levels in the Aftermath of Hurricane Katrina: A Pilot Project of Homes in New Orleans Undergoing Renovation

PubMed Central

Chew, Ginger L.; Wilson, Jonathan; Rabito, Felicia A.; Grimsley, Faye; Iqbal, Shahed; Reponen, Tiina; Muilenberg, Michael L.; Thorne, Peter S.; Dearborn, Dorr G.; Morley, Rebecca L.

2006-01-01

Background After Hurricane Katrina, many New Orleans homes remained flooded for weeks, promoting heavy microbial growth. Objectives A small demonstration project was conducted November 2005–January 2006 aiming to recommend safe remediation techniques and safe levels of worker protection, and to characterize airborne mold and endotoxin throughout cleanup. Methods Three houses with floodwater lines between 0.3 and 2 m underwent intervention, including disposal of damaged furnishings and drywall, cleaning surfaces, drying remaining structure, and treatment with a biostatic agent. We measured indoor and outdoor bioaerosols before, during, and after intervention. Samples were analyzed for fungi [culture, spore analysis, polymerase chain reaction (PCR)] and endotoxin. In one house, real-time particle counts were also assessed, and respirator-efficiency testing was performed to establish workplace protection factors (WPF). Results At baseline, culturable mold ranged from 22,000 to 515,000 colony-forming units/m3, spore counts ranged from 82,000 to 630,000 spores/m3, and endotoxin ranged from 17 to 139 endotoxin units/m3. Culture, spore analysis, and PCR indicated that Penicillium, Aspergillus, and Paecilomyces predominated. After intervention, levels of mold and endotoxin were generally lower (sometimes, orders of magnitude). The average WPF against fungal spores for elastomeric respirators was higher than for the N-95 respirators. Conclusions During baseline and intervention, mold and endotoxin levels were similar to those found in agricultural environments. We strongly recommend that those entering, cleaning, and repairing flood-damaged homes wear respirators at least as protective as elastomeric respirators. Recommendations based on this demonstration will benefit those involved in the current cleanup activities and will inform efforts to respond to future disasters. PMID:17185280

Mold and endotoxin levels in the aftermath of Hurricane Katrina: a pilot project of homes in New Orleans undergoing renovation.

PubMed

Chew, Ginger L; Wilson, Jonathan; Rabito, Felicia A; Grimsley, Faye; Iqbal, Shahed; Reponen, Tiina; Muilenberg, Michael L; Thorne, Peter S; Dearborn, Dorr G; Morley, Rebecca L

2006-12-01

After Hurricane Katrina, many New Orleans homes remained flooded for weeks, promoting heavy microbial growth. A small demonstration project was conducted November 2005-January 2006 aiming to recommend safe remediation techniques and safe levels of worker protection, and to characterize airborne mold and endotoxin throughout cleanup. Three houses with floodwater lines between 0.3 and 2 m underwent intervention, including disposal of damaged furnishings and drywall, cleaning surfaces, drying remaining structure, and treatment with a biostatic agent. We measured indoor and outdoor bioaerosols before, during, and after intervention. Samples were analyzed for fungi [culture, spore analysis, polymerase chain reaction (PCR)] and endotoxin. In one house, realtime particle counts were also assessed, and respirator-efficiency testing was performed to establish workplace protection factors (WPF). At baseline, culturable mold ranged from 22,000 to 515,000 colony-forming units/m3, spore counts ranged from 82,000 to 630,000 spores/m3, and endotoxin ranged from 17 to 139 endotoxin units/m3. Culture, spore analysis, and PCR indicated that Penicillium, Aspergillus, and Paecilomyces predominated. After intervention, levels of mold and endotoxin were generally lower (sometimes, orders of magnitude). The average WPF against fungal spores for elastomeric respirators was higher than for the N95 respirators. During baseline and intervention, mold and endotoxin levels were similar to those found in agricultural environments. We strongly recommend that those entering, cleaning, and repairing flood-damaged homes wear respirators at least as protective as elastomeric respirators. Recommendations based on this demonstration will benefit those involved in the current cleanup activities and will inform efforts to respond to future disasters.

A developmental evaluation to enhance stakeholder engagement in a wide-scale interactive project disseminating quality improvement data: study protocol for a mixed-methods study.

PubMed

Laycock, Alison; Bailie, Jodie; Matthews, Veronica; Cunningham, Frances; Harvey, Gillian; Percival, Nikki; Bailie, Ross

2017-07-13

Bringing together continuous quality improvement (CQI) data from multiple health services offers opportunities to identify common improvement priorities and to develop interventions at various system levels to achieve large-scale improvement in care. An important principle of CQI is practitioner participation in interpreting data and planning evidence-based change. This study will contribute knowledge about engaging diverse stakeholders in collaborative and theoretically informed processes to identify and address priority evidence-practice gaps in care delivery. This paper describes a developmental evaluation to support and refine a novel interactive dissemination project using aggregated CQI data from Aboriginal and Torres Strait Islander primary healthcare centres in Australia. The project aims to effect multilevel system improvement in Aboriginal and Torres Strait Islander primary healthcare. Data will be gathered using document analysis, online surveys, interviews with participants and iterative analytical processes with the research team. These methods will enable real-time feedback to guide refinements to the design, reports, tools and processes as the interactive dissemination project is implemented. Qualitative data from interviews and surveys will be analysed and interpreted to provide in-depth understanding of factors that influence engagement and stakeholder perspectives about use of the aggregated data and generated improvement strategies. Sources of data will be triangulated to build up a comprehensive, contextualised perspective and integrated understanding of the project's development, implementation and findings. The Human Research Ethics Committee (HREC) of the Northern Territory Department of Health and Menzies School of Health Research (Project 2015-2329), the Central Australian HREC (Project 15-288) and the Charles Darwin University HREC (Project H15030) approved the study. Dissemination will include articles in peer-reviewed journals, policy and research briefs. Results will be presented at conferences and quality improvement network meetings. Researchers, clinicians, policymakers and managers developing evidence-based system and policy interventions should benefit from this research. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women.

PubMed Central

Fogarty, L. A.; Heilig, C. M.; Armstrong, K.; Cabral, R.; Galavotti, C.; Gielen, A. C.; Green, B. M.

2001-01-01

OBJECTIVE: The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection. METHODS: HIV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use. RESULTS: Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at 12 months. CONCLUSIONS: The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention effects were minimal and short-lived. Factors related to the theory, intervention design, and sample characteristics help explain these differences. PMID:11889279

"KiDS and Diabetes in Schools" project: Experience with an international educational intervention among parents and school professionals.

PubMed

Bechara, Glaucia Margonari; Castelo Branco, Fernanda; Rodrigues, Avelino Luiz; Chinnici, Daniela; Chaney, David; Calliari, Luis Eduardo P; Franco, Denise Reis

2018-06-01

Although it is known that school care is a major challenge in diabetes treatment, there is still no published international initiative. The aims of this study were to introduce an international educational intervention tool, the International Diabetes Federation (IDF) KiDS and Diabetes in Schools project (KiDS project), and to describe its impact on diabetes knowledge and behavior of caregivers and school professionals. The KiDS project was developed with the support of IDF and the International Society for Pediatric and Adolescent Diabetes and provides online free material in 10 languages, directed to caregivers and school personnel. A pilot evaluation of the KiDS intervention was performed in Brazil. An educational intervention was conducted in 5 primary schools, with 42 parents and school staff, followed by 2 individual interviews after 1 and 3 months. The results were evaluated in a qualitative study with a descriptive design based on content analysis. School staff acquired new knowledge on diabetes and its treatment. They felt more confident when helping students with diabetes and said the educational intervention promoted a positive impact on the teacher-student relationship, on the caring for health, and on school infrastructure. Family members of children with diabetes stated that the educational intervention gave them an opportunity to strengthen and update information on treatment and improve their knowledge. The KiDS project is the first international tool directed to foster a safe and supportive environment and a better understanding of diabetes in schools. In this pilot evaluation, it achieved the goal of informing and changing the behavior of parents and school staff, thus improving the care provided to children with diabetes in schools. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Women's Health at Work Program: musculoskeletal pain experienced by women of Chinese background working on market gardens in the Sydney Basin.

PubMed

Innes, Ev; Crowther, Amber; Fonti, Fiona; Quayle, Leonie

2010-01-01

OBJECTIVE/PARTICIPANTS: This report describes a project undertaken by three final (4th) year occupational therapy undergraduate students from the University of Sydney, Australia, in their final fieldwork placement. The project involved women from a Chinese background who worked on market gardens across the Sydney Basin. Its purpose was to identify musculoskeletal risks in the work environment and work practices of a selected group of seven Cantonese-speaking women working on market gardens in the Western Sydney region. The approaches used in the project reflected a risk management approach, and involved background research, initial interviews, task analysis, hazard identification, risk assessment, data analysis, identification of key issues, and developing recommendations, in collaboration with participants and consultation with professionals. The key issues identified as contributing factors to musculoskeletal pain and injuries were: (1) work practices (long work hours, repetitive work); (2) biomechanical factors (repetitive and sustained work postures, poor manual handling practices) and limited training; (3) ergonomics of the equipment used; (4) fatigue. Two priority areas for intervention were identified: (1) pain management, and (2) preventative strategies (improving both the work environment and work practices). Recommendations were made in collaboration with the women, and in consultation with health professionals.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

PubMed Central

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-01-01

Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services. PMID:17603898

Sexual HIV Risk Among Male Parolees and Their Female Partners: The Relate Project

PubMed Central

Comfort, Megan; Reznick, Olga Grinstead; Dilworth, Samantha E.; Binson, Diane; Darbes, Lynae A.; Neilands, Torsten B.

2014-01-01

Background The massively disproportionate impact of America’s prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man’s release from prison. Methods We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. Results Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners’ influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. Conclusion The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration. PMID:25642396

Public Health Clinical Demonstration Project for Smoking Cessation in Veterans with Posttraumatic Stress Disorder

PubMed Central

Dedert, Eric A.; Wilson, Sarah M.; Calhoun, Patrick S.; Moore, Scott D.; Hamlett-Berry, Kim W.; Beckham, Jean C.

2009-01-01

Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Five hundred eighty-four veteran smokers were contacted by invitational letters. Interested veterans received follow-up telephone calls using standardized scripts offering three intervention resources: 1) a referral to the National Cancer Institute’s Smoking Quitline, 2) web-based counseling, and 3) local Veteran Affairs pharmacologic treatment for smoking cessation. Twenty-three percent of survey recipients participated in the clinical program. Two months after these resources were offered by phone, follow-up phone calls indicated that 25% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a 2.6% impact (i.e., reach [31.1% of smokers accessed intervention] by efficacy [8.4% of those accessing intervention quit]), meaning that 2.6% of the total number of targeted smokers reported 8 week abstinence. Results suggested that this brief, low-cost intervention was feasible and promoted smoking cessation in veterans with posttraumatic stress disorder. PMID:19737675

Lessons learned from training peer-leaders to conduct Body Project workshops.

PubMed

Vanderkruik, Rachel; Strife, Samantha; Dimidjian, Sona

2017-01-01

The Body Project is a cognitive-dissonance intervention that is effective in improving body satisfaction for high school and college aged women. The Body Project can be implemented by trained peers, thus increasing its potential for broad and cost-effective dissemination. Little is known, however, about peer-leaders' perceptions of their training needs and preferences to deliver prevention programs. This qualitative study explored the perceptions of training strengths and areas of improvement among 14 Body Project peer-leaders at a college campus through a series of focus groups. Recommendations are made to inform training for the Body Project as well as peer-led prevention and treatment interventions more broadly.

Developing and Testing a Model to Predict Outcomes of Organizational Change

PubMed Central

Gustafson, David H; Sainfort, François; Eichler, Mary; Adams, Laura; Bisognano, Maureen; Steudel, Harold

2003-01-01

Objective To test the effectiveness of a Bayesian model employing subjective probability estimates for predicting success and failure of health care improvement projects. Data Sources Experts' subjective assessment data for model development and independent retrospective data on 221 healthcare improvement projects in the United States, Canada, and the Netherlands collected between 1996 and 2000 for validation. Methods A panel of theoretical and practical experts and literature in organizational change were used to identify factors predicting the outcome of improvement efforts. A Bayesian model was developed to estimate probability of successful change using subjective estimates of likelihood ratios and prior odds elicited from the panel of experts. A subsequent retrospective empirical analysis of change efforts in 198 health care organizations was performed to validate the model. Logistic regression and ROC analysis were used to evaluate the model's performance using three alternative definitions of success. Data Collection For the model development, experts' subjective assessments were elicited using an integrative group process. For the validation study, a staff person intimately involved in each improvement project responded to a written survey asking questions about model factors and project outcomes. Results Logistic regression chi-square statistics and areas under the ROC curve demonstrated a high level of model performance in predicting success. Chi-square statistics were significant at the 0.001 level and areas under the ROC curve were greater than 0.84. Conclusions A subjective Bayesian model was effective in predicting the outcome of actual improvement projects. Additional prospective evaluations as well as testing the impact of this model as an intervention are warranted. PMID:12785571

Preventing Serious Conduct Problems in School-Age Youths: The Fast Track Program

PubMed Central

Slough, Nancy M.; McMahon, Robert J.; Bierman, Karen L.; Coie, John D.; Dodge, Kenneth A.; Foster, E. Michael; Greenberg, Mark T.; Lochman, John E.; McMahon, Robert J.; Pinderhughes, Ellen E.

2009-01-01

Children with early-starting conduct Problems have a very poor prognosis and exact a high cost to society. The Fast Track project is a multisite, collaborative research project investigating the efficacy of a comprehensive, long-term, multicomponent intervention designed to prevent the development of serious conduct problems in high-risk children. In this article, we (a) provide an overview of the development model that serves as the conceptual foundation for the Fast Track intervention and describe its integration into the intervention model; (b) outline the research design and intervention model, with an emphasis on the elementary school phase of the intervention; and (c) summarize findings to dale concerning intervention outcomes. We then provide a case illustration, and conclude with a discussion of guidelines for practitioners who work with children with conduct problems. PMID:19890487

A school-based physical activity promotion intervention in children: rationale and study protocol for the PREVIENE Project.

PubMed

Tercedor, Pablo; Villa-González, Emilio; Ávila-García, Manuel; Díaz-Piedra, Carolina; Martínez-Baena, Alejandro; Soriano-Maldonado, Alberto; Pérez-López, Isaac José; García-Rodríguez, Inmaculada; Mandic, Sandra; Palomares-Cuadros, Juan; Segura-Jiménez, Víctor; Huertas-Delgado, Francisco Javier

2017-09-26

The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children. A total of 300 children (grade 3; 8-9 years of age) from six schools in Granada (Spain) will be enrolled in one of the 8-week interventions (one intervention per school; 50 children per school) or a control group (no intervention school; 50 children). Outcomes will include physical activity (measured by accelerometry), physical fitness (assessed using the ALPHA fitness battery), and anthropometry (height, weight and waist circumference). Furthermore, they will include sleep health (measured by accelerometers, a sleep diary, and sleep health questionnaires), academic achievement (grades from the official school's records), and health-related quality of life (child and parental questionnaires). To assess the effectiveness of the different interventions on objectively measured PA and the other outcomes, the generalized linear model will be used. The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children.

An experimental therapeutics test of whether adding dissonance-induction activities improves the effectiveness of a selective obesity and eating disorder prevention program.

PubMed

Stice, E; Rohde, P; Shaw, H; Gau, J M

2018-03-01

Compare the Healthy Weight obesity and eating disorder prevention program, which promotes participant-driven gradual lifestyle changes to bring energy intake and expenditure into balance, to a new intervention, Project Health, which adds activities to create cognitive dissonance about unhealthy eating, a sedentary lifestyle, and excess body fat, and an obesity education video-control condition. College students at risk for both outcomes because of weight concerns (N=364, 72% female) were randomized to condition, completing pretest, posttest, and 6, 12 and 24-month follow-up assessments. Project Health participants showed significantly smaller increases in measured body mass index (BMI) through 2-year follow-up than both Healthy Weight participants and controls (both d=-0.18), and significantly lower onset of overweight/obesity over 2-year follow-up than Healthy Weight participants and controls (13 vs 21% and 22%). Healthy Weight and Project Health participants showed significantly greater eating disorder symptom reductions than controls through 2-year follow-up. Healthy Weight and Project Health participants showed marginally lower eating disorder onset over follow-up than controls (3 and 3% vs 8% respectively). The reduced increases in BMI and future overweight/obesity onset for Project Health relative to both an active matched intervention and a minimal intervention control condition are noteworthy, especially given the short 6-h intervention duration. The reduction in eating disorder symptoms for Healthy Weight and Project Health relative to controls was also encouraging. Results suggest that adding dissonance-induction activities increased weight loss effects. Yet, effects for both were generally small and the eating disorder onset prevention effects were only marginal, potentially because intervention groups included both sexes, which reduced eating disorder incidence and sensitivity.

A qualitative study of a food intervention in a primary school: Pupils as agents of change.

PubMed

Ensaff, H; Canavon, C; Crawford, R; Barker, M E

2015-12-01

This study explored the impact of a school-based kitchen project at a large inner London school. Timetabled kitchen classroom sessions (90 min every fortnight) were held with all 7-9 year old pupils. Semi-structured focus group discussions (with 76 pupils, 16 parents) and interviews (with headteachers, catering managers and specialist staff) were conducted at the intervention school and a matched control school. Categories and concepts were derived using a grounded theory approach. Data analysis provided three main categories each with their related concepts: Pupil factors (enthusiasm and enjoyment of cooking, trying new foods, food knowledge and awareness, producing something tangible); School factors (learning and curriculum links, resource implications and external pressures) and Home factors (take home effects, confidence in cooking and self-esteem, parents' difficulties cooking at home with children). Children's engagement and the opportunity to cook supported increased food awareness, skills and food confidence. In the grounded theory that emerged, take home effects beyond the school gate dominate, as children act as agents of change and influence cooking and food choice at home. These short term outcomes have the potential to lead to longer term outcomes including changing eating behaviour and diet. Copyright © 2015 Elsevier Ltd. All rights reserved.

Relationship between organizational factors and performance among pay-for-performance hospitals.

PubMed

Vina, Ernest R; Rhew, David C; Weingarten, Scott R; Weingarten, Jason B; Chang, John T

2009-07-01

The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance. An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture. More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05). Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.

The process evaluation of It's Your Move!, an Australian adolescent community-based obesity prevention project.

PubMed

Mathews, Louise B; Moodie, Marj M; Simmons, Annie M; Swinburn, Boyd A

2010-07-30

Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region. The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities. The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs. While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.

PubMed

Paskett, Electra; Thompson, Beti; Ammerman, Alice S; Ortega, Alexander N; Marsteller, Jill; Richardson, DeJuran

2016-08-01

Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. Project HOPE—The People-to-People Health Foundation, Inc.

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

PubMed Central

Stead, Martine; Angus, Kathryn; Holme, Ingrid; Cohen, David; Tait, Gayle

2009-01-01

Background Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be. Aim This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement. Method Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills. Results The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation. Conclusion Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe. PMID:19674514

A Pilot Study Promoting Participation of Families with Limited Resources in Early Autism Intervention

PubMed Central

Carr, Themba; Lord, Catherine

2016-01-01

Background Relatively little research about autism early intervention has occurred in families of low socioeconomic status. Barriers to participation for under-resourced families (i.e., families with low incomes or limited education), pose a significant problem. The purpose of this pilot study was to apply empirically supported methods promoting participation of families with low-income and low-education levels to an established intervention for children with autism spectrum disorder (ASD). Method Participant recruitment specifically targeted families whose income was equal to or below two times the federal poverty line and whose caregiver(s) had no more than two years of college attendance. An evidence-based intervention was modified to be more accessible to participating families. Adaptations focused on decreasing access barriers, decreasing attrition, and promoting positive change within families. Success of the program was measured quantitatively and qualitatively. Results Twenty-seven families were referred to the project, 13 of which did not meet eligibility requirements. Eight families enrolled, maintained participation for the majority of the project and provided positive qualitative feedback of their experiences. Project and treatment attrition were calculated at 62% and 12.5%, respectively. Treatment attendance was high, but length of time to complete treatment was greatly influenced by the number of session cancellations. Conclusions The exploratory project demonstrated that practical modifications to standard early intervention protocols can promote engagement in families with limited resources. Recommendations for programs seeking to implement interventions in under-resourced communities are discussed. PMID:27019670

A childhood obesity prevention programme in Barcelona (POIBA Project): Study protocol of the intervention.

PubMed

Sánchez-Martínez, Francesca; Juárez, Olga; Serral, Gemma; Valmayor, Sara; Puigpinós, Rosa; Pasarín, María Isabel; Díez, Élia; Ariza, Carles

2018-02-05

Childhood obesity preventive interventions should promote a healthy diet and physical activity at home and school. This study aims to describe a school-based childhood obesity preventive programme (POIBA Project) targeting 8-to-12- year-olds. Evaluation study of a school-based intervention with a pre-post quasi-experimental design and a comparison group. Schools from disadvantaged neighbourhoods are oversampled. The intervention consists of 9 sessions, including 58 activities of a total duration between 9 and 13 hours, and the booster intervention of 2 sessions with 8 activities lasting 3 or 4 hours. They are multilevel (individual, family and school) and multicomponent (classroom, physical activity and family). Data are collected through anthropometric measurements, physical fitness tests and lifestyle surveys before and after the intervention and the booster intervention. In the intervention group, families complete two questionnaires about their children's eating habits and physical activity. The outcome variable is the cumulative incidence rate of obesity, obtained from body mass index values and body fat assessed by triceps skinfold thickness. The independent variables are socio-demographic, contextual, eating habits, food frequency, intensity of physical activity and use of new technologies. It is essential to implement preventive interventions at early ages and to follow its effects over time. Interventions involving diet and physical activity are the most common, being the most effective setting the school. The POIBA Project intervenes in both the school and family setting and focuses on the most disadvantaged groups, in which obesity is most pronounced and difficult to prevent.

Evaluating the Social Validity of Project "TEAM": A Problem-Solving Intervention to Teach Transition Age Youth with Developmental Disabilities to Resolve Environmental Barriers

ERIC Educational Resources Information Center

Kramer, Jessica M.; Hwang, I-Ting; Helfrich, Christine A.; Samuel, Preethy S.; Carrellas, Ann

2018-01-01

Project "TEAM" teaches transition-age youth with developmental disabilities (DD) to identify physical and social environmental barriers and supports, generate solutions to barriers, and request modifications to increase participation. Establishing the social validity of this environment focused intervention with youth and their parents…

The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 4.

ERIC Educational Resources Information Center

Godley, Susan Harrington; Meyers, Robert J.; Smith, Jane Ellen; Karvinen, Tracy; Titus, Janet C.; Godley, Mark D.; Dent, George; Passetti, Lora; Kelberg, Pamela

This publication was written for therapists and their supervisors who may want to implement the adolescent community reinforcement approach intervention, which was one of the five interventions tested by the Center for Substance Abuse Treatment's (CSAT's) Cannabis Youth Treatment (CYT) Project. The CYT Project provided funding to support a study…

The Effect of an Instructional Intervention on Middle School English Learners' Science and English Reading Achievement

ERIC Educational Resources Information Center

Lara-Alecio, Rafael; Tong, Fuhui; Irby, Beverly J.; Guerrero, Cindy; Huerta, Maggie; Fan, Yinan

2012-01-01

This study examined the effect of a quasi-experimental project on fifth grade English learners' achievement in state-mandated standards-based science and English reading assessment. A total of 166 treatment students and 80 comparison students from four randomized intermediate schools participated in the current project. The intervention consisted…

Evaluating the Acceptability and Feasibility of Project ACCEPT: An Intervention for Youth Newly Diagnosed with HIV

ERIC Educational Resources Information Center

Hosek, Sybil G.; Lemos, Diana; Harper, Gary W.; Telander, Kyle

2011-01-01

Given the potential for negative psychosocial and medical outcomes following an HIV diagnosis, Project ACCEPT, a 12-session behavioral intervention, was developed and pilot-tested for youth (aged 16-24) newly diagnosed with HIV. Fifty participants recently diagnosed with HIV were enrolled from 4 sites selected through the Adolescent Medicine…

Pre-Vocational Immersion as Risk Intervention in a Mainstream Setting: A Preliminary Evaluation of Project OASES.

ERIC Educational Resources Information Center

Morrow, Daniel Hibbs; And Others

This study evaluates a 1-year, pre-vocational intervention--Project OASES (Occupational and Academic Skills for the Employment of Students)--for at-risk middle school students in the Pittsburgh (Pennsylvania) Public School District. The study sample consisted of 502 former participants and 148 active participants (1988-1989 school year) plus…

[Effectiveness of a joint project between primary care and mental health to improve the recording of cardiovascular risk factors in patients with psychosis].

PubMed

Viñas Cabrera, Lidia; Fernández San-Martín, María Isabel; Martín López, Luis Miguel

2013-01-01

To evaluate the effectiveness of a joint team intervention between primary care (PC) and mental health (MH) to improve information on cardiovascular risk factors (CVRF) in psychotic patients. Multicenter before-after intervention study. Seven primary care and 2 mental health centers in Barcelona participated. All patients between 18-65 years old with a confirmed diagnosis of psychosis assigned to PC teams (n = 690) are included. Shared clinical sessions, developing a joint GP-MH protocol and implement it. Gender, age, number of Appointments per center/year, smoking, blood pressure, body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, glucose, waist circumference (WC), Cardiovascular Risk. Comparison of CVRF records from 2008 to 2010 using statistical tests for paired data. Calculation of CVRF prevalence in accordance with metabolic syndrome criteria and the criteria for referral to GP. The mean age was 42.3 (SD 11.4) years, with 67% males. All CVRF significantly Increased in clinical notes, particularly all blood test parameters and WC. More than 35% of patients had a CVRF according to metabolic syndrome criteria. Criteria to refer to PC physician (2010) identified: obesity 51.9%, 23.9% hypertension, high cholesterol 20.4% and 11.6% diabetes. CVRF recording improvement. High percentage of patients needed GP intervention due to a CVRF. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Psychosis prediction and clinical utility in familial high-risk studies: Selective review, synthesis, and implications for early detection and intervention

PubMed Central

Shah, Jai L.; Tandon, Neeraj; Keshavan, Matcheri S.

2016-01-01

Aim Accurate prediction of which individuals will go on to develop psychosis would assist early intervention and prevention paradigms. We sought to review investigations of prospective psychosis prediction based on markers and variables examined in longitudinal familial high-risk (FHR) studies. Methods We performed literature searches in MedLine, PubMed and PsycINFO for articles assessing performance characteristics of predictive clinical tests in FHR studies of psychosis. Studies were included if they reported one or more predictive variables in subjects at FHR for psychosis. We complemented this search strategy with references drawn from articles, reviews, book chapters and monographs. Results Across generations of familial high-risk projects, predictive studies have investigated behavioral, cognitive, psychometric, clinical, neuroimaging, and other markers. Recent analyses have incorporated multivariate and multi-domain approaches to risk ascertainment, although with still generally modest results. Conclusions While a broad range of risk factors has been identified, no individual marker or combination of markers can at this time enable accurate prospective prediction of emerging psychosis for individuals at FHR. We outline the complex and multi-level nature of psychotic illness, the myriad of factors influencing its development, and methodological hurdles to accurate and reliable prediction. Prospects and challenges for future generations of FHR studies are discussed in the context of early detection and intervention strategies. PMID:23693118

The Influence of a Postdischarge Intervention on Reducing Hospital Readmissions in a Medicare Population

PubMed Central

Frey, Beth; Hall, Benjamin; Painter, Philip

2013-01-01

Abstract Hospital readmissions in the Medicare population may be related to a number of factors, including reoccurrence of illness, failure to understand or follow physician direction, or lack of follow-up care, among others. These readmissions significantly increase cost and utilization in this population, and are expected to increase with the projected growth in Medicare enrollment. The authors examined whether a postdischarge telephonic intervention for patients reduced 30-day hospital readmissions as compared to a matched control population. Postdischarge telephone calls were placed to patients after discharge from a hospital. Readmissions were monitored through health care claims data analysis. Of 48,538 Medicare members who received the intervention, 4504 (9.3%) were readmitted to the hospital within 30 days, as compared to 5598 controls (11.5%, P<0.0001). A direct correlation was observed between the timing of the intervention and the rate of readmission; the closer the intervention to the date of discharge the greater the reduction in number of readmissions. Furthermore, although emergency room visits were reduced in the intervention group as compared to controls (8.1% vs. 9.4%, P<0.0001), physician office visits increased (76.5% vs. 72.3%, P<0.0001), suggesting the intervention may have encouraged members to seek assistance leading to avoidance of readmission. As a group, overall cost savings were $499,458 for members who received the intervention, with $13,964,773 in savings to the health care plan. Support for patients after hospital discharge clearly affected hospital readmission and associated costs and warrants further development. (Population Health Management 2013;16:310–316) PMID:23537154

Effects of a weight management program delivered by social media on weight and metabolic syndrome risk factors in overweight and obese adults: A randomised controlled trial.

PubMed

Jane, Monica; Hagger, Martin; Foster, Jonathan; Ho, Suleen; Kane, Robert; Pal, Sebely

2017-01-01

The aim of this project was to evaluate the effectiveness of using social media to augment the delivery of, and provide support for, a weight management program delivered to overweight and obese individuals during a twenty four week intervention. Participants randomly divided into either one of two intervention groups or a control group. The two intervention groups were instructed to follow identical weight-management program. One group received the program within a Facebook group, along with a support network with the group, and the other intervention group received the same program in a booklet. The control group was given standard care. Participants' weight and other metabolic syndrome risk factors were measured at baseline and at weeks 6, 12, 18 and 24. The Facebook Group reported a 4.8% reduction in initial weight, significant compared to the CG only (p = 0.01), as well as numerically greater improvements in body mass index, waist circumference, fat mass, lean mass, and energy intake compared to the Pamphlet Group and the Control Group. These results demonstrate the potential of social media to assist overweight and obese individuals with respect to dietary and physical activity modifications for weight management, and justify further research into the inclusion of social media in clinical weight management programs. It is anticipated that social media will provide an invaluable resource for health professionals, as a low maintenance vehicle for communicating with patients, as well as a source of social support and information sharing for individuals undergoing lifestyle modifications.

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh

PubMed Central

Alonge, Olakunle; He, Siran; Wadhwaniya, Shirin; Rahman, Fazlur; Rahman, Aminur; Arifeen, Shams El

2014-01-01

ABSTRACT Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning—global funding, political will, scale, sustainability, and capacity building; (ii) engaging—coordination, involvement of appropriate individuals; (iii) executing—focused action, multisectoral actions, quality of execution; and (iv) evaluating—rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings. PMID:25895188

Education and Raising Awareness of Seismic Risk in the Black Sea Basin

NASA Astrophysics Data System (ADS)

Florin Balan, Stefan; Alcaz, Vasile; Trifonova, Petya; Uker, Nalan; Tataru, Dragos

2014-05-01

The Project "Black Sea Earthquake Safety Net(work)" ESNET has the intention to educate and raise awareness of seismic risk in the Black Sea Basin in four countries: Moldova, Romania, Bulgaria and Turkey. The project is financed through "The Black Sea Basin Joint Operational Programme", an EU operational programmes under European Neighborhood & Partnership Instrument (ENPI). The programme is financed by ENPI. The participation of Turkey is financed by Instrument for Pre-accession Assistance. It is implemented during the period 2007 - 2013. The project wants to contribute to the prevention of natural disasters generated by earthquakes in Black Sea Basin by developing a joint monitoring and intervention concept. All the countries involved in the project have their own studies, strategies, prevention and intervention systems in case of earthquakes, but until now there has not been an integrated approach so far in the Black Sea Basin. Given the cross-border character of seismic activity, it is necessary to have a cross-border approach on prevention, monitoring and intervention in case of earthquakes. Main objectives : 1. The assessment of the disaster potential, with accent on the seismic risk degree and the earthquakes effects in the intervention area. For achieving the main objective is to have an accurate and up-to-date assessment of the potential of disasters provoked by earthquakes in the project area/regions. This assessment will be carried out at national level and will be used in designing the common concept/approach for dealing with earthquakes at regional level, thus ensuring the cross-border character of the objective. 2.To develop an integrated seismic monitoring and intervention concept. This integrated concept, built on the basis of the previous objective, will have a cross-border relevance and is at the core of the action. The monitoring and intervention in case of earthquakes will be coordinated among the participating countries based on this, thus a more effective and efficient approach being ensured. 3. To increase the capacity of local institutions emergency intervention units for joint response activities in case of disasters. By involving the local emergency units and public administration in the project activities, especially in trainings, conferences and consultations, a better cooperation at cross-border level will be achieved. Step by step, the respective bodies will increase the cooperation and will benefit from each others expertise. Target groups : Research institutions and universities; Emergency intervention units; Local public authorities; NGOs. Final beneficiaries of the project: the population in the regions of the project. The project has a high educational perspective through its: a)training activities and b)training tools applied in the process. A) the training of 20 people from the emergency units from each country (80 in total) by experts in risk management. B) The Seismic Safety Web Portal of the project presenting all activities, maps and materials posted by members of the network agreement and not only. Also for changing expertise, opinions and long distance conferences is available a special software communication tool. An educational book is printed in 3 languages to be distributed in partner countries with main results.

Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting.

PubMed

De Almeida Mello, Johanna; Van Durme, Therese; Macq, Jean; Declercq, Anja

2012-08-06

Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons. This is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention--comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project. This research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of risk for institutionalization. The identification of effective home care projects in delaying institutionalization will be useful to inform and empower home care providers, policy and related decision makers to manage and improve home care services.

Suicide and attempted suicide: epidemiological surveillance as a crucial means of a local suicide prevention project in Trento's Province.

PubMed

Di Napoli, Wilma Angela; Della Rosa, Alberto

2015-09-01

The World Health Organization identifies suicide among the top 10 causes of death in many countries with an overall mortality rate of 16 per 100,000 inhabitants. Furthermore suicide attempts present a frequency 4-10 times greater than the suicidal events, representing also one of the main risk factors to lead to recurrent attempts of suicide. In 2008 the Autonomous Province of Trento launched a suicide prevention pogram called "Invitation to Life" which includes various interventions intended to counter the phenomenon of suicide in the region. Actually the epidemiological research upon the phenomenon of suicide in Trentino region is one of the main pillars of the project: it represents a fundamental requirement to identify risk and protective factors in the population in order to adopt more specific and effective preventive strategies. This article aims to present methods and instruments for epidemiological monitoring of suicide and attempted suicide which are applied in Trentino and to describe results after seven years from the beginning of the local prevention program "Invitation to life".

Improving the well-being of children and youths: a randomized multicomponent, school-based, physical activity intervention.

PubMed

Smedegaard, Søren; Christiansen, Lars Breum; Lund-Cramer, Pernille; Bredahl, Thomas; Skovgaard, Thomas

2016-10-28

The benefits of physical activity for the mental health and well-being of children and young people are well-established. Increased physical activity during school hours is associated with better physical, psychological and social health and well-being. Unfortunately many children and young people exercise insufficiently to benefit from positive factors like well-being. The main aim of this study is to develop, implement and evaluate a multi-component, school-based, physical activity intervention to improve psychosocial well-being among school-aged children and youths from the 4 th to the 6 th grade (10-13 years). A four-phased intervention - design, pilot, RCT, evaluation - is carried out for the development, implementation and evaluation of the intervention which are guided by The Medical Research Council framework for the development of complex interventions. 24 schools have been randomized and the total study population consists of 3124 children (baseline), who are followed over a period of 9 months. Outcome measure data at the pupil level are collected using an online questionnaire at baseline and at follow-up, 9 months later with instruments for measuring primary (general physical self-worth) and secondary outcomes (self-perceived sport competences, body attractiveness, scholastic competences, social competences and global self-worth; enjoyment of PA; self-efficacy; and general well-being) that are both valid and manageable in setting-based research. The RE-AIM framework is applied as an overall instrument to guide the evaluation. The intervention focuses on the mental benefits of physical activity at school, which has been a rather neglected theme in health promotion research during recent decades. This is unfortunate as mental health has been proclaimed as one of the most important health concerns of the 21 st century. Applying a cluster RCT study design, evaluating the real-world effectiveness of the intervention, this study is one of the largest physical activity intervention projects promoting psychosocial well-being among children and youths. Through a comprehensive effectiveness evaluation and a similar substantial process evaluation, this study is designed to gain knowledge on a broad variety of implementation issues and give detailed information on project delivery and challenges at the school level - among other things to better inform future practice. Date of registration: 24 April 2015 retrospectively registered at Current Controlled Trials with study ID ISRCTN12496336.

Behavioral Intervention Materials Compendium. OPRE Report 2018-08

ERIC Educational Resources Information Center

Anzelone, Caitlin, Ed.; Dechausay, Nadine, Ed.; Alemany, Xavier, Ed.

2018-01-01

The Behavioral Interventions to Advance Self-Sufficiency (BIAS) project conducted 15 randomized controlled trials of behavioral interventions across eight states, in the domains of work support, child support, and child care. BIAS used a systematic approach called "behavioral diagnosis and design" to develop the interventions and their…

Effectiveness of a Dissonance-Based Eating Disorder Prevention Program for Ethnic Groups in Two Randomized Controlled Trials

PubMed Central

Stice, Eric; Marti, C. Nathan; Cheng, Zhen Hadassah

2014-01-01

Objective As young women from certain ethnic minority groups have reported less pursuit of the thin ideal and body dissatisfaction than European American young women we tested whether a dissonance-based prevention program designed to reduce thin-ideal internalization among women with body dissatisfaction is less effective for the former relative to the later groups. We also tested whether intervention effects are larger when participants from minority groups worked with a facilitator matched versus not matched on ethnicity. Method In Study 1, 426 female undergraduates (M age = 21.6, SD = 5.6) were randomized to clinician-led Body Project groups or an educational control group. In Study 2, 189 female undergraduates were randomized to peer-led Body Project groups or a waitlist control condition. Results Although there was some variation in risk factor scores across ethnic groups, ethnic minority participants did not demonstrate consistently higher or lower risk relative to European American participants. Intervention effects did not significantly differ for participants from minority groups versus European American participants in either trial. There was no evidence that effects were significantly larger when minority participants and facilitators were matched on ethnicity. Conclusions Results suggest that the Body Project is similarly effective for African American, Asian American, European American, and Hispanic female college students, and when participants and facilitators are matched or not on minority ethnicity status, implying that this prevention program can be broadly disseminated in this population. PMID:24655465

Effectiveness of a dissonance-based eating disorder prevention program for ethnic groups in two randomized controlled trials.

PubMed

Stice, Eric; Marti, C Nathan; Cheng, Zhen Hadassah

2014-04-01

As young women from certain ethnic minority groups have reported less pursuit of the thin ideal and body dissatisfaction than European American young women we tested whether a dissonance-based prevention program designed to reduce thin-ideal internalization among women with body dissatisfaction is less effective for the former relative to the later groups. We also tested whether intervention effects are larger when participants from minority groups worked with a facilitator matched versus not matched on ethnicity. In Study 1, 426 female undergraduates (M age=21.6, SD=5.6) were randomized to clinician-led Body Project groups or an educational control group. In Study 2, 189 female undergraduates were randomized to peer-led Body Project groups or a waitlist control condition. Although there was some variation in risk factor scores across ethnic groups, ethnic minority participants did not demonstrate consistently higher or lower risk relative to European American participants. Intervention effects did not significantly differ for participants from minority groups versus European American participants in either trial. There was no evidence that effects were significantly larger when minority participants and facilitators were matched on ethnicity. Results suggest that the Body Project is similarly effective for African American, Asian American, European American, and Hispanic female college students, and when participants and facilitators are matched or not on minority ethnicity status, implying that this prevention program can be broadly disseminated in this population. Copyright © 2014 Elsevier Ltd. All rights reserved.

Universal Prevention Exposure as a Moderator of the Community Context: Findings from the PROSPER Project.

PubMed

Chilenski, Sarah M; Welsh, Janet A; Perkins, Daniel F; Feinberg, Mark E; Greenberg, Mark T

2016-03-01

This study examined how participation in a universal family skills-building program may interact with community risks and resources to produce youth outcomes. Prior research has noted community-level variability in risk and protective factors, but thus far no study has examined the role that participation on a community-wide intervention may play in moderating the effects of community risks or resources. The study included 14 communities (seven in Iowa, seven in Pennsylvania) that implemented a family focused evidence-based program as part of the PROSPER project. Community level variables included both risk factors (percent of low income families, the availability of alcohol and tobacco, norms regarding adolescent substance use, incidence of drug-related crimes) and community resources (proactive school leadership, availability of youth-serving organizations, and student involvement in youth activities). The proximal youth and family outcomes included youth perceptions of their parents' management skills, parent-child activities, and family cohesion. Results indicated that the Strengthening Families Program:10-14 may have moderated the impact of the community risks and resources on community-level youth outcomes; risk levels meaningfully associated with community-level change in program participants, though these results varied somewhat by outcome. Generally, higher levels of resources also meaningfully associated with more positive change after participating in the family-focused intervention. These results suggest that the effect of some evidence-based programs may be even stronger in some communities than others; more research in this area is needed. © Society for Community Research and Action 2016.

Challenges in doing multi-disciplinary health promotion research in Germany.

PubMed

Igel, Ulrike; Gausche, Ruth; Lück, Martina; Lipek, Tobias; Spielau, Ulrike; Garz, Maria; Kiess, Wieland; Grande, Gesine

2017-08-23

Health problems such as obesity are increasingly addressed by complex intervention programmes which operate at multiple levels of influence (e.g. families, schools, neighbourhoods) involving partners from various academic, professional and cultural backgrounds. Following a complex participatory health promotion approach is challenging, because conflicting interests as well as contextual constraints may occur which are rarely discussed empirically. Process evaluations of some programmes investigate factors influencing the implementation process. However, researchers' perspectives on inter- and transdisciplinary work are mostly neglected. This paper aims at illustrating and critically analysing challenges that arose in the planning and implementation of a health promotion project in a socially deprived neighbourhood in Germany. Drawing on minutes, email conversations, and research diary entries we reflect on discrepancies and difficult interactions within the research team, with collaborating (academic) institutions (interdisciplinary work) and with the community partners (transdisciplinary work) respectively. Differences in language, interests, success criteria, professional preferences and habits as well as contextual factors are worked out and coping strategies or solutions are proposed. According to our experiences, bringing to light researchers' positions, preferences and interactions with the community is necessary to find a balance between research and practice, to develop adequate solutions for challenging situations and to evaluate the process, effectiveness and transferability of a programme. Health promotion research should report not only on the effectiveness of interventions but also on struggles, unsuccessful attempts and useful (or useless) strategies to fuel discourse on opportunities in and the efficacy and transferability of health promotion projects. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Recruitment to online therapies for depression: pilot cluster randomized controlled trial.

PubMed

Jones, Ray B; Goldsmith, Lesley; Hewson, Paul; Williams, Christopher J

2013-03-05

Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting "leaked" and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp).

The effectiveness of knowledge translation interventions for promoting evidence-informed decision-making among nurses in tertiary care: a systematic review and meta-analysis.

PubMed

Yost, Jennifer; Ganann, Rebecca; Thompson, David; Aloweni, Fazila; Newman, Kristine; Hazzan, Afeez; McKibbon, Ann; Dobbins, Maureen; Ciliska, Donna

2015-07-14

Nurses are increasingly expected to engage in evidence-informed decision-making (EIDM) to improve client and system outcomes. Despite an improved awareness about EIDM, there is a lack of use of research evidence and understanding about the effectiveness of interventions to promote EIDM. This project aimed to discover if knowledge translation (KT) interventions directed to nurses in tertiary care are effective for improving EIDM knowledge, skills, behaviours, and, as a result, client outcomes. It also sought to understand contextual factors that affect the impact of such interventions. A systematic review funded by the Canadian Institutes of Health Research (PROSPERO registration: CRD42013003319) was conducted. Included studies examined the implementation of any KT intervention involving nurses in tertiary care to promote EIDM knowledge, skills, behaviours, and client outcomes or studies that examined contextual factors. Study designs included systematic reviews, quantitative, qualitative, and mixed method studies. The search included electronic databases and manual searching of published and unpublished literature to November 2012; key databases included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica (EMBASE). Two reviewers independently performed study selection, risk of bias assessment, and data extraction. Studies with quantitative data determined to be clinically homogeneous were synthesized using meta-analytic methods. Studies with quantitative data not appropriate for meta-analysis were synthesized narratively by outcome. Studies with qualitative data were synthesized by theme. Of the 44,648 citations screened, 30 citations met the inclusion criteria (18 quantitative, 10 qualitative, and 2 mixed methods studies). The quality of studies with quantitative data ranged from very low to high, and quality criteria was generally met for studies with qualitative data. No studies evaluated the impact on knowledge and skills; they primarily investigated the effectiveness of multifaceted KT strategies for promoting EIDM behaviours and improving client outcomes. Almost all studies included an educational component. A meta-analysis of two studies determined that a multifaceted intervention (educational meetings and use of a mentor) did not increase engagement in a range of EIDM behaviours [mean difference 2.7, 95 % CI (-1.7 to 7.1), I (2) = 0 %]. Among the remaining studies, no definitive conclusions could be made about the relative effectiveness of the KT interventions due to variation of interventions and outcomes, as well as study limitations. Findings from studies with qualitative data identified the organizational, individual, and interpersonal factors, as well as characteristics of the innovation, that influence the success of implementation. KT interventions are being implemented and evaluated on nurses' behaviour and client outcomes. This systematic review may inform the selection of KT interventions and outcomes among nurses in tertiary care and decisions about further research.

[The Impact of Risk Factors and Effective Factors on Success in Crisis Intervention for Children and Adolescents].

PubMed

Wisiol, Florian; Juen, Barbara; Unterrainer, Christine

2017-05-01

The Impact of Risk Factors and Effective Factors on Success in Crisis Intervention for Children and Adolescents This article focuses on the evaluation of (inpatient) crisis interventions for children and adolescents, who can be admitted into the residential area of the KIZ for up to eight weeks in order to provide acute protection against massive violence, neglect or family conflicts in emergency situations. How successful the crisis intervention is or can be depends on various factors that have been worked out in this study. Various factors have an impact on success in crisis intervention; above all the participation, a good relationship and/or cooperation with the Counselors in the Crisis Intervention Center contribute to a great success. Restoring their own possibilities for action after a massive crisis, the strengthening of self-efficacy in crisis intervention must be considered critically. The young clients see little change here. The crisis intervention must therefore not only focus on its most important function, protection and security, but also on the strengthening of self-esteem and a positive sense of coherence as part of the crisis intervention.

A Perinatal Intervention Program for Urban American Indians Part 1: Design, Implementation, and Outcomes

PubMed Central

Davis, Carol L.; Prater, Sandra L.

2001-01-01

High infant mortality rates among American Indians are disproportionate to state statistics for other races and higher than the national average. These findings prompted a community health center in a large Midwestern city to create and provide an American Indian infant mortality reduction project in the early 1990s. Strategies for program implementation included networking with local organizations, communicating with reservation health clinics throughout the state, educating American Indian mothers and their community about factors contributing to American Indian infant mortality, and providing individual case management to American Indian women and infants. We offer this article for three reasons: This grant project was successful, disparity in rates of infant mortality among peoples of color continues, and a paucity of information exists about the health behaviors of American Indian women. PMID:17273261

Implementation of a Nurse Driven Pathway to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive Care Setting.

PubMed

Rowe, Angela D; McCarty, Karen; Huett, Amy

2018-03-13

A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention. The aim of this quality improvement project had two aims. First, to reduce HAPI incidence in the PICU by 10%. Second, to increase consistent usage of pressure injury prevention strategies as evidenced by a 10% increase in pressure injury bundle compliance. The third aim was to identify if there are differences in percentage of interventions implemented between two different groups of patients. Donabedian's model of Structure, Process, and Outcomes guided the development and implementation of this quality improvement project. Interventions focused on risk assessment subscale scores have the opportunity to mitigate specific risk factors and improve pressure injury prevention. Through implementation of the nurse driven pathway there was as 57% decrease in reported HAPIs in the PICU as well as a 66% increase in pressure ulcer prevention bundle compliance. Implementation of the nurse driven pressure injury prevention pathway was successful. There was a significant increase in bundle compliance for pressure ulcer prevention and a decrease in reported HAPIs. The pathway developed and implemented for this quality improvement project could be adapted to other populations and care settings to provide guidance across the continuum. Copyright © 2018 Elsevier Inc. All rights reserved.

Sustainability of a Community-Based CHOICE Program to Improve the Health and Nutrition Status of Mothers and Infants in Indonesia.

PubMed

Eder, Clara; Khatiwada, Lila Kumar; Schooley, Janine

2018-06-01

Objectives Few studies have been undertaken to determine whether and how project results are sustained. University of Notre Dame (ND) and Project Concern International conducted a Post-Project Sustainability Study (PSS) of a USAID-funded program (CHOICE), implemented in Indonesia, Banten province, between 2003 and 2007, in order to determine lasting effects and improve PSS methodologies. Methods Sustainability was measured through a comparison of data collected on mother-infant pairs in 2014 with final evaluation data from 2007; and through a comparison of 2014 data collected from the CHOICE villages and comparison villages. Results The analysis showed positive differences in multiple indicators in CHOICE villages between 2007 and 2014, including births attended by skilled personnel (Mean Difference 48.56, 95% CI 38.68 to 58.43) and treatment of diarrhea (MD 16.42, 95% CI - 0.94 to 33.37). However, only one statistically significant difference between intervention and comparison groups in 2014 was observed, infants with diarrhea whose mothers sought advice or treatment (MD - 5.48, 95% CI - 9.55 to 1.39), showing more mothers in intervention group sought advice or treatment. Because contextual factors were not studied in detail and baseline data was not available for the comparison villages, it is difficult to determine the reasons for the results. Given that longitudinal data was not collected, it is also difficult to determine whether results fluctuated between 2007 and 2014. Conclusions for practice This PSS contributes to the limited body of knowledge in sustainability research. Lessons learned from this study will increase potential for sustainable impact of projects, as more rigorous measurement will lead to greater overall understanding of how sustainability actually "happens".

Experiences with Recruitment of Marginalized Groups in a Danish Health Promotion Program: A Document Evaluation Study.

PubMed

Rasmussen, Marianne; Poulsen, Eva Kanstrup; Rytter, Anne Stoffersen; Kristiansen, Tine Mechlenborg; Bak, Carsten Kronborg

2016-01-01

Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. Documents from all 12 of the included municipalities were collected to conduct a document evaluation. The collected documents consisted of 1,500 pages of written material with 12 project descriptions, three midterm and 10 final evaluations. The collected data were analyzed through a qualitative content analysis. The results are based on the fact that only 10 municipalities have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability to cope with new situations and strangers. Additional geographical challenges emerged, especially in rural areas. Positive experiences with recruitment approaches were mainly related to relationship building and trust building, especially through face-to-face contact and the project employees' presence in the neighborhood. Additionally, adjusting some of the interventions and the recruitment strategy increased participation. This study found that relation and trust between the residents and the project employees is an important factor in the recruitment of marginalized groups in deprived neighborhoods as well as adjusting the health interventions or recruitment strategy to the target groups. In future research, it is necessary to examine which recruitment approaches are effective under which circumstances to increase participation among marginalized groups.

Examining How Adding a Booster to a Behavioral Nutrition Intervention Prompts Parents to Pack More Vegetables and Whole Gains in Their Preschool Children's Sack Lunches.

PubMed

Sweitzer, Sara J; Ranjit, Nalini; Calloway, Eric E; Hoelscher, Deanna M; Almansor, Fawaz; Briley, Margaret E; Roberts-Gray, Cynthia R

2016-01-01

Data from a five-week intervention to increase parents' packing of vegetables and whole grains in their preschool children's sack lunches showed that, although changes occurred, habit strength was weak. To determine the effects of adding a one-week booster three months post-intervention, children's (N = 59 intervention and 48 control) lunches were observed at baseline (week 0), post-intervention (week 6), pre-booster (week 20), and post-booster (week 26). Servings of vegetables and whole grains were evaluated in repeated measures models and results inspected relative to patterns projected from different explanatory models of behavior change processes. Observed changes aligned with projections from the simple associative model of behavior change. Attention in future studies should focus on behavioral intervention elements that leverage stimulus-response associations to increase gratification parents receive from providing their children with healthy lunches.

76 FR 37336 - Applications for New Awards; Rehabilitation Research and Training Center-Interventions To Promote...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

...--Interventions To Promote Community Living Among Individuals With Disabilities AGENCY: Office of Special... Research Projects and Centers Program-- Rehabilitation Research and Training Center (RRTC)-- Interventions... Program, published in the Federal Register on February 1, 2008 (73 FR 6132) and the RRTC on Interventions...

Students' Evidence-Based Practice Intervention for Children with Oppositional Defiant Disorder

ERIC Educational Resources Information Center

Ronen, Tammie

2005-01-01

Objective: This project integrates clinical intervention as an integral part of social work studies for third-year students. Students applied a new manual-based intervention aiming to develop self-control skills among children exhibiting oppositional defiant disorder. Throughout, students were involved in assessment, intervention, and evaluation.…

Clinical Effectiveness of Weight Loss and Weight Maintenance Interventions for Men: A Systematic Review of Men-Only Randomized Controlled Trials (The ROMEO Project).

PubMed

Robertson, Clare; Avenell, Alison; Stewart, Fiona; Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Boyers, Dwayne

2017-07-01

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials' registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m 2 (or ≥28 kg/m 2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program -3.2 kg, 95% confidence interval -4.8 to -1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was -4.9 kg, 95% confidence interval -5.9 to -4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed.

Clinical Effectiveness of Weight Loss and Weight Maintenance Interventions for Men: A Systematic Review of Men-Only Randomized Controlled Trials (The ROMEO Project)

PubMed Central

Robertson, Clare; Avenell, Alison; Stewart, Fiona; Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Boyers, Dwayne

2015-01-01

Men are underrepresented in obesity services, suggesting current weight loss service provision is suboptimal. This systematic review evaluated evidence-based strategies for treating obesity in men. Eight bibliographic databases and four clinical trials’ registers were searched to identify randomized controlled trials (RCTs) of weight loss interventions in men only, with mean/median body mass index of ≥30 kg/m2 (or ≥28 kg/m2 with cardiac risk factors), with a minimum mean/median duration of ≥52 weeks. Interventions included diet, physical activity, behavior change techniques, orlistat, or combinations of these; compared against each other, placebo, or a no intervention control group; in any setting. Twenty-one reports from 14 RCTs were identified. Reducing diets produced more favorable weight loss than physical activity alone (mean weight change after 1 year from a reducing diet compared with an exercise program −3.2 kg, 95% confidence interval −4.8 to −1.6 kg, reported p < .01). The most effective interventions combined reducing diets, exercise, and behavior change techniques (mean difference in weight at 1 year compared with no intervention was −4.9 kg, 95% confidence interval −5.9 to −4.0, reported p < .0001). Group interventions produced favorable weight loss results. The average reported participant retention rate was 78.2%, ranging from 44% to 100% retention, indicating that, once engaged, men remained committed to a weight loss intervention. Weight loss for men is best achieved and maintained with the combination of a reducing diet, increased physical activity, and behavior change techniques. Strategies to increase engagement of men with weight loss services to improve the reach of interventions are needed. PMID:26130729

Tribal recommendations for designing culturally appropriate technology-based sexual health interventions targeting Native youth in the Pacific Northwest.

PubMed

Craig Rushing, Stephanie; Stephens, David

2012-01-01

Media technologies, including the Internet, cell phones, and video games, offer new avenues to reach Native youth on sensitive health topics. Project Red Talon, a sexually transmitted disease (STD)/HIV prevention project that serves the 43 federally recognized tribes in Oregon, Washington, and Idaho, used community-based participatory research methods in partnership with the Northwest tribes to review existing technology-based interventions and generate recommendations for designing interventions that reflect the culture, needs, and organizational capacities of participating tribes and Native youth. These findings are now being used to guide the development of technology-based health interventions targeting American Indian/Alaska Native teens and young adults.

Heat and Health in a Changing Climate: Building a Decision Support Tool for California Public Health Officials

NASA Astrophysics Data System (ADS)

Steinberg, N.

2017-12-01

There is considerable interest in overlaying climate projections with social vulnerability maps as a mechanism for targeting community adaptation efforts. Yet the identification of relevant factors for adaptation- and resilience-based decisions remain a challenge. Our findings show that successful adaptation interventions are more likely when factors are grouped and spatially represented. By designing a decision-support tool that is focused on informing long-term planning to mitigate the public health impacts of extreme heat, communities can more easily integrate climate, land use, and population characteristics into local planning processes. The ability to compare risks and potential health impacts across census tracts may also position local practitioners to leverage scarce resources. This presentation will discuss the information gaps identified by planners and public health practitioners throughout California and illustrate the spatial variations of key health risk factors.

Improving Student Learning via Mobile Phone Video Content: Evidence from the BridgeIT India Project

ERIC Educational Resources Information Center

Wennersten, Matthew; Quraishy, Zubeeda Banu; Velamuri, Malathi

2015-01-01

Past efforts invested in computer-based education technology interventions have generated little evidence of affordable success at scale. This paper presents the results of a mobile phone-based intervention conducted in the Indian states of Andhra Pradesh and Tamil Nadu in 2012-13. The BridgeIT project provided a pool of audio-visual learning…

Employment Interventions for Individuals with ASD: The Relative Efficacy of Supported Employment with or without Prior Project Search Training

ERIC Educational Resources Information Center

Schall, Carol M.; Wehman, Paul; Brooke, Valerie; Graham, Carolyn; McDonough, Jennifer; Brooke, Alissa; Ham, Whitney; Rounds, Rachael; Lau, Stephanie; Allen, Jaclyn

2015-01-01

This paper presents findings from a retrospective observational records review study that compares the outcomes associated with implementation of supported employment (SE) with and without prior Project SEARCH with ASD Supports (PS-ASD) on wages earned, time spent in intervention, and job retention. Results suggest that SE resulted in competitive…

Interrupting Everyday Life: Public Interventionist Art as Critical Public Pedagogy

ERIC Educational Resources Information Center

Desai, Dipti; Darts, David

2016-01-01

In this article we explore two urban interventions art projects in the public sphere designed by our Masters' students at New York University as they set the stage for a discussion on how urban art interventions can function as a form of critical public pedagogy. We argue that these kinds of public art projects provided a space for dialogue with…

Effect of Foster Care on Language Learning at Eight Years: Findings from the Bucharest Early Intervention Project

ERIC Educational Resources Information Center

Windsor, Jennifer; Moraru, Ana; Nelson, Charles A., III.; Fox, Nathan A.; Zeanah, Charles H.

2013-01-01

This study reports on language outcomes at eight years from the Bucharest Early Intervention Project, a randomized controlled study of foster care. We previously have shown that children placed in foster care by age two have substantially stronger preschool language outcomes than children placed later and children remaining in institutional care.…

Community Colleges: Open Door or Revolving Door? Intervention Strategies To Reduce the Number of Probationary Students and Increase Student Persistence.

ERIC Educational Resources Information Center

Gonzalez, John Manuel

This doctoral dissertation investigates the Student Success Project (SSP) at the fictitiously named Bay Community College, a single-campus district in Southern California. The project was initiated in response to the high probationary, disqualified and dropout rates among first-time students. Its goal was to implement interventions to help…

Unpacking the Black Box of the Chicago School Readiness Project Intervention: The Mediating Roles of Teacher-Child Relationship Quality and Self-Regulation

ERIC Educational Resources Information Center

Jones, Stephanie M.; Bub, Kristen L.; Raver, C. Cybele

2013-01-01

Research Findings: This study examines the theory of change of the Chicago School Readiness Project (CSRP), testing a sequence of theory-derived mediating mechanisms that include the quality of teacher-child relationships and children's self-regulation. The CSRP is a multicomponent teacher and classroom-focused intervention, and its…

Conducting HIV Interventions for Asian Pacific Islander Men Who Have Sex with Men: Challenges and Compromises in Community Collaborative Research

ERIC Educational Resources Information Center

Operario, Don; Nemoto, Tooru; Ng, Terence; Syed, Javid; Mazarei, Mazdak

2005-01-01

This article describes the process of implementing a community collaborative HIV prevention intervention research project targeting Asian and Pacific Islander (API) men who have sex with men (MSM). This article traces the genesis of the project--which linked university researchers with an API-focused community based organization--starting from its…

Physical Activity Intervention for Older Adults with Intellectual Disability: Report on a Pilot Project

ERIC Educational Resources Information Center

Podgorski, Carol Ann; Kessler, Karen; Cacia, Barbara; Peterson, Derick R.; Henderson, C. Michael

2004-01-01

A 12-week pilot project on physical activity was introduced in a day habilitation setting to a group of 12 older adults with intellectual disability and a variety of physical and behavioral conditions. Our purpose was to determine whether (a) this intervention would positively impact physical function in this population, (b) consumers would choose…

Intervention, Treatment, and Prevention of Sexual Abuse and Assault: A Training Program for Racial Minority Service Providers. Final Report.

ERIC Educational Resources Information Center

Specktor, Peggy; Stafford, Rick, Ed.

The Minnesota Program for Victims of Sexual Assault conducted a 9-month training program for racial minority human service professionals from September 1983 through May 1984. The objectives of the project were to improve the identification, intervention, and treatment of sexual assault victims and their families. The project targeted Blacks,…

NIMH Project Accept (HPTN 043): results from in-depth interviews with a longitudinal cohort of community members.

PubMed

Maman, Suzanne; van Rooyen, Heidi; Stankard, Petra; Chingono, Alfred; Muravha, Tshifhiwa; Ntogwisangu, Jacob; Phakathi, Zipho; Srirak, Namtip; F Morin, Stephen

2014-01-01

NIMH Project Accept (HPTN 043) is a community- randomized trial to test the safety and efficacy of a community-level intervention designed to increase testing and lower HIV incidence in Tanzania, Zimbabwe, South Africa and Thailand. The evaluation design included a longitudinal study with community members to assess attitudinal and behavioral changes in study outcomes including HIV testing norms, HIV-related discussions, and HIV-related stigma. A cohort of 657 individuals across all sites was selected to participate in a qualitative study that involved 4 interviews during the study period. Baseline and 30-month data were summarized according to each outcome, and a qualitative assessment of changes was made at the community level over time. Members from intervention communities described fewer barriers and greater motivation for testing than those from comparison communities. HIV-related discussions in intervention communities were more grounded in personal testing experiences. A change in HIV-related stigma over time was most pronounced in Tanzania and Zimbabwe. Participants in the intervention communities from these two sites attributed community-level changes in attitudes to project specific activities. The Project Accept intervention was associated with more favorable social norms regarding HIV testing, more personal content in HIV discussions in all study sites, and qualitative changes in HIV-related stigma in two of five sites.

Opportunities to Meet Challenges in Rural Prevention Research

PubMed Central

Spoth, Richard

2008-01-01

Various rural prevention research challenges have been articulated through a series of sessions convened since the mid 1990s by the National Institutes of Health, particularly the National Institute on Drug Abuse. Salient in this articulation was the need for effective collaboration among rural practitioners and scientists, with special consideration of accommodating the diversity of rural areas and surmounting barriers to implementation of evidence-based interventions. This paper summarizes the range of challenges in rural prevention research and describes an evolving community-university partnership model addressing them. The model entails involvement of public school staff and other rural community stakeholders, linked with scientists by Land Grant University-based Extension system staff. Examples of findings from over 16 years of partnership-based intervention research projects include those on engagement of rural residents, quality implementation of evidence-based interventions, and long-term community-level outcomes, as well as factors in effectiveness of the partnerships. Findings suggest a future focus on building capacity for practitioner-scientist collaboration and developing a network for more widespread implementation of the partnership model in a manner informed by lessons learned from partnership-based research to date. PMID:18237324

The effect of Nordic Walking on joint status, quality of life, physical ability, exercise capacity and pain in adult persons with haemophilia.

PubMed

Salim, Maryem; Brodin, Elisabeth; Spaals-Abrahamsson, Yvonne; Berntorp, Erik; Zetterberg, Eva

2016-06-01

Nordic Walking is an exercise form requiring significant energy consumption, but where the use of poles minimizes the risk of injury. The aim of this pilot study was to examine the effect of 3 months of Nordic Walking on males (>40 years of age) with haemophilia, regarding joint function (Haemophilia Joint Health Score), physical ability (Haemophilia Exercise Project - Test-Questionnaire), exercise capacity (6-min walking test), pain (visual analogue scale) and quality of life (the Swedish version of The Short Form Health Survey, SF-36). Pre-interventional and post-interventional scores of above-mentioned parameters were analysed, using Wilcoxon Signed Ranks Test. Eleven participants were recruited to the study. Statistically significant improvements were observed in physical ability (P value: 0.01) and body perception (P value: 0.02). The intervention did not increase number of bleedings or factor consumption. This is the first study ever evaluating Nordic Walking in persons with haemophilia. Our results suggest that Nordic Walking is safe and efficient, also in patients with haemophilic arthropathy.