Ramsey, Alex T; Montgomery, Katherine
Despite concerns around the use of technology-based interventions, they are increasingly being employed by social workers as a direct practice methodology to address the mental health needs of vulnerable clients. Researchers have highlighted the importance of using innovative technologies within social work practice, yet little has been done to summarize the evidence and collectively assess findings. In this systematic review, we describe accounts of technology-based mental health interventions delivered by social workers over the past 10 years. Results highlight the impacts of these tools and summarize advantages and disadvantages to utilizing technologies as a method for delivering or facilitating interventions.
Orlowski, Simone; Lawn, Sharon; Venning, Anthony; Winsall, Megan; Jones, Gabrielle M; Wyld, Kaisha; Damarell, Raechel A; Antezana, Gaston; Schrader, Geoffrey; Smith, David; Collin, Philippa; Bidargaddi, Niranjan
Background Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. Objective To investigate consumer involvem...
Free, Caroline; Phillips, Gemma; Galli, Leandro; Watson, Louise; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy
Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72-0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. Text messaging interventions increased adherence to ART and
Full Text Available BACKGROUND: Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. METHODS AND FINDINGS: We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010. Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART adherence, use of text messages reduced high viral load (>400 copies, with a relative risk (RR of 0.85 (95% CI 0.72-0.99, but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47-1.32]. In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77-2.62]. Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. CONCLUSIONS: Text
Lawn, Sharon; Venning, Anthony; Winsall, Megan; Jones, Gabrielle M; Wyld, Kaisha; Damarell, Raechel A; Antezana, Gaston; Schrader, Geoffrey; Smith, David; Collin, Philippa; Bidargaddi, Niranjan
Background Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. Objective To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. Methods Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. Results A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable
Orlowski, Simone Kate; Lawn, Sharon; Venning, Anthony; Winsall, Megan; Jones, Gabrielle M; Wyld, Kaisha; Damarell, Raechel A; Antezana, Gaston; Schrader, Geoffrey; Smith, David; Collin, Philippa; Bidargaddi, Niranjan
Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to
MacDonell, Kathleen Watson; Prinz, Ronald J
In the past 10 years, mental and behavioral health has seen a proliferation of technology-based interventions in the form of online and other computer-delivered programs. This paper focuses on technology-based treatment and preventive interventions aimed at benefitting children and adolescents via either involving the parents and families, or only the youth. The review considered only technology-based interventions that had at least one published study with a randomized controlled trial design. Questions being addressed included: (1) What are the technology-based interventions in the mental/behavioral health area that have been systematically evaluated in published studies? (2) What are the common and unique characteristics of these interventions and their application with respect to sample characteristics, target problems, and technology characteristics (platforms, structures, elements, and communication formats)? and (3) Which intervention approaches and strategies have accrued the greatest evidence? The review identified 30 technology-based psychosocial interventions for children and families, 19 of which were parent or family-focused (32 studies) and 11 of which were youth-focused (in 13 studies). For the parent/family-focused interventions, greatest promise was found in those that addressed either youth behavioral problems or depressive/anxious symptoms, as well as more general bolstering of parenting efficacy. The youth-focused interventions showed some promise in reducing depressive/anxious symptoms. Advantages and disadvantages of the technology-based approaches were considered, and areas for future research and development were discussed.
Kaipainen, Kirsikka; Lappalainen, Raimo; Hoffrén, Henna; Myllymäki, Tero; Kinnunen, Marja-Liisa; Mattila, Elina; Happonen, Antti P; Rusko, Heikki; Korhonen, Ilkka
Background Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. Objective The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. Methods This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. Results A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. Conclusions
David J. Kim
Full Text Available Introduction: Technology-based interventions offer an opportunity to address high-risk behaviors in the emergency department (ED. Prior studies suggest behavioral health strategies are more effective when gender differences are considered. However, the role of gender in ED patient preferences for technology-based interventions has not been examined. The objective was to assess whether patient preferences for technology-based interventions varies by gender. Methods: This was a secondary analysis of data from a systematic survey of adult (18 years of age, English-speaking patients in a large urban academic ED. Subjects were randomly selected during a purposive sample of shifts. The iPad survey included questions on access to technology, preferences for receiving health information, and demographics. We defined ‘‘technology-based’’ as web, text message, e-mail, social networking, or DVD; ‘‘non-technology-based’’ was defined as in-person, written materials, or landline. We calculated descriptive statistics and used univariate tests to compare men and women. Gender-stratified multivariable logistic regression models were used to examine associations between other demographic factors (age, race, ethnicity, income and technology-based preferences for information on specific risky behaviors. Results: Of 417 participants, 45.1% were male. There were no significant demographic differences between men and women. Women were more likely to use computers (90.8% versus 81.9%; p¼0.03, Internet (66.8% versus 59.0%; p¼0.03, and social networks (53.3% versus 42.6%; p¼0.01. 89% of men and 90% of women preferred technology-based formats for at least type of health information; interest in technology-based for individual health topics did not vary by gender. Concern about confidentiality was the most common barrier to technology-based use for both genders. Multivariate analysis showed that for smoking, depression, drug/alcohol use, and injury
Ranney, Megan L; Choo, Esther K; Spirito, Anthony; Mello, Michael J
This study aimed to (1) determine the prevalence of technology use and interest in technology-based interventions among adolescent emergency department patients and (2) examine the association between interest in an intervention and self-reported risky behaviors. Adolescents (age, 13-17 years) presenting to an urban pediatric emergency department completed a survey regarding baseline technology use, risky behaviors, and interest in and preferred format for behavioral health interventions. Questions were drawn from validated measures when possible. Descriptive statistics and χ2 tests were calculated to identify whether self-reported risky behaviors were differentially associated with intervention preference. Two hundred thirty-four patients (81.8% of eligible) consented to participate. Almost all used technology, including computers (98.7%), social networking (84.9%), and text messaging (95.1%). Adolescents reported high prevalence of risky behaviors as follows: unintentional injury (93.2%), peer violence exposure (29.3%), dating violence victimization (23.0%), depression or anxiety (30.0%), alcohol use (22.8%), drug use (36.1%), cigarette use (16.4%), and risky sexual behaviors (15.1%). Most were interested in receiving behavioral interventions (ranging from 93.6% interest in unintentional injury prevention, to 73.1% in smoking cessation); 45% to 93% preferred technology-based (vs in person, telephone call, or paper) interventions for each topic. Proportion interested in a specific topic and proportion preferring a technology-based intervention did not significantly differ by self-reported risky behaviors. Among this sample of adolescent emergency department patients, high rates of multiple risky behaviors are reported. Patients endorsed interest in receiving interventions for these behaviors, regardless of whether they reported the behavior. Most used multiple forms of technology, and approximately 50% preferred a technology-based intervention format.
Rushing, Stephanie Craig; Stephens, David
American Indian and Alaska Native (AI/AN) youth are disproportionally burdened by many common adolescent health issues, including drug and alcohol use, injury and violence, sexually transmitted infections, and teen pregnancy. Media technologies, including the Internet, cell phones, and video games, offer new avenues for reaching adolescents on a…
Rushing, Stephanie Craig; Stephens, David
American Indian and Alaska Native (AI/AN) youth are disproportionally burdened by many common adolescent health issues, including drug and alcohol use, injury and violence, sexually transmitted infections, and teen pregnancy. Media technologies, including the Internet, cell phones, and video games, offer new avenues for reaching adolescents on a…
Aldehaim, Abdulkarim Yousef; Alotaibi, Faisal F; Uphold, Constance R; Dang, Stuti
This article is a systematic review of the impact of technology-based intervention on outcomes related to care providers for those who survived a stroke. Literature was identified in the PubMed, PsycINFO, Scopus, and Cochrane databases for evidence on technology-based interventions for stroke survivors' caregivers. The search was restricted for all English-language articles from 1970 to February 2015 that implied technology-based interventions. This review included studies that measured the impact of these types of approaches on one or more of the following: depression and any of the following-problem-solving ability, burden, health status, social support, preparedness, and healthcare utilization by care recipient-as secondary outcomes. Telephone or face-to-face counseling sessions were not of interest for this review. The search strategy yielded five studies that met inclusion criteria: two randomized clinical trials and three pilot/preliminary studies, with diverse approaches and designs. Four studies have assessed the primary outcome, two of which reported significant decreases in caregivers' depressive symptoms. Two studies had measured each of the following outcomes-burden, problem-solving ability, health status, and social support-and they revealed no significant differences following the intervention. Only one study assessed caregivers' preparedness and showed improved posttest scores. Healthcare services use by the care recipient was assessed by one study, and the results indicated significant reduction in emergency department visits and hospital re-admissions. Despite various study designs and small sample sizes, available data suggest that an intervention that incorporates a theoretical-based model and is designed to target caregivers as early as possible is a promising strategy. Furthermore, there is a need to incorporate a cost-benefit analysis in future studies.
Grynszpan, Ouriel; Weiss, Patrice L.; Perez-Diaz, Fernando; Gal, Eynat
This article reports the results of a meta-analysis of technology-based intervention studies for children with autism spectrum disorders. We conducted a systematic review of research that used a pre-post design to assess innovative technology interventions, including computer programs, virtual reality, and robotics. The selected studies provided…
Raaijmakers, Lieke C H; Pouwels, Sjaak; Berghuis, Kim A; Nienhuijs, Simon W
The prevalence of obesity increases worldwide. The use of technology-based interventions can be beneficial in weight loss interventions. This review aims to provide insight in the effectiveness of technology-based interventions on weight loss and quality of life for patients suffering overweight or obesity compared to standard care. Pubmed, PsycInfo, Web of Science, ScienceDirect, CINAHL and Embase were searched from the earliest date (of each database) up to February 2015. Interventions needed to be aimed at reducing or maintaining weight loss in persons with a body mass index (BMI) ≥ 25 kg/m(2) and have a technology aspect. Cochrane Collaboration's tool for assessing risk of bias was used for rating the methodological quality. Twenty-seven trials met inclusion criteria. Thirteen studies showed significant effects on weight loss compared to controls. Most interventions used a web-based approach (42%). Interventions were screened for five technical key components: self-monitoring, counsellor feedback and communication, group support, use of a structured program and use of an individually tailored program. All interventions that used a combination of all five or four components showed significant decreases in weight compared to controls. No significant results for quality of life were found. Outcomes on program adherence were reported in six studies. No significant results were found between weight loss and program adherence. Evidence is lacking about the optimal use of technology in weight loss interventions. However, when the optimal combination of technological components is found, technology-based interventions may be a valid tool for weight loss. Furthermore, more outcomes on quality of life and information about the effect of technology-based intervention after bariatric surgery are needed.
Khan, Khalid M; Evans, Sydney S; Bielko, Sylvanna L; Rohlman, Diane S
Adolescent farmworkers are exposed to loud noise during farm activities. We present a prospective study that evaluated the efficacy of low-cost, technology-based intervention approaches in high schools to enhance the use of hearing protection among adolescent farmworkers. Six high schools in Iowa that agreed to participate in the study were divided into three equal groups through cluster-randomisation with each group receiving one of the three formats of hearing protection intervention: (a) classroom training, (b) classroom training coupled with smartphone app training and (c) computer training. Participants completed baseline (pre-training) and six-week post-intervention surveys for assessing hearing protection knowledge, attitudes and behaviour. Seventy participants from six schools were initially enrolled but 50 completed both pre- and post-intervention surveys. In most cases, all three groups showed significant improvement in hearing protection knowledge, attitude and frequency of use from pre- to post-intervention. However, changes between groups were statistically non-significant. Although all three formats led to improvements on hearing protection knowledge, attitude and behaviour, the findings of the study, perhaps due to the small sample size, did not allow us to detect whether technology-based hearing protection interventions were more effective than the traditional face-to-face training for adolescent farmworkers.
Litvin, Erika B; Abrantes, Ana M; Brown, Richard A
Research devoted to the development of therapeutic, behavioral interventions for substance use disorders (SUDs) that can be accessed and delivered via computer and mobile technologies has increased rapidly during the past decade. Numerous recent reviews of this literature have supported the efficacy of technology-based interventions (TBIs), but have also revealed their great heterogeneity and a limited understanding of treatment mechanisms. We conducted a "review of reviews" focused on summarizing findings of previous reviews with respect to moderators of TBIs' efficacy, and present an organizing framework of considerations involved in designing and evaluating TBIs for SUDs. The four primary elements that comprise our framework are Accessibility, Usage, Human Contact, and Intervention Content, with several sub-elements within each category. We offer some suggested directions for future research grouped within these four primary considerations. We believe that technology affords unique opportunities to improve, support, and supplement therapeutic and peer relationships via dynamic applications that adapt to individuals' constantly changing motivation and treatment needs. We hope that our framework will aid in guiding programmatic progress in this exciting field.
Senn, Theresa E; Braksmajer, Amy; Coury-Doniger, Patricia; Urban, Marguerite A; Carey, Michael P
HIV positive Black men who have sex with men (MSM) are retained in HIV medical care at suboptimal rates. Interventions targeted to Black MSM are needed to help to improve their retention in care. The purposes of this study were to investigate the use of mobile technology among HIV+ Black MSM and to explore participants' thoughts about the use of mobile technology for HIV retention in care interventions. Twenty-two HIV+ Black MSM completed a technology use survey and participated in a qualitative interview regarding technology-based interventions. The majority of participants (95%) had access to a cell phone, and used their phones frequently (median 3 hours/day). Men preferred interventions that would allow for anonymous participation and that would provide individually tailored support. Mobile technology is a promising approach to intervention delivery for both younger and older HIV+ Black MSM. These interventions should incorporate features that are desirable to men (i.e., anonymous participation and individual tailoring).
Benjamin W. Van Voorhees
Full Text Available Efforts to prevent depression have become a key health system priority. Currently, there is a high prevalence of depression among adolescents, and treatment has become costly due to the recurrence patterns of the illness, impairment among patients, and the complex factors needed for a treatment to be effective. Primary care may be the optimal location to identify those at risk by offering an Internet-based preventive intervention to reduce costs and improve outcomes. Few practical interventions have been developed. The models for Internet intervention development that have been put forward focus primarily on the Internet component rather than how the program fits within a broader context. This paper describes the conceptualization for developing technology based preventive models for primary care by integrating the components within a behavioral vaccine framework. CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training has been developed and successfully implemented within various health systems over a period of 14 years among adolescents and young adults aged 13–24.
Jupri, A.; Drijvers, P.H.M.|info:eu-repo/dai/nl/074302922; Van den Heuvel-Panhuizen, M.|info:eu-repo/dai/nl/069266255
Digital technology plays an increasingly important role in daily life, mathematics education and algebra education in particular. To investigate the effect of a technology-rich intervention related to initial algebra on the achievement of 12–13 year old Indonesian students, we set up an experiment.
Jupri, A.; Drijvers, P.H.M.|info:eu-repo/dai/nl/074302922; Van den Heuvel-Panhuizen, M.|info:eu-repo/dai/nl/069266255
Digital technology plays an increasingly important role in daily life, mathematics education and algebra education in particular. To investigate the effect of a technology-rich intervention related to initial algebra on the achievement of 12–13 year old Indonesian students, we set up an experiment.
Noar, Seth M.
Computer technology-based interventions (CBIs) represent a promising area for HIV prevention behavioral intervention research. Such programs are a compelling prevention option given their potential for broad reach, customized content, and low cost delivery. The purpose of the current article is to provide a review of the state of the literature on CBIs. First, we define CBIs in HIV prevention and highlight the many advantages of such interventions. Next, we provide an overview of what is currently known regarding the efficacy of CBIs in HIV prevention, focusing on two recent meta-analyses of this literature. Finally, we propose an agenda for future directions for research in the area of CBIs, using the RE-AIM model as an organizing guide. We conclude that with the continued growth of computer technologies, opportunities to apply such technologies in HIV prevention will continue to blossom. Further research is greatly needed to advance an understanding of not only how and under what circumstances CBIs can be efficacious, but also how the reach, adoption, implementation, and maintenance of such programs in clinical and community settings can be achieved. PMID:21287420
Long, JoAnn D; Gannaway, Paula; Ford, Cindy; Doumit, Rita; Zeeni, Nadine; Sukkarieh-Haraty, Ola; Milane, Aline; Byers, Beverly; Harrison, LaNell; Hatch, Daniel; Brown, Justin; Proper, Sharlan; White, Patricia; Song, Huaxin
As the world becomes increasingly digital, advances in technology have changed how students access evidence-based information. Research suggests that students overestimate their ability to locate quality online research and lack the skills needed to evaluate the scientific literature. Clinical nurses report relying on personal experience to answer clinical questions rather than searching evidence-based sources. To address the problem, a web-based, evidence-based research (EBR) tool that is usable from a computer, smartphone, or iPad was developed and tested. The purpose of the EBR tool is to guide students through the basic steps needed to locate and critically appraise the online scientific literature while linking users to quality electronic resources to support evidence-based practice (EBP). Testing of the tool took place in a mixed-method, quasi-experimental, and two-population randomized controlled trial (RCT) design in a U.S. and Middle East university. A statistically significant improvement in overall research skills was supported in the quasi-experimental nursing student group and RCT nutrition student group using the EBR tool. A statistically significant proportional difference was supported in the RCT nutrition and PharmD intervention groups in participants' ability to distinguish the credibility of online source materials compared with controls. The majority of participants could correctly apply PICOTS to a case study when using the tool. The data from this preliminary study suggests that the EBR tool enhanced student overall research skills and selected EBP skills while generating data for assessment of learning outcomes. The EBR tool places evidence-based resources at the fingertips of users by addressing some of the most commonly cited barriers to research utilization while exposing users to information and online literacy standards of practice, meeting a growing need within nursing curricula. © 2016 Sigma Theta Tau International.
The effectiveness of information and communication technology-based psychological interventions for paediatric chronic pain: protocol for a systematic review, meta-analysis and intervention content analysis.
Traynor, Angeline; Morrissey, Eimear; Egan, Jonathan; McGuire, Brian E
Resource and geographic barriers are the commonly cited constraints preventing the uptake of psychological treatment for chronic pain management. For adults, there is some evidence to support the use of information and communication technology (ICT) as a mode of treatment delivery. However, mixed findings have been reported for the effectiveness and acceptability of psychological interventions delivered using information and communication technology for children and adolescents. This is a protocol for a review that aims to (i) evaluate the effectiveness of psychological interventions delivered using information and communication technology for children and adolescents with chronic pain and (ii) identify the intervention components and usability factors in technology-based treatments associated with behaviour change. We will conduct a systematic review to evaluate the effectiveness of psychological interventions for paediatric chronic pain delivered using ICT. We plan to directly compare ICT-based, psychological interventions with active control, treatment as usual or waiting list control conditions. This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Published and unpublished randomised controlled trials will be included and the literature search will comprise Ovid MEDLINE, Ovid Embase, PsycINFO and the Cochrane Library on Wiley, including CENTRAL and Cochrane Database of Systematic Reviews. Grey literature including theses, dissertations, technical and research reports will also be examined. Two review authors will independently conduct study selection, relevant data extraction and assessment of methodological quality. Risk of bias in included studies will be assessed using the Cochrane Collaboration risk of bias tool criteria. Two qualified coders will independently code behaviour change techniques according to the behaviour change taxonomy (v1) of 93 hierarchically
Vélez-Coto, María; Rodríguez-Fórtiz, María José; Rodriguez-Almendros, María Luisa; Cabrera-Cuevas, Marcelino; Rodríguez-Domínguez, Carlos; Ruiz-López, Tomás; Burgos-Pulido, Ángeles; Garrido-Jiménez, Inmaculada; Martos-Pérez, Juan
People with low-functioning ASD and other disabilities often find it difficult to understand the symbols traditionally used in educational materials during the learning process. Technology-based interventions are becoming increasingly common, helping children with cognitive disabilities to perform academic tasks and improve their abilities and knowledge. Such children often find it difficult to perform certain tasks contained in educational materials since they lack necessary skills such as abstract reasoning. In order to help these children, the authors designed and created SIGUEME to train attention and the perceptual and visual cognitive skills required to work with and understand graphic materials and objects. A pre-test/post-test design was implemented to test SIGUEME. Seventy-four children with low-functioning ASD (age=13.47, SD=8.74) were trained with SIGUEME over twenty-five sessions and compared with twenty-eight children (age=12.61, SD=2.85) who had not received any intervention. There was a statistically significant improvement in the experimental group in Attention (W=-5.497, p<0.001). There was also a significant change in Association and Categorization (W=2.721, p=0.007) and Interaction (W=-3.287, p=0.001). SIGUEME is an effective tool for improving attention, categorization and interaction in low-functioning children with ASD. It is also a useful and powerful instrument for teachers, parents and educators by increasing the child's motivation and autonomy. Copyright © 2017 Elsevier Ltd. All rights reserved.
This thesis focuses on refugees and mental health interventions. A literature review and 24 months of participant observation among Tamil refugee parents in Norway form the basis of the findings presented here. The first study is concerned with refugees and public mental health services in Norway. Many refugees may have difficulties trusting professional helpers within the bureaucratically organized public health care system, replacing these services with relationships to other...
Lyles, Courtney R; Sarkar, Urmimala; Osborn, Chandra Y
Consumer health technologies can educate patients about diabetes and support their self-management, yet usability evidence is rarely published even though it determines patient engagement, optimal benefit of any intervention, and an understanding of generalizability. Therefore, we conducted a narrative review of peer-reviewed articles published from 2009 to 2013 that tested the usability of a web- or mobile-delivered system/application designed to educate and support patients with diabetes. Overall, the 23 papers included in our review used mixed (n = 11), descriptive quantitative (n = 9), and qualitative methods (n = 3) to assess usability, such as documenting which features performed as intended and how patients rated their experiences. More sophisticated usability evaluations combined several complementary approaches to elucidate more aspects of functionality. Future work pertaining to the design and evaluation of technology-delivered diabetes education/support interventions should aim to standardize the usability testing processes and publish usability findings to inform interpretation of why an intervention succeeded or failed and for whom.
Full Text Available First year students pursuing engineering education face problems with their listening skills. Most of the Indian schools use a bilingual method for teaching subjects from primary school through high school. Nonetheless, students entering university education develop anxiety in listening to classroomlectures in English. This article reports an exploratory study that aimed to find out whether the listening competences of students improved when technology was deployed in language laboratory. It also investigated the opinions of the students about using teacher-suggested websites for acquiring listening skills. The results of the study indicated that the use of technology in a language laboratory for training students in listening competences had reduced the anxiety of the students when listening to English. Further, there was a significant improvement on the part of students in acquiring listening skills through technology-based intervention.Muchos estudiantes de ingeniería de primer año en India tienen problemas con sus habilidades de escucha en inglés; experimentan ansiedad al momento de escuchar conferencias en inglés, pese a que provienen de colegios donde se sigue un modelo bilingüe para enseñar materias desde la primariahasta la secundaria. Con el objetivo de averiguar si las competencias de escucha de los estudiantes mejoran cuando se introduce la tecnología en el laboratorio de idiomas, se realizó un estudio exploratorio en el que se tuvieron en cuenta las opiniones de los estudiantes acerca del uso de sitios web sugeridos por el docente para adquirir habilidades de escucha. Los resultados indican que el uso de la tecnología en el laboratorio de idiomas reduce la ansiedad de los estudiantes al momento de escuchar conferencias en inglés y que progresan significativamente en sus habilidades de escucha.
