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Fan, Aihua, and Xumei Chen. "Exploring the Relationship between Transport Interventions, Mode Choice, and Travel Perception: An Empirical Study in Beijing, China." International Journal of Environmental Research and Public Health 17, no. 12 (June 15, 2020): 4258. http://dx.doi.org/10.3390/ijerph17124258.
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Transport interventions help to facilitate the sustainable travel behavior. The effects of transport interventions on travel choices have been addressed extensively. However, little research has been devoted to the influence of transport interventions and travel choice on travel perception. This study aimed to investigate the relationship among the three aspects. Two intervention measures, information intervention and public transport service improvement, were selected. Intervention experiments were designed to collect mode choice and corresponding travel perception in different experiment stages. Process models of information intervention and public transport service improvement were proposed. The results show that information intervention only had a minor effect on mode choice and had no direct effect on travel perception. Public transport service improvement in in-vehicle time and comfort enhanced public transport use dramatically. Comfort improvement also had positive effects on travel perception. Walking had positive and public transport trips had negative effects on travel perception. For travelers who had a high evaluation of car trips, the probability of green mode use would decrease. Travelers who gave high marks to trips by green mode would have a higher probability to keep traveling by green mode. This study contributes to facilitating public transport use and enhancing positive perception during traveling.
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Alderman, Gary L., and Marjorie Nix. "Teachers' Intervention Preferences Related to Explanations for Behavior Problems, Severity of the Problem, and Teacher Experience." Behavioral Disorders 22, no. 2 (February 1997): 87–95. http://dx.doi.org/10.1177/019874299702200201.
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The purpose of this study was to examine teachers' preference for positive versus negative interventions based on the amount of information they were provided about the student with behavior problems. A total of 144 educators, mostly teachers, completed a questionnaire that asked them to choose the intervention they would be most likely to use. Half of the participants received scenarios that contained no explanation of behavior, and half had detailed explanations of possible reasons for misbehaviors. Although there was an overall preference for the selection of positive interventions, having an explanation of misbehavior did lead to the choice of more positive interventions than negative interventions in some cases. These choices are discussed as well as their relationship to the experience level of the teacher and the severity of the problem.
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Zadro, Joshua R., Mary O’Keeffe, Jodie L. Allison, Kirsty A. Lembke, Joanna L. Forbes, and Christopher G. Maher. "Effectiveness of Implementation Strategies to Improve Adherence of Physical Therapist Treatment Choices to Clinical Practice Guidelines for Musculoskeletal Conditions: Systematic Review." Physical Therapy 100, no. 9 (June 2, 2020): 1516–41. http://dx.doi.org/10.1093/ptj/pzaa101.
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Abstract Objective The objective of this study was to evaluate the effectiveness of implementation strategies aimed at improving the adherence of physical therapists’ treatment choices to clinical practice guidelines for a range of musculoskeletal conditions. Methods For this review, searches were performed in several databases combining terms synonymous with “practice patterns” and “physical therapy” until August 2019. The review included randomized controlled trials that investigated any intervention to improve the adherence of physical therapists’ treatment choices to clinical practice guidelines or research evidence. Treatment choices assessed by surveys, audits of clinical notes, and treatment recording forms were the primary measures of adherence. Self-reported guideline adherence was the secondary measure. Three reviewers independently assessed risk of bias. Because of heterogeneity across studies, only a narrative synthesis of the results was performed. Results Nine studies were included. Four demonstrated a positive effect on at least 1 measure of treatment choices for low back pain and acute whiplash. One involved a comparison with no intervention, and 3 involved a comparison with another active intervention. The interventions that demonstrated a positive effect included dissemination of clinical practice guidelines, with additional elements including interactive educational meetings (3 studies), tailored interventions and monitoring of the performance of health care delivery (1 study), peer assessment (1 study), and local opinion leaders plus educational outreach visits (1 study). Conclusions Although this review revealed limited trials evaluating interventions to increase physical therapists’ use of evidence-based treatments for musculoskeletal conditions compared with no intervention, it highlighted some interventions that may be effective. Impact Dissemination of clinical practice guidelines, interactive educational meetings, tailored interventions and monitoring the performance of health care delivery, peer assessment, and use of local opinion leaders plus educational outreach visits should be implemented to improve physical therapists’ adherence to clinical practice guidelines for a range of musculoskeletal conditions.
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Krajbich, Ian, Bastiaan Oud, and Ernst Fehr. "Benefits of Neuroeconomic Modeling: New Policy Interventions and Predictors of Preference." American Economic Review 104, no. 5 (May 1, 2014): 501–6. http://dx.doi.org/10.1257/aer.104.5.501.
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Neuroeconomics strives to use knowledge from neuroscience to improve models of decisionmaking. Here we introduce a biologically plausible, drift-diffusion model that is able to jointly predict choice behavior and response times across different choice environments. The model has both normative and positive implications for economics. First, we consistently observe that decisionmakers inefficiently allocate their time to choices for which they are close to indifference. We demonstrate that we can improve subjects' welfare using a simple intervention that puts a time limit on their choices. Second, response times can be used to predict indifference points and the strength of preferences.
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Wiseman, Nicola, Neil Harris, and Patricia Lee. "Lifestyle knowledge and preferences in preschool children: Evaluation of the Get up and Grow healthy lifestyle education programme." Health Education Journal 75, no. 8 (July 28, 2016): 1012–24. http://dx.doi.org/10.1177/0017896916648726.
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Objective: Early childhood is considered a window of opportunity for lifestyle interventions, as this is a critical life-stage at which children accumulate knowledge and skills around behaviours such as eating and physical activity. This study examined how exposure to a settings-based healthy lifestyle programme influences knowledge and preference of food and physical play in preschool children. Design: Quasi-experimental, pre–post intervention design. Methods: Pre- and post-impact evaluation of a healthy lifestyle intervention using an innovative computerised photo-pair food and exercise questionnaire and an age-appropriate test of executive function. The study included 82 children aged 3–5 years and was structured with an intervention and a control group. Quantitative data were analysed using SPSS v22. Results: For the intervention group, there was a significant improvement in overall knowledge of healthy lifestyle behaviours post-intervention, particularly in the identification of healthy and unhealthy food choices. There was no associated change in behavioural preferences. Conclusion: The study highlighted that age-appropriate lifestyle interventions with preschool-aged children can lead to improved knowledge of healthy lifestyle choices. However, improvement in knowledge of healthy lifestyle behaviours does not necessarily lead to positive changes in food and activity preferences that inform choices.
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Stephenson, Judith, Julia V. Bailey, Ana Gubijev, Preethy D'Souza, Sandy Oliver, Ann Blandford, Rachael Hunter, et al. "An interactive website for informed contraception choice: randomised evaluation of Contraception Choices." DIGITAL HEALTH 6 (January 2020): 205520762093643. http://dx.doi.org/10.1177/2055207620936435.
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Objective Improving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception. Methods The Contraception Choices website is an interactive digital intervention which offers tailored advice to aid contraception decision-making ( www.contraceptionchoices.org ). In a parallel single-blind trial, we randomised 927 women aged 15–30 years from six clinic settings to access the intervention website (n = 464) or to a waiting-list control group (n = 463). The study was initially a feasibility trial, evolving into an evaluation of efficacy, with two primary outcomes at six months: long-acting reversible contraception (LARC) use, and satisfaction with contraceptive method. Secondary outcomes included self-reported pregnancy and sexually transmitted infection diagnoses. Free-text comments on the 3 and 6 month outcome surveys were analysed thematically. Findings There was no significant difference between intervention and control groups in the proportion of women using LARC [30.4% intervention versus 31.0% control; adjusted odds ratio 0.87 (95% confidence interval 0.60 to 1.28)]; satisfaction with contraceptive method [82.6% versus 82.1%; adjusted ordinal odds ratio 0.93 (95% CI 0.69 to 1.25)]; self-reported pregnancy [3.3% versus 4.1%; adjusted odds ratio 0.90 (95% CI 0.45 to 1.79)] nor sexually transmitted infection [5.3% versus 4.7%; adjusted odds ratio 0.72 (95% CI 0.55 to 2.36)]. Highly positive free-text comments from intervention participants indicated that the website facilitates contraception choice and can help women feel better prepared before consultation with healthcare providers. Interpretation The Contraception Choices website was popular for its design, trustworthy information and decision aids but it was not associated with significant differences in use of LARC or satisfaction with contraceptive method. An interactive website can aid contraception choice, but interventions that address factors beyond women’s control, such as access to services, and partner, family or community influences are needed to complement this approach. Research in context Preventing unintended pregnancy through effective use of contraception is essential for women’s health, but choosing between different contraceptive methods can be challenging, and the opportunity for adequate discussion during routine consultations is often constrained. Evidence before this study We conducted two systematic literature reviews: 1) Factors influencing contraception choice, uptake and use: a meta-synthesis of systematic reviews; and 2) Effectiveness of interactive digital interventions (IDI) for contraception choice, uptake and use. For the first review we searched PubMed, CDSR, Epistemonikos, DoPHER, DARE, NHS Economic Evaluation Database, Campbell Library, NIHR Health Technology Assessment, and Health Evidence Canada databases for systematic reviews which addressed contraceptive choice, uptake or use, from 2000 to 2017. PROSPERO registration number: CRD42017081521 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81521 . We synthesised the findings of 18 systematic reviews of mostly moderate or high quality. They highlighted the importance of women’s knowledge, beliefs, perceptions of side effects and health risks, as well as relationship status, social network, economic and healthcare factors on contraception choice and use. For the second review, we searched 23 electronic databases, trials registers and reference lists for randomised controlled trials of IDI for contraception, including CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, ASSIA and PsycINFO, from start date to June 2017. PROSPERO registration number: CRD42017081636. We found only five randomised trials of IDI, all from the USA. Risk of bias prevented synthesis of results. www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81636 . Added value of this study Women’s common concerns about contraception – fear of hormones, weight gain, cancer, infertility, mood changes, breaks from contraception and changes in bleeding patterns – underpinned development of a new interactive website ( www.contraceptionchoices.org ). Contraception Choices addresses women’s concerns through succinct text; Q and A format ( Frequently Asked Questions, Did you Know?; videos of women and health professionals); an effectiveness infographic, and an interactive decision aid ( What’s right for me?). In an online randomised trial with 927 women attending clinics, we found no association of the Contraception Choices intervention with the primary outcomes – satisfaction with contraceptive method and uptake of long-acting reversible methods at 6 months. Nor did we find an association with secondary adverse outcomes – sexually transmitted infections or pregnancy. Comments from women indicated that the website can meet young women’s need for information on the benefits and drawbacks of contraception, help them to make informed decisions, and feel better prepared before healthcare consultations. Contraception Choices is now available on the NHS website: www.nhs.uk/conditions/contraception/which-method-suits-me Implications of all the available evidence Interactive digital interventions (websites) can aid contraception choice, but other intervention research is needed to address wider influences on unintended pregnancy, including partner views, friends, family, the media, wider society and experiences with healthcare professionals. Future research could examine the impact of the website in different settings, e.g. schools or different countries. We hypothesise that use of the website during contraceptive consultations might improve the efficiency or quality of consultation, for both patients and healthcare providers. Appropriate methodology and time-scale for evaluating digital health interventions remains a key question.
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St. Pierre, Christine, Win Guan, Leah Barry, Grace Dease, Sydney Gottlieb, Arielle Morris, Jamison Merrill, and Jennifer M. Sacheck. "Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review." Nutrients 13, no. 8 (August 10, 2021): 2749. http://dx.doi.org/10.3390/nu13082749.
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Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.
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Ponsford, Ruth, Sara Bragg, Elizabeth Allen, Nerissa Tilouche, Rebecca Meiksin, Lucy Emmerson, Laura Van Dyck, et al. "A school-based social-marketing intervention to promote sexual health in English secondary schools: the Positive Choices pilot cluster RCT." Public Health Research 9, no. 1 (January 2021): 1–190. http://dx.doi.org/10.3310/phr09010.
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Background The UK still has the highest rate of teenage births in western Europe. Teenagers are also the age group most likely to experience unplanned pregnancy, with around half of conceptions in those aged < 18 years ending in abortion. After controlling for prior disadvantage, teenage parenthood is associated with adverse medical and social outcomes for mothers and children, and increases health inequalities. This study evaluates Positive Choices (a new intervention for secondary schools in England) and study methods to assess the value of a Phase III trial. Objectives To optimise and feasibility-test Positive Choices and then conduct a pilot trial in the south of England assessing whether or not progression to Phase III would be justified in terms of prespecified criteria. Design Intervention optimisation and feasibility testing; pilot randomised controlled trial. Setting The south of England: optimisation and feasibility-testing in one secondary school; pilot cluster trial in six other secondary schools (four intervention, two control) varying by local deprivation and educational attainment. Participants School students in year 8 at baseline, and school staff. Interventions Schools were randomised (1 : 2) to control or intervention. The intervention comprised staff training, needs survey, school health promotion council, year 9 curriculum, student-led social marketing, parent information and review of school/local sexual health services. Main outcome measures The prespecified criteria for progression to Phase III concerned intervention fidelity of delivery and acceptability; successful randomisation and school retention; survey response rates; and feasible linkage to routine administrative data on pregnancies. The primary health outcome of births was assessed using routine data on births and abortions, and various self-reported secondary sexual health outcomes. Data sources The data sources were routine data on births and abortions, baseline and follow-up student surveys, interviews, audio-recordings, observations and logbooks. Results The intervention was optimised and feasible in the first secondary school, meeting the fidelity targets other than those for curriculum delivery and criteria for progress to the pilot trial. In the pilot trial, randomisation and school retention were successful. Student response rates in the intervention group and control group were 868 (89.4%) and 298 (84.2%), respectively, at baseline, and 863 (89.0%) and 296 (82.0%), respectively, at follow-up. The target of achieving ≥ 70% fidelity of implementation of essential elements in three schools was achieved. Coverage of relationships and sex education topics was much higher in intervention schools than in control schools. The intervention was acceptable to 80% of students. Interviews with staff indicated strong acceptability. Data linkage was feasible, but there were no exact matches for births or abortions in our cohort. Measures performed well. Poor test–retest reliability on some sexual behaviour measures reflected that this was a cohort of developing adolescents. Qualitative research confirmed the appropriateness of the intervention and theory of change, but suggested some refinements. Limitations The optimisation school underwent repeated changes in leadership, which undermined its participation. Moderator analyses were not conducted as these would be very underpowered. Conclusion Our findings suggest that this intervention has met prespecified criteria for progression to a Phase III trial. Future work Declining prevalence of teenage pregnancy suggests that the primary outcome in a full trial could be replaced by a more comprehensive measure of sexual health. Any future Phase III trial should have a longer lead-in from randomisation to intervention commencement. Trial registration Current Controlled Trials ISRCTN12524938. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 1. See the NIHR Journals Library website for further project information.
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Jones, Emily, Luciana Zuest, Sean Bulger, Eloise Elliott, Kibum Cho, and Christa Lilly. "Initial Findings of a Multicomponent School Health Intervention in Rural Appalachia: The Greenbrier CHOICES Project." Health Education & Behavior 47, no. 2 (January 20, 2020): 332–43. http://dx.doi.org/10.1177/1090198119897612.
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Background. Schools are an important setting for health promotion because they afford children and adolescents numerous opportunities to accumulate the recommended physical activity (PA) minutes and make other health-related decisions, including healthy eating. Unfortunately, there is little evidence of coordinated school-based health interventions in rural Appalachia. The Greenbrier Children’s Health Opportunities Involving Coordinated Efforts in Schools Project was a federally funded, 3-year, multicomponent school-based health intervention focused on PA, healthy eating, and weight management. Aims. The purpose of this study was to evaluate the impact of Greenbrier Children’s Health Opportunities Involving Coordinated Efforts in Schools on adolescent PA, dietary behaviors, and weight status. Method. Measures of PA, dietary behaviors, and body mass index were collected across 14 data points throughout the intervention (including a baseline in Year 1). Results. Participants included 4,633 randomly selected middle school students ( M = 2,289, F = 2,344) across the intervention. Baseline to Year 3 findings revealed a 12.8 percentage point increase in students achieving 60 minutes of daily PA. There were no significant differences in either dietary behavior or body mass index. Discussion. Findings provide evidence of the positive impact comprehensive school-based health interventions can have on middle school student health-related behaviors. Conclusion. Schools remain an ideal setting for health promotion. Initiatives targeting more than one level of influence on health-related behaviors are more likely to succeed.
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Murphy, Debra A., Xinguang Chen, Sylvie Naar-King, and Jeffrey T. Parsons for the Adolescent Trials N. "Alcohol and Marijuana Use Outcomes in the Healthy Choices Motivational Interviewing Intervention for HIV-Positive Youth." AIDS Patient Care and STDs 26, no. 2 (February 2012): 95–100. http://dx.doi.org/10.1089/apc.2011.0157.
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Czuchry, M., S. Timpson, M. L. Williams, A. M. Bowen, and E. A. Ratliff. "Improving condom self‐efficacy and use among individuals living with HIV: The positive choices mapping intervention." Journal of Substance Use 14, no. 3-4 (January 2009): 230–39. http://dx.doi.org/10.1080/14659890902874212.
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Gittelsohn, Joel, Hee-Jung Song, Sonali Suratkar, Mohan B. Kumar, Elizabeth G. Henry, Sangita Sharma, Megan Mattingly, and Jean A. Anliker. "An Urban Food Store Intervention Positively Affects Food-Related Psychosocial Variables and Food Behaviors." Health Education & Behavior 37, no. 3 (November 3, 2009): 390–402. http://dx.doi.org/10.1177/1090198109343886.
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Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.
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De Cock, Nathalie, Wendy Van Lippevelde, Jolien Vangeel, Melissa Notebaert, Kathleen Beullens, Steven Eggermont, Benedicte Deforche, et al. "Feasibility and impact study of a reward-based mobile application to improve adolescents’ snacking habits." Public Health Nutrition 21, no. 12 (April 2, 2018): 2329–44. http://dx.doi.org/10.1017/s1368980018000678.
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AbstractObjectiveAdolescents’ snacking habits are driven by both explicit reflective and implicit hedonic processes. Hedonic pathways and differences in sensitivity to food rewards in addition to reflective determinants should be considered. The present study evaluated the feasibility and impact of a mobile phone-delivered intervention, incorporating explicit reflective and implicit rewarding strategies, on adolescents’ snack intake.DesignAdolescents (n 988; mean age 14·9 (sd 0·70) years, 59·4 % boys) completed a non-randomized clustered controlled trial. Adolescents (n 416) in the intervention schools (n 3) were provided with the intervention application for four weeks, while adolescents (n 572) in the control schools (n 3) followed the regular curriculum. Outcomes were differences in healthy snacking ratio and key determinants (awareness, intention, attitude, self-efficacy, habits and knowledge). Process evaluation data were collected via questionnaires and through log data of the app.ResultsNo significant positive intervention effects on the healthy snack ratio (b=−3·52 (se 1·82), P>0·05) or targeted determinants were observed. Only 268 adolescents started using the app, of whom only fifty-five (20·5 %) still logged in after four weeks. Within the group of users, higher exposure to the app was not significantly associated with positive intervention effects. App satisfaction ratings were low in both high and low user groups. Moderation analyses revealed small positive intervention effects on the healthy snack ratio in high compared with low reward-sensitive boys (b=1·38 (se 0·59), P<0·05).ConclusionsThe intervention was not able to improve adolescents’ snack choices, due to low reach and exposure. Future interventions should consider multicomponent interventions, teacher engagement, exhaustive participatory app content development and tailoring.
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Berghorn, Forrest J., and Donna E. Schafer. "Reminiscence Intervention in Nursing Homes: What and Who Changes?" International Journal of Aging and Human Development 24, no. 2 (March 1987): 113–27. http://dx.doi.org/10.2190/bk83-8xme-kfjx-ud2g.
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The results of experimental studies of reminiscing are not as uniformly optimistic about its therapeutic value as is the theoretical literature. Moreover, anecdotal evidence regarding the impact of reminiscence interventions is more positive than the statistical evidence. This study suggests reasons for these previous findings, and examines data from a discussion group intervention in thirty nursing homes, in which 185 residents completed pre- and posttests. It analyzes the characteristics of participants in relation to modifications in selected attitudes and behaviors over the intervention period. Analysis of variance and discriminant analysis revealed no significant relationships between attitudinal or behavioral modifications and demographic or other characteristics, with one exception. Value-choices made by participants were related to such modifications. The findings are interpreted in terms of the “mental adaptability” of participants and the compensatory nature of reminiscence in an institutional setting.
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Silva, Adolfo Henrique Coutinho e., Moacir Sancovschi, and Ariane Gabriela Chagas dos Santos. "The opportunistic approach of the Positive Accounting Theory (PAT) fails to explain choices made at OGX: An anomalous situation?" Revista de Contabilidade e Organizações 13 (December 19, 2019): e164412. http://dx.doi.org/10.11606/issn.1982-6486.rco.2019.164412.
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This paper has two objectives: (1) to demonstrate that the main accounting choices made by accountants and managers of OGX Company throughout its full business life cycle were not opportunistic, as often suggested by the hypothesis of Positive Accounting Theory; and (2) to demonstrate that these accounting choices may be better explained by the Theory of Corporate Scandals, by the Monitoring Hypothesis and by the Corporate Reputation Hypothesis. The research was conducted using a longitudinal case study approach, from 2006-2015, in order to identify visible accounting decisions in annual financial statements reports. It was found that the analyzed Company had the incentives to preform opportunistic accounting choices, such as the ones predicted by the PAT hypothesis and had also done through several situations in its business life cycle that could have influenced it to perform opportunistic accounting choices. However, there is no evidence that the Company ever made use of either opportunistic increasing-income accounting changes to impact their financial debt-covenants and bonus plan, or decreasing-income accounting to avoid government intervention, as suggested by the opportunistic approach of PAT hypothesis.
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Wyld, L., M. W. R. Reed, K. Collins, M. Burton, K. Lifford, A. Edwards, S. Ward, et al. "Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices." British Journal of Surgery 108, no. 5 (March 23, 2021): 499–510. http://dx.doi.org/10.1093/bjs/znab005.
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Abstract Background Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. Methods A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. Results A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference –0.20, 95 per cent confidence interval (C.I.) –2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference –4.5 (C.I. –8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. Conclusion The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Buja, Alessandra, Andrea Rabensteiner, Milena Sperotto, Giulia Grotto, Chiara Bertoncello, Silvia Cocchio, Tatjana Baldovin, Paolo Contu, Chiara Lorini, and Vincenzo Baldo. "Health Literacy and Physical Activity: A Systematic Review." Journal of Physical Activity and Health 17, no. 12 (December 1, 2020): 1259–74. http://dx.doi.org/10.1123/jpah.2020-0161.
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Background: The importance of health literacy (HL) in health promotion is increasingly clear and acknowledged globally, especially when addressing noncommunicable diseases. This paper aimed to collect and summarize all current data from observational studies generating evidence of the association between HL and physical activity (PA) and to analyze intervention studies on the promotion of PA to ascertain whether HL moderates the efficacy of such intervention. Methods: A comprehensive systematic literature search of observational studies investigating the association between HL and PA was performed. Intervention studies on the promotion of PA that also measured the HL levels of participants and its effect on the outcome of the intervention were also identified. Results: Of the 22 studies included in this review, 18 found a significant positive association between high HL and high levels of PA. The only intervention study among them indicated that HL was not a significant moderator of the intervention’s effectiveness. Conclusion: HL can enable individuals to make deliberate choices about their PA and thus contribute to preventing many chronic noncommunicable diseases. That said, low levels of HL do not seem to influence the efficacy of health promotion interventions.
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Basen-Engquist, Karen, Karin K. Coyle, Guy S. Parcel, Douglas Kirby, Stephen W. Banspach, Scott C. Carvajal, and Elizabeth Baumler. "Schoolwide Effects of a Multicomponent HIV, STD, and Pregnancy Prevention Program for High School Students." Health Education & Behavior 28, no. 2 (April 2001): 166–85. http://dx.doi.org/10.1177/109019810102800204.
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Few studies have tested schoolwide interventions to reduce sexual risk behavior, and none have demonstrated significant schoolwide effects. This study evaluates the schoolwide effects of Safer Choices, a multicomponent, behavioral theory–based HIV, STD, and pregnancy prevention program, on risk behavior, school climate, and psychosocial variables. Twenty urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 months after baseline), and 31 months after baseline. At 19 months, the program had a positive effect on the frequency of sex without a condom. At 31 months, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. Schoolwide changes in condom use demonstrated that a school-based program can reduce the sexual risk behavior of adolescents.
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Sikkema, Kathleen J., Laurie Abler, Nathan B. Hansen, Patrick A. Wilson, Anya S. Drabkin, Arlene Kochman, Jessica C. MacFarlane, et al. "Positive Choices: Outcomes of a Brief Risk Reduction Intervention for Newly HIV-Diagnosed Men Who Have Sex with Men." AIDS and Behavior 18, no. 9 (April 28, 2014): 1808–19. http://dx.doi.org/10.1007/s10461-014-0782-3.
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Madden, Ruth Ann, Heather Kane, and Reina Eisner. "Obesity Self-Management Education: A Community-Based Project for an Underserved Population." Clinical Scholars Review 6, no. 1 (2013): 30–38. http://dx.doi.org/10.1891/1939-2095.6.1.30.
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Obesity is a disease linked to several cardiovascular and endocrine dysfunctions as well as decreased life expectancy and quality of life. Obesity management is a prevalent and persistent concern in primary care. We implemented an educational intervention to promote self-management for 10 patients in a medically underserved clinic to support patients in addressing weight management through positive self-care behaviors. Lifestyle interventions for these participants resulted in self-reported minimal weight loss with significant and sustained lifestyle modifications, such as healthier food choices, portion control, and increased exercise. Recommendations for the future include the use of health care professionals to educate patients about self-management and goal setting with sustained follow-up in treatment of chronic disease.
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Montanari, Kate M., Cassandra L. Bowe, Sherry S. Chesak, and Susanne M. Cutshall. "Mindfulness: Assessing the Feasibility of a Pilot Intervention to Reduce Stress and Burnout." Journal of Holistic Nursing 37, no. 2 (August 28, 2018): 175–88. http://dx.doi.org/10.1177/0898010118793465.
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Purpose: To examine the feasibility of a brief mindfulness intervention and to reduce nurse stress and burnout in an inpatient medical unit. Design: Single-arm, pre/post test study design. Method: Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and pre/post demographic questionnaires given at pre-intervention (baseline) and 6 weeks post-intervention. Intervention effectiveness was compared between the pre-survey ( N = 52) and post-survey ( N = 33). Five choices were offered to inpatient staff: a guided mindfulness CD, soothing sounds machine with a breathing technique instructional, mindfulness prompts, a journal, and water/snacks during six consecutive weekends. Findings: The mean PSS score did not improve and demonstrated a slight increase during the six-weekend intervention. However, mean MBI scores for the subscales of emotional exhaustion and depersonalization did demonstrate improvement as evident by decreased scores. Additionally, the mean MBI score for the subscale of personal accomplishment also improved with increased scores. Qualitative themes were positive and included relaxation, nourishment, and refocus. Majority of participants (75%) perceived the intervention as being effective or very effective in reducing stress at work. Respondents were “interested” or “very interested” in continuing a similar intervention in the future (84.9%). Conclusion: The improvement in scores for the MBI measures were a positive finding. The intervention was low cost, individualized, and accessible. The feasibility and perceptions of the intervention’s effectiveness has positive implications for the well-being of nurses.
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Alshorman, Jamal, Yulong Wang, Fengzhao Zhu, Lian Zeng, Kaifang Chen, Sheng Yao, Xirui Jing, Yanzhen Qu, Tingfang Sun, and Xiaodong Guo. "Medical Communication Services after Traumatic Spinal Cord Injury." Journal of Healthcare Engineering 2021 (August 31, 2021): 1–11. http://dx.doi.org/10.1155/2021/4798927.
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It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).
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Köpke, S., J. Kasper, P. Flachenecker, H. Meißner, A. Brandt, B. Hauptmann, G. Bender, et al. "Patient education programme on immunotherapy in multiple sclerosis (PEPIMS): a controlled rater-blinded study." Clinical Rehabilitation 31, no. 2 (July 10, 2016): 250–61. http://dx.doi.org/10.1177/0269215516639734.
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Objective: To investigate the effectiveness of a multi-component evidence-based education programme on disease modifying therapies in multiple sclerosis. Design: Controlled trial with two consecutive patient cohorts and a gap of two months between cohorts. Setting: Three neurological rehabilitation centres. Subjects: Patients with multiple sclerosis within rehabilitation. Interventions: Control group (CG) participants were recruited and received standard information. Two months later, intervention group (IG) participants were recruited and received a six-hour nurse-led interactive group education programme consisting of two parts and a comprehensive information brochure. Main measures: Primary endpoint was “informed choice”, comprising of adequate risk knowledge in combination with congruency between attitude towards immunotherapy and actual immunotherapy uptake. Further outcomes comprised risk knowledge, decision autonomy, anxiety and depression, self-efficacy, and fatigue. Results: A total of 156 patients were included (IG=75, CG=81). The intervention led to significantly more participants with informed choice (IG: 47% vs. CG: 23%, P=0.004). The rate of persons with adequate risk knowledge was significantly higher in the IG two weeks after the intervention (IG: 54% vs. CG: 31%, P=0.007), but not after six months (IG: 48% vs. CG: 31%, P=0.058). No significant differences were shown for positive attitude towards disease modifying therapy (IG: 62% vs. CG: 71%, P=0.29) and for disease modifying therapy status after six months (IG: 61.5% vs CG: 68.6%, P=0.39). Also no differences were found for autonomy preferences and decisional conflict after six months. Conclusion: Delivering evidence-based information on multiple sclerosis disease modifying therapies within a rehabilitation setting led to a marked increase of informed choices.
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Diniz, Carmen Simone Grilo, Ana Carolina Arruda Franzon, Beatriz Fioretti-Foschi, Denise Yoshie Niy, Livia Sanches Pedrilio, Edson Amaro Jr, and João Ricardo Sato. "Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 10, no. 5 (May 21, 2021): e25016. http://dx.doi.org/10.2196/25016.
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Background In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID) PRR1-10.2196/25016
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Bai, Yeon K., Soyoung Lee, and Kaitlin Overgaard. "Critical Review of Theory Use in Breastfeeding Interventions." Journal of Human Lactation 35, no. 3 (May 17, 2019): 478–500. http://dx.doi.org/10.1177/0890334419850822.
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Background: Numerous efforts to promote breastfeeding resulted in a steady increase in the rates of breastfeeding initiation and duration. Increasing numbers of breastfeeding interventions are focused on breastfeeding maintenance and exclusivity and based on behavioral theories. Few studies critically analyzed the use of theories in breastfeeding intervention development and evaluation. Research aim: The aim of this critical review was to examine the existing literature about breastfeeding intervention, and investigate the role of theory in its development, implementation, and evaluation to provide future directions and implications for breastfeeding interventions. Methods: This critical review examined the existing breastfeeding intervention studies that used self-efficacy theories (SE), theory of planned behavior (TPB), and social cognitive theory (SCT) and were published during the past decade. Using five databases, studies in which researchers explicitly applied these three theories to frame the intervention were selected. Studies were critically reviewed for fidelity to theory in intervention design, delivery, and evaluation. Results: Eighteen studies were reviewed: nine SE-, five TPB-, and four SCT-based. Most interventions were focused on building mothers’ breastfeeding self-efficacy to improve breastfeeding exclusivity and duration. To achieve this goal, researchers who developed SE-based interventions used individual approaches, whereas other researchers who based studies on TPB incorporated social and environmental changes. SE-based studies were more likely to include theory-based instruments, but TPB- and SCT-based studies demonstrated less consistent choices of measurement. Researchers in most studies did not test the relationships between the proposed theoretical constructs and breastfeeding outcomes as guided by theories. Inconsistent outcomes resulted among the studies due to variations in study follow-ups. Conclusion: Sound applications of single or multiple theories demonstrate a great potential to help practitioners and researchers develop effective breastfeeding interventions and evaluate true impacts on positive breastfeeding outcomes.
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Barnhart, Wesley R., Susan M. Havercamp, Allison Lorenz, and Emily A. Yang. "Better Together: A Pilot Study on Cooking Matters for Adults With Developmental Disabilities and Direct Support Professionals." Nutrition and Metabolic Insights 12 (January 2019): 117863881984003. http://dx.doi.org/10.1177/1178638819840036.
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Adults with developmental disabilities face barriers to making healthy lifestyle choices that mirror the barriers faced by the direct support professionals who serve them. These two populations, direct support professionals and adults with developmental disabilities, are likely to lead inactive lifestyles, eat unhealthy diets, and be obese. Moreover, direct support professionals influence the nutrition knowledge, attitudes, and health behaviors of the adults with developmental disabilities whom they serve. We piloted a cooking-based nutrition education program, Cooking Matters for Adults, to dyads of adults with developmental disabilities (n = 8) and direct support professionals (n = 7). Team-taught by a volunteer chef and nutrition educator, Cooking Matters for Adults uses an active learning approach to teach food preparation safety skills and nutrition knowledge to inform healthy food and beverage choices. We assessed healthy food preparation, intake of a balanced diet, healthy food and beverage choices, and cooking confidence and barriers at pre-test, post-test, and 6-months after the intervention. Among both adults with developmental disabilities and direct support professionals, positive trends in healthy food preparation, eating a balanced diet, and reduction in cooking barriers were observed at post-test and 6-months. We also qualitatively assessed knowledge of and attitudes toward healthy eating, frequency of food and beverage intake, knowledge about kitchen skills and safety, as well as overall satisfaction, cooking confidence, and acceptability of the dyad approach. Participants with developmental disabilities and direct support professionals reported that they learned about healthy food and beverage choices and various cooking skills. Participants reported confidence in skills learned and were satisfied with the intervention and approach of including adults with developmental disabilities and direct support professionals in the intervention together.
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Mistura, Matheus, Nicole Fetterly, Ryan E. Rhodes, Dona Tomlin, and Patti-Jean Naylor. "Examining the Efficacy of a ‘Feasible’ Nudge Intervention to Increase the Purchase of Vegetables by First Year University Students (17–19 Years of Age) in British Columbia: A Pilot Study." Nutrients 11, no. 8 (August 2, 2019): 1786. http://dx.doi.org/10.3390/nu11081786.
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In the transition from high school to university, vegetable consumption tends to deteriorate, potentially influencing immediate and longer-term health outcomes. Nudges, manipulation of the environment to influence choice, have emerged as important to behavior change goals. This quasi-experimental pilot study examined the impact of a contextually feasible evidence-informed nudge intervention on food purchasing behavior of older adolescents (1st year students) in a university residence cafeteria in British Columbia, Canada. A co-design process with students and staff identified a student relevant and operationally feasible nudge intervention; a placement nudge, fresh vegetables at the hot food table, combined with a sensory and cognitive nudge, signage encouraging vegetable purchase). Using a 12-week single-case A-B-A-B design, observations of the proportion of vegetables purchased were used to assess intervention efficacy. Data analysis included visual trend inspection, central tendency measures, data overlap, variability and latency. Visual trend inspection showed a positive trend when nudges were in place, which was more apparent with female purchases and during the first intervention (B) phase. However, further analysis showed lack of baseline stability, high variability across phases and overlapping data, limiting efficacy conclusions. Menu choices, staff encouragement, term timing and student finances are other potential influences. Further ‘real world’ nudge research is needed.
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Macoveanu, J., U. Knorr, A. Skimminge, M. G. Søndergaard, A. Jørgensen, M. Fauerholdt-Jepsen, O. B. Paulson, G. M. Knudsen, H. R. Siebner, and L. V. Kessing. "Altered reward processing in the orbitofrontal cortex and hippocampus in healthy first-degree relatives of patients with depression." Psychological Medicine 44, no. 6 (July 19, 2013): 1183–95. http://dx.doi.org/10.1017/s0033291713001815.
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BackgroundHealthy first-degree relatives of patients with major depression (rMD+) show brain structure and functional response anomalies and have elevated risk for developing depression, a disorder linked to abnormal serotonergic neurotransmission and reward processing.MethodIn a two-step functional magnetic resonance imaging (fMRI) investigation, we first evaluated whether positive and negative monetary outcomes were differentially processed by rMD+ individuals compared to healthy first-degree relatives of control probands (rMD−). Second, in a double-blinded placebo-controlled randomized trial we investigated whether a 4-week intervention with the selective serotonergic reuptake inhibitor (SSRI) escitalopram had a normalizing effect on behavior and brain responses of the rMD+ individuals.ResultsNegative outcomes increased the probability of risk-averse choices in the subsequent trial in rMD+ but not in rMD− individuals. The orbitofrontal cortex (OFC) displayed a stronger neural response when subjects missed a large reward after a low-risk choice in the rMD+ group compared to the rMD− group. The enhanced orbitofrontal response to negative outcomes was reversed following escitalopram intervention compared to placebo. Conversely, for positive outcomes, the left hippocampus showed attenuated response to high wins in the rMD+ compared to the rMD− group. The SSRI intervention reinforced the hippocampal response to large wins. A subsequent structural analysis revealed that the abnormal neural responses were not accounted for by changes in gray matter density in rMD+ individuals.ConclusionsOur study in first-degree relatives of depressive patients showed abnormal brain responses to aversive and rewarding outcomes in regions known to be dysfunctional in depression. We further confirmed the reversal of these aberrant activations with SSRI intervention.
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Wrieden, Wendy L., Annie S. Anderson, Pat J. Longbottom, Karen Valentine, Martine Stead, Martin Caraher, Tim Lang, Bill Gray, and Elizabeth Dowler. "The impact of a community-based food skills intervention on cooking confidence, food preparation methods and dietary choices – an exploratory trial." Public Health Nutrition 10, no. 2 (February 2007): 203–11. http://dx.doi.org/10.1017/s1368980007246658.
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AbstractObjectiveTo evaluate the feasibility of undertaking a food skills intervention study in areas of social deprivation aimed at altering cooking confidence, food preparation methods and dietary choices.DesignA standardised skills programme was implemented in community-based settings. Pre- (T1) and post-intervention (T2) and 6-month follow-up (T3) measures (7-day diaries and self-administered questionnaires) were undertaken in intervention and comparison groups.SettingEight urban communities in Scotland.SubjectsOne hundred and thirteen adults living in areas of social deprivation.ResultsIt was clear that many subjects led fragmented lives and found commitment to intervention classes problematic. Sixty-three subjects completed the final (T3) assessments. The response to each component varied due to inability to attend sessions, illness, study requirements, employment, moving out of the area, change in circumstances, loss of interest and loss of postal questionnaires. At baseline, reported consumption of fruit and vegetables was low (mean frequency 8.1 ± 4.78 times per week). Fruit intake increased significantly (P < 0.05) between T1 and T2 in the intervention group (1.7 ± 2.36 to 2.7 ± 3.28 times per week) only. Between T1 and T3, there was a significant increase (P < 0.05) in intervention subjects who reported confidence in following a recipe (67–90%,).ConclusionsThis exploratory trial shows that a food skills intervention is likely to have a small but positive effect on food choice and confidence in food preparation. A full-scale randomised controlled trial in this hard-to-reach group would require a range of flexible approaches rather than a fully defined intervention, and presents challenges for trial design.
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Chatters, Robin, Jennifer Roberts, Gail Mountain, Sarah Cook, Gill Windle, Claire Craig, and Kirsty Sprange. "The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study." BMJ Open 7, no. 9 (September 2017): e016711. http://dx.doi.org/10.1136/bmjopen-2017-016711.
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ObjectivesTo assess the long-term effect on health and well-being of the Lifestyle Matters programme.DesignQualitative study of a subset of intervention arm participants who participated in the Lifestyle Matters randomised controlled trial (RCT).SettingThe intervention took place at community venues within two sites in the UK.ParticipantsA purposeful sample of 13 participants aged between 66 and 88 years from the intervention arm of the RCT were interviewed at 24 months post randomisation. Interviews aimed to understand how participants had used their time in the preceding 2 years and whether the intervention had any impact on their lifestyle choices, participation in meaningful activities and well-being.InterventionLifestyle Matters is a 4-month occupational therapy intervention, consisting of group and individual sessions, designed to enable community living older people to make positive lifestyle choices and participate in new or neglected activities through increasing self-efficacy.ResultsInterviews revealed that the majority of interviewed participants were reportedly active at 24 months, with daily routines and lifestyles not changing significantly over time. All participants raised some form of benefit from attending Lifestyle Matters, including an improved perspective on life, trying new hobbies and meeting new friends. A number of intervention participants spoke of adapting to their changing circumstances, but there were significant and lasting benefits for 2 of 13 intervention participants interviewed.ConclusionThe majority of those who experienced the Lifestyle Matters intervention reported minor benefits and increases in self-efficacy, but they did not perceive that it significantly improved their health and well-being. The two participants who had experienced major benefits also reported having had life-changing events, suggesting that this intervention is most effective at the time when lifestyle has to be reconsidered if mental well-being is to be sustained.Trial registrationISRCTN,ISRCTN67209155, post results.
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Traino, Heather M., Stacy M. West, Camilla W. Nonterah, Jennifer Russell, and Eva Yuen. "Communicating About Choices in Transplantation (COACH)." Progress in Transplantation 27, no. 1 (November 25, 2016): 31–38. http://dx.doi.org/10.1177/1526924816679844.
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Introduction: Previous research highlights the difficulties patients with end-stage renal disease awaiting kidney transplant experience while attempting to manage both the logistical and the content-related aspects of discussions about transplantation. This article presents pilot results of the behavioral communication intervention program, Communicating about Choices in Transplantation (COACH), designed to improve transplant candidates’ communication about transplantation. Research Questions: As compared to matched controls, increases in knowledge of deceased and living donor transplantation, communication self-efficacy, intentions to hold conversations about transplantation, and self-reported discussion were expected for pilot participants from pre- and postassessment; decreases in conversational difficulties were also posited. Design: Using a nonrandomized quasi-experimental design, we compared transplant knowledge and communication between patients completing a 2-hour COACH session (pilot sample) to a sample of matched controls (n = 10). Data were collected via semi-structured telephone interviews upon enrollment and 1 month after enrollment or attendance at a COACH program session. Results: The results revealed significant differences in knowledge from pre- to postassessment between the pilot and control samples ( P = .02). Although no other statistically significant between-group differences were found, paired-sample t tests revealed significant pre–post increases in transplant knowledge (7.6 [standard deviation, SD = 2.0] to 9.5 [SD =1.8]; P = .05) and communication self-efficacy (1255.8 [SD = 239.7] to 1513.8 [SD = 114.3]; P = .009) for pilot participants. Decreases in perceived conversational difficulties were also observed ( P = .53). Discussion: Results provide preliminary support for the program’s impact. Moreover, participant evaluations of the COACH were overwhelmingly positive. A more definitive program evaluation with a larger, more diverse sample is currently underway.
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Cole, Bethany, Emma Bailey, and Liz Ewins. "Phew! time to focus on physical health and wellbeing: improving the assessment and management of physical health in an early intervention in psychosis service." BJPsych Open 7, S1 (June 2021): S179. http://dx.doi.org/10.1192/bjo.2021.487.
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AimsNICE guidelines recommend that patients under Early Intervention (EI) in Psychosis Services have systematic monitoring and intervention of cardiometabolic risk factors. We undertook a Quality Improvement Project (QIP) in the Bath and North East Somerset (BaNES) EI Team to improve rates of compliance with national guidelines. We aimed to increase the percentage of service users with a physical health assessment documented in the past 12 months. Other aims included improving monitoring of physical health parameters in those taking antipsychotic medication and increasing the delivery of interventions for abnormal results.BackgroundThe most common cause of premature mortality in people who experience psychosis and schizophrenia is cardiovascular disease. The 'Standards for Early Intervention in Psychosis Service' states that patients should be offered personalised healthy lifestyle interventions, including advice on diet, physical activity, and access to smoking cessation services. Physical health should be monitored at least annually, with more frequent assessments if antipsychotic medication is prescribed.MethodWe identified seven key factors for improving physical health: Body Mass Index (BMI), Blood Pressure, Glucose Regulation, Blood Lipids, Smoking, Alcohol and Illicit drug use. Baseline compliance and intervention rates were measured in March 2019. Six ‘Plan, Do, Study, Act’ Cycles were completed over the following ten months. Examples of the changes made included: a new online diary and whiteboard, abbreviation of the assessment form, teaching for the EI team, and a new weekly ‘Physical Health and Wellbeing’ (PHeW) Clinic. This clinic involved phlebotomy, discussions around lifestyle choices, review of medication side effects, and neurological examination.We measured the compliance with guidelines each month and the total number of interventions delivered at three-monthly intervals. We collected qualitative feedback on these changes in team meetings and with written questionnaires (including feedback from patients).ResultDocumentation of all key factors doubled from 30.2% at baseline to 63.3% in January 2020. The total number of interventions for raised BMI and lipid levels also increased. Feedback from staff and patients was positive. The clinic helped start conversations with patients about lifestyle choices, prompting improvements in weight, physical activity, lipid levels, and alcohol intake. Patient awareness and ownership over their physical health also improved.ConclusionThis project utilised multiple strategies to reduce health complications for BaNES EI service users. A structural change in the assessment and management of physical health proved to be an effective and sustainable solution to optimise the health and wellbeing of this patient group.
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Rahman, Md Shahidur, and AKM Salek. "Role of Exercise as a Therapeutic Intervention for Hypertension." University Heart Journal 5, no. 1 (August 18, 2009): 36–39. http://dx.doi.org/10.3329/uhj.v5i1.3440.
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Physical exercise is found to have positive health and well being of a person since time immemorial. Regular exercise has proved to normalize the elevated blood pressure of mild to moderate intensity by many studies. The blood pressure response to such exercise may also be used to screen normotensive persons for the risk of developing elevated blood pressure. For mild hypertension aerobic exercise and life style changes such as weight loss, dietary changes such as salt restriction and cessation of smoking are probably better choices. In moderate to severe essential hypertension, exercise should be combined with life style changes and medication. The aim of this review study is to delineate the effect of exercise in the control of elevated blood pressure. Methods used were analysis of the published article collected from the internet and other sources. The specific aims were to emphasis the importance of exercise as therapeutic intervention for the control of hypertension. doi: 10.3329/uhj.v5i1.3440 University Heart Journal Vol. 5, No. 1, January 2009 36-39
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Donnelly-Strozzo, Mary K., and Anne Belcher. "Decision Support for Women With Early Breast Cancer." Clinical Scholars Review 8, no. 2 (2015): 222–30. http://dx.doi.org/10.1891/1939-2095.8.2.222.
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Approximately 100,000 new cases of lymph node–negative, estrogen receptor–positive breast cancer are diagnosed each year in the United States (Jemal et al., 2007). Adjuvant treatment for these patients is recommended and may include chemotherapy, hormonal therapy, combined chemotherapy plus hormonal therapy, or observation alone. Patient uncertainty plus dissatisfaction with the level of decision-making control over treatment options is common. This evidence-based practice change project focuses on improving the decision-making confidence of women with early stage breast cancer by increasing active participation in the discussion of treatment options. Seven participants’ decision control preferences were determined using a Control Preferences Scale. The effect of this intervention on satisfaction with the process was evaluated by using a 6-question Satisfaction With Decision instrument. There was a significant difference p < .05 in satisfaction with the decision process using a 2-tailed t test. This test was used to evaluate the effect of the intervention on satisfaction with the decision-making process compared to a group of women who did not receive the intervention. Women with early breast cancer can benefit from nursing interventions targeted at supporting their preferred level of decision control when making decision regarding treatment choices.
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Cowdrey, Felicity Ann, Lorna Hogg, and Kate Chapman. "Is there a choice to make? A pilot study investigating attitudes towards treatment in an Early Intervention for Psychosis service." Mental Health Review Journal 23, no. 2 (June 11, 2018): 110–20. http://dx.doi.org/10.1108/mhrj-09-2017-0038.
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Purpose The purpose of this paper is to investigate health care professionals’ (HCPs) and service-users’ (SUs) attitudes towards different treatment options in an Early Intervention for Psychosis (EIP) service as well as the topical issue of offering choice over treatment. Design/methodology/approach Seven SUs accessing an EIP service and nine HCPs completed qualitative surveys about treatment for psychosis. Data were analysed thematically. Findings Both HCPs and SUs appeared to have a generally positive attitude to the range of interventions offered by the EIP service and SUs talked about the importance of all treatment options being explored. There was variation in attitudes towards SUs having choice over their treatment and a number of factors were identified as crucial in influencing attitudes including mental capacity, risk and level of engagement. Research limitations/implications Small sample size, recruitment from only one EIP service and using a survey design limit generalisability and depth of analysis. Practical implications HCPs working in EIP services should explore different treatment options fully with SUs but be aware that they may feel unable to make the decision themselves. Such discussions should be revisited throughout an individual’s care as their ability and desire to make informed choices may change over time. Continuing Professional Development and clinical supervision should be used to help HCPs reflect on the choice agenda and the implications of this for clinical practice. Originality/value Few studies have examined attitudes towards treatments for psychosis. This is an evolving and important clinical area that remains under researched. Recommendations for service-development, future research and clinical practice are made.
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Nsangi, Allen, Daniel Semakula, Claire Glenton, Simon Lewin, Andrew D. Oxman, Matt Oxman, Sarah Rosenbaum, et al. "Informed health choices intervention to teach primary school children in low-income countries to assess claims about treatment effects: process evaluation." BMJ Open 9, no. 9 (September 2019): e030787. http://dx.doi.org/10.1136/bmjopen-2019-030787.
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BackgroundWe developed the informed health choices (IHC) primary school resources to teach children how to assess the trustworthiness of claims about the effects of treatments. We evaluated these resources in a randomised trial in Uganda. This paper describes the process evaluation that we conducted alongside this trial.ObjectivesTo identify factors affecting the implementation, impact and scaling up of the intervention; and potential adverse and beneficial effects of the intervention.MethodsAll 85 teachers in the 60 schools in the intervention arm of the trial completed a questionnaire after each lesson and at the end of the term. We conducted structured classroom observations at all 60 schools. For interviews and focus groups, we purposively selected six schools. We interviewed district education officers, teachers, head teachers, children and their parents. We used a framework analysis approach to analyse the data.ResultsMost of the participants liked the IHC resources and felt that the content was important. This motivated the teachers and contributed to positive attitudes. Although some teachers started out lacking confidence, many found that the children’s enthusiasm for the lessons made them more confident. Nearly everyone interviewed thought that the children learnt something important and many thought that it improved their decision-making. The main barrier to scaling up use of the IHC resources that participants identified was the need to incorporate the lessons into the national curriculum.ConclusionThe mostly positive findings reflect the trial results, which showed large effects on the children’s and the teachers’ critical appraisal skills. The main limitations of this evaluation are that the investigators were responsible for both developing and evaluating the intervention.
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Fehler-Cabral, Giannina, Rebecca Campbell, and Debra Patterson. "Adult Sexual Assault Survivors’ Experiences With Sexual Assault Nurse Examiners (SANEs)." Journal of Interpersonal Violence 26, no. 18 (May 20, 2011): 3618–39. http://dx.doi.org/10.1177/0886260511403761.
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Sexual assault survivors often feel traumatized by the care received in traditional hospital emergency departments. To address these problems, Sexual Assault Nurse Examiner (SANE) programs were created to provide comprehensive medical care, crisis intervention, and forensic services. However, there is limited research on the actual experiences and emotional impact of sexual assault survivors who seek treatment from SANEs. This qualitative study examined twenty rape survivors’ experiences with forensic nurse examiners of a Midwestern SANE program. Findings suggest that SANEs provided survivors with care and compassion, clear explanations, and choices. Taken together, these positive experiences were perceived as “humanizing”. However, some survivors perceived forensic nurses as hurtful when they were not provided with choices, explanation, and/or acted cold and distant. Implications for future research on SANE care and practice are discussed.
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Mandic, Dubravka, Vesna Bjegovic-Mikanovic, Dejana Vukovic, Bosiljka Djikanovic, Zeljka Stamenkovic, and Nebojsa M. Lalic. "Successful promotion of physical activity among students of medicine through motivational interview and Web-based intervention." PeerJ 8 (July 8, 2020): e9495. http://dx.doi.org/10.7717/peerj.9495.
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Background Regular physical activity supports healthy behavior and contributes to the reduction of preventable diseases. Students in their social transition period are the ideal groups for interventions. The higher education period, associated with demanding changes and poor time management, results in a low level of physical activity. In this age, social media usually are a suitable channel of communication and multicomponent interventions are the most desirable. It has not been sufficiently investigated how effective a Web-based approach is among university students when it comes to physical activity in the long-term period. We combined a Web-based approach with motivational interviews and tested these two interventions together and separate to assess their impact on improving the physical activity of medical students 1 year after the intervention. Methods All 514 first-year students at the Faculty of Medicine in Belgrade were invited to fill in a baseline questionnaire. Also, they underwent measurement of weight, height and waist circumference. After that, students selected a 6 months intervention according to their preference: Intervention through social media (Facebook) (Group 1) or combined with a motivational interview (Group 2). Group 3 consisted of students without any intervention. One year after completion of the 6 months intervention period, all students were invited to a second comprehensive assessment. Analyses were performed employing a wide range of statistical testing, including direct logistic regression, to identify determinants of increased physical activity measured by an average change of Metabolic Equivalent of Task (MET). This outcome measure was defined as the difference between the values at baseline and one year after completion of the 6 months intervention period. Results Due to a large number of potential determinants of the change of MET, three logistic regression models considered three groups of independent variables: basic socio-demographic and anthropometric data, intervention and willingness for change, and health status with life choices. The only significant model comprised parameters related to the interventions (p < 0.001). It accurately classified 73.5% of cases. There is a highly significant overall effect for type of intervention (Wald = 19.5, df = 2, p < 0.001) with high odds for the increase of physical activity. Significant relationship between time and type of intervention also existed (F = 7.33, p < 0.001, partial η2 = 0.091). The influence of both factors (time and interventions) led to a change (increase) in the dependent variable MET. Conclusion Our study confirmed the presence of low-level physical activity among students of medicine and showed that multicomponent interventions have significant potential for positive change. The desirable effects of the Web-based intervention are higher if an additional booster is involved, such as a motivational interview.
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Semakula, Daniel, Allen Nsangi, Andrew Oxman, Claire Glenton, Simon Lewin, Sarah Rosenbaum, Matt Oxman, et al. "Informed Health Choices media intervention for improving people’s ability to critically appraise the trustworthiness of claims about treatment effects: a mixed-methods process evaluation of a randomised trial in Uganda." BMJ Open 9, no. 12 (December 2019): e031510. http://dx.doi.org/10.1136/bmjopen-2019-031510.
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We developed the Informed Health Choices podcast to improve people’s ability to assess claims about the effects of treatments. We evaluated the effects of the podcast in a randomised trial.ObjectivesWe conducted this process evaluation to assess the fidelity of the intervention, identify factors that affected the implementation and impact of the intervention and could affect scaling up, and identify potential adverse and beneficial effects.SettingThe study was conducted in central Uganda in rural, periurban and urban settings.ParticipantsWe collected data on parents who were in the intervention arm of the Informed Health Choices study that evaluated an intervention to improve parents’ ability to assess treatment effects.ProceduresWe conducted 84 semistructured interviews during the intervention, 19 in-depth interviews shortly after, two focus group discussions with parents, one focus group discussion with research assistants and two in-depth interviews with the principal investigators. We used framework analysis to manage qualitative data, assessed the certainty of the findings using the GRADE-CERQual (Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative Research) approach, and organised findings in a logic model.OutcomesProportion of participants listening to all episodes; factors influencing the implementation of the podcast; ways to scale up and any adverse and beneficial effects.ResultsAll participants who completed the study listened to the podcast as intended, perhaps because of the explanatory design and recruitment of parents with a positive attitude. This was also likely facilitated by the podcast being delivered by research assistants, and providing the participants with MP3 players. The podcast was reportedly clear, understandable, credible and entertaining, which motivated them to listen and eased implementation. No additional adverse effects were reported.ConclusionsParticipants experienced the podcast positively and were motivated to engage with it. These findings help to explain the short-term effectiveness of the intervention, but not the decrease in effectiveness over the following year.
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Gao, Pingyang, and Gaoqing Zhang. "Accounting Manipulation, Peer Pressure, and Internal Control." Accounting Review 94, no. 1 (March 1, 2018): 127–51. http://dx.doi.org/10.2308/accr-52078.
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ABSTRACT We study firms' investment in internal controls to reduce accounting manipulation. We first show that peer managers' manipulation decisions are strategic complements: one manager manipulates more if he believes that reports of peer firms are more likely to be manipulated. As a result, one firm's investment in internal controls has a positive externality on peer firms. It reduces its own manager's manipulation, which, in turn, mitigates the manipulation pressure on managers at peer firms. Firms do not internalize this positive externality and, thus, underinvest in their internal controls over financial reporting. The problem of underinvestment provides one justification for regulatory intervention in firms' internal controls choices. JEL Classifications: G18; M41; M48; K22.
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Feldman, Charles H., Heather Hartwell, Joseph Brusca, Haiyan Su, and Hang Zhao. "Nutrition information and its influence on menu choice within higher education establishments." British Food Journal 117, no. 4 (April 2, 2015): 1399–410. http://dx.doi.org/10.1108/bfj-06-2014-0219.
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Purpose – The purpose of this paper is to evaluate the influence of nutritional information on menu choices in a higher educational setting using a menu designed by the students themselves. Design/methodology/approach – Based on USDA healthy eating standards, a menu comprising seven healthy and seven unhealthy meal options were presented, once unlabeled as control (n=214) and once labeled with healthy and non-healthy nutrient icons as an intervention test menu (n=212). Findings – Findings demonstrate that despite a positive observed trend, there were no significant differences between healthy selection of labeled and unlabeled dishes (p=0.16). Practical implications – Providing nutritional information in student cafeterias may be challenging but helpful. However, more strategies need to be developed with student input to provide nutrition data on menus in an informative, comprehensive, yet friendly way that encourages healthy eating in campus foodservices. Social implications – No labeling system or legislation can control choices made by individuals, so the responsibility for a healthy selection must always remain personal. However, consumers should have input on menus as they have a stake in the outcome of the products. Originality/value – This novel study tested a student-designed menu to assess whether user input can influence food choice.
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RENAUD, KAREN, and VERENA ZIMMERMANN. "Nudging folks towards stronger password choices: providing certainty is the key." Behavioural Public Policy 3, no. 02 (February 13, 2018): 228–58. http://dx.doi.org/10.1017/bpp.2018.3.
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AbstractPersuading people to choose strong passwords is challenging. One way to influence password strength, as and when people are making the choice, is to tweak the choice architecture to encourage stronger choice. A variety of choice architecture manipulations (i.e. ‘nudges’) have been trialled by researchers with a view to strengthening the overall password profile. None has made much of a difference so far. Here, we report on our design of an influential behavioural intervention tailored to the password choice context: a hybrid nudge that significantly prompted stronger passwords. We carried out three longitudinal studies to analyse the efficacy of a range of ‘nudges’ by manipulating the password choice architecture of an actual university web application. The first and second studies tested the efficacy of several simple visual framing ‘nudges’. Password strength did not budge. The third study tested expiration dates directly linked to password strength. This manipulation delivered a positive result: significantly longer and stronger passwords. Our main conclusion was that the final successful nudge provided participants with absolute certainty as to the benefit of a stronger password and that it was this certainty that made the difference.
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Kato-Lin, Yi-Chin, Uttara Bharath Kumar, Bhargav Sri Prakash, Bhairavi Prakash, Vasini Varadan, Sanjeeta Agnihotri, Nrutya Subramanyam, Pradeep Krishnatray, and Rema Padman. "Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial." JMIR mHealth and uHealth 8, no. 11 (November 18, 2020): e15717. http://dx.doi.org/10.2196/15717.
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Background Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. Methods We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, P=.04), even after controlling for baseline food preference. Conclusions A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively.
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Marchello, Nicholas, Christine Daley, Jinxiang Hu, Debra Sullivan, and Heather Gibbs. "Improving Patient Satisfaction Through Nutrition Literacy Assessment: A Pilot Study." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 1329. http://dx.doi.org/10.1093/cdn/nzaa059_046.
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Abstract Objectives Nutrition literacy is the capacity to apply nutrition information to dietary choices and is associated with diet quality. Understanding patient nutrition literacy deficits may help dietitians provide a more patient-centered intervention and improve patient satisfaction with their nutrition care. This pilot study examined the effects of nutrition literacy assessments on patient satisfaction. Methods Participants (n = 89) were patients scheduled for an appointment with an outpatient dietitian. All participants completed the validated Nutrition Literacy Assessment Instrument (NLit) prior to their visit with a dietitian. Intervention-arm dietitians accessed patient NLit results to focus interventions towards individual nutrition literacy deficits. Control-arm dietitians did not access NLit results and provided traditional interventions. All participants returned one month later to retake the NLit and a modified version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, a patient-centered satisfaction survey developed by the Agency for Healthcare Research and Quality (AHRQ). Correlations were used to examine relationships between patient satisfaction and baseline NLit scores, change in NLit scores, and randomization. Bootstrapped multiple linear regression models were used to examine relationships between patient satisfaction, changes in NLit score, and sociodemographic variables. Results Mean patient satisfaction score for the cohort was 9.01 (10-point scale). Patient satisfaction was correlated with improvements in NLit score (Spearman's r = 0.265, P = 0.012). Partial correlations showed a positive relationship between changes in NLit score and patient satisfaction (r = 0.302, P = 0.006) when controlling for randomization, age, sex, education, income, and ethnicity. Regression models showed a positive association between patient satisfaction and change in NLit score (adjusted r2 = 0.087, P = 0.036). Conclusions Improved nutrition literacy may improve patient satisfaction. Nutrition literacy assessments may aid dietitians to focus nutrition interventions, individualizing nutrition education, and improve patient satisfaction. Funding Sources This work was supported by a CTSA grant from NCATS and the School of Health Professions.
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Favuzzi, Nicoletta, Paolo Trerotoli, Maria Grazia Forte, Nicola Bartolomeo, Gabriella Serio, Domenico Lagravinese, and Francesco Vino. "Evaluation of an Alimentary Education Intervention on School Canteen Waste at a Primary School in Bari, Italy." International Journal of Environmental Research and Public Health 17, no. 7 (April 8, 2020): 2558. http://dx.doi.org/10.3390/ijerph17072558.
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The “Love Food, Not Waste” project was conducted to train students on good food choices and evaluate food waste in school canteens. Teachers, parents and students were surveyed before and after training. Weights of both the served and wasted food were recorded for one week both before the educational intervention in February 2019 and after the educational intervention in March 2019, using the same menu. Students completed a food satisfaction questionnaire on the days the data were collected. For the first dish, the mean wastes per school were 1199 g before training and 1054 g after training. For the second dish, the mean wastes per school were 246 g before training and 220 g after training. For the side course, the means wastes per school were 663 g before training and 747 g after training. The results did not significantly differ among weeks or schools. Less food was wasted when boys judged the food’s general aspects like smell, taste and appearance as positive; more food was wasted when girls judged these factors as negative. Food waste monitoring is mandatory but does not always occur. Analyzing food waste relative to students’ food perceptions can help determine whether educational interventions can help reduce waste. Students’ satisfaction must also be considered.
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Muzaffar, Henna, Cassandra J. Nikolaus, Brian G. Ogolsky, Amanda Lane, Carli Liguori, and Sharon M. Nickols-Richardson. "Promoting Cooking, Nutrition, and Physical Activity in Afterschool Settings." American Journal of Health Behavior 43, no. 6 (November 1, 2019): 1050–63. http://dx.doi.org/10.5993/ajhb.43.6.4.
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Objective: In this study, we evaluated the afterschool PAWS (Peer-education About Weight Steadiness) Club program delivered by peer or adult educators to improve food choices, physical activity, and psychosocial variables related to healthy eating. Methods: We had 109 adolescents (53 in adult-led group; 56 in peer-led group) participate in a cluster randomized controlled intervention. The 12-session curriculum framed within Social Cognitive Theory (SCT) and Stages of Change addressed mediators of behavior change related to cooking skills, food intake, and physical activity. Anthropometric, dietary intake, physical activity, and SCT mediators were assessed at baseline, post-intervention, and 6-months post-intervention. Results: Adolescents in the peer-led group significantly improved whole grain intake at post-intervention (p = .017) and 6-months post-intervention (p = .014). Both peer-led and adult-led groups had significant reductions in caloric intake at 6-months post-intervention (p = .047). Only the adult-led group improved self-efficacy (SE) and social/family support (SS) for healthy eating at post-intervention [p = .019 (SE); p = .048 (SS)] and 6-months post-intervention [p = .036 (SE); p = .022 (SS)]. Conclusions: The PAWS Club program promoted lower caloric intake by adolescents. Peer educators were effective at increasing whole grains in adolescents, and adult educators contributed to positive changes in SE and SS related to healthy eating.
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Verburgh, Marjolein, Petra Verdonk, Yolande Appelman, Monique Brood-van Zanten, and Karen Nieuwenhuijsen. "“I Get That Spirit in Me”—Mentally Empowering Workplace Health Promotion for Female Workers in Low-Paid Jobs during Menopause and Midlife." International Journal of Environmental Research and Public Health 17, no. 18 (September 4, 2020): 6462. http://dx.doi.org/10.3390/ijerph17186462.
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During menopause and midlife, female workers, particularly those in low-paid jobs, experience more occupational health problems than other groups of workers. Workplace interventions are often lacking, however. In the Netherlands, a workplace health promotion intervention—the work–life program (WLP)—has been developed to support female workers. Here, we tailored the WLP to the needs of female workers in low-paid jobs working at Amsterdam University Medical Center. In an exploratory mixed-methods study with a convergent design, among 56 participants, we used questionnaires before and after the intervention and semi-structured, in-depth interviews to address the following research question: What is the impact of the WLP on the women’s health and work functioning? Our quantitative data showed that menopausal symptoms improved significantly after the WLP. Our qualitative data, derived from 12 participants, showed that the WLP initiated a process of mental empowerment that initiated positive changes in four domains: behavior, physical health, mental wellbeing, and in the workplace. Taken with caution, our findings suggest that the WLP mentally empowers female workers to make choices that enhance their health and wellbeing, both at work and in their private lives, as summarized in the quote of one participant: “I get that spirit in me!”.
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Parrish, Danielle E., Kirk von Sternberg, Laura J. Benjamins, Jacquelynn Duron, and Mary Velasquez. "CHOICES-TEEN: Reducing Substance-Exposed Pregnancy and HIV Among Juvenile Justice Adolescent Females." Research on Social Work Practice 29, no. 6 (June 20, 2018): 618–27. http://dx.doi.org/10.1177/1049731518779717.
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Objective: The feasibility and acceptability of CHOICES-TEEN—a three-session intervention to reduce overlapping risks of alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP), and HIV—was assessed among females in the juvenile justice system. Method: Females aged 14–17 years on community probation in Houston, TX, were eligible if presenting with aforementioned health risks. Outcome measures—obtained at 1- and 3-months postbaseline—included the Timeline Followback, Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory–Short, and open-ended questions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age = 16). Results: The results suggest strong acceptability and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% at 1 month, 71.4% at 3 months), TEP (77% of smokers [ n = 17] at reduced risk at 1 month, 50% at 3 months), and HIV (52.4% at 1 month, 28.6% at 3 months).
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Adamson, Ashley J., and John C. Mathers. "Effecting dietary change." Proceedings of the Nutrition Society 63, no. 4 (November 2004): 537–47. http://dx.doi.org/10.1079/pns2004395.
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A world epidemic of diet-related chronic disease is currently being faced. In the UK incidence of obesity alone has tripled in the last 20 years and this trend is predicted to continue. Consensus exists for the urgent need for a change in diet and other lifestyle factors and for the direction and targets for this change. The evidence for how this change can be achieved is less certain. It has been established that disease processes begin in childhood. Recent evidence indicates that dietary habits too are established in childhood but that these habits are amenable to change. While establishing a healthy lifestyle in childhood is paramount, interventions have the potential to promote positive change throughout the life course. Success in reversing current trends in diet-related disease will depend on commitment from legislators, health professionals, industry and individuals, and this collaboration must seek to address not only the food choices of the individual but also the environment that influences such choices. Recent public health policy development in England, if fully supported and implemented, is a positive move towards this goal. Evidence for effective strategies to promote dietary change at the individual level is emerging and three reviews of this evidence are discussed. In addition, three recent dietary intervention studies, in three different settings and with different methods and aims, are presented to illustrate methods of effecting dietary change. Further work is required on what factors influence the eating behaviour and physical activity of individuals. There is a need for further theory-based research on which to develop more effective strategies to enable individuals to adopt healthier lifestyles.
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Li, Shuling, Tingru Zhang, Ben D. Sawyer, Wei Zhang, and Peter A. Hancock. "Angry Drivers Take Risky Decisions: Evidence from Neurophysiological Assessment." International Journal of Environmental Research and Public Health 16, no. 10 (May 15, 2019): 1701. http://dx.doi.org/10.3390/ijerph16101701.
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The present study investigated the risk-taking behaviors of angry drivers, which were coincidentally measured via behavioral and electroencephalographic (EEG) recordings. We manipulated a driving scenario that concerned a Go/No-Go decision at an intersection when the controlling traffic light was in its yellow phase. This protocol was based upon the underlying format of the Iowa gambling task. Variation in the anger level was induced through task frustration. The data of twenty-four drivers were analyzed via behavioral and neural recordings, and P300 was specifically extracted from EEG traces. In addition, the behavioral performance was indexed by the percentage of high-risk choices minus the number of the low-risk choices taken, which identified the risk-taking propensity. Results confirmed a significant main effect of anger on the decisions taken. The risk-taking propensity decreased across the sequence of trial blocks in baseline assessments. However, with anger, the risk-taking propensity increased across the trial regimen. Drivers in anger state also showed a higher mean amplitude of P300 than that in baseline state. Additionally, high-risk choices evoked larger P300 amplitude than low-risk choices during the anger state. Moreover, the P300 amplitude of high-risk choices was significantly larger in the anger state than the baseline state. The negative feedback induced larger P300 amplitude than that recorded in positive feedback trials. The results corroborated that the drivers exhibited higher risk-taking propensity when angry although they were sensitive to the inherent risk-reward evaluations within the scenario. To reduce this type of risk-taking, we proposed some effective/affective intervention methods.