Chen, Jyu-Lin; Guedes, Claudia M; Cooper, Bruce A; Lung, Audrey E
In the United States, approximately one-third of adolescents are now overweight or obese, and one in six is obese. This financial cost and the larger nonfinancial costs of obesity make obesity prevention and management for adolescents imperative for the health of the nation. However, primary care visits are typically brief, and primary care providers may lack adequate resources to help overweight or obese adolescents to manage weight issues. To augment the efficacy of primary care visits for adolescent weight management, mobile phone technology can be used as an adjunct treatment that provides additional opportunities for encouraging improvement in lifestyle, attainment, and maintenance of healthy weight. The purposes of this study were to (1) measure effects of an innovative mobile phone technology-based intervention for overweight and obese adolescents and to (2) examine the intervention's feasibility for use in primary care clinics. The mobile phone-based intervention had three components: use of the Fitbit Flex, participation in an online educational program, and receipt of biweekly text messages during the maintenance phase. A randomized controlled study design was utilized. Data regarding anthropometrics (body mass index [BMI] and waist-to-hip ratio), blood pressure, levels of physical and sedentary activity, diet, and self-efficacy regarding physical activity and diet were collected at baseline and at 3 and 6 months after the baseline assessment. A total of 40 adolescents participated in the study. At the 6-month follow-up visit, compared to participants in the control group, the mobile phone-based intervention participants had significant improvement in BMI (z=-4.37, P=.001), diastolic blood pressure (z=-3.23, P=.001), physical activity days per week (z=2.58, P=.01), TV and computer time (z=-3.34, P=.001), servings of fruits and vegetables per day (z=2.74, P=.006), servings of soda and sweetened drinks (z=-3.19, P=.001), physical activity self-efficacy (z=2
Parwej, Saroj; Kumar, Rajesh; Walia, Indarjeet; Aggarwal, Arun K
To measure the effectiveness of a reproductive health education package in improving the knowledge of adolescent girls aged 15-19 years in Chandigarh (India). A reproductive health education package, developed in consultation with parents, teachers and adolescents, was delivered to randomly sampled classes of two senior secondary schools and one school was selected as control. In one school, a nurse conducted 15 sessions for 94 students in three batches using conventional education approach. In another school she conducted sessions for a selected group of 20 adolescents who later disseminated the messages informally to their 84 classmates (peer education). Using a 70-item structured questionnaire the knowledge of 95 adolescents from conventional, 84 from peer, and 94 from control school were assessed before and one month after the last session. Change in the score in intervention and control groups was tested by ANOVA taking age and socio-economic status as covariates. Teachers, parents and students overwhelmingly (88%, 95.5% and 93% respectively) favoured reproductive health education program. Five percent of the respondents reported that someone in their class is having sexual relations, and 13% of the girls approved of pre-marital sexual relations. Reproductive health knowledge scores improved significantly after intervention in conventional education (27.28) and peer education group (20.77) in comparison to the controls (3.64). Post-test scores were not significantly different between peer education group and conventional education group (43.65 and 40.52 respectively) though the time consumed in delivering the peer education intervention was almost one third of the time taken to implement conventional education. Peer education and conventional education strategies were effective in improving the reproductive health knowledge of adolescent girls but peer strategy was less time consuming.
Full Text Available Recent years have witnessed much progress in the incorporation of economic considerations into the evaluation of public health interventions. In England, the Centre for Public Health Excellence within the National Institute for Health and Care Excellence works to develop guidance for preventing illness and assessing which public health interventions are most effective and provide best value for money...
Martin, Emily C; Basen-Engquist, Karen; Cox, Matthew G; Lyons, Elizabeth J; Carmack, Cindy L; Blalock, Janice A; Demark-Wahnefried, Wendy
Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors' interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. The aim of this study was to determine the factors that predict cancer survivors' interest in new technology-based health behavior intervention modalities versus traditional modalities. Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants' demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone-based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone-based diet interventions
Nabovati, Ehsan; Vakili-Arki, Hasan; Taherzadeh, Zhila; Saberi, Mohammad Reza; Medlock, Stephanie; Abu-Hanna, Ameen; Eslami, Saeid
The purpose of this systematic review was to identify features and effects of information technology (IT)-based interventions on outcomes related to drug-drug interactions (DDI outcomes). A literature search was conducted in Medline, EMBASE, and the Cochrane Library for published English-language studies. Studies were included if a main outcome was related to DDIs, the intervention involved an IT-based system, and the study design was experimental or observational with controls. Study characteristics, including features and effects of IT-based interventions, were extracted. Nineteen studies comprising five randomized controlled trials (RCT), five non-randomized controlled trials (NRCT) and nine observational studies with controls (OWC) were included. Sixty-four percent of prescriber-directed interventions, and all non-prescriber interventions, were effective. Each of the following characteristics corresponded to groups of studies of which a majority were effective: automatic provision of recommendations within the providers' workflow, intervention at the time of decision-making, integration into other systems, and requiring the reason for not following the recommendations. Only two studies measured clinical outcomes: an RCT that showed no significant improvement and an OWC that showed improvement, but did not statistically assess the effect. Most studies that measured surrogate outcomes (e.g. potential DDIs) and other outcomes (e.g. adherence to alerts) showed improvements. IT-based interventions improve surrogate clinical outcomes and adherence to DDI alerts. However, there is lack of robust evidence about their effectiveness on clinical outcomes. It is recommended that researchers consider the identified features of effective interventions in the design of interventions and evaluate the effectiveness on DDI outcomes, particularly clinical outcomes.
Schaffer, Marjorie A.; Anderson, Linda J. W.; Rising, Shannon
School nurses (SNs) use public health nursing knowledge and skills to provide nursing services to school populations. The Public Health Intervention Wheel is a practice framework that can be used to explain and guide public health nursing interventions. SNs who were also members of the National Association of School Nurses completed an electronic…
Noar, Seth M; Willoughby, Jessica Fitts
The rapidly changing media landscape and proliferation of new technologies creates vast new opportunities for HIV prevention. The fast growth of the relatively new eHealth field is a testament to the excitement and promise of these new technologies. eHealth interventions in HIV prevention tested to date include computer- and Internet-based interventions; chat room interventions; text messaging interventions; and social media. The current article provides a brief review of these types of interventions in HIV prevention, including their unique advantages and evidence of efficacy. Implications for future research in the eHealth HIV prevention field are discussed.
Giulio E. Lancioni
Full Text Available Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a access brief periods of stimulation through one or two microswitches, (b pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD or through two SGD-related sensors, (c control stimulation options through computer or radio systems and a microswitch, (d communicate through modified messaging or telephone systems operated via microswitch, and (e control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.
Schlegl, Sandra; Bürger, Carolina; Schmidt, Luise; Herbst, Nirmal; Voderholzer, Ulrich
Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.
Bürger, Carolina; Schmidt, Luise; Herbst, Nirmal; Voderholzer, Ulrich
Background Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. Methods A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed. PMID:25840591
Kovalskys, Irina; Rausch Herscovici, Cecile; Indart Rougier, Paula; De Gregorio, María José; Zonis, Luciana; Orellana, Liliana
parsimonious model for each outcome will be reported. The False Discovery Rate criterion will be used to correct for multiple testing in non-planned analyses. It is a pioneer assessment of the impact of a technology-based virtual intervention and a school-based PA program, designed to prevent obesity, and involving the parents at public schools of Buenos Aires. Current Controlled Trials ISRCTN58093412 . Registered March 14th, 2016 (retrospectively registered).
Kizakevich, Paul N; Eckhoff, Randall; Weger, Stacey; Weeks, Adam; Brown, Janice; Bryant, Stephanie; Bakalov, Vesselina; Zhang, Yuying; Lyden, Jennifer; Spira, James
With the emergence of mobile health (mHealth) apps, there is a growing demand for better tools for developing and evaluating mobile health interventions. Recently we developed the Personal Health Intervention Toolkit (PHIT), a software framework which eases app implementation and facilitates scientific evaluation. PHIT integrates self-report and physiological sensor instruments, evidence-based advisor logic, and self-help interventions such as meditation, health education, and cognitive behavior change. PHIT can be used to facilitate research, interventions for chronic diseases, risky behaviors, sleep, medication adherence, environmental monitoring, momentary data collection health screening, and clinical decision support. In a series of usability evaluations, participants reported an overall usability score of 4.5 on a 1-5 Likert scale and an 85 score on the System Usability Scale, indicating a high percentile rank of 95%.
Christensen, Helen; Batterham, Philip J; O'Dea, Bridianne
Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now being considered as a means to identify at-risk individuals, offer self-help through web interventions or to deliver proactive interventions in response to individuals' posts on social media. In this article, we examine research studies which focus on these three aspects of suicide and the internet: the use of online screening for suicide, the effectiveness of e-health interventions aimed to manage suicidal thoughts, and newer studies which aim to proactively intervene when individuals at risk of suicide are identified by their social media postings. We conclude that online screening may have a role, although there is a need for additional robust controlled research to establish whether suicide screening can effectively reduce suicide-related outcomes, and in what settings online screening might be most effective. The effectiveness of Internet interventions may be increased if these interventions are designed to specifically target suicidal thoughts, rather than associated conditions such as depression. The evidence for the use of intervention practices using social media is possible, although validity, feasibility and implementation remains highly uncertain.
Pacione, Laura; Measham, Toby; Rousseau, Cécile
The mental health consequences of war and other forms of organized violence for children represent a serious global public health issue. Much of the research on the mental health of war-affected civilians has focused on refugees who have sought asylum in high-income countries and face the dual stress of a traumatic past and resettlement. This review will focus on the mental health of refugee children who have fled war as well as interventions to both prevent and treat adverse mental health outcomes. While war can have devastating mental health consequences, children raised in the midst of armed conflict also display resilience. Effective interventions for refugee children will be discussed both in terms of prevention and treatment of psychopathology, with a focus on recent developments in the field.
Heron, Kristin E.; Smyth, Joshua M.
Purpose Psychosocial and health behavior treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These Ecological Momentary Interventions [EMI] are treatments that are provided to people during their everyday lives (i.e., in real time) and in natural settings (i.e., real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviors and psychological and physical symptoms. Methods Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. Results There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviors and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. Conclusions Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviors and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive. PMID:19646331
Indig, Devon; Lee, Karen; Grunseit, Anne; Milat, Andrew; Bauman, Adrian
To achieve population-wide health improvement, public health interventions found effective in selected samples need to be 'scaled up' and implemented more widely. The pathways through which interventions are scaled up are not well characterised. The aim of this paper is to identify examples of public health interventions which have been scaled up and to develop a conceptual framework which quantifies and describes this process. A multi-stage international literature search was undertaken to identify examples of public health interventions in high income countries that have been scaled up or implemented at scale. Initial abstract review identified articles which met all the criteria of being a: 1) public health intervention; 2) chronic disease prevention focus; 3) program delivered at a wide geographical scale (state, national or international). Interventions were reviewed and coded into a conceptual framework pathway to document their scaling up process. For each program, an in-depth review of the identified articles was undertaken along with a broad internet based search to determine the outcomes of the dissemination process. A conceptual framework of scaling up pathways was developed that involved four stages (development, efficacy testing, real world trial and dissemination) to which the 40 programs were mapped. The search identified 40 public health interventions that showed evidence of being scaled up. Four pathways were identified to capture the different scaling up trajectories taken which included: 'Type I - Comprehensive' (55%) which passed through all four stages, 'Type II - Efficacy omitters' (5%) which did not conduct efficacy testing, 'Type III - Trial omitters' (25%) which did not conduct a real world trial, and 'Type IV - At scale dissemination' (15%) which skipped both efficacy testing and a real world trial. This is the first study to classify and quantify the potential pathways through which public health interventions in high income countries are
Wertlieb, D; Budman, S; Demby, A; Randall, M
Marital separation is a stressful life event implicated in much current thinking and practice in mental health, health psychology and psychosomatic medicine. This study examines marital separation in a controlled, prospective design. The participants were 314 Health Maintenance Organization (HMO) subscribers followed over a two year period. Marital separation was experienced by 127 of these participants early in the two-year study period. A stratified random half of these separated individuals participated in a short-term psychoeducational group intervention, "Seminars for the Separated." Measures of psychosocial adjustment and medical utilization were analyzed to describe correlates of marital separation and to evaluate the intervention. Statistically significant increases in medical utilization by people experiencing marital separation were observed in comparisons with married control subjects. Much of this increased utilization occurred in the year surrounding the actual separation and may be accounted for by mental health visits as well as nonmental health contacts with the health plan. The effects of the intervention were not evident until controls for baseline levels of medical utilization were introduced into the multivariate analysis. Even then, intervention effects were slight. Methodological problems and implications for further study are presented.
Full Text Available Abstract Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54 to analyze and evaluate the data. Results The findings are as follows: (1 Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2 After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3 Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service on service quality was greater than electronic facilities (electronic medical record systems in technology-based service encounters. Convenience and
Chang, Hsin Hsin; Chang, Ching Sheng
Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality
LeGrand, Sara; Muessig, Kathryn E; Pike, Emily C; Baltierra, Nina; Hightow-Weidman, Lisa B
The rate of HIV infections among young black men who have sex with men (YBMSM) continues to rise at an alarming pace. YBMSM are particularly vulnerable to social isolation and a lack of social support due to experiences with racism and homophobia, which may have implications for sexual risk behaviors. The purpose of this study was to explore perceptions of social isolation and sense of community among YBMSM, the need for and receptivity to social networking features designed to reduce social isolation and build community within an Internet- and mobile phone-based primary and secondary HIV prevention intervention for YBMSM and to identify strategies to develop these features. Focus groups were conducted with 22 YBMSM aged 20-30 years at three sites in North Carolina. Data from the focus groups were thematically analyzed using NVivo. Feelings of social isolation and lack of a sense of community were strongly endorsed by participants with homophobia, lack of opportunities for social engagement, and a focus on sex rather than friendship in interpersonal relationships with other YBMSM cited as contributing factors. Participants were receptive to a social networking intervention designed to reduce social isolation and build community. Recommendations offered by participants to increase acceptability and usability of such features included: availability of information about healthy relationships, the ability to connect with other YBMSM and health care providers, and ensuring the site had ongoing facilitation by the study team as well as monitoring for inappropriate content. The development of a social networking feature of an HIV prevention intervention may present an opportunity to reduce social isolation, build community, and reduce risky sexual behaviors among YBMSM. The findings from this study are being used to inform the development of a social networking feature for an existing Internet- and mobile phone-based primary and secondary HIV prevention intervention for
Lefebvre, R C; Flora, J A
The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.
Ipsen, Christine; Jenny, Gregor
This symposium is one of three symposia submitted by the "International organizational health intervention research partnership". The aim of this symposium is to present new empirical developments based on participatory intervention models. All five studies have developed and applied intervention...
Pots, Wendy Theresia Maria
Interventions that are easily available, attractive and feasible help to broaden the effect public mental health interventions can have on depression. In this thesis, a specific subset of Mindfulness-based Interventions (MBIs) as public mental health interventions for people with mild to moderate de
Pots, Wendy Theresia Maria
Interventions that are easily available, attractive and feasible help to broaden the effect public mental health interventions can have on depression. In this thesis, a specific subset of Mindfulness-based Interventions (MBIs) as public mental health interventions for people with mild to moderate de
Full Text Available In this paper, a data compression technology-based intelligent data acquisition (IDAQ system was developed for structural health monitoring of civil structures, and its validity was tested using random signals (El-Centro seismic waveform. The IDAQ system was structured to include a high-performance CPU with large dynamic memory for multi-input and output in a radio frequency (RF manner. In addition, the embedded software technology (EST has been applied to it to implement diverse logics needed in the process of acquiring, processing and transmitting data. In order to utilize IDAQ system for the structural health monitoring of civil structures, this study developed an artificial filter bank by which structural dynamic responses (acceleration were efficiently acquired, and also optimized it on the random El-Centro seismic waveform. All techniques developed in this study have been embedded to our system. The data compression technology-based IDAQ system was proven valid in acquiring valid signals in a compressed size.
Bull, Sheana S.; Levine, Deborah; Black, Sandra R.; Schmiege, Sarah; Santelli, John
Background Youth are using social media regularly and represent a group facing substantial risk for sexually transmitted infection (STI). Although there is evidence that the Internet can be used effectively in supporting healthy sexual behavior, this hasn't yet extended to social networking sites. Purpose To determine whether STI prevention messages delivered via Facebook are efficacious in preventing increases in sexual risk behavior at 2 and 6 months. Design Cluster RCT, October 2010–May 2011. Setting/participants Individuals (seeds) recruited in multiple settings (online, via newspaper ads and face-to-face) were asked to recruit three friends, who in turn recruited additional friends, extending three waves from the seed. Seeds and waves of friends were considered networks and exposed to either the intervention or control condition. Intervention Exposure to Just/Us, a Facebook page developed with youth input, or to control content on 18–24 News, a Facebook page with current events for 2 months. Main outcome measures Condom use at last sex and proportion of sex acts protected by condoms. Repeated measures of nested data were used to model main effects of exposure to Just/Us and time by treatment interaction. Results 1578 participants enrolled, with 14% Latino and 35% African-American; 75% of participants completed at least one study follow-up. Time by treatment effects were observed at 2 months for condom use (intervention 68% vs control 56%, p=0.04) and proportion of sex acts protected by condoms (intervention 63% vs control 57%, p=0.03) where intervention participation reduced the tendency for condom use to decrease over time. No effects were seen at 6 months. Conclusions Social networking sites may be venues for efficacious health education interventions. More work is needed to understand what elements of social media are compelling, how network membership influences effects, and whether linking social media to clinical and social services can be beneficial
Shegog, Ross; Craig Rushing, Stephanie; Gorman, Gwenda; Jessen, Cornelia; Torres, Jennifer; Lane, Travis L; Gaston, Amanda; Revels, Taija Koogei; Williamson, Jennifer; Peskin, Melissa F; D'Cruz, Jina; Tortolero, Susan; Markham, Christine M
Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86 % agreement across lessons) and in comparison to other learning channels (57-100 %) and rated the lessons as helpful in making better health choices (73-100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.
Fournier, Cynthia; Drouin, Mélodie-Anne; Marcoux, Jérémie; Garel, Patricia; Bochud, Emmanuel; Théberge, Julie; Aubertin, Patrice; Favreau, Gil; Fleet, Richard
Abstract Objective To present Cirque du Soleil’s social circus program, Cirque du Monde, to explore its potential as a primary health care tool for family physicians. Data sources A review of the literature in PubMed, the Cochrane Library, PsycINFO, LaPresse, Eureka, Google Scholar, and Érudit using the key words circus, social circus, Cirque du Monde, and Cirque du Soleil; a Montreal-based initiative, Espace Transition, modeled on Cirque du Monde; and personal communication with Cirque du Soleil’s Social Circus Training Advisor. Study selection The first 50 articles or websites identified for each key word in each of the databases were examined on the basis of their titles and abstracts in the case of articles, and on the basis of their titles and page content in the case of websites. Articles and websites that explored an aspect of social circuses or that described an intervention that involved circuses were then retained for analysis. Because all literature on social circuses was searched, no criterion for year of publication was used. Synthesis No articles on the social circus as a health intervention were found. One study on the use of the circus as an intervention in schools was identified. It demonstrated an increase in self-esteem in the children who took part. One study on the use of the circus in a First Nations community was found; it contained nonspecific, qualitative findings. The other articles identified were merely descriptions of social circuses. One website was identified on the use of the social circus to help youth who had been treated in a hospital setting for major psychiatric disorders to re-enter the community. The team in the pediatric psychiatry department at Centre Hospitalier Universitaire Sainte-Justine, the children’s hospital in Montreal, Que, was contacted; they were leading this project, called Espace Transition. The unpublished preliminary findings of its pilot project demonstrate substantial improvements in overall patient
Ramsey, Alex; Lord, Sarah; Torrey, John; Marsch, Lisa; Lardiere, Michael
This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost and privacy), potential end users (e.g., technology literacy and attitudes about technology), organization structure and climate (e.g., budget and infrastructure), and factors external to organizations (e.g., broadband accessibility and reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools.
Lee, Nam-Ju; Bakken, Suzanne; Saba, Virginia
It is imperative that public health nurses define their services and provide evidence supporting the effectiveness of interventions. The purpose of this paper is to examine the ex-tent to which two standardized nursing terminologies--Home Health Care Classification (HHCC) and Nursing Interventions Classification (NIC)--represent public health nursing practice according to core public health function in Public Health Nursing Intervention model. First, we divided all HHCC and NIC interventions into intervention focus levels: individual/family-focused, community-focused, and system-focused. Second, we categorized HHCC and NIC interventions according to core public health functions: assessment, policy development, and assurance and the categories of interventions in the PHI Model. We identified HHCC and NIC Nursing interventions that represented public health nursing concepts across core public health functions and categories of the PHI model. Analysis of the findings demonstrated that HHCC and NIC have terms for the concepts in the PHI model. Although HHCC and NIC cover many concepts in public health nursing practice, additional research is needed to extend these terminologies and to evaluate other standardized terminologies that can reflect more comprehensively public health nursing interventions.
Kant Hiran, Kamal; Doshi, Ruchi; Henten, Anders
Abstract - Education plays a very important role for the development of the country. Education has multiple dimensions from schooling to higher education and research. In all these domains, there is invariably a need for technology based teaching and learning tools are highly demanded in the acad...
Lau, Patrick W C; Lau, Erica Y; Wong, Del P; Ransdell, Lynda
A growing body of research has employed information and communication technologies (ICTs) such as the Internet and mobile phones for disseminating physical activity (PA) interventions with young populations. Although several systematic reviews have documented the effects of ICT-based interventions on PA behavior, very few have focused on children and adolescents specifically. The present review aimed to systematically evaluate the efficacy and methodological quality of ICT-based PA interventions for children and adolescents based on evidence from randomized controlled trials. Electronic databases Medline, PsycInfo, CINAHL, and Web of Science were searched to retrieve English language articles published in international academic peer-reviewed journals from January 1, 1997, through December 31, 2009. Included were articles that provided descriptions of interventions designed to improve PA-related cognitive, psychosocial, and behavioral outcomes and that used randomized controlled trial design, included only children (6-12 years old) and adolescents (13-18 years old) in both intervention and control groups, and employed Internet, email, and/or short message services (SMS, also known as text messaging) as one or more major or assistive modes to deliver the intervention. In total, 9 studies were analyzed in the present review. All studies were published after 2000 and conducted in Western countries. Of the 9 studies, 7 demonstrated positive and significant within-group differences in at least one psychosocial or behavioral PA outcome. In all, 3 studies reported positive and significant between-group differences favoring the ICT group. When between-group differences were compared across studies, effect sizes were small in 6 studies and large in 3 studies. With respect to methodological quality, 7 of the 9 studies had good methodological quality. Failure to report allocation concealment, blinding to outcome assessment, and lack of long-term follow-up were the criteria met
LaMontagne, Anthony D; Martin, Angela; Page, Kathryn M; Reavley, Nicola J; Noblet, Andrew J; Milner, Allison J; Keegel, Tessa; Smith, Peter M
Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions...
Sieben, Angelien; Bredie, S J H Bas; van Laarhoven, C J H M Kees; Schoonhoven, Lisette; Burger, David M; van Onzenoort, Hein A W
Poor adherence to medication is one of the most important determinants in the treatment of patients with chronic disorders. e-Health-based interventions may be able to improve treatment adherence. This article gives an overview of the available e-Health interventions and the extent to which they can improve adherence. We searched in the PubMed, Cinahl, PsycInfo, and Embase databases for e-Health interventions that aimed at improving adherence to treatment. Of the 16 included studies, 15 used a website and one used an app. Ten studies showed a significant improvement in treatment adherence by using the intervention. e-Health interventions were generally complex. Simple interventions were the most successful in improving treatment adherence.
Eisenstein, Eric L.; Lobach, David F.; Montgomery, Paul; Kawamoto, Kensaku; Anstrom, Kevin J.
Health information technology evaluators need to distinguish between intervention efficacy as assessed in the ideal circumstances of clinical trials and intervention effectiveness as assessed in the real world circumstances of actual practice. Because current evaluation study designs do not routinely allow for this distinction, we have developed a framework for evaluation of implementation fidelity that considers health information technologies as complex interventions and makes use of common intervention components as defined in the Oxford Implementation Index. We also propose statistical methods for the evaluation of interventions at the system and component level using the Rubin Causal Model. We then describe how to apply this framework to evaluate an ongoing clinical trial of three health information technology interventions currently implemented in a 17,000 patient community-based health network caring for Medicaid beneficiaries in Durham County, North Carolina. PMID:18693828
We conducted a scoping review of evidence on digital interventions for sexual health promotion for young people aged 13 to 24 years in the UK, defining sexual health in holistic terms, to include physical, emotional, mental and social well-being in relation to sexuality. Interactive digital interventions (IDI are defined as digital media programmes that provide sexual health information and tailored decision support, behaviour-change support, and/or emotional support for sexual health issues. We conducted a thorough review of literature to locate and synthesise available evidence on digital interventions for sexual health spanning the last ten years, integrating the findings with the views of key informants (young people, parents, and experts in digital media/sexual health. Results and conclusions There were few studies that assess the factors related to successful implementation of sexual health promotion IDIs. Potential barriers and facilitators to implementation of IDI should be addressed at the very beginning of an intervention development process. Engaging with sexual health promotion interventions online allows private and convenient access as well as potentially reaching populations who engage less frequently with mainstream services. However, it is difficult to ensure that users will find the intervention, or engage for long enough for them to be effective. The reach of online IDI could be enhanced by linking sexual health promotion interventions with existing digital systems such as STI self-test websites, or with trusted branded websites or popular social networking sites. Offering interventions in static settings such as the clinic or classroom encourages engagement and enables interventions to be delivered with fidelity but potentially at the expense of the privacy and convenience offered by online interventions. Using the knowledge of local staff is vital for both successful intervention development and successful implementation. An effective
Vaughn W Barry
Full Text Available Vaughn W Barry1, Amanda C McClain1, Sara Shuger1, Xuemei Sui1, James W Hardin2, Gregory A Hand1, Sara Wilcox1, Steven N Blair1,21Department of Exercise Science; 2Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USAPurpose: The SenseWear™ Armband is an activity monitor developed to improve lifestyle self-monitoring. Currently, few studies assess electronic self-monitoring and weight loss with a lifestyle intervention program. To our knowledge, only one study has used the SenseWear Armband in combination with a lifestyle intervention to improve weight loss, and no studies have evaluated whether a self-monitoring intervention based solely on the armband can promote weight loss. Consequently, the aims of the study were to assess weight loss from electronic self-monitoring, to compare these values to the lifestyle intervention and standard care groups, and to compare weight loss with lifestyle intervention with and without the armband.Patients and methods: We recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 years; BMI, 33.3 ± 5.2 kg/m2 to participate in the 9-month study. Participants were randomized into one of four weight loss groups: 1 the standard care group received a self-directed weight loss program, complete with an evidence-based weight loss manual (standard care, n = 50; 2 a 14-week group-based behavioral weight loss program followed by weekly, biweekly, and monthly telephone counseling calls (GWL, n = 49; 3 the use of the armband to help improve lifestyle self-monitoring (SWA alone, n = 49; or (4 the group-based behavioral weight loss program and follow-up telephone counseling calls plus the armband (GWL + SWA, n = 49. All participants received the evidence-based weight loss manual at baseline. All measures were performed at baseline and months 4 and 9. The primary outcomes were weight loss and waist circumference reduction.Results: This study is a well-designed randomized
Martinsson, Camilla; Lohela-Karlsson, Malin; Kwak, Lydia; Bergström, Gunnar; Hellman, Therese
To achieve a sustainable working life it is important to know more about what could encourage employers to increase the use of preventive and health promotive interventions. The objective of the study is to explore and describe the employer perspective regarding what incentives influence their use of preventive and health promotive workplace interventions. Semi-structured focus group interviews were carried out with 20 representatives from 19 employers across Sweden. The economic sectors represented were municipalities, government agencies, defence, educational, research, and development institutions, health care, manufacturing, agriculture and commercial services. The interviews were transcribed verbatim and the data were analysed using latent content analysis. Various incentives were identified in the analysis, namely: "law and provisions", "consequences for the workplace", "knowledge of worker health and workplace health interventions", "characteristics of the intervention", "communication and collaboration with the provider". The incentives seemed to influence the decision-making in parallel with each other and were not only related to positive incentives for engaging in workplace health interventions, but also to disincentives. This study suggests that the decision to engage in workplace health interventions was influenced by several incentives. There are those incentives that lead to a desire to engage in a workplace health intervention, others pertain to aspects more related to the intervention use, such as the characteristics of the employer, the provider and the intervention. It is important to take all incentives into consideration when trying to understand the decision-making process for workplace health interventions and to bridge the gap between what is produced through research and what is used in practice.
Edward Ivor Broughton
Full Text Available There is little evidence to direct health systems toward providing efficient interventions to address medical errors, defined as an unintended act of omission or commission or one not executed as intended that may or may not cause harm to the patient but does not achieve its intended outcome. We believe that lack of guidance on what is the most efficient way to reduce adverse events and improve the quality of health care limits the scale-up of health system improvement interventions. Challenges to economic evaluation of these interventions include defining and implementing improvement interventions in different settings with high fidelity, capturing all of the positive and negative effects of the intervention, using process measures of effectiveness rather than health outcomes, and determining the full cost of the intervention and all economic consequences its effects. However, health system improvement interventions should be treated similarly to individual medical interventions and undergo rigorous economic evaluation to provide actionable evidence to guide policy-makers in decisions of resources allocation for improvement activities among other competing demands for health care resources.
Broughton, Edward Ivor; Marquez, Lani
There is little evidence to direct health systems toward providing efficient interventions to address medical errors, defined as an unintended act of omission or commission or one not executed as intended that may or may not cause harm to the patient but does not achieve its intended outcome. We believe that lack of guidance on what is the most efficient way to reduce medical errors and improve the quality of health-care limits the scale-up of health system improvement interventions. Challenges to economic evaluation of these interventions include defining and implementing improvement interventions in different settings with high fidelity, capturing all of the positive and negative effects of the intervention, using process measures of effectiveness rather than health outcomes, and determining the full cost of the intervention and all economic consequences of its effects. However, health system improvement interventions should be treated similarly to individual medical interventions and undergo rigorous economic evaluation to provide actionable evidence to guide policy-makers in decisions of resource allocation for improvement activities among other competing demands for health-care resources.
Nielsen, Karina; Randall, Raymond; Holten, Ann-Louise
In recent years, there has been an increasing interest in how organizational-level occupational health interventions aimed at improving psychosocial working conditions and employee health and well-being may be planned, implemented and evaluated. It has been claimed that such interventions have...... the alteration of the way in which work is designed, organized and managed. The methods identified are the Risk Management approach and the Management Standards from Great Britain, the German Health Circles approach, Work Positive from Ireland and Prevenlab from Spain. Comparative analyses reveal...... their appropriateness in conducting organizationallevel occupational health interventions. Finally, we discuss where we still need more research to determine the working ingredients of organizational-level occupational health interventions....
Kegler, Michelle Crozier; Miner, Kathleen
Interventions to address current, future, and potential public health dilemmas, such as air pollution, urban sprawl, brown field reclamation, and threats of intentional toxic exposures would benefit from a synergy between the disciplines of environmental health and health education. A comparison between the Protocol for Assessing Community Excellence in Environmental Health and the PRECEDE-PROCEED model used in health education illustrates some similarities and differences in terminology, assessment procedures, intervention design, and types of evidence used by the two disciplines. Promising intervention strategies draw on the expertise of both fields and include social action, policy and media advocacy, coalition building, organizational change, lay health advisers, risk communication, and tailored educational messages. Appropriate targets of change can range from the equitable distribution of resources to individual behavior change. Significant interdisciplinary evaluation research is necessary to accelerate the identification of successful models for reducing the burden of environmental health problems in communities.
Krishnaswamy, Saroja; Subramaniam, Kavitha; Indran, Tishya; Low, Wah-Yun
Disasters, natural or man-made, bring numerous health care challenges. In any crisis, mental health programs are a requirement during both the acute and postemergency phases. In the Asian tsunami on December 26, 2004, some of the northwestern coastal areas of Malaysia, particularly the island of Penang, were affected with devastating effects on the residents. Such disasters can predispose to mental health problems among the affected people. An early mental health intervention program was carried out in Balik Pulau, Penang, an area badly affected by the tsunami. The objective of the intervention program was to identify the victims, counsel them, make referrals if necessary, and provide help and resources to prevent the development of mental health problems. Penang residents identified as tsunami victims by the local health authorities were recruited. A group of health care workers, school teachers, village authorities, and volunteers were trained to carry out the crisis intervention program by health care workers experienced in crisis interventions. A total of 299 adults participated in the crisis intervention program, with follow-up assessments being made 4 to 6 weeks later. At the follow-up assessment, 1% of the victims had a problem and they were then referred for further medical assessment. This indicates that the intervention program in the first 2 weeks after the tsunami disaster with referrals to medical services may have helped stabilize the victims.
Murray, Elizabeth; Hekler, Eric B; Andersson, Gerhard; Collins, Linda M; Doherty, Aiden; Hollis, Chris; Rivera, Daniel E; West, Robert; Wyatt, Jeremy C
Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluations of digital health interventions present special challenges. This paper aims to examine these challenges and outline an evaluation strategy in terms of the research questions needed to appraise such interventions. As they are at the intersection of biomedical, behavioral, computing, and engineering research, methods drawn from all of these disciplines are required. Relevant research questions include defining the problem and the likely benefit of the digital health intervention, which in turn requires establishing the likely reach and uptake of the intervention, the causal model describing how the intervention will achieve its intended benefit, key components, and how they interact with one another, and estimating overall benefit in terms of effectiveness, cost effectiveness, and harms. Although RCTs are important for evaluation of effectiveness and cost effectiveness, they are best undertaken only when: (1) the intervention and its delivery package are stable; (2) these can be implemented with high fidelity; and (3) there is a reasonable likelihood that the overall benefits will be clinically meaningful (improved outcomes or equivalent outcomes at lower cost). Broadening the portfolio of research questions and evaluation methods will help with developing the necessary knowledge base to inform decisions on policy, practice, and research. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Kegler, Michelle Crozier; Miner, Kathleen
Interventions to address current, future, and potential public health dilemmas, such as air pollution, urban sprawl, brown field reclamation, and threats of intentional toxic exposures would benefit from a synergy between the disciplines of environmental health and health education. A comparison between the Protocol for Assessing Community…
Berkman, Nancy D; Sheridan, Stacey L; Donahue, Katrina E; Halpern, David J; Viera, Anthony; Crotty, Karen; Holland, Audrey; Brasure, Michelle; Lohr, Kathleen N; Harden, Elizabeth; Tant, Elizabeth; Wallace, Ina; Viswanathan, Meera
To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and
There are recognised shortages in most health professions in Australia. This is evidence that previous attempts at health workforce planning have failed. This paper argues that one reason for such failure is the lack of appropriate structures for health workforce planning. It also suggests that Australia needs to move beyond planning for particular professions and that health workforce planning needs to be based on identifying skill shortages as much as shortages in particular named professio...
LaMontagne, Anthony D; Martin, Angela; Page, Kathryn M; Reavley, Nicola J; Noblet, Andrew J; Milner, Allison J; Keegel, Tessa; Smith, Peter M
Mental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations. To realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work-related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy. An integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace.
Diehr, Paula; Hannon, Peggy; Pizacani, Barbara; Forehand, Mark; Meischke, Hendrika; Curry, Susan; Martin, Diane P.; Weaver, Marcia R.; Harris, Jeffrey
As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and…
Diehr, Paula; Hannon, Peggy; Pizacani, Barbara; Forehand, Mark; Meischke, Hendrika; Curry, Susan; Martin, Diane P.; Weaver, Marcia R.; Harris, Jeffrey
As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and…
Griffiths, P E; West, C
The widely cited Nuffield Council on Bioethics 'Intervention Ladder' structurally embodies the assumption that personal autonomy is maximized by non-intervention. Consequently, the Intervention Ladder encourages an extreme 'negative liberty' view of autonomy. Yet there are several alternative accounts of autonomy that are both arguably superior as accounts of autonomy and better suited to the issues facing public health ethics. We propose to replace the one-sided ladder, which has any intervention coming at a cost to autonomy, with a two-sided 'Balanced Intervention Ladder,' where intervention can either enhance or diminish autonomy. We show that not only the alternative, richer accounts of autonomy but even Mill's classic version of negative liberty puts some interventions on the positive side of the ladder. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
Sykes, Catherine R
This commentary provides some reactions to the rehabilitation treatment taxonomy project in relation to work already underway to develop an International Classification of Health Interventions. This commentary also includes some comments in response to questions posed by the authors.
Many mental health disorders emerge in late childhood and early adolescence and contribute to the burden of these disorders among young people and later in life. We systematically reviewed literature published up to December 2015 to identify systematic reviews on mental health interventions in adolescent population. A total of 38 systematic reviews were included. We classified the included reviews into the following categories for reporting the findings: school-based interventions (n = 12); c...
Bushong, C; Coverdale, J; Battaglia, J
Over the past 30 years, adolescents represent the only age group in the United States whose health status has not improved significantly. In this population, major health problems that are becoming increasingly important in regard to preventive intervention include substance abuse, depression, teenage pregnancy, and AIDS. Research in adolescent mental health during the past decade has focused on both the etiology and the prevention of problem behaviors. We review the development and application of various preventive intervention approaches in the field of adolescent mental health and discuss implications for future directions.
Gordon, Michael S; Carswell, Steven B; Schadegg, Mary; Mangen, Kayla; Merkel, Kelly; Tangires, Susan; Vocci, Frank J
Avatar-assisted therapy (AAT) is a novel and emerging technology that uses the Internet to enable clinicians and clients in substance abuse treatment to participate in group counseling sessions from separate and remote locations in real time through the use of avatars and virtual environments. The current study is a pilot proof-of-concept feasibility study involving individuals in outpatient substance abuse treatment. This report addresses two questions: (1) are individuals who present for substance abuse treatment interested in receiving AAT and (2) what factors are associated with better treatment success. Individuals who presented at the treatment clinic who met study eligibility criteria, and provided their written informed consent to participate, were included in the current study (N = 59; 78% male). Twenty-eight (47.5%) participants completed 16 weeks of treatment and attended more sessions compared to non-completers (M = 14.3 vs. 7.5 p < .05). Those individuals who completed treatment were less likely to have a positive urine drug screen at baseline (21.5 vs. 78.6%; p < .05). Furthermore, those individuals who successfully completed treatment were less likely to have positive urine drug screens during treatment compared to those who did not complete (29.7% vs. 70.3%, p < .05). There were no arrests during treatment for completers and non-completers. Poor retention in substance use disorder treatment has long been a major problem for public health. AAT is a feasible approach that has the potential to expand treatment to individuals who might have difficulty accessing treatment. Moreover, AAT may be appealing to clients who are concerned about anonymity and confidentiality.
Lassi, Zohra S; Salam, Rehana A; Das, Jai K; Wazny, Kerri; Bhutta, Zulfiqar A
The Millennium Development Goal era has resulted in improvements in maternal and child health worldwide. As more children are surviving past their fifth birthday, the population of adolescents is increasing. Adolescence is a time of significant developmental transition; adolescence sets the stage for adult health through risks taken and beneficial and detrimental habits that are formed and it is thus an optimal time to target health interventions. Beginning interventions in adolescence or even earlier in childhood maximizes the impact on the individual's health in adult life. Evidence suggests that interventions to promote sexual and reproductive health, physical activity and healthy lifestyle, mental health and wellbeing, safe and hazard-free environment, improving access to nutritious and healthy foods, and minimizing exposure to substance abuse can improve health outcomes in young adolescents. School-based delivery strategies appear to be the most highly evaluated for improving adolescent health; they have been used to deliver interventions such as sexual health, substance abuse prevention, and nutritional interventions. Use of social media and information technologies, cash transfers, social protection, and micro-finance initiatives are promising strategies; however, given the lack of rigorous evaluations, there is a need for further research. Additional research is also warranted to strengthen the evidence base by establishing causality, understanding the differential impacts of adolescent health in different contexts particularly in low- and middle-income countries. In addition, research and evaluation in the domain of adolescent health must focus on how to implement interventions effectively at-scale, sustain the impacts over time and ensure equitable outcomes.
McNamee, Paul; Murray, Elizabeth; Kelly, Michael P; Bojke, Laura; Chilcott, Jim; Fischer, Alastair; West, Robert; Yardley, Lucy
This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.
Dawkins-Moultin, Lenna; McDonald, Andrea; McKyer, Lisako
While health literacy research has experienced tremendous growth in the last two decades, the field still struggles to devise interventions that lead to lasting change. Most health literacy interventions are at the individual level and focus on resolving clinician-patient communication difficulties. As a result, the interventions use a deficit model that treats health literacy as a patient problem that needs to be fixed or circumvented. We propose that public health health literacy interventions integrate the principles of socioecology and critical pedagogy to develop interventions that build capacity and empower individuals and communities. Socioecology operates on the premise that health outcome is hinged on the interplay between individuals and their environment. Critical pedagogy assumes education is inherently political, and the ultimate goal of education is social change. Integrating these two approaches will provide a useful frame in which to develop interventions that move beyond the individual level.
Golner, J H
This paper attempts to draw analogies between the Sabbath and certain mental health interventions. These interventions are derived from a family centered education program developed by the author for teachers and student and related to social group work. Five interventions characterizing this program were extracted and compared with Abraham Joshua Heschel's philosophy of the Sabbath: simulation, here-and-now emphasis, private reflection, emphasis on process, and positive feedback. The author concludes that both the Sabbath and family centered education oriented interventions should reinforce a deeper understanding and appreciation of one another.
Cherrington, Andrea L.; Agne, April A; Lampkin, Yolanda; Birl, Annie; Shelton, Tanya C.; Guzman,Alfredo; Willig, James H.
Community Health Worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the healthcare team and enhance care. We tested a model for the integration of a CHW delivered mHealth intervention to improve diabetes self-management. Seventy-two African American patients with diabetes were followed using t...
Ridde, V; Haddad, S
Forty years ago, Schwartz and Lellouch invented pragmatic clinical trials. Their proposal has not yet been fully espoused. This appears to be the case today also in the domain of public health interventions evaluation, where some still insist on the superiority of experimental methods. Yet evaluations of complex public health interventions are fraught with pitfalls for researchers. Most such interventions take place in natural experimental contexts, where they have no control over the context or the factors that modify implementation and influence the effects. Experimental approaches are, in these cases, not very appropriate, and yet decision makers want to be able to take decisions to improve them. This article presents our experience over the past 5years with evaluative research in two public health interventions. We wish to show how we conduct evaluations in practice using a pragmatic approach. The article is focused on elements that have not, to date, received much attention in the francophone literature: the evaluability assesment and intervention logic, research strategies reinforced particularly by mixed methods and time series, and the analysis of implementation fidelity and mechanisms that foster effectiveness. Because the pragmatic approach to evaluative research stresses the need for good understanding of context and uses reinforced methodological strategies, it allows for rigorous responses to evaluation questions raised by those implementing complex public health interventions. Thus, experimental approaches are not necessarily required to analyze the effectiveness of interventions.
Hublet, Anne; Maes, Lea; Mommen, Jasmine; Deforche, Benedicte; De Bourdeaudhuij, Ilse
Disadvantaged groups are often not reached by mainstream health promotion interventions. Implementing health promotion (HP) interventions in social economy companies, can be an opportunity to reach those people. The implementation of these interventions in social economy companies was studied. Factors that could be related to the implementation of HP and being supportive towards implementation in the future, were investigated. An online, quantitative survey was sent to all 148 sheltered and social workshops in Flanders. In the questionnaire, the status of HP interventions and characteristics of the workshop were explored. Personal factors (such as attitudes towards HP, behavioural control, social norms and moral responsibility) were asked to the person responsible for implementation of HP interventions. Univariate and multivariate logistic regressions were performed. Respondents of 88 workshops completed the questionnaire. Almost 60% of the workshops implemented environmental or policy interventions. Having a positive attitude towards HP, being more morally responsible, and having the subjective norm that employees are positive towards health promotion at work, were related to being more supportive towards the implementation of HP in the univariate analyses. Only attitude stayed significantly related to being more supportive towards the implementation of HP in the multivariate analyses. Sheltered and social workshops are open to HP interventions, but more can be done to optimize the implementation. To persuade persons responsible for the implementation of HP to invest more in HP, changing attitudes concerning the benefits of health promotion for the employee and the company, is an important strategy.
According to US government statistics, health care expenditures approached $2 trillion in 2005 or $6,697/person, with spending expected to exceed $4.1 trillion by 2016 (http://www.cms.hhs.gov/NationalHealthExpendData/). Total Centers for Medicare and Medicaid Services spending (including Medicaid, State Children's Health Insurance Program (SCHIP), and Medicare) was $660.7 million in 2005. Despite the decline in the growth rate of health care spending growth over the past 4 years, health care spending increased 6.9% from 2004 to 2005 and was 16% of the gross domestic product (GDP) in 2005 and forecasted to be 19.6% of the GDP by 2016. Although the percentage of GDP may not concern providers of health care products or services, it has an affect on the rest of the economy. Spending on health care by employers or patients increases the cost of the products produced, making goods produced here in the United States less attractive to world markets in the age of globalization in addition to leaving less money for patients to spend on other goods and services or save.
Camic, Paul M; Chatterjee, Helen J
The majority of public health programmes are based in schools, places of employment and in community settings. Likewise, nearly all health-care interventions occur in clinics and hospitals. An underdeveloped area for public health-related planning that carries international implications is the cultural heritage sector, and specifically museums and art galleries. This paper presents a rationale for the use of museums and art galleries as sites for public health interventions and health promotion programmes through discussing the social role of these organisations in the health and well-being of the communities they serve. Recent research from several countries is reviewed and integrated into a proposed framework for future collaboration between cultural heritage, health-care and university sectors to further advance research, policy development and evidence-based practice.
Zhang, Jing; Luo, Rong; Chen, Shi; Petrovic, Djordje; Redfern, Julie; Xu, Dong Roman; Patel, Anushka
Background With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth
Full Text Available Monitoring universal health coverage (UHC focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the
Boerma, Ties; AbouZahr, Carla; Evans, David; Evans, Tim
Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups-promotion/prevention, and treatment/care-as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of
Rock, Melanie J.; McIntyre, Lynn; Persaud, Steven A.; Thomas, Karen L.
Media advocacy is a well-established strategy for transmitting health messages to the public. This paper discusses a media advocacy intervention that raised issues about how the public interprets messages about the negative effects of poverty on population health. In conjunction with the publication of a manuscript illustrating how income-related…
Costa Rica, whose life expectancy was 74 years by 1985, has reached a health level comparable to a developed country. The health achievements of this country are product of political and socioeconomic circumstances as well as of right public health policies. Until about 1970 the features of Costa Rica mortality, although somewhat better than the Latin American average, evolved in a similar way to the rest of the region. In particular, the decades of 1940s and 1950s saw dramatic improvements in life expectancy, thanks mainly to the import of low-cost, high-effectiveness health technologies. In the 1970s, however, Costa Rica departed from a regional pattern of stagnation and managed to close the gap with developed countries in terms of mortality levels. A dramatic decline in the infant mortality rate from 60 to 19 per 1,000 took place in this decade. The main determinants of this breakthrough were health interventions, notably a primary health care program, even though favorable socioeconomic conditions and a reduced fertility also played a role. Ecological data and other evidence suggest that up to three fourths of the mortality decline was accounted for contemporary improvements in public health services, with about 40 percent attributable to primary health care interventions. Furthermore, by targeting interventions on the less privileged population, these interventions had the merit of reducing geographic and socioeconomic differentials in child mortality.
Full Text Available Susan M Carr,1–3 Monique Lhussier,1,3 Natalie Forster1,3 1Public Health Research, Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK; 2Department of Education and Training, Federation University Australia, Ballarat, VIC, Australia; 3Fuse, Centre for Translational Research in Public Health, Newcastle upon Tyne, UK Abstract: The use of lay health advisers has become an established approach within public health, in particular for impact on health inequalities and engaging socially excluded groups. Evidence on how differences in terms of the multiple role dimensions impact the outcomes of programs is limited. This creates ambiguity for decision makers on which roles should be implemented in different contexts for different needs. This paper applies realist logic to an inquiry to explore the mechanisms that may operate in lay-led intervention models and understand how, why, and in what respect these lead to particular outcomes. It draws on a project focusing on health-related lifestyle advisers and further insights gained from a subsequent related project about outreach with traveler communities. Analysis highlights multiple and potentially interacting aspects of lay health-adviser roles that may influence their success, including characteristics of lay health advisers, characteristics of target populations, purpose or intent of interventions, and how advice is given. A model is proposed from which to examine the contexts and mechanisms of lay health advisers that may impact outcomes, and is subsequently applied to two examples of reported lay health-adviser interventions. The combination of skills and characteristics of lay health advisers must be considered when planning which interventions might be appropriate when targeting specific needs or target populations. Focus only on the peer/layperson distinction may overlook other potentially important skills and mechanisms of action integral
Nissen, Nina Konstantin; Madsen, Mette; Olsen Zwisler, Ann-Dorthe
AIMS: Relatives of heart patients experience anxiety, uncertainty, and low quality of life, and the hospitalization of a heart patient is associated with increased risk of death for the partner. Relatives' physical and mental problems may be rectified by activities established by the health...... systematically reviewed to clarify what the health services do for relatives of heart patients and to assess the effects of interventions. We searched Medline, EMBASE, PsycINFO, CINAHL database, CSA and the Cochrane Library from January 2000 to March 2006. RESULTS: Only six scientific articles reported...... on interventions testing health service activities for relatives of heart patients, and one literature review scrutinized earlier studies within the field. All the interventions indicate positive effects on patients' and/or relatives' health and well-being, in accordance with nurses' assessments. Nevertheless...
Luca, Nadina Raluca; Suggs, L Suzanne
The existing literature suggests that theories and models can serve as valuable frameworks for the design and evaluation of health interventions. However, evidence on the use of theories and models in social marketing interventions is sparse. The purpose of this systematic review is to identify to what extent papers about social marketing health interventions report using theory, which theories are most commonly used, and how theory was used. A systematic search was conducted for articles that reported social marketing interventions for the prevention or management of cancer, diabetes, heart disease, HIV, STDs, and tobacco use, and behaviors related to reproductive health, physical activity, nutrition, and smoking cessation. Articles were published in English, after 1990, reported an evaluation, and met the 6 social marketing benchmarks criteria (behavior change, consumer research, segmentation and targeting, exchange, competition and marketing mix). Twenty-four articles, describing 17 interventions, met the inclusion criteria. Of these 17 interventions, 8 reported using theory and 7 stated how it was used. The transtheoretical model/stages of change was used more often than other theories. Findings highlight an ongoing lack of use or underreporting of the use of theory in social marketing campaigns and reinforce the call to action for applying and reporting theory to guide and evaluate interventions.
Tamim, Suha Rahif
The purpose of this study was to explore how health education professionals create ehealth and mhealth education interventions. Three research questions led this qualitative study. The first research question focused on the use of learning theories, instructional models, and instructional design models. The second research question focused on the…
Tamim, Suha Rahif
The purpose of this study was to explore how health education professionals create ehealth and mhealth education interventions. Three research questions led this qualitative study. The first research question focused on the use of learning theories, instructional models, and instructional design models. The second research question focused on the…
This article has a two-fold approach. First, it investigates relationships between work organizational factors, and health and performance outcomes. Second, it compares two change strategy approaches in workplace health interventions by studying changes of these factors and outcomes. The sample consisted of ten Swedish small enterprises including 102 individuals, who answered a before and after questionnaire about organizational factors and outcomes. The leaders were interviewed and answered a questionnaire about performed workplace health interventions. Statistical methods used were reliability tests, correlation analyses and t-tests. Results indicate rather strong links between indicators of respectful leadership, creative work and team spirit, and the outcome indicators self-assessed health and judged workplace adaptability in association with customer satisfaction. The results concerning changes of determinants and outcomes (after workplace health interventions) showed significant differences between enterprises using a broad change strategy and those using an expert/problem-based strategy with the former having more favourable results. The leader interview results also point at obstacles concerning workplace change processes as lack of resources, insufficient competence and influence of external factors. The study results suggest that work organizational factors and integrated models for workplace health intervention are of importance for health and performance outcomes in small enterprises.
Asad, Asad L; Kay, Tamara
Although a substantial literature examines the relationship between culture and health in myriad individual contexts, a lack of comparative data across settings has resulted in disparate and imprecise conceptualizations of the concept for scholars and practitioners alike. This article examines scholars and practitioners' understandings of culture in relation to health interventions. Drawing on 169 interviews with officials from three different nongovernmental organizations working on health issues in multiple countries-Partners in Health, Oxfam America, and Sesame Workshop-we examine how these respondents' interpretations of culture converge or diverge with recent developments in the study of the concept, as well as how these understandings influence health interventions at three different stages-design, implementation, and evaluation-of a project. Based on these analyses, a tripartite definition of culture is built-as knowledge, practice, and change-and these distinct conceptualizations are linked to the success or failure of a project at each stage of an intervention. In so doing, the study provides a descriptive and analytical starting point for scholars interested in understanding the theoretical and empirical relevance of culture for health interventions, and sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.
Cidália Guia; Raquel Rodrigues dos Santos; Rogério da Silva Nunes
Currently, in the Bologna context, university teaching methods focus on the student and on a learning experience based on practical methods. Under the guidance of teachers, students in the second year of the first Environmental Health Course at the Polytechnic Institute of Beja have designed and developed the following nine community intervention projects relating to environmental health: dangerous products (mercury); habitability and geriatrics; health education and the environment; drinking...
Sarmiento, Juan Pablo
Purpose: The purpose of this paper is to map out and characterize existing health-promotion initiatives at Florida International University (FIU) in the USA in order to inform decision makers involved in the development of a comprehensive and a long-term healthy university strategy. Design/methodology/approach: This study encompasses a narrative…
Wolff, Jonathan; Edwards, Sarah; Richmond, Sarah; Orr, Shepley; Rees, Geraint
Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that 'experience' is a better basis for evaluation. The other, inspired by Amartya Sen, argues that 'capability' should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing 'instruments' designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives.
Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H
Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (child morbidity, anemia, and growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.
Pinto, Bernardine M; Floyd, Andrea
To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer. Electronic databases and recent review papers. Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy. There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.
Mohr, David C; Schueller, Stephen M; Montague, Enid; Burns, Michelle Nicole; Rashidi, Parisa
A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework. The BIT model defines both the conceptual and technological architecture of a BIT. Conceptually, a BIT model should answer the questions why, what, how (conceptual and technical), and when. While BITs generally have a larger treatment goal, such goals generally consist of smaller intervention aims (the "why") such as promotion or reduction of specific behaviors, and behavior change strategies (the conceptual "how"), such as education, goal setting, and monitoring. Behavior change strategies are instantiated with specific intervention components or "elements" (the "what"). The characteristics of intervention elements may be further defined or modified (the technical "how") to meet the needs, capabilities, and preferences of a user. Finally, many BITs require specification of a workflow that defines when an intervention component will be delivered. The BIT model includes a technological framework (BIT-Tech) that can integrate and implement the intervention elements, characteristics, and workflow to deliver the entire BIT to users over time. This implementation may be either predefined or include adaptive systems that can tailor the intervention based on data from the user and the user's environment. The BIT model provides a step towards formalizing the translation of developer aims into intervention components, larger treatments, and methods of delivery in a manner that supports research and communication between investigators on how to design, develop, and deploy BITs.
In this article I discuss the findings from a case study focusing on processes involving pupils to bring about health promotion changes. The case study is related to a large EU intervention project aiming to promote health and wellbeing among children (4-16 years), ‘Shape Up: a school-community a......In this article I discuss the findings from a case study focusing on processes involving pupils to bring about health promotion changes. The case study is related to a large EU intervention project aiming to promote health and wellbeing among children (4-16 years), ‘Shape Up: a school...... study showed that, if given sufficient guidance, children can act as agents of health promoting changes. The main arena for pupils’ influence was the pupils’ council. Pupils were meaningfully involved in two actions, which targeted road safety around the school and a playground for a disadvantaged...
Gebauer, Line; Vuust, Peter
Chances are that you have listened to music for several hours during the past week. A recent Danish survey found that 76 % of adults between 12 and 70 years listened to music for more than one hour daily (Engagement, 2010). Indeed, music is consistently rated to be among the top ten pleasures tha...... hope to provide an overview of existing evidence that may facilitate applications of music and the development of novel technologies that can assist music intervention in the healthcare sector in Denmark as well as internationally.......Chances are that you have listened to music for several hours during the past week. A recent Danish survey found that 76 % of adults between 12 and 70 years listened to music for more than one hour daily (Engagement, 2010). Indeed, music is consistently rated to be among the top ten pleasures...... that people value the most in life (Rentfrow and Gosling, 2003), but music can do more than just lift your spirit. Throughout the past decade, solid biomedical and psychological evidence is beginning to emerge, demonstrating the beneficial effects of music for a variety of somatic and psychiatric disorders...
Pons-Vigues, Mariona; Diez, Elia; Morrison, Joana; Salas-Nicas, Sergio; Hoffmann, Rasmus; Burstrom, Bo; van Dijk, Jitse P.; Borrell, Carme
Background: Health inequalities can be tackled with appropriate health and social policies, involving all community groups and governments, from local to global. The objective of this study was to carry out a scoping review on social and health policies or interventions to tackle health inequalities
Lam, Lawrence T; Lam, Mary K
Excessive use of the Internet is considered a problematic behaviour by clinicians and researchers. Cognitive behaviour therapy (CBT) has been advocated for a long time as a treatment approach and has been extended to include family therapy in the recent years. As eTherapy (eHealth) has become an important component in the treatment of many mental health problems, it is prudent to explore the current status of the eHealth approach as an intervention option for this problem. This systematic review aims to examine the current development of online intervention programmes for this particular condition. The PRISMA guidelines for systematic reviews and meta-analysis were employed to conduct the search for literature following a systematic and structured approach. Of the 182 articles screened, three satisfied the selection criteria. Information was extracted and analysed systematically for each study and tabulated. All these studies were pilot studies with small sample sizes. Two of these articles aimed to explore the therapeutic efficacy of newly developed online intervention programmes for Internet addiction (IA) and online gaming addiction. The third article described the design and development of an App for smartphone addiction. The results obtained from this review have provided insight into the on-going development of eHealth interventions as well as the health informatics approaches in offering a possible and practical solution to tackle this growing problem.
Tesdahl, Eric; Gesell, Sabina B
Recent developments in the study of health and social networks have focused on linkages between health outcomes and naturally occurring social relations, such as friendship or kinship. Based on findings in this area, a new generation of health behavior intervention programs have been implemented that rely on the formation of new social relations among program participants. However, little is known about the qualities of these de novo social relations. We examined the social networks of 59 participants within a randomized controlled trial of an intervention designed to prevent excessive gestational weight gain. We employed exponential random graph modeling techniques to analyze supportive relationships formed between participants in the intervention arm, to detect unique effects of program participation on the likelihood of forming ties. Program participation had a positive effect on the likelihood of forming supportive social relations, however, in this particular timeframe we did not detect any additional effect of such relations on the health behaviors or outcomes of interest. Our findings raise two critical questions: do short-term group-level programs reliably lead to the formation of new social relations among participants; and do these relations have a unique effect on health outcomes relative to standard methods of health behavior intervention?
Vu, Lan Thi Hoang; Nguyen, Ngan Thi Kim; Tran, Hanh Thi Duc; Muhajarine, Nazeem
Socio-economic development in Vietnam has resulted in increased internal migration particularly among young women seeking employment opportunities in cities. Vietnamese female migrants who enter new environments often encounter the loss or neglect of their right to access sexual and reproductive health services. To address this, a mobile health (mHealth) intervention model was implemented over 12 months (2013-2014) in a factory in the Long Bien industrial zone of Hanoi, Vietnam. The intervention provided sexual and reproductive health services for female migrants through text messaging, information booklets accompanied maps, and free counseling via a hotline. To evaluate the impact of the intervention, pre- and post-intervention data were collected to measure changes in women's knowledge and practices related to sexual and reproductive health. Qualitative data in the form of personal interviews were also collected. The sample size for the baseline survey was 411 women, and for the post-intervention survey it was 482 women (the intervention involved an open cohort). The majority of women were unmarried and under the age of 25. Results indicate that there was high uptake of the intervention services and that most women found the services important and useful. In addition, there was evidence that the intervention (1) increased women's knowledge of sexual and reproductive health (e.g., proper use of condoms, identification of high-risk behaviors such as having unprotected sex), and (2) fostered improved practices related to sexual and reproductive health (e.g., increased gynecological check-ups and use of condoms). The study demonstrated the feasibility of implementing a multi-faceted intervention for migrant women working in an industrial zone in Hanoi, Vietnam as well as its successful uptake and some early positive effects. This can be used to inform future design and implementation of mHealth/eHealth intervention models for migrant and other vulnerable/hard to
CAI Yumao(蔡于茂); ZENG Xuchun(曾序春); DONG Shifu(董时富)
Acquired Immune Deficiency Syndrome (AIDS) isan infectious disease caused by HIV. It has been epidemic formore than 20 years, but there is no cure of it. Health educationand behavioral interventions are some of the most effectiveapproaches in the control and prevention of AIDS. China isone of the countries with the fastest growing HIVseroprevalence rate, and is facing a widespread epidemic ofAIDS. Currently, high-risk populations such as individualswith multiple sexual partners and intravenous drug users arethe main foci of health education and behavioral interventionsin China. Encouraging results have been observed in manyforms of health education and behavioral intervention. Theapplication of health education and behavioral interventionsmust emerge from scientific evidence, follow a series ofstrategies, be carried out from various perspectives, andrequire the participation of all societal communities.
Weine, Stevan Merrill
In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive m...
An essential characteristic of advanced practice nurses is the use of theory in practice. Clinical nurse specialists apply theory in providing or directing patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Knowledge of technology and pharmacology has far outpaced knowledge of how to facilitate health behavior change, and new theories are needed to better understand how practitioners can facilitate health behavior change. In this article, the Integrated Theory of Health Behavior Change is described, and an example of its use as foundation to intervention development is presented. The Integrated Theory of Health Behavior Change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation. Engagement in self-management behaviors is seen as the proximal outcome influencing the long-term distal outcome of improved health status. Person-centered interventions are directed to increasing knowledge and beliefs, self-regulation skills and abilities, and social facilitation. Using a theoretical framework improves clinical nurse specialist practice by focusing assessments, directing the use of best-practice interventions, and improving patient outcomes. Using theory fosters improved communication with other disciplines and enhances the management of complex clinical conditions by providing holistic, comprehensive care.
Semenza, Jan C; Krishnasamy, Prasanna V
Design and implementation of health-promoting community interventions can advance public health and community well-being; however, realization of such programs is often challenging. Even more challenging is the implementation of ecologic interventions to revitalize built urban environments. A structured intervention entitled ;Intersection Repair; was devised in Portland, Oregon, by a non-profit organization, to implement urban gathering places in the public right of way; specific steps included situation analysis, community outreach, asset mapping, design workshops, construction permitting, building workshops, and process evaluation. The community created human-scale urban landscapes with interactive art installations to encourage social interactions. Such aesthetic improvements, which included painted street murals, information kiosks, hanging gardens, water fountains, benches, and so on, were intended to strengthen social networks and social capital by providing places for residents to engage in conversation. Community engagement in neighborhood design benefits the public at multiple levels, by promoting a healthier lifestyle, over and above urban landscape improvements.
Sormunen, Marjorita; Tossavainen, Kerttu; Turunen, Hannele
A 2-year, participatory action research school health study focused on developing components for home-school partnerships to support children's health learning process. Two intervention schools implemented strengthened health and collaboration-orientated activities; two control schools followed the national core curriculum without extracurricular activities. The parents of fourth-grade pupils (10-11 years at baseline) completed questionnaires before intervention in spring 2008 (N = 348) and after intervention in spring 2010 (N = 358). A two-way analysis of variance was conducted to determine whether time (2008/2010) and group (intervention/control) influenced parents' perceptions and experiences of parental involvement, health education and health support received from the school. Compared with controls, the intervention schools' parents experienced greater involvement ethos (Cohen's d = 0.57, P < 0.001), increased knowledge of health education (Cohen's d = 0.60, P = 0.02) and health support (Cohen's d = 0.35, P = 0.02). Health education participation among parents increased only partially during the intervention (Cohen's d = -0.12, P = 0.193). School health interventions based on schools' needs may have the potential to influence positively the relationship between home and school and increase the visibility of health education. The study was undertaken within the Schools for Health in Europe program.
Shirazi, Mehra; Engelman, Kimberly K; Mbah, Olive; Shirazi, Aida; Robbins, Irma; Bowie, Janice; Popal, Rona; Wahwasuck, Arlene; Whalen-White, Denice; Greiner, Allen; Dobs, Adrian; Bloom, Joan
Members of underrepresented minority (URM) groups are at higher risk of disproportionately experiencing greater breast cancer-related morbidity and mortality and thus, require effective interventions that both appropriately target and tailor to their unique characteristics. We sought to describe the targeting and tailoring practices used in the development and dissemination of three breast cancer screening interventions among URM groups. Three national Community Network Programs (CNPs) funded by the National Cancer Institute have focused on breast cancer screening interventions as their major research intervention. Each targeted different populations and used participatory research methods to design their intervention tailored to the needs of their respective audience. The Alameda County Network Program (ACNP) to Reduce Cancer Disparities partnered with community members to design and conduct 2-hour "Tea Party" education sessions for Afghan women. The Kansas Community Cancer Disparities Network co-developed and deployed with community members a computerized Healthy Living Kansas (HLK) Breast Health program for rural Latina and American Indian women. The Johns Hopkins Center to Reduce Cancer Disparities employed a train-the-trainer COACH approach to educate urban African-American women about breast cancer. Each CNP program targeted diverse URM women and, using participatory approaches, tailored a range of interventions to promote breast cancer screening. Although all projects shared the same goal outcome, each program tailored their varying interventions to match the target community needs, demonstrating the importance and value of these strategies in reducing breast cancer disparities.
Marlow, Ruth; Hansford, Lorraine; Edwards, Vanessa; Ukoumunne, Obioha C; Norman, Shelley; Ingarfield, Sara; Sharkey, Siobhan; Logan, Stuart; Ford, Tamsin
Purpose: The purpose of this paper is to explore the feasibility of a classroom management course as a public health intervention. Improved socio-emotional skills may boost children's developmental and academic trajectory, while the costs of behaviour problems are enormous for schools with considerable impact on others' well-being.…
Ruzek, Josef I; Kuhn, Eric; Jaworski, Beth K; Owen, Jason E; Ramsey, Kelly M
Mobile technologies offer potentially critical ways of delivering mental health support to those experiencing war, ethnic conflict, and human-caused and natural disasters. Research on Internet interventions suggests that effective mobile mental health technologies can be developed, and there are early indications that they will be acceptable to war and disaster survivors, and prove capable of greatly increasing the reach of mental health services. Promising mhealth interventions include video teleconferencing, text messaging, and smartphone-based applications. In addition, a variety of social media platforms has been used during and immediately after disasters to increase agility in responding, and strengthen community and individual resilience. Globally, PTSD Coach has been downloaded over 243,000 times in 96 countries, and together with large-scale use of social media for communication during disasters, suggests the potential for reach of app technology. In addition to enabling improved self-management of post-trauma problems, mobile phone interventions can also enhance delivery of face-to-face care by mental health providers and increase the effectiveness of peer helpers and mutual aid organizations. More research is needed to establish the efficacy of mhealth interventions for those affected by war and disaster. Research should also focus on the identification of active elements and core processes of change, determination of effective ways of increasing adoption and engagement, and explore ways of combining the various capabilities of mobile technologies to maximize their impact.
Bock, Beth C; Rosen, Rochelle K; Barnett, Nancy P; Thind, Herpreet; Walaska, Kristen; Foster, Robert; Deutsch, Christopher; Traficante, Regina
The development of mHealth applications is often driven by the investigators and developers with relatively little input from the targeted population. User input is commonly limited to "like/dislike" post- intervention consumer satisfaction ratings or device or application specific user analytics such as usability. However, to produce successful mHealth applications with lasting effects on health behaviors it is crucial to obtain user input from the start of each project and throughout development. The aim of this tutorial is to illustrate how qualitative methods in an iterative process of development have been used in two separate behavior change interventions (targeting smoking and alcohol) delivered through mobile technologies (ie, text messaging). A series of focus groups were conducted to assist in translating a face-to-face smoking cessation intervention onto a text message (short message service, SMS) delivered format. Both focus groups and an advisory panel were used to shape the delivery and content of a text message delivered intervention for alcohol risk reduction. An in vivo method of constructing message content was used to develop text message content that was consistent with the notion of texting as "fingered speech". Formative research conducted with the target population using a participatory framework led to important changes in our approach to intervention structure, content development, and delivery. Using qualitative methods and an iterative approach that blends consumer-driven and investigator-driven aims can produce paradigm-shifting, novel intervention applications that maximize the likelihood of use by the target audience and their potential impact on health behaviors.
Huijg, Johanna Maria
Despite the promising findings related to the efficacy of primary health care-based physical activity interventions and recommendations for primary health care professionals to promote physical activity, the introduction of physical activity interventions in routine daily primary health care
Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost-effectiveness analysis and cost-benefit analysis provide key information to health decision makers on the efficiency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas—water, sanitation, hygiene (WSH), vector control, and air pollution—and to critically examine the policy relevance and scientific quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990–2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution). Overall, the economic evidence base on environmental health interventions remains relatively weak—too few studies per intervention, of variable scientific quality and from diverse locations which limits generalisability of findings. Importantly, there still exists a disconnect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research findings into accessible documentation for policy makers and limited relevance of research findings, and the often low importance of economic evidence in budgeting decisions. These findings underline the importance of involving policy makers in the defining of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds. PMID:21572840
Full Text Available Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost- effectiveness analysis and cost-benefit analysis provide key information to health decision makers on the efficiency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas—water, sanitation, hygiene (WSH, vector control, and air pollution—and to critically examine the policy relevance and scientific quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990–2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution. Overall, the economic evidence base on environmental health interventions remains relatively weak—too few studies per intervention, of variable scientific quality and from diverse locations which limits generalisability of findings. Importantly, there still exists a disconnect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research findings into accessible documentation for policy makers and limited relevance of research findings, and the often low importance of economic evidence in budgeting decisions. These findings underline the importance of involving policy makers in the defining of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds.
Weine, Stevan Merrill
In refugee resettlement, positive psychosocial outcomes for youth and adults depend to a great extent on their families. Yet refugee families find few empirically based services geared toward them. Preventive mental health interventions that aim to stop, lessen, or delay possible negative individual mental health and behavioral sequelae through improving family and community protective resources in resettled refugee families are needed. This paper describes 8 characteristics that preventive mental health interventions should address to meet the needs of refugee families, including: Feasibility, Acceptability, Culturally Tailored, Multilevel, Time Focused, Prosaicness, Effectiveness, and Adaptability. To address these 8 characteristics in the complex environment of refugee resettlement requires modifying the process of developmental research through incorporating innovative mental health services research strategies, including: resilience framework, community collaboration, mixed methods with focused ethnography, and the comprehensive dynamic trial. A preventive intervention development cycle for refugee families is proposed based on a program of research on refugees and migrants using these services research strategies. Furthering preventive mental health for refugee families also requires new policy directives, multisystemic partnerships, and research training.
Tullar, Jessica M; Brewer, Shelley; Amick, Benjamin C; Irvin, Emma; Mahood, Quenby; Pompeii, Lisa A; Wang, Anna; Van Eerd, Dwayne; Gimeno, David; Evanoff, Bradley
Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions. The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.
Khalesi, Zahra Bostani; Simbar, Masoumeh; Azin, Seyed Ali; Zayeri, Farid
Sexual health promotion is the process of enabling people to increase control over their sexual health that should be based on people's needs and abilities. The aim of this study was to explore public sexual health promotion interventions and strategies. This study was a qualitative content analysis approach. This qualitative study was a qualitative part of an exploratory sequential qualitative-quantitative study that took place between November 2014 and May 2015 and was conducted in Rasht, Iran. Data were collected using semi-structured interviews with 38 engaged and married men and women as well as nine key informants. The data were analyzed by the content analysis method and by using qualitative data analysis software MAXqda 2011. Analyzing participants' perspectives and experiences revealed two main categories, i.e., 1) General actions to promote sexual health (with three sub-categories: public policies promoting sexual health, development of sexual health supporting environments, and removal of barriers to receiving services) and 2) Specific actions in the current health system (with three sub-categories: economic policy, empowering individuals and the society, and reviewing the current health system). General actions (public policies, supporting environments developed, and removal of barriers to receiving services) and integration of specific actions in the health system, such as empowering individuals' needs for promoting sexual health. Achieving these goals necessitates the review of the current health system in Iran.
Czabała, Czesław; Charzyńska, Katarzyna; Mroziak, Barbara
A review based on the DataPrev final report concerning workplace mental health promotion is presented. Out of 4865 studies identified in a comprehensive bibliographical data search, 315 were selected for abstract screening and 79 were included in the final review. The studies were categorized in terms of their aims/expected outcomes and evaluated for quality on the grounds of their design and type of analysis. The most frequent aims were stress reduction and better coping, followed by increased job satisfaction and effectiveness, mental health enhancement and reduction in mental health-related absenteeism. In the 79 intervention studies, 99 outcome variables were measured using 163 instruments, mostly developed for the study purposes. Different intervention categories turned out to be used to attain the same aim, with skills training being the most popular (other approaches included improvement of occupational qualifications and working conditions, physical exercise, relaxation and multicomponent interventions). Among the few intervention programs that were implemented and evaluated in two or more studies, the Stress Inoculation Training (Cecil and Forman, in Effects of stress inoculation training and coworker support groups on teachers' stress. Journal of School Psychology, 28, 105, 1990) based on the model by Meichenbaum (Meichenbaum, in Stress Inoculation Training. Pergamon Press, New York, 1985) seemed to be the most promising. Its effectiveness, evidenced in a majority of the measures, was evaluated in studies using the randomized controlled design. This paper is illustrated by high-quality intervention studies. In high and moderate quality studies, positive effects were reported in about a half of the examined outcome variables. However, conclusive evidence of intervention programs effectiveness would require further research-repetition of studies using treatments equivalent to the experimental ones, and outcome evaluation taking into account other criteria
Zhou, Kai-Ge; Wu, Zhi-Fan; Sun, Xiao-Sheng
Health communication and behavior intervention are main measures adopted in health education. Behavior intervention among these measures is the direct one to affect individual and group behaviors. Patients demand more than health information communication, but rely on health intervention service and related products. This essay starts from…
Full Text Available Background: No organized school oral health program is existent in India. Aim: The aim of this study is to test the feasibility and efficacy of an economical school oral health promotional intervention with educational and preventive components. Settings and Design: School oral health promotional intervention carried out in one of the randomly selected school and evaluated through short duration prospective model. Materials and Methods: A total of 100 children with an age range of 10-12 years with no previous history of dental intervention were enrolled. Interventions comprised of oral health education (delivered through lecture and demonstrations by an undergraduate dental student and topical antibacterial therapy (fluoride varnish and povidone iodine. Outcomes consisted of Knowledge and practices (KAP regarding oral health, clinical oral health related parameters such as plaque index (PI, gingival index (GI and caries activity as per Modified Snyder′s test. These were reported at baseline, 3 weeks and 6 months follow-up examination by a calibrated examiner. Statistical Analysis: McNemar Bowker′s test, Student′s t-test, Pearson Chi-square tests were used. Results: Highly significant (P < 0.001 improvements in KAP scores, PI scores, GI scores and caries activity were reported at 3 weeks and 6 months follow-up examination. Conclusion: This small economical school oral health program positively influenced oral health related practices and parameters of oral health such as oral cleanliness, gingival health and caries activity.
Kolbe-Alexander Tracy L
employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration United States Clinical Trails Register NCT 01494207
Stephen P. Luby
Full Text Available Pigs are intermediate hosts and potential reservoirs of a number of pathogens that can infect humans. The objectives of this manuscript are to understand pig raising patterns in Bangladesh, interactions between pigs and humans, social stigma and discrimination that pig raisers experience and to explore the implications of these findings for public health interventions. The study team conducted an exploratory qualitative study by interviewing backyard pig raisers and nomadic herders (n = 34, observing daily interactions between pigs and humans (n = 18 and drawing seasonal diagrams (n = 6 with herders to understand the reasons for movement of nomadic herds. Pig raisers had regular close interaction with pigs. They often touched, caressed and fed their pigs which exposed them to pigs' saliva and feces. Herders took their pigs close to human settlements for scavenging. Other domestic animals and poultry shared food and sleeping and scavenging places with pigs. Since pigs are taboo in Islam, a majority of Muslims rejected pig raising and stigmatized pig raisers. This study identified several potential ways for pigs to transmit infectious agents to humans in Bangladesh. Poverty and stigmatization of pig raisers make it difficult to implement health interventions to reduce the risk of such transmissions. Interventions that offer social support to reduce stigma and highlight economic benefits of disease control might interest of pig raisers in accepting interventions targeting pig borne zoonoses.
Nahar, Nazmun; Uddin, Main; Sarkar, Rouha Anamika; Gurley, Emily S; Uddin Khan, M Salah; Hossain, M Jahangir; Sultana, Rebeca; Luby, Stephen P
Pigs are intermediate hosts and potential reservoirs of a number of pathogens that can infect humans. The objectives of this manuscript are to understand pig raising patterns in Bangladesh, interactions between pigs and humans, social stigma and discrimination that pig raisers experience and to explore the implications of these findings for public health interventions. The study team conducted an exploratory qualitative study by interviewing backyard pig raisers and nomadic herders (n=34), observing daily interactions between pigs and humans (n=18) and drawing seasonal diagrams (n=6) with herders to understand the reasons for movement of nomadic herds. Pig raisers had regular close interaction with pigs. They often touched, caressed and fed their pigs which exposed them to pigs' saliva and feces. Herders took their pigs close to human settlements for scavenging. Other domestic animals and poultry shared food and sleeping and scavenging places with pigs. Since pigs are taboo in Islam, a majority of Muslims rejected pig raising and stigmatized pig raisers. This study identified several potential ways for pigs to transmit infectious agents to humans in Bangladesh. Poverty and stigmatization of pig raisers make it difficult to implement health interventions to reduce the risk of such transmissions. Interventions that offer social support to reduce stigma and highlight economic benefits of disease control might interest of pig raisers in accepting interventions targeting pig borne zoonoses.
Posny, Drew; Wang, Jin; Mukandavire, Zindoga; Modnak, Chairat
Cholera continues to be a serious public health concern in developing countries and the global increase in the number of reported outbreaks suggests that activities to control the diseases and surveillance programs to identify or predict the occurrence of the next outbreaks are not adequate. These outbreaks have increased in frequency, severity, duration and endemicity in recent years. Mathematical models for infectious diseases play a critical role in predicting and understanding disease mechanisms, and have long provided basic insights in the possible ways to control infectious diseases. In this paper, we present a new deterministic cholera epidemiological model with three types of control measures incorporated into a cholera epidemic setting: treatment, vaccination and sanitation. Essential dynamical properties of the model with constant intervention controls which include local and global stabilities for the equilibria are carefully analyzed. Further, using optimal control techniques, we perform a study to investigate cost-effective solutions for time-dependent public health interventions in order to curb disease transmission in epidemic settings. Our results show that the basic reproductive number (R0) remains the model's epidemic threshold despite the inclusion of a package of cholera interventions. For time-dependent controls, the results suggest that these interventions closely interplay with each other, and the costs of controls directly affect the length and strength of each control in an optimal strategy. Copyright © 2015 Elsevier Inc. All rights reserved.
Hawkins, Robert P; Han, Jeong-Yeob; Pingree, Suzanne; Shaw, Bret R; Baker, Timothy B; Roberts, Linda J
A number of researchers have identified interactivity and presence as potentially important attributes of e-Health applications, because they are believed to influence users to interact with systems in ways that increase commitment, learning, and other desirable responses. This paper reports on the development of brief scales to assess the two concepts, and on use of them with participants in six conditions of a large-scale trial of interventions for breast cancer patients. Overall, the Internet scored very low on both measures. Versions of an integrated system of services (CHESS) scored higher, particularly as conditions added features to different versions of the system. Interventions involving a human Cancer Information Mentor scored highest, though even the Mentor was perceived as more interactive and having more presence when combined with the integrated eHealth system.
Lemay, Nancy Vollmer; Sullivan, Tara; Jumbe, Brian; Perry, Cary Peabody
mHealth has great potential to change the landscape of health service delivery in less developed countries--expanding the reach of health information to frontline health workers in remote areas. Formative, process, and summative evaluation each play an important role in mHealth interventions. K4Health conducted a Health Information Needs Assessment in Malawi from July to September 2009 (formative evaluation) that found widespread use of cell phones among health workers offering new opportunities for knowledge exchange, especially in areas where access to health information is limited. K4Health subsequently designed an 18-month demonstration project (January 2010 to June 2011) to improve the exchange and use of family planning/reproductive health and HIV/AIDS knowledge among health workers, which included the introduction of a short message service (SMS) network. K4Health conducted a pretest of the mHealth intervention from June to October 2010. A baseline assessment was carried out in November 2010 before expanding the SMS network and included use of qualitative and quantitative measures and comparison groups (summative evaluation). Routinely collected statistics also guide the program (process evaluation). This article describes the approach and main findings of the SMS baseline study and contributes to a growing body of evidence measuring the effectiveness and efficiency of mHealth programs using a strong evaluation design.
Mizumoto, Kaori; Murakami, Genki; Oshidari, Kenro; Trisnantoro, Laksono; Yoshiike, Nobuo
Asia has recorded the fastest economic growth in the world. However, some countries are still struggling with economic stagnation and poverty. Even in the emerging countries, there are economic disparities between urban and rural areas within a country. Reflecting the situations, nutritional issues in Asia came to be the antithetical situation of excess and insufficiency. The rate of overweight and obesity keeps increasing, especially in emerging countries. Meanwhile, underweight is still a critical problem in the region. Although the importance of nutrition is well recognized for social and economic development, it is difficult to identify the immediate outcome of nutrition interventions. Evidence-based decision-making is an important element of quality health care and efficiency and effectiveness are always key words. Along with enhanced attention to accountability and transparency of budget use in health services, attention to the economic evaluation of nutrition interventions has increased in recent years. In this symposium, we will review the current situation of nutritional issues and economic evaluation of nutrition interventions in Asia through experience of an international organization, the basis and trends for health care economics, and also efforts have been made in an Asian country. Discussion will be made about efficient and effective ways to evaluate projects/programmes for nutrition improvement.
Riley, William T; Rivera, Daniel E; Atienza, Audie A; Nilsen, Wendy; Allison, Susannah M; Mermelstein, Robin
Mobile technologies are being used to deliver health behavior interventions. The study aims to determine how health behavior theories are applied to mobile interventions. This is a review of the theoretical basis and interactivity of mobile health behavior interventions. Many of the mobile health behavior interventions reviewed were predominately one way (i.e., mostly data input or informational output), but some have leveraged mobile technologies to provide just-in-time, interactive, and adaptive interventions. Most smoking and weight loss studies reported a theoretical basis for the mobile intervention, but most of the adherence and disease management studies did not. Mobile health behavior intervention development could benefit from greater application of health behavior theories. Current theories, however, appear inadequate to inform mobile intervention development as these interventions become more interactive and adaptive. Dynamic feedback system theories of health behavior can be developed utilizing longitudinal data from mobile devices and control systems engineering models.
Hjorth, Peter; Davidsen, Annette Sofie; Killian, Reinhold;
-month intervention study, and the interventionwas active awareness on physical health. Results: In the intervention group the staff reducedtheir waist circumference by 2.3 cm (95% CI: 0.3–4.4) when controlling for gender, age andcigarette consumption. In the control group, the staff changed their waist...... of an intervention programme for improving physical health in staff working in longtermpsychiatric treatment facilities. Furthermore, the paper measured the association betweenstaff’s changes in physical health and the patients’ changes in physical health. Methods: Thestudy was a cluster randomized controlled 12......’s changes in health parameters (body mass index, total body fat and qualityof life). Conclusion: The staff in the intervention group showed a significant reduction of waistcircumference, while staff in the control group showed a non-significant increase. Furthermore,a significant reduction in the diastolic...
Alain Soto Ugalde
Full Text Available Background: inadequate access to an appropriate dental care in certain communities, together with the absence of prevention programs, is associated with health status deterioration in the population of Venezuela, especially in children. Objective: to assess the effectiveness of an oral health educational program for developing attitude changes and healthy oral habits. Methods: an intervention study was conducted in 80 children and 10 teachers from a school in Rio Chico, Miranda State, Venezuela, during January-September, 2010. A diagnosis focused on the oral hygiene index of the children, their learning needs, as well as those of their teachers was performed. A program including teaching materials such as educational games and software was developed. Information was obtained through surveys and focus groups. Results: significant differences between the initial and the final level of knowledge were observed, as well as in the oral hygiene index. Children’s approval of the program was demonstrated, considering its relevance regarding oral health. Conclusions: by means of the educational program, the intervention led to satisfactory changes in children’s behaviour and way of thinking, in terms of oral health; results that confirm its validity.
Sauer, R. L.; Magnuson, J. W.; Scruby, R. R.; Scheld, H. W.
Advanced microgravity plant biology research and life support system development for the spacecraft environment are critically hampered by the lack of a technology base. This inadequacy stems primarily from the fact that microgravity results in a lack of convective currents and phase separation as compared to the one gravity environment. A program plan is being initiated to develop this technology base. This program will provide an iterative flight development effort that will be closely integrated with both basic science investigations and advanced life support system development efforts incorporating biological processes. The critical considerations include optimum illumination methods, root aeration, root and shoot support, and heat rejection and gas exchange in the plant canopy.
Evans-Lacko, Sara; London, Jillian; Japhet, Sarah; Rüsch, Nicolas; Flach, Clare; Corker, Elizabeth; Henderson, Claire; Thornicroft, Graham
Stigma and discrimination associated with mental health problems is an important public health issue, and interventions aimed at reducing exposure to stigma and discrimination can improve the lives...
Raffaele, Barbara; Matarese, Maria; Alvaro, Rosaria; Piredda, Michela; De Marinis, Maria Grazia
Health promotion interventions are aimed at improving health by seeking to influence lifestyles, healthcare services and physical, cultural and socioeconomic environments. Several publications support the relevance of theory-based interventions directed to promoting health. However, the adoption of an educational conceptual framework in the planning and evaluation of health promotion interventions is still limited. The aim of this article is to describe the educational paradigms for health promotion intervention and analyse the main educational theories and models used in literature, reporting the international debate about the type and level of application of different theoretical frameworks in health promotion interventions.
Walker, Rae; Hassall, John; Chaplin, Sue; Congues, Janet; Bajayo, Rachael; Mason, Wendy
This project explored the literature in which key concepts in primary health care and health promotion are overtly applied to the problem of climate change. This paper contains a discussion of the literature relevant to health promotion principles and intervention strategies for addressing climate change mitigation and adaptation in the primary health care sector. The concept of primary health care is that used by the World Health Organization, based on the Declaration of Alma Ata and often referred to as comprehensive primary health care to differentiate it from primary medical care. This was a review of literature identified in electronic databases using two sets of search terms. Set A consisted of 'climate change or global warming or greenhouse effect' and set B consisted of 11 key concepts in primary health care and health promotion, for example community resilience, health promotion, social change, food security and economic development. Relevant literature was identified at the intersection of search term A with a term from set B. A search was completed for each set B term. This paper reports a discussion of major categories of health promotion interventions, namely health communication, community building and settings approaches and uses examples drawn from literature on community resilience and summer heat. These interventions are all applicable to the primary health care sector. There is a small literature on health promotion interventions for climate change mitigation and adaptation but it is incomplete and scattered across many sources. An important area for further research is to link the logic of service provision in primary health care to the logic of mitigation and adaptation in a changing environment. Interventions that link the logic must also link diverse services to provide coherent action on local and domestic scales, the scales at which primary health care acts. Another research gap is in regard to institutional change in the primary health
-community approach to influencing determinants of healthy and balanced growing up’. Qualitative case study research was carried out in a school in the Netherlands. Data sources included project documents, interviews and observations. Thematic analysis was carried out combining the different data sources. The case......In this article I discuss the findings from a case study focusing on processes involving pupils to bring about health promotion changes. The case study is related to a large EU intervention project aiming to promote health and wellbeing among children (4-16 years), ‘Shape Up: a school...... study showed that, if given sufficient guidance, children can act as agents of health promoting changes. The main arena for pupils’ influence was the pupils’ council. Pupils were meaningfully involved in two actions, which targeted road safety around the school and a playground for a disadvantaged...
Pagani, Victoria; Kivits, Joëlle; Minary, Laetitia; Cambon, Linda; Claudot, Frédérique; Alla, François
Introduction: Since 2000, the notion of “complex interventions” has been emerging in the health research field. “Complex interventions” and “complexity” are commonly used terms, but they are generally not defined. Conceptual ambiguities persist concerning the notion of complexity. The objective of this exploratory review is to characterize the notion of complexity: What is complexity? Where does this notion come from and what does it cover? What are the consequences of complexity in the health field?Methods: To clarify the concept of complexity, a narrative review was conducted in the fields of humanities and social science, managerial economics, psychology and healthcare.Results: The concept of complexity, that can be attributed to Edgar Morin, has been the subject of appropriations, adaptations, and operations in multiple areas. Complexity consists of understanding the factors influencing individual decisions. In the field of healthcare, the concept of complexity is used more pragmatically and is defined by objective characteristics of interventions (defined as complex) or their contexts for the practical purposes of evaluation.Discussion: The notions of complexity and complex interventions have implications for researchers and users of the results of research. In particular, the notion of complexity is designed to provide a better understanding of the mechanism of effectiveness of interventions, support transferability and use by actors and decision-makers.
Duncan, Edward; Best, Catherine; Hagen, Suzanne
One person in every four will suffer from a diagnosable mental health condition during their life course. Such conditions can have a devastating impact on the lives of the individual, their family and society. Increasingly partnership models of mental health care have been advocated and enshrined in international healthcare policy. Shared decision making is one such partnership approach. Shared decision making is a form of patient-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This is advocated on the basis that patients have a right to self-determination and also in the expectation that it will increase treatment adherence. To assess the effects of provider-, consumer- or carer-directed shared decision making interventions for people of all ages with mental health conditions, on a range of outcomes including: patient satisfaction, clinical outcomes, and health service outcomes. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2008, Issue 4), MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), PsycINFO (1967 to November 2008), CINAHL (1982 to November 2008), British Nursing Index and Archive (1985 to November 2008) and SIGLE (1890 to September 2005 (database end date)). We also searched online trial registers and the bibliographies of relevant papers, and contacted authors of included studies. Randomised controlled trials (RCTs), quasi-randomised controlled trials (q-RCTs), controlled before-and-after studies (CBAs); and interrupted time series (ITS) studies of interventions to increase shared decision making in people with mental health conditions (by DSM or ICD-10 criteria). Data on recruitment methods, eligibility criteria, sample characteristics, interventions, outcome measures, participant flow and outcome data from each study were extracted by one author and checked by another. Data are presented in a narrative
Lysdahl, Kristin Bakke; Hofmann, Bjørn
Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA) literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1) multiple and changing perspectives, 2) indeterminate phenomena, 3) uncertain causality, 4) unpredictable outcome, and 5) ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.
Husso, Marita; Virkki, Tuija; Notko, Marianne; Holma, Juha; Laitila, Aarno; Mäntysaari, Mikko
Intervening in domestic violence in the health care and social service settings is a complex and contested issue. In this qualitative, multidisciplinary study, the barriers to but also the possibilities for health care professionals in encountering victims of violence were scrutinised. The focus was on omissions in service structure and practices. The data consisted of six focus group interviews with nurses, physicians, social workers and psychologists in specialist health care (n = 30) conducted in Finland in 2009. The aim was to explore professionals' processes of making sense of violence interventions and the organisational practices of violence interventions. Four types of framing of the domestic violence issue were identified: (i) practical frame, (ii) medical frame, (iii) individualistic frame and (iv) psychological frame. Each frame consisted of particular features relating to explaining, structuring or dismissing the question of domestic violence in health care settings. The main themes included the division of responsibilities and feasibility of treatment. All four frames underlie the tendency for healthcare professionals to arrive at sense-making practices where it is possible to focus on fixing the injuries and consequences of domestic violence and bypassing the issue of violence as the cause of symptoms and injuries. The results indicate that developing successful practices both in identifying survivors of domestic violence and in preventing further victimisation requires a broad understanding of the effects of domestic violence and the challenges for health care professionals in dealing with it. New perspectives are needed in creating adequate practices both for victims of violence seeking help and for professionals working with this issue. Strong support at the organisational level and established practices throughout the fields of health and social care are the key elements in building a responsible approach to domestic violence.
Chang Ching; Chang Hsin
Abstract Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enh...
Corley, Courtney D.; Mihalcea, Rada; Mikler, Armin R.; Sanfilippo, Antonio P.
Recently, human papilloma virus has been implicated to cause several throat and oral cancers and hpv is established to cause most cervical cancers. A human papilloma virus vaccine has been proven successful to reduce infection incidence in FDA clinical trials and it is currently available in the United States. Current intervention policy targets adolescent females for vaccination; however, the expansion of suggested guidelines may extend to other age groups and males as well. This research takes a first step towards automatically predicting personal beliefs, regarding health intervention, on the spread of disease. Using linguistic or statistical approaches, sentiment analysis determines a texts affective content. Self-reported HPV vaccination beliefs published in web and social media are analyzed for affect polarity and leveraged as knowledge inputs to epidemic models. With this in mind, we have developed a discrete-time model to facilitate predicting impact on the reduction of HPV prevalence due to arbitrary age and gender targeted vaccination schemes.
Full Text Available There is a growing interest for the potential health benefits of human-animal interactions. Although scientific evidence on the effects is far from being consistent, companion animals are used with a large number of human subjects, ranging from children to elderly people, who benefit most from emotional support. Based on a comprehensive review of the literature, this paper examines the potential for domesticated animals, such as dogs, for providing emotional and physical opportunities to enrich the lives of many frail subjects. In particular, we focus on innovative interventions, including the potential use of dogs to improve the life of emotionally-impaired children, such as those affected by autism spectrum disorders. Overall an ever increasing research effort is needed to search for the mechanism that lie behind the human-animal bond as well as to provide standardized methodologies for a cautious and effective use of animal-assisted interventions.
Mourão Carvalhal, Maria Isabel Martins; Fonseca, Sandra; de Castro Coelho, Eduarda Maria Rocha Teles
The aim of the communication was to present the baseline data from incidence of obesity, eating habits, physical activity and sedentary behaviour, before ELSa, interventional Portuguese health program. The sample was composed of 496 children (238 girls and 258 boys) with an average 7.7 (± 2.5) years of age. Thinness, overweight and obesity were calculated by using the BMI and the cut off of Cole et al., 24 h dietary recalls and a general questionnaire was completed by the parents to provide information about eating habits, sedentary behaviour and physical activity. The results indicated high incidence of overweight and obesity, many hours in screen activities and low level of physical activity. The eating habits seemed healthy, but our children's lifestyles were sedentary. To combat the high incidence of obesity it is very urgent to design a multi-level intervention aimed to modify key behaviours: physical activity, screen time and nutrition.
Cirulli, Francesca; Borgi, Marta; Berry, Alessandra; Francia, Nadia; Alleva, Enrico
There is a growing interest for the potential health benefits of human-animal interactions. Although scientific evidence on the effects is far from being consistent, companion animals are used with a large number of human subjects, ranging from children to elderly people, who benefit most from emotional support. Based on a comprehensive review of the literature, this paper examines the potential for domesticated animals, such as dogs, for providing emotional and physical opportunities to enrich the lives of many frail subjects. In particular, we focus on innovative interventions, including the potential use of dogs to improve the life of emotionally-impaired children, such as those affected by autism spectrum disorders. Overall an ever increasing research effort is needed to search for the mechanism that lie behind the human-animal bond as well as to provide standardized methodologies for a cautious and effective use of animal-assisted interventions.
Ribisl, Kurt M; Leeman, Jennifer; Glasser, Allison M
The relatively high cost of delivering many public health interventions limits their potential for broad public impact by reducing their likelihood of adoption and maintenance over time. Practitioners identify cost as the primary factor for which interventions they select to implement, but researchers rarely disseminate cost information or consider its importance when developing new interventions. A new approach is proposed whereby intervention developers assess what individuals and agencies adopting their interventions are willing to pay and then design interventions that are responsive to this price range. The ultimate goal is to develop effective and affordable interventions, called lean interventions, which are widely adopted and have greater public health impact.
Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre
Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We
Full Text Available Marginalised populations in many low- and middle-income countries experience an increasing burden of disease, in sub-Saharan Africa to a large extent due to faltering health systems and serious HIV epidemics. Also other poverty related diseases (PRDs are prevalent, especially respiratory and diarrhoeal diseases in children, malnutrition, maternal and perinatal health problems, tuberculosis and malaria. Daily, nearly 30,000 children under the age of 5 die, most from preventable causes, and 8,000 people die from HIV infections. In spite of the availability of powerful preventive and therapeutic tools for combating these PRDs, their implementation, especially in terms of equitable delivery, leaves much to be desired. The research community must address this tragic gap between knowledge and implementation. Epidemiologists have a very important role to play in conducting studies on diseases that account for the largest share of the global disease burden. A shift of focus of epidemiologic research towards intervention studies addressing health problems of major public health importance for disadvantaged population groups is needed. There is a need to generate an evidence-base for interventions that can be implemented on a large scale; this can result in increased funding of health promotion programs as well as enable rational prioritization and integration between different health interventions. This will require close and synergetic teamwork between epidemiologists and other professions across disciplines and sectors. In this way epidemiologists can contribute significantly to improve health and optimise health care delivery for marginalized populations.
Full Text Available Psychological strain in working life is gaining ever more attention. Health care workers are often under extreme emotional stress, which can become so overwhelming that they show signs of mental ill-health. This project aimed to develop a model for sustainable psychological support within a hospital clinic to prevent mental ill-health among employees. Mental strains at work and mental ill-health among clinic employees were mapped out, after which interventions for psychological support were designed in collaboration with employees. The interventions were conducted over one year and evaluated. Throughout the process the clinic received continuous feedback. Both questionnaires and interviews were used. The results of identifying mental strains and conducting interventions showed that employees experienced mental strain at work and perceived a need for support. Intervention evaluations showed that the project provided support, new insights, and an increased acceptance for long-term prevention of mental strain. Quantitative and qualitative methodologies supported the results. The conclusion was that increased legitimacy for mental strain at work and continuous feedback between clinic management and employees, as well as organizational circumstances are important factors when developing long-term intervention programs with various forms of psychological support.
Hennemann, Severin; Beutel, Manfred E; Zwerenz, Rüdiger
eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed.
Full Text Available Objective: To promote awareness of healthy lifestyles, to help decrease the risk factors that cause cardiovascular disease, obesity, diabetes, hypertension and hyperlipidemia, through Health Education (HE. Material and Methods: Between November and December 2014 in the prison of Soria, HE intervention in cardiovascular diseases was performed. Participation was offered to 160 inmates at the Prison. The intervention consisted of individual interviews with anthropometric assessment and review of medical records and three group sessions with theoretical and practical content of these diseases, as well as dietary recommendations, Mediterranean diet and exercise. Knowledge gained from surveys conducted for that purpose was evaluated. Results: A total of 33 (21% of 160. Average age 38.2 (35.2 to 41.3. Prevalence: Normal weight (BMI 18 to 24.9 18 (54.5%, overweight BMI (25.0 to 29.9 11 (33.3%, obesity (IBMI from 30 4 (12. 1%. Cardiovascular risk (CVR as ICC (waist hip ratio 10 (30% high risk, REGICOR 4 (12.1% moderate risk. Relative risk of comorbidity in 2 (6.0% had a slightly increased risk, 4 (12.1% had increased risk. Conclusions: HE interventions are necessary and effective in modifying lifestyles. The calculation of CVT should serve to implement preventive measures to reduce the factors of cardiovascular risk.
Brown, K. E.; Newby, K.; Caley, M.; Danahay, A.; Kehal, I.
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among…
Full Text Available Abstract Background Objective of the study was to assess the effects of strategies to integrate targeted priority population, health and nutrition interventions into health systems on patient health outcomes and health system effectiveness and thus to compare integrated and non-integrated health programmes. Methods Systematic review using Cochrane methodology of analysing randomised trials, controlled before-and-after and interrupted time series studies. We defined specific strategies to search PubMed, CENTRAL and the Cochrane Effective Practice and Organisation of Care Group register, considered studies published from January 1998 until September 2008, and tracked references and citations. Two reviewers independently agreed on eligibility, with an additional arbiter as needed, and extracted information on outcomes: primary (improved health, financial protection, and user satisfaction and secondary (improved population coverage, access to health services, efficiency, and quality using standardised, pre-piloted forms. Two reviewers in the final stage of selection jointly assessed quality of all selected studies using the GRADE criteria. Results Of 8,274 citations identified 12 studies met inclusion criteria. Four studies compared the benefits of Integrated Management of Childhood Illnesses in Tanzania and Bangladesh, showing improved care management and higher utilisation of health facilities at no additional cost. Eight studies focused on integrated delivery of mental health and substance abuse services in the United Kingdom and United States of America. Integrated service delivery resulted in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients, with no significant difference found overall. Quality of care, patient satisfaction, and treatment engagement were higher in integrated delivery models. Conclusions Targeted priority population health interventions we identified led to improved health
Full Text Available Mary Laurenson, Tracey Heath, Sarah GribbinUniversity of Hull, Faculty of Health and Social Care, Department of Health Professional Studies, Cottingham, Hull, United KingdomIntroduction: Communication is an intrinsic part of collaborative working but can be problematic when the complexities of professional and personal identities inhibit quality care provision. This paper investigates these complexities and recommends interventions to facilitate collaborative working.Methods: A qualitative comparative approach examined data collected from participants using purposive non-probability sampling. Perspectives were obtained from four professional groups (nurses, social workers, care managers, and police, from different organizations with different theoretical and practice frameworks, and from a fifth group (informal carers.Results: Curriculum change and leadership initiatives are required to address the complexities inhibiting collaborative working relationships. Integrating complexity theory, personality typology, and problem-based learning into the curriculum to understand behavioral actions will enable interventions to effect change and promote the centrality of those being cared for.Keywords: interprofessional education and working, complexity, communication, personality, problem-based learning
Full Text Available Currently, in the Bologna context, university teaching methods focus on the student and on a learning experience based on practical methods. Under the guidance of teachers, students in the second year of the first Environmental Health Course at the Polytechnic Institute of Beja have designed and developed the following nine community intervention projects relating to environmental health: dangerous products (mercury; habitability and geriatrics; health education and the environment; drinking water; information and communication in environmental health; efficient use of resources in public buildings; child development in outdoor spaces; and allergenic factors in housing. This pedagogical action takes place over three semesters, corresponding to the three distinct phases: design, implementation and evaluation / dissemination. To ensure the viability of the projects, each group of three students has established partnerships with various entities, such as city and parish councils, hospitals, schools, consumer cooperatives, companies dealing with hazardous waste, the Youth Institute and other commercial enterprises. Although it has not been possible to evaluate the whole project, preliminary results suggest that the planned activities have been very successful, with health benefits for the people involved, through environmental improvements or an increase in empowerment. It was also possible to achieve economic gains and contribute to the conservation of the environment. The students were able to gain skills and knowledge in a teaching model characterized by the absence of lectures in which students, assisted by teachers, take decisions and independent action, simulating a real context of professional practice. This experience suggests that, by utilizing the Bologna method, the polytechnic institutions may improve their real contribution to the health of communities.
von Thiele Schwarz, Ulrica; Augustsson, Hanna; Hasson, Henna; Stenfors-Hayes, Terese
To test the effects of integrating health protection and health promotion with a continuous improvement system (Kaizen) on proximal employee outcomes (health promotion, integration, and Kaizen) and distal outcomes (workability, productivity, self-rated health and self-rated sickness absence). Twelve units in a county hospital in Sweden were randomized to control or intervention groups using a quasiexperimental study design. All staff (approximately 500) provided self-ratings in questionnaires at baseline, and a 12- and 24-month follow-up (response rate, 79% to 87.5%). There was a significant increase in the proximal outcomes over time in the intervention group compared with the control group, and a trend toward improvement in the distal outcomes workability and productivity. Integration seems to promote staff engagement in health protection and promotion, as well as to improve their understanding of the link between work and health.
Full Text Available BACKGROUND: Health information on the Internet is ubiquitous, and its use by health consumers prevalent. Finding and understanding relevant online health information, and determining content reliability, pose real challenges for many health consumers. PURPOSE: To identify the types of interventions that have been implemented to assist health consumers to find reliable online health information, and where possible, describe and compare the types of outcomes studied. DATA SOURCES: PubMed, PsycINFO, CINAHL Plus and Cochrane Library databases; WorldCat and Scirus 'gray literature' search engines; and manual review of reference lists of selected publications. STUDY SELECTION: Publications were selected by firstly screening title, abstract, and then full text. DATA EXTRACTION: Seven publications met the inclusion criteria, and were summarized in a data extraction form. The form incorporated the PICOS (Population Intervention Comparators Outcomes and Study Design Model. Two eligible gray literature papers were also reported. DATA SYNTHESIS: Relevant data from included studies were tabulated to enable descriptive comparison. A brief critique of each study was included in the tables. This review was unable to follow systematic review methods due to the paucity of research and humanistic interventions reported. LIMITATIONS: While extensive, the gray literature search may have had limited reach in some countries. The paucity of research on this topic limits conclusions that may be drawn. CONCLUSIONS: The few eligible studies predominantly adopted a didactic approach to assisting health consumers, whereby consumers were either taught how to find credible websites, or how to use the Internet. Common types of outcomes studied include knowledge and skills pertaining to Internet use and searching for reliable health information. These outcomes were predominantly self-assessed by participants. There is potential for further research to explore other avenues for
Colaci, Daniela; Chaudhri, Simran; Vasan, Ashwin
The wide availability and relative simplicity of mobile phones make them a promising instrument for delivering a variety of health-related interventions. Mobile health (mHealth) interventions have been tested in a variety of health delivery areas, but research has been restricted to pilot and small studies with limited generalizability. The aim of this review was to explore the current evidence on the use of mHealth for maternal health interventions in low- and low middle-income countries. Peer-reviewed papers were identified from Medline/PubMed, Web of Science, and Cochrane Library via a combination of search terms. Quantitative or mixed-methods papers published in the English language between January 2000 and July 2015 were included. Three hundred and seventy papers were found in the literature search. We assessed the full text of 57 studies, and included 19 in the review. Study designs included were 5 randomized controlled trials, 9 before and after comparisons, 1 study with endline assessment only, 3 postintervention assessments, and 1 cohort study. Quality assessment elucidated 9 low-quality, 5 moderate, and 5 high studies. Five studies supported the use of mobile phones for data collection, 3 for appointment reminders, and 4 for both appointment reminders and health promotion. Six studies supported the use of mHealth for provider-to-provider communication and 1 for clinical management. Studies demonstrated promise for the use of mHealth in maternal health; however, much of the evidence came from low- and moderate-quality studies. Pilot and small programs require more rigorous testing before allocating resources to scaling up this technology. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Durks, Desire; Fernandez-Llimos, Fernando; Hossain, Lutfun N.; Franco-Trigo, Lucia; Benrimoj, Shalom I.; Sabater-Hernández, Daniel
Background: Intervention Mapping is a planning protocol for developing behavior change interventions, the first three steps of which are intended to establish the foundations and rationales of such interventions. Aim: This systematic review aimed to identify programs that used Intervention Mapping to plan changes in health care professional…
Hays, Krystal; Aranda, Maria P.
Faith-based interventions have emerged culturally sensitive way to address mental health issues among African Americans. This systematic review explores the scope and efficacy of faith-based mental health intervention outcomes among African Americans. Extracted data included the study population, setting, study design, intervention, adaptations,…
Buijs, P.; Dijk, F. van
The TNO review Essential interventions on Workers’ Health by Primary Health Care shows those interventions in primary, secondary and tertiary prevention are necessary and feasible but not yet satisfactorily evidence-based. Necessary, because primary or community health care covers about 80% of the w
Serrano, Elena; Larrañaga, Isabel; Morteruel, Maite; Baixas de Ros, María Dolores; Basterrechea, Mikel; Martinez, Dolores; Aldasoro, Elena; Bacigalupe, Amaia
An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner.
Lysdahl, Kristin Bakke
Full Text Available Complexity entails methodological challenges in assessing health care interventions. In order to address these challenges, a series of characteristics of complexity have been identified in the Health Technology Assessment (HTA literature. These characteristics are primarily identified and developed to facilitate effectiveness, safety, and cost-effectiveness analysis. However, ethics is also a constitutive part of HTA, and it is not given that the conceptions of complexity that appears relevant for effectiveness, safety, and cost-effectiveness analysis are also relevant and directly applicable for ethical analysis in HTA. The objective of this article is therefore to identify and elaborate a set of key characteristics of complex health care interventions relevant for addressing ethical aspects in HTA. We start by investigating the relevance of the characteristics of complex interventions, as defined in the HTA literature. Most aspects of complexity found to be important when assessing effectiveness, safety, and efficiency turn out also to be relevant when assessing ethical issues of a given health technology. However, the importance and relevance of the complexity characteristics may differ when addressing ethical issues rather than effectiveness. Moreover, the moral challenges of a health care intervention may themselves contribute to the complexity. After identifying and analysing existing conceptions of complexity, we synthesise a set of five key characteristics of complexity for addressing ethical aspects in HTA: 1 multiple and changing perspectives, 2 indeterminate phenomena, 3 uncertain causality, 4 unpredictable outcome, and 5 ethical complexity. This may serve as an analytic tool in addressing ethical issues in HTA of complex interventions.
Keller, Linda Olson; Strohschein, Susan; Lia-Hoagberg, Betty; Schaffer, Marjorie A
The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing. The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/public health nursing practice, education, and administration. The two articles provide a foundation and vision for population-based public health nursing practice and direction for improving population health.
Full Text Available Insufficient physical activity and excessive sedentary behavior elevate health risk. Mobile applications (apps provide one mode for delivering interventions to modify these behaviors and reduce health risk. The purpose of this study was to characterize the need for and acceptability of health behavior interventions among rural adults and evaluate the interest in and the value of app-based interventions in this population. Central Pennsylvania adults with smartphones (N = 258 completed a brief web survey in October–November 2012. Most adults report one or both inactivity-related behavioral risk factors, would use a free app to modify those risk behaviors, and would pay a small amount for that app. Low-cost, efficacious apps to increase physical activity or reduce sedentary behavior should be promoted in public health practice. User experience should be at the forefront of this process to increase value and minimize burden in the service of long-term engagement, behavior change, and health risk reduction.
Titilayo, Odetola D; Okanlawon, F A
Maternal mortality is high in Nigeria especially in rural areas due to knowledge deficit about expected care and labour process, socio-cultural belief, health care workers' attitude, physical and financial barriers to quality health care access. Mobile health (m-health) technology which is the use of mobile telecommunication devices in health care delivery reduces costs, improves care access, removes time and distance barriers and facilitates patient-provider communications needed to make appropriate health decisions. Previous studies empowering nurses with m-health knowledge resulted in improved uptake of health care services. There exists a literature dearth about knowledge and perception of nurses in Nigeria. This study became expedient to empower nurses working at the grassroots with the knowledge of m-health and assess the impact of educational training on their perception of its effectiveness. This quasi-experimental study carried out in four randomly selected LGAs across Oyo South Senatorial district involved participants at experimental (20 nurses) and control levels (27 nurses). A validated 25-item questionnaire explored nurses' perception, knowledge and perceived effectiveness of m-health in improving uptake of maternal health services in Nigeria among both groups before intervention. Intervention group nurses had a training equipping them with knowledge of m-health nursing intervention (MNHI) for a period of one week. Their perception, knowledge and perceived effectiveness were re-assessed at three-months and six-months after MHNI. Data were analyzed using Chi-square and repeated measures ANOVA at 5% significance level. In the EG, knowledge score significantly increased from 21.9±4.5 at baseline to 23.6±4.6 and 23.2±5.6 at three-month and six-month respectively while there was no significant difference in knowledge score among CG over the study period. A very significant difference was shown in the knowledge and perception of mobile health and its
Schelvis, R.M; Oude Hengel, K.M.; Burdorf, A.; Blatter, B.M.; Strijk, J.E.; Beek, A.J. van
Occupational health researchers regularly conduct evaluative intervention research for which a randomized controlled trial (RCT) may not be the most appropriate design (eg, effects of policy measures, organizational interventions on work schedules). This article demonstrates the appropriateness of a
Kosse RC; Bouvy ML; de Vries TW; Kaptein AA; Geers HC; van Dijk L; Koster ES
.... The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. Intervention...
Head, Katharine J; Noar, Seth M; Iannarino, Nicholas T; Grant Harrington, Nancy
This meta-analysis investigated the efficacy of text messaging-based health promotion interventions. Nineteen randomized controlled trials conducted in 13 countries met inclusion criteria and were coded on a variety of participant, intervention, and methodological moderators. Meta-analytic procedures were used to compute and aggregate effect sizes. The overall weighted mean effect size representing the impact of these interventions on health outcomes was d = .329 (95% CI = .274, .385; p text-only interventions and interventions that included texting plus other components. Interventions that used an individualized or decreasing frequency of messages over the course of the intervention were more successful than interventions that used a fixed message frequency. We discuss implications of these results for health promotion interventions that use text messaging.
Geraghty, Adam W A; Torres, Leandro D; Leykin, Yan; Pérez-Stable, Eliseo J; Muñoz, Ricardo F
Worldwide automated Internet health interventions have the potential to greatly reduce health disparities. High attrition from automated Internet interventions is ubiquitous, and presents a challenge in the evaluation of their effectiveness. Our objective was to evaluate variables hypothesized to be related to attrition, by modeling predictors of attrition in a secondary data analysis of two cohorts of an international, dual language (English and Spanish) Internet smoking cessation intervention. The two cohorts were identical except for the approach to follow-up (FU): one cohort employed only fully automated FU (n = 16 430), while the other cohort also used 'live' contact conditional upon initial non-response (n = 1000). Attrition rates were 48.1 and 10.8% for the automated FU and live FU cohorts, respectively. Significant attrition predictors in the automated FU cohort included higher levels of nicotine dependency, lower education, lower quitting confidence and receiving more contact emails. Participants' younger age was the sole predictor of attrition in the live FU cohort. While research on large-scale deployment of Internet interventions is at an early stage, this study demonstrates that differences in attrition from trials on this scale are (i) systematic and predictable and (ii) can largely be eliminated by live FU efforts. In fully automated trials, targeting the predictors we identify may reduce attrition, a necessary precursor to effective behavioral Internet interventions that can be accessed globally.
Gaitonde, Rakhal; Oxman, Andrew D; Okebukola, Peter O; Rada, Gabriel
Background Corruption is the abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organisation or others close to oneself; where the benefits may be financial, material or non-material. It is wide-spread in the health sector and represents a major problem. Objectives Our primary objective was to systematically summarise empirical evidence of the effects of strategies to reduce corruption in the health sector. Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence. Search methods We searched 14 electronic databases up to January 2014, including: CENTRAL; MEDLINE; EMBASE; sociological, economic, political and other health databases; Human Resources Abstracts up to November 2010; Euroethics up to August 2015; and PubMed alerts from January 2014 to June 2016. We searched another 23 websites and online databases for grey literature up to August 2015, including the World Bank, the International Monetary Fund, the U4 Anti-Corruption Resource Centre, Transparency International, healthcare anti-fraud association websites and trial registries. We conducted citation searches in Science Citation Index and Google Scholar, and searched PubMed for related articles up to August 2015. We contacted corruption researchers in December 2015, and screened reference lists of articles up to May 2016. Selection criteria For the primary analysis, we included randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies that evaluated the effects of an intervention to reduce corruption in the health sector. For the secondary analysis, we included case studies that clearly described an intervention to reduce corruption in the health sector, addressed either our primary or secondary objective, and stated the methods that the study authors used to collect and
Nybo, Lars; Sundstrup, Emil; Jakobsen, Markus D
The purpose of this study was to determine the effectiveness of brief intense interval training as exercise intervention for promoting health and to evaluate potential benefits about common interventions, that is, prolonged exercise and strength training.......The purpose of this study was to determine the effectiveness of brief intense interval training as exercise intervention for promoting health and to evaluate potential benefits about common interventions, that is, prolonged exercise and strength training....
Zusevics, Kaija L.; Johnson, Sheri
Hope is positively correlated with educational attainment and health. Interventions based on project-based learning (PBL) may increase youth hope. This study examined how a PBL intervention affected hope among urban students of color. Students in health classes were invited to participate. A PBL health class was implemented in four classrooms. The…
Tufts, Kimberly Adams; Johnson, Kaprea F; Shepherd, Jewel Goodman; Lee, Ju-Young; Bait Ajzoon, Muna S; Mahan, Lauren B; Kim, Miyong T
The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.
Henschel, S; Goodman, P; Atkinson, RW; Zeka, A; Analitis, A; Katsouyanni, K; Pascal, M.; Chanel, O; Medina, S; Forsberg, B
Intervention studies play an important role in supporting and complementing scientific validation of results of epidemiological non-intervention studies linking air pollution and health. In this paper a collection of existing published intervention studies is reviewed with the aim to give a summarized overview spanning a variety of approaches regarding the type of the intervention and findings with the main focus on studies that assessed interventions that improved air quality and the associa...
Caldwell, Deborah M; Welton, Nicky J
Clinical and statistical heterogeneity are commonplace in meta-analysis of mental health interventions. One possible source of this heterogeneity is the complexity of the intervention being evaluated. Complexity may relate to the intervention, or to the way in which it is implemented; however, the most common interpretation of a complex intervention is one which has multiple, potentially interacting components. In this article we outline different analytical strategies suggested for incorporating intervention complexity in a meta-analysis.
Payne, Hannah E; Lister, Cameron; West, Josh; Bernhardt, Jay M.
Background Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. Objective The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior in...
Payne, Hannah E.; Lister, Cameron; West, Josh; Bernhardt, Jay M.
Background Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. Objective The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior in...
Keller, Linda Olson; Strohschein, Susan; Schaffer, Marjorie A; Lia-Hoagberg, Betty
The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.
Yardley, Lucy; Morrison, Leanne; Bradbury, Katherine; Muller, Ingrid
This paper describes an approach that we have evolved for developing successful digital interventions to help people manage their health or illness. We refer to this as the "person-based" approach to highlight the focus on understanding and accommodating the perspectives of the people who will use the intervention. While all intervention designers seek to elicit and incorporate the views of target users in a variety of ways, the person-based approach offers a distinctive and systematic means of addressing the user experience of intended behavior change techniques in particular and can enhance the use of theory-based and evidence-based approaches to intervention development. There are two key elements to the person-based approach. The first is a developmental process involving qualitative research with a wide range of people from the target user populations, carried out at every stage of intervention development, from planning to feasibility testing and implementation. This process goes beyond assessing acceptability, usability, and satisfaction, allowing the intervention designers to build a deep understanding of the psychosocial context of users and their views of the behavioral elements of the intervention. Insights from this process can be used to anticipate and interpret intervention usage and outcomes, and most importantly to modify the intervention to make it more persuasive, feasible, and relevant to users. The second element of the person-based approach is to identify "guiding principles" that can inspire and inform the intervention development by highlighting the distinctive ways that the intervention will address key context-specific behavioral issues. This paper describes how to implement the person-based approach, illustrating the process with examples of the insights gained from our experience of carrying out over a thousand interviews with users, while developing public health and illness management interventions that have proven effective in trials
Milani, Richard V; Lavie, Carl J
Cardiac rehabilitation and exercise training (CRET) provides health risk intervention in cardiac patients over a relatively short time frame. Worksite health programs offer a unique opportunity for health intervention, but these programs remain underused due to concerns over recouping the costs. We evaluated the clinical efficacy and cost-effectiveness of a 6-month worksite health intervention using staff from CRET. Employees (n = 308) and spouses (n = 31) of a single employer were randomized to active intervention (n = 185) consisting of worksite health education, nutritional counseling, smoking cessation counseling, physical activity promotion, selected physician referral, and other health counseling versus usual care (n = 154). Health risk status was assessed at baseline and after the 6-month intervention program, and total medical claim costs were obtained in all participants during the year before and the year after intervention. Significant improvements were demonstrated in quality-of-life scores (+10%, p = 0.001), behavioral symptoms (depression -33%, anxiety -32%, somatization -33%, and hostility -47%, all p values health habits (-60%, p = 0.0001), and total health risk (-25%, p = 0.0001). Of employees categorized as high risk at baseline, 57% were converted to low-risk status. Average employee annual claim costs decreased 48% (p = 0.002) for the 12 months after the intervention, whereas control employees' costs remained unchanged (-16%, p = NS), thus creating a sixfold return on investment. In conclusion, worksite health intervention using CRET staff decreased total health risk and markedly decreased medical claim costs within 12 months.
Ariel Soares Teles
Full Text Available Current mobile devices allow the execution of sophisticated applications with the capacity for identifying the user situation, which can be helpful in treatments of mental disorders. In this paper, we present SituMan, a solution that provides situation awareness to MoodBuster, an ecological momentary assessment and intervention mobile application used to request self-assessments from patients in depression treatments. SituMan has a fuzzy inference engine to identify patient situations using context data gathered from the sensors embedded in mobile devices. Situations are specified jointly by the patient and mental health professional, and they can represent the patient’s daily routine (e.g., “studying”, “at work”, “working out”. MoodBuster requests mental status self-assessments from patients at adequate moments using situation awareness. In addition, SituMan saves and displays patient situations in a summary, delivering them for consultation by mental health professionals. A first experimental evaluation was performed to assess the user satisfaction with the approaches to define and identify situations. This experiment showed that SituMan was well evaluated in both criteria. A second experiment was performed to assess the accuracy of the fuzzy engine to infer situations. Results from the second experiment showed that the fuzzy inference engine has a good accuracy to identify situations.
Eckhoff, Randall Peter; Kizakevich, Paul Nicholas; Bakalov, Vesselina; Zhang, Yuying; Bryant, Stephanie Patrice; Hobbs, Maria Ann
Personal Health Intervention Toolkit (PHIT) is an advanced cross-platform software framework targeted at personal self-help research on mobile devices. Following the subjective and objective measurement, assessment, and plan methodology for health assessment and intervention recommendations, the PHIT platform lets researchers quickly build mobile health research Android and iOS apps. They can (1) create complex data-collection instruments using a simple extensible markup language (XML) schema; (2) use Bluetooth wireless sensors; (3) create targeted self-help interventions based on collected data via XML-coded logic; (4) facilitate cross-study reuse from the library of existing instruments and interventions such as stress, anxiety, sleep quality, and substance abuse; and (5) monitor longitudinal intervention studies via daily upload to a Web-based dashboard portal. For physiological data, Bluetooth sensors collect real-time data with on-device processing. For example, using the BinarHeartSensor, the PHIT platform processes the heart rate data into heart rate variability measures, and plots these data as time-series waveforms. Subjective data instruments are user data-entry screens, comprising a series of forms with validation and processing logic. The PHIT instrument library consists of over 70 reusable instruments for various domains including cognitive, environmental, psychiatric, psychosocial, and substance abuse. Many are standardized instruments, such as the Alcohol Use Disorder Identification Test, Patient Health Questionnaire-8, and Post-Traumatic Stress Disorder Checklist. Autonomous instruments such as battery and global positioning system location support continuous background data collection. All data are acquired using a schedule appropriate to the app's deployment. The PHIT intelligent virtual advisor (iVA) is an expert system logic layer, which analyzes the data in real time on the device. This data analysis results in a tailored app of interventions
Personal Health Intervention Toolkit (PHIT) is an advanced cross-platform software framework targeted at personal self-help research on mobile devices. Following the subjective and objective measurement, assessment, and plan methodology for health assessment and intervention recommendations, the PHIT platform lets researchers quickly build mobile health research Android and iOS apps. They can (1) create complex data-collection instruments using a simple extensible markup language (XML) schema; (2) use Bluetooth wireless sensors; (3) create targeted self-help interventions based on collected data via XML-coded logic; (4) facilitate cross-study reuse from the library of existing instruments and interventions such as stress, anxiety, sleep quality, and substance abuse; and (5) monitor longitudinal intervention studies via daily upload to a Web-based dashboard portal. For physiological data, Bluetooth sensors collect real-time data with on-device processing. For example, using the BinarHeartSensor, the PHIT platform processes the heart rate data into heart rate variability measures, and plots these data as time-series waveforms. Subjective data instruments are user data-entry screens, comprising a series of forms with validation and processing logic. The PHIT instrument library consists of over 70 reusable instruments for various domains including cognitive, environmental, psychiatric, psychosocial, and substance abuse. Many are standardized instruments, such as the Alcohol Use Disorder Identification Test, Patient Health Questionnaire-8, and Post-Traumatic Stress Disorder Checklist. Autonomous instruments such as battery and global positioning system location support continuous background data collection. All data are acquired using a schedule appropriate to the app’s deployment. The PHIT intelligent virtual advisor (iVA) is an expert system logic layer, which analyzes the data in real time on the device. This data analysis results in a tailored app of interventions
Courtney, Karen L
This workshop will explore the challenges in translating existing health interventions to new e-health delivery mechanisms. Challenges to be covered include: identifying and retaining the active ingredients of an intervention; and measurement and validation of newly translated interventions. This session will appeal to health researchers and e-health developers. Participants will have an opportunity to work on cases in small groups to foster in-depth discussion and sharing. Following this session, participants will be able to articulate critical issues to be addressed in translating interventions to a new delivery mechanism and share potential solutions to various translation challenges.
Donna M. Kazemi
Conclusions: Intervention programs to reduce drinking by college students need to address developmental dynamics of freshmen students, including gender, psychosocial factors, personality, and lifestyle health-promoting behaviors.
Forsman, Anna K; Nordmyr, Johanna; Wahlbeck, Kristian
The aim of this review was to assess the effectiveness of psychosocial interventions for the promotion of mental health and prevention of depression among older people. A systematic review of prospective controlled trials was conducted including 69 studies. The studies were divided into physical exercise, skill training, reminiscence, social activities, group support and multicomponent interventions. Data from 44 trials contributed to a meta-analysis of effectiveness. Overall, psychosocial interventions had a positive effect on quality of life and positive mental health. The pooled interventions also had a statistically significant effect on reduction in depressive symptoms. Social activities significantly improved positive mental health, life satisfaction and quality of life and reduced depressive symptoms. Based on the results of this study, duration of interventions is of importance, since interventions lasting for >3 months exhibited more positive effects compared with shorter interventions. Meaningful social activities, tailored to the older individual's abilities and preferences should be considered in aiming to improve mental health among older people.
Cabassa, Leopoldo J; Camacho, David; Vélez-Grau, Carolina M; Stefancic, Ana
Health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals can help improve the physical health of people with serious mental illness (SMI). Yet, the quality of the studies examining these health interventions and their impact on health outcomes remains unclear. To address this gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. We rated the methodological quality of studies, summarized intervention strategies and health outcomes, and evaluated the inclusion of racial and ethnic minorities in these studies. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to conduct our systematic literature review. Electronic bibliographic databases and manual searches were used to locate articles that were published in English in peer-reviewed journals between 1990 and 2015, described peer-based health interventions for people with SMI, and evaluated the impact of the interventions on physical health outcomes. Two independent reviewers used a standardized instrument to rate studies' methodological quality, abstracted study characteristics, and evaluated the effects of the interventions on different health outcomes. Eighteen articles were reviewed. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Mixed and limited intervention effects were reported for most health outcomes. The most promising interventions were self-management and peer-navigator interventions. Efforts to strengthen the evidence of peer-based interventions require a research agenda that focuses on establishing the efficacy and effectiveness of these interventions across different populations and settings. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Full Text Available Lot quality assurance sampling (LQAS is used to evaluate health services. Subunits of a population (lots are accepted or rejected according to the number of failures in a random sample (N of a given lot. If failures are greater than decision value (d, we reject the lot and recommend corrective actions in the lot (i.e. intervention area; if they are equal to or less than d, we accept it. We used LQAS to monitor coverage during the last 3 days of a meningitis vaccination campaign in Niger. We selected one health area (lot per day reporting the lowest administrative coverage in the previous 2 days. In the sampling plan we considered: N to be small enough to allow us to evaluate one lot per day, deciding to sample 16 individuals from the selected villages of each health area, using probability proportionate to population size; thresholds and d to vary according to administrative coverage reported; α≤5% (meaning that, if we would have conducted the survey 100 times, we would have accepted the lot up to five times when real coverage was at an unacceptable level and β≤20% (meaning that we would have rejected the lot up to 20 times, when real coverage was equal or above the satisfactory level. We classified all three lots as with the acceptable coverage. LQAS appeared to be a rapid, simple, and statistically sound method for in-process coverage assessment. We encourage colleagues in the field to consider using LQAS in complement with other monitoring techniques such as house-to-house monitoring.
Pugh, Gemma; Gravestock, Helen L; Hough, Rachael E; King, Wendy M; Wardle, Jane; Fisher, Abigail
It is important that teenage and young adult (TYA) cancer survivors adopt a healthy lifestyle, since health vulnerabilities associated with their diagnosis and treatment may be exacerbated by poor health behaviors. This review aims to synthesize the current literature on health behavior change interventions created specifically for TYA-aged cancer survivors. MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for studies investigating interventions targeting one or more health behaviors, including: physical activity, diet, smoking cessation, and alcohol consumption. Studies were eligible for review if the study population were defined as TYA cancer survivors and the mean age of the sample was younger than 30 years of age. Twelve studies were identified, of which nine were randomized controlled trials. Physical activity was the most commonly targeted health behavior. Six of the 12 interventions included within this review were successful in changing health behavior. Due to the heterogeneity of intervention characteristics, the relationship between intervention efficacy or outcome and intervention content, delivery mode, or theoretical framework was not discernible. Nevertheless, trends emerged relating to the delivery and content of health behavior interventions designed specifically for TYA cancer survivors. More research is required to identify the most effective means of promoting health behavior change among the TYA cancer survivor population. Specifically, future research should focus on providing evidence of the efficiency and feasibility of interventions that use online technologies to facilitate remote intervention delivery and peer support.
Bouzid, Maha; Hooper, Lee; Hunter, Paul R
Climate change is likely to be one of the most important threats to public health in the coming years. Yet despite the large number of papers considering the health impact of climate change, few have considered what public health interventions may be of most value in reducing the disease burden. We aimed to evaluate the effectiveness of public health interventions to reduce the disease burden of high priority climate sensitive diseases. For each disease, we performed a systematic search with no restriction on date or language of publication on Medline, Web of Knowledge, Cochrane CENTRAL and SCOPUS up to December 2010 to identify systematic reviews of public health interventions. We retrieved some 3176 records of which 85 full papers were assessed and 33 included in the review. The included papers investigated the effect of public health interventions on various outcome measures. All interventions were GRADE assessed to determine the strength of evidence. In addition we developed a systematic review quality score. The interventions included environmental interventions to control vectors, chemoprophylaxis, immunization, household and community water treatment, greening cities and community advice. For most reviews, GRADE showed low quality of evidence because of poor study design and high heterogeneity. Also for some key areas such as floods, droughts and other weather extremes, there are no adequate systematic reviews of potential public health interventions. In conclusion, we found the evidence base to be mostly weak for environmental interventions that could have the most value in a warmer world. Nevertheless, such interventions should not be dismissed. Future research on public health interventions for climate change adaptation needs to be concerned about quality in study design and should address the gap for floods, droughts and other extreme weather events that pose a risk to health.
Conclusions: This exhaustive review found that well-implemented interventions can promote adolescent health. These findings are consistent with recent reviews. Implications for practice, public health, and research are discussed.
Tufano, James T; Karras, Bryant T
Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes. This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer-assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model. Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.
Kohrt, Brandon A; Jordans, Mark J D; Koirala, Suraj; Worthman, Carol M
The anthropological study of human biology, health, and child development provides a model with potential to address the gap in population-wide mental health interventions. Four key concepts from human biology can inform public mental health interventions: life history theory and tradeoffs, redundancy and plurality of pathways, cascades and multiplier effects in biological systems, and proximate feedback systems. A public mental health intervention for former child soldiers in Nepal is used to illustrate the role of these concepts in intervention design and evaluation. Future directions and recommendations for applying human biology theory in pursuit of public mental health interventions are discussed. © 2014 Wiley Periodicals, Inc.
Golden, Shelley D.; Moracco, Kathryn E.; Feld, Ashley L.; Turner, Kea L.; DeFrank, Jessica T.; Brewer, Noel T.
Background: Vaccination programs in school health centers (SHCs) may improve adolescent vaccine coverage. We conducted a process evaluation of an intervention to increase SHC-located vaccination to better understand the feasibility and challenges of such interventions. Method: Four SHCs participated in an intervention to increase provision of…
Kloek, G.C.; Lenthe, van F.J.; Nierop, van P.W.M.; Koelen, Maria A.; Mackenbach, J.P.
This study investigates the impact of a 2-year community intervention on health-related behaviour among adults aged 18-65 years living in deprived neighbourhoods in Eindhoven, The Netherlands. The intervention is evaluated in a community intervention trial with a quasi-experimental design in a longi
Linn, A.J.; Vervloet, M.; Dijk, L. van; Smit, E.G.; Weert, J.C.M. van
Background: Since medication nonadherence is considered to be an important health risk, numerous interventions to improve adherence have been developed. During the past decade, the use of Internet-based interventions to improve medication adherence has increased rapidly. Internet interventions have
Kim, Su Hyun; Lee, Anna
Low health literacy is a potential barrier to self-management among patients with diabetes. A variety of strategies for low health literacy have been proposed for diabetes self-management interventions, but interventions accommodating low health literacy have been heterogeneous in terms of content and have produced mixed results. To systematically review health-literacy-sensitive diabetes management interventions, with a focus on identifying strategies for accommodating patients with low health literacy, and to examine the efficacy of these interventions to improve health outcomes. PubMed, CINAHL, and EMBASE were searched for intervention studies published between January 2000 and January 2015. Two authors separately identified full-texts according to the inclusion criteria and assessed study quality using the quantitative components of the Mixed Methods Appraisal Tool. The final list of studies to be analyzed was made through discussion. The meta-analysis was conducted using a random effects model. Thirteen studies were selected from the 490 studies found in our initial search. We identified a range of strategies for accommodating those with low health literacy in diabetes self-management interventions, which encompassed four domains: written communication, spoken communication, empowerment, and language/cultural consideration. Using at least one of the spoken communication strategies led to positive cognitive/psychological, self-care, and health outcomes. We found that, overall, health-literacy-sensitive diabetes management interventions were effective in reducing HbA1C level in the meta-analysis. Healthcare providers should consider active implementation of strategies for accommodating people with low health literacy in diabetes self-management interventions. The routine use of spoken communication strategies would be necessary to achieve the best health outcomes in diabetes self-management interventions. More research is needed to determine the individual
Ntiri, Daphne W.; Stewart, Merry
This study evaluated the effect of a transformative learning (TL) intervention on functional health literacy and diabetes knowledge in older African Americans. Twenty participants from senior community centers completed a six-session intervention. The short-form Test of Functional Health Literacy in Adults (s-TOFHLA), Literacy Assessment for…
Rash, Elizabeth M.
Brief interventions based on motivational interviewing (MI) are emerging as effective strategies for behavior change in college students. However, implementation of MI-based brief interventions may be challenging in the college health environment, and their practicality is controversial. The author explored college health clinicians' perspectives…
Davis, Cathy; Martin, Graham; Kosky, Robert; O'Hanlon, Anne
This literature review was undertaken as part of the National Mental Health Strategy on the development and maintenance of a national early intervention network for mental health in young people. Its purpose is to facilitate the development of innovative early intervention services across Australia by developing and maintaining a national network…
Panasewicz, Anna; Pedersen, Susanne S.; Veenhuis, Stefanie J G;
Long-term health-related quality of life (HRQOL) in the elderly after percutaneous coronary intervention (PCI) is unknown. We 1) compared HRQOL of elderly (≥70 years) with younger patients (......Long-term health-related quality of life (HRQOL) in the elderly after percutaneous coronary intervention (PCI) is unknown. We 1) compared HRQOL of elderly (≥70 years) with younger patients (...
Sperber, Nina R.; Bosworth, Hayden B.; Coffman, Cynthia J.; Lindquist, Jennifer H.; Oddone, Eugene Z.; Weinberger, Morris; Allen, Kelli D.
We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain…
Full Text Available Abstract Background Despite India's recent economic growth, health and human development indicators of Scheduled Tribes (ST or Adivasi (India's indigenous populations lag behind national averages. The aim of this review was to identify the public health interventions or components of these interventions that are effective in reducing morbidity or mortality rates and reducing risks of ill health among ST populations in India, in order to inform policy and to identify important research gaps. Methods We systematically searched and assessed peer-reviewed literature on evaluations or intervention studies of a population health intervention undertaken with an ST population or in a tribal area, with a population health outcome(s, and involving primary data collection. Results The evidence compiled in this review revealed three issues that promote effective public health interventions with STs: (1 to develop and implement interventions that are low-cost, give rapid results and can be easily administered, (2: a multi-pronged approach, and (3: involve ST populations in the intervention. Conclusion While there is a growing body of knowledge on the health needs of STs, there is a paucity of data on how we can address these needs. We provide suggestions on how to undertake future population health intervention research with ST populations and offer priority research avenues that will help to address our knowledge gap in this area.
Eisenstein, Eric L.; Anstrom, Kevin J.; Macri, Jennifer M.; Crosslin, David R.; Johnson, Frederick S.; Kawamoto, Kensaku; Lobach, David F.
This study describes a framework for conducting economic analyses for health information technology (HIT) interventions, in the context of three interventions that are currently being implemented in a community-based health network caring for 17,779 Medicaid beneficiaries in Durham County, North Carolina. We show that if the HIT interventions were to redirect only 10% of low-severity emergency room encounters to outpatient care, it will result in $12,523 of monthly savings. PMID:16779235
Gagnon, Marie-Pierre; Beogo, Idrissa; Buyl, Ronald
e-Health interventions could contribute to healthy aging (HA) but their effectiveness has not been synthesised. This study aims to systematically review the effectiveness of e-health interventions for supporting HA. We will perform standardized searches to identify experimental and quasi-experimental studies evaluating the effectiveness of e-health interventions for HA. Outcomes of interest are: wellbeing, quality of life, activities of daily living, leisure activities, knowledge, evaluation of care, social support, skill acquisition and healthy behaviours. We will also consider adverse effects such as social isolation, anxiety, and burden on informal caregivers. Two reviewers will independently assess studies for inclusion and extract data using a standardised tool. We will calculate effect sizes related to e-health interventions. If not possible, we will present the findings in a narrative form. This systematic review will provide unique knowledge on the effectiveness of e-health interventions for supporting HA.
Quinlan, Elizabeth; Robertson, Susan; Miller, Natasha; Robertson-Boersma, Danielle
The problem of staff-to-staff bullying and its consequences in the health care sector has given rise to urgent knowledge needs among health care employers, union representatives, and professional associations. The purpose of this scoping review is to increase the uptake and application of synthesized research results of interventions designed to address bullying among coworkers within health care workplaces. The scoping review's methodology uses an adapted version of the Arksey and O'Malley framework to locate and review empirical studies involving interventions designed to address bullying in health care workplaces. The findings of the review reveal eight articles from three countries discussing interventions that included educative programming, bullying champions/advocates, and zero-tolerance policies. The reported evaluations extend beyond bullying to include organizational culture, trust in management, retention rates, and psychosocial health. The most promising reported outcomes are from participatory interventions. The results of the review make a compelling case for bullying interventions based on participatory principles.
Welch, V; Petkovic, J; Pardo Pardo, J; Rader, T; Tugwell, P
Social media use has been increasing in public health and health promotion because it can remove geographic and physical access barriers. However, these interventions also have the potential to increase health inequities for people who do not have access to or do not use social media. In this paper, we aim to assess the effects of interactive social media interventions on health outcomes, behaviour change and health equity. We conducted a rapid response overview of systematic reviews. We used a sensitive search strategy to identify systematic reviews and included those that focussed on interventions allowing two-way interaction such as discussion forums, social networks (e.g. Facebook and Twitter), blogging, applications linked to online communities and media sharing. Eleven systematic reviews met our inclusion criteria. Most interventions addressed by the reviews included online discussion boards or similar strategies, either as stand-alone interventions or in combination with other interventions. Seven reviews reported mixed effects on health outcomes and healthy behaviours. We did not find disaggregated analyses across characteristics associated with disadvantage, such as lower socioeconomic status or age. However, some targeted studies reported that social media interventions were effective in specific populations in terms of age, socioeconomic status, ethnicities and place of residence. Four reviews reported qualitative benefits such as satisfaction, finding information and improved social support. Social media interventions were effective in certain populations at risk for disadvantage (youth, older adults, low socioeconomic status, rural), which indicates that these interventions may be effective for promoting health equity. However, confirmation of effectiveness would require further study. Several reviews raised the issue of acceptability of social media interventions. Only four studies reported on the level of intervention use and all of these reported
Pfefferbaum, Betty; Newman, Elana; Nelson, Summer D
The purpose of this review is to describe interventions used with children who are exposed to disasters and terrorism and to present information about the potential benefits of these interventions. A literature search conducted in January 2013 using relevant databases and literature known to the authors that was not generated by the search yielded a total of 85 studies appropriate for review. Intervention approaches used with children exposed to disasters and terrorism included preparedness interventions, psychological first aid, psychological debriefing, psychoeducation, cognitive behavioral techniques, exposure and narrative techniques, eye movement desensitization and reprocessing, and traumatic grief interventions. The investigation of these interventions is complex, and studies varied in methodological rigor (e.g., sample size, the use of control groups, outcomes measured). Given the limitations in the currently available empirical information, this review integrates the literature, draws tentative conclusions about the current state of knowledge, and suggests future directions for study.
Durks, Desire; Fernandez-Llimos, Fernando; Hossain, Lutfun N; Franco-Trigo, Lucia; Benrimoj, Shalom I; Sabater-Hernández, Daniel
Intervention Mapping is a planning protocol for developing behavior change interventions, the first three steps of which are intended to establish the foundations and rationales of such interventions. This systematic review aimed to identify programs that used Intervention Mapping to plan changes in health care professional practice. Specifically, it provides an analysis of the information provided by the programs in the first three steps of the protocol to determine their foundations and rationales of change. A literature search was undertaken in PubMed, Scopus, SciELO, and DOAJ using "Intervention Mapping" as keyword. Key information was gathered, including theories used, determinants of practice, research methodologies, theory-based methods, and practical applications. Seventeen programs aimed at changing a range of health care practices were included. The social cognitive theory and the theory of planned behavior were the most frequently used frameworks in driving change within health care practices. Programs used a large variety of research methodologies to identify determinants of practice. Specific theory-based methods (e.g., modelling and active learning) and practical applications (e.g., health care professional training and facilitation) were reported to inform the development of practice change interventions and programs. In practice, Intervention Mapping delineates a three-step systematic, theory- and evidence-driven process for establishing the theoretical foundations and rationales underpinning change in health care professional practice. The use of Intervention Mapping can provide health care planners with useful guidelines for the theoretical development of practice change interventions and programs.
Lock, C A; Kaner, E F
Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group.
Gold, Judy; Pedrana, Alisa E; Stoove, Mark A; Chang, Shanton; Howard, Steve; Asselin, Jason; Ilic, Olivia; Batrouney, Colin; Hellard, Margaret E
Online social networking sites offer a novel setting for the delivery of health promotion interventions due to their potential to reach a large population and the possibility for two-way engagement. However, few have attempted to host interventions on these sites, or to use the range of interactive functions available to enhance the delivery of health-related messages. This paper presents lessons learnt from "The FaceSpace Project", a sexual health promotion intervention using social networking sites targeting two key at-risk groups. Based on our experience, we make recommendations for developing and implementing health promotion interventions on these sites. Elements crucial for developing interventions include establishing a multidisciplinary team, allowing adequate time for obtaining approvals, securing sufficient resources for building and maintaining an online presence, and developing an integrated process and impact evaluation framework. With two-way interaction an important and novel feature of health promotion interventions in this medium, we also present strategies trialled to generate interest and engagement in our intervention. Social networking sites are now an established part of the online environment; our experience in developing and implementing a health promotion intervention using this medium are of direct relevance and utility for all health organizations creating a presence in this new environment.
Ivandic, Ivana; Freeman, Aislinne; Birner, Ulrich; Nowak, Dennis; Sabariego, Carla
Objectives The aim of the systematic review was to provide an overview of the evidence on the effectiveness of brief interventions targeting mental health and well-being in organizational settings and compare their effects with corresponding interventions of common (ie, longer) duration. Methods An extensive systematic search was conducted using the Medline and PsycINFO databases for the period of 2000-2016. Randomized-controlled trials (RCT) and quasi-experimental studies evaluating primary or secondary brief interventions carried out in the workplace settings were included. Subsequently, common interventions matching brief interventions by type and assessed outcomes were included. The methodological quality of included studies was appraised using NICE guidelines and the best evidence synthesis approach was applied. Results The review identified 11 brief interventions and 9 corresponding common interventions. Included studies varied substantially in sample size and characteristics, methodological quality, duration of follow-up, types of intervention, and assessed outcomes. All but one study evaluating brief interventions had high risk of bias. No evidence was found on the effectiveness of brief stress management, relaxation, massage, mindfulness meditation, or multimodal interventions. We found limited evidence on the effectiveness of brief positive psychology interventions. Conclusions Our review highlights the need for high-quality studies evaluating brief mental health and well-being interventions in organizational settings. Future studies should use methodologically rigorous designs and improved reporting of methods and results to provide conclusive evidence on the effectiveness and sustainability of the intervention effects.
Lanpher, Michele G.; Askew, Sandy; Bennett, Gary G.
In the U.S., 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics, as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12 month digital health treatment aimed to prevent weight gain among overweight and class I obese black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. Over half (55%)of participants had low health literacy, which was more common for those with fewer years of educational attainment and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy. PMID:27043756
Lanpher, Michele G; Askew, Sandy; Bennett, Gary G
In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy.
Klasnja, Predrag; Pratt, Wanda
Mobile phones are becoming an increasingly important platform for the delivery of health interventions. In recent years, researchers have used mobile phones as tools for encouraging physical activity and healthy diets, for symptom monitoring in asthma and heart disease, for sending patients reminders about upcoming appointments, for supporting smoking cessation, and for a range of other health problems. This paper provides an overview of this rapidly growing body of work. We describe the features of mobile phones that make them a particularly promising platform for health interventions, and we identify five basic intervention strategies that have been used in mobile-phone health applications across different health conditions. Finally, we outline the directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions. Copyright © 2011 Elsevier Inc. All rights reserved.
Shaw, Ryan Jeffrey
The goal of this study was to design an intervention that would help people stay in the continued response phase of the Behavior Change Process and help prevent weight relapse. Using the Behavior Change Process and regulatory focus theory, an intervention was developed that leveraged short message service (SMS) to deliver messages to people who…
Shaw, Ryan Jeffrey
The goal of this study was to design an intervention that would help people stay in the continued response phase of the Behavior Change Process and help prevent weight relapse. Using the Behavior Change Process and regulatory focus theory, an intervention was developed that leveraged short message service (SMS) to deliver messages to people who…
Yuan, Nicole P.; Castaneda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra
Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay…
Yuan, Nicole P.; Castaneda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra
Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay…
Golden, Shelley D.; Earp, Jo Anne L.
Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to…
Cofiño, Rafael; Aviñó, Dory; Benedé, Carmen Belén; Botello, Blanca; Cubillo, Jara; Morgan, Antony; Paredes-Carbonell, Joan Josep; Hernán, Mariano
An asset-based approach could be useful to revitalise health promotion or community health interventions combining work with multiple partnerships, positive health, community engagement, equity and orientation of health determinants. We set some recommendations about how to incorporate the assets model in programmes, projects and interventions in health promotion. Some techniques are described for assets mapping and some experiences with this methodology being developed in different regions are systematised. We propose the term "Asset-based Health Promotion/Community Health" as an operational definition to work at the local level with a community engagement and participatory approach, building alliances between different institutions at the state-regional level and trying to create a framework for action with the generation of evaluations and evidence to work on population interventions from the perspective of positive health.
Jones, Christina Jane; Smith, Helen; Llewellyn, Carrie
Lack of adherence to health-promoting advice challenges the successful prevention and management of many conditions. The Health Belief Model (HBM) was developed in 1966 to predict health-promoting behaviour and has been used in patients with wide variety of disease. The HBM has also been used to inform the development of interventions to improve health behaviours. Several reviews have documented the HBM's performance in predicting behaviour, but no review has addressed its utility in the design of interventions or the efficacy of these interventions. A systematic review was conducted to identify interventional studies which use the HBM as the theoretical basis for intervention design. The HBM has been used continuously in the development of behaviour change interventions for 40 years. Of 18 eligible studies, 14 (78%) reported significant improvements in adherence, with 7 (39%) showing moderate to large effects. However, only six studies used the HBM in its entirety and five different studies measured health beliefs as outcomes. Intervention success appeared to be unrelated to HBM construct addressed challenging the utility of this model as the theoretical basis for adherence-enhancing interventions. Interventions need to be described in full to allow for the identification of effective components and replication of studies.
Koehlmoos Tracey P
Full Text Available Abstract Background Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh. Methods Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER. Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context. Conclusion Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis
Everett, Anita S; Reese, Jennifer; Coughlin, Janelle; Finan, Patrick; Smith, Michael; Fingerhood, Michael; Berkowitz, Scott; Young, J Hunter; Johnston, Diedre; Dunbar, Linda; Zollinger, Raymond; Ju, Jin; Reuland, Melissa; Strain, Eric C; Lyketsos, Constantine
Health systems in the USA have received a mandate to improve quality while reining in costs. Several opportunities have been created to stimulate this transformation. This paper describes the design, early implementation and lessons learned for the behavioural components of the John Hopkins Community Health Partnership (J-CHiP) programme. J-CHiP is designed to improve health outcomes and reduce the total healthcare costs of a group of high healthcare use patients who are insured by the government-funded health insurance programmes, Medicaid and Medicare. These patients have a disproportionately high prevalence of depression, other psychiatric conditions, and unhealthy behaviours that could be addressed with behavioural interventions. The J-CHiP behavioural intervention is based on integrated care models, which include embedding mental health professionals into primary sites. A four-session behaviour-based protocol was developed to motivate self-efficacy through illness management skills. In addition to staff embedded in primary care, the programme design includes expedited access to specialist psychiatric services as well as a community outreach component that addresses stigma. The progress and challenges involved with developing this programme over a relatively short period of time are discussed.
The increasing popularity of social networking sites (SNSs) has drawn scholarly attention in recent years, and a large amount of efforts have been made in applying SNSs to health behavior change interventions. However, these interventions showed mixed results, with a large variance of effect sizes in Cohen's d ranging from -1.17 to 1.28. To provide a better understanding of SNS-based interventions' effectiveness, a meta-analysis of 21 studies examining the effects of health interventions using SNS was conducted. Results indicated that health behavior change interventions using SNS are effective in general, but the effects were moderated by health topic, methodological features, and participant features. Theoretical and practical implications of findings are discussed.
White, Becky K; Burns, Sharyn K; Giglia, Roslyn C; Scott, Jane A
Evaluating complex health promotion interventions that use mobile apps requires comprehensive and adaptive evaluation plans. As mobile usage becomes increasingly sophisticated and personalised, broad evaluation plans are important in determining the impact and efficacy of a mobile health (mHealth) app. Evaluation should consider user feedback and outcome measures, as well as examine elements such as the robustness of the technology, the intervention principles and engagement strategies, and the interaction of the user with the technology. This paper introduces four mHealth evaluation models and tools and describes the evaluation plan that has been developed for Milk Man, a breastfeeding app targeting new and expectant fathers. Milk Man is a socially connected, gamified app that is being tested in a large Randomised Control Trial (RCT). While there is a need for mobile apps to be evaluated in adequately powered RCTs, trialling mobile apps over a long period of time presents challenges. Incorporating robust evaluation design will help ensure that technological performance, app intervention principles, as well as health and behavioural outcomes are measured. The detail and scope of the Milk Man app evaluation plan will ensure the findings add to the evidence base and have broad relevance to health promotion practitioners.So what? Evidence about the efficacy of mHealth interventions is an emerging area and appropriate evaluation skills are needed. This paper illustrates an evaluation planning approach for mHealth interventions that could be adapted for use by health promotion practitioners and researchers.
Cunningham, John A; Gulliver, Amelia; Farrer, Lou; Bennett, Kylie; Carron-Arthur, Bradley
Over the last several years, there has been a substantial increase in the number of publications reporting on Internet interventions for mental health and addictions. This paper provides a summary of the recent research on Internet interventions for the most common mental health and addictions concerns-depression, anxiety, alcohol and smoking. There is considerable evidence for the effectiveness of Internet-based interventions targeting depression, anxiety disorders, alcohol use and smoking. Small to moderate effect sizes have been reported for interventions targeting depression, anxiety and alcohol use, and smoking interventions have shown large effects. The addition of human support to depression and anxiety interventions has generally resulted in larger treatments effects, but this trend has not been observed in trials of interventions targeting alcohol use. There is some evidence that online interventions can be as effective as face-to-face therapies, at least for anxiety disorders. Despite a proliferation of research activity in this area, gaps in knowledge remain. Future research should focus on the development and evaluation of interventions for different platforms (e.g. smartphone applications), examining the long-term impacts of these interventions, determining active intervention components and identifying methods for enhancing tailoring and engagement. Careful consideration should be given to the ongoing technical and clinical expertise required to ensure that Internet interventions are delivered safely and professionally in a rapidly changing technology environment.
Grindrod, Kelly A; Patel, Payal; Martin, Janet E
To determine which interventions are effective in influencing health practitioners' prescribing practices and explore differences in intervention complexity, setting, sustainability, cost effectiveness, and impact on patient outcomes. A systematic search for English-language systematic reviews was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature, EMBASE, and the Cochrane Library from the date of inception to July 2005 using search terms in accordance with Cochrane recommendations. Included reviews were required to clearly report a search strategy, inclusion/exclusion criteria, literature assessment criteria, and methods for synthesizing or summarizing information and references. Two reviewers independently identified studies for inclusion, assessed study quality, and extracted relevant information. Interventions were classified as consistently effective, inconsistently effective, and effectiveness uncertain. Thirty-four of 4585 titles reviewed met the inclusion criteria. Quality scores ranged from 70% to 100%. Consistently effective interventions included reminders (manual and computerized), audit and feedback, educational outreach visits, organizational strategies, and patient-mediated interventions. Inconsistently effective interventions included computer decision support systems and educational meetings. Multi-faceted interventions were consistently shown to be more efficacious than single interventions. Limited data precluded exploration of the effects of interventions in different settings, sustainability of effect, cost effectiveness, and patient clinical outcomes. Interventions that are most effective for impacting prescribing practice include audit and feedback, reminders, educational outreach visits, and patient-mediated interventions. To maximize impact, pharmacists' efforts to positively impact prescribing practices should focus on these intervention types rather than relying primarily on passive didactics or dissemination
Pimenta, Henderson Barbosa; Caldeira, Antonio Prates; Mamede, Sílvia
Experimental studies on the effectiveness of educational interventions to improve patient care are scarce, especially for low-resources settings. This study investigated the effects of 2 educational interventions on the treatment of hypertensive patients in primary health care in Brazil. Forty-one physicians were randomly assigned either to an "active educational intervention" (21 physicians) or to a "passive educational intervention" (20 physicians). The former comprised 1 small group discussion of routine practices, 1 outreach visit, and 3 reminders. The latter consisted of delivery of printed guidelines. Measures of quality of treatment provided for hypertensive patients (181 patients of physicians from the active intervention; 136 patients of physicians from the passive intervention) were obtained through patient interview and charts review, before and 3 months after the intervention. Chi-square and independent t-tests were performed for comparison between the conditions. The groups did not differ before the study. After the intervention, the active intervention group outperformed the passive intervention group in several measures, such as improved prescription of antihypertensive drugs (80% of patients of physicians from the active intervention vs 51% patients of physicians from the passive intervention; p Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.
Kohatsu, Neal D.; Paciotti, Brian M.; Byrne, Jennifer V.; Kizer, Kenneth W.
Introduction Prevention is the most cost-effective approach to promote population health, yet little is known about the delivery of health promotion interventions in the nation’s largest Medicaid program, Medi-Cal. The purpose of this study was to inventory health promotion interventions delivered through Medi-Cal Managed Care Plans; identify attributes of the interventions that plans judged to have the greatest impact on their members; and determine the extent to which the plans refer members to community assistance programs and sponsor health-promoting community activities. Methods The lead health educator from each managed care plan was asked to complete a 190-item online survey in January 2013; 20 of 21 managed care plans responded. Survey data on the health promotion interventions with the greatest impact were grouped according to intervention attributes and measures of effectiveness; quantitative data were analyzed using descriptive statistics. Results Health promotion interventions judged to have the greatest impact on Medi-Cal members were delivered in various ways; educational materials, one-on-one education, and group classes were delivered most frequently. Behavior change, knowledge gain, and improved disease management were cited most often as measures of effectiveness. Across all interventions, median educational hours were limited (2.4 h), and median Medi-Cal member participation was low (265 members per intervention). Most interventions with greatest impact (120 of 137 [88%]) focused on tertiary prevention. There were mixed results in referring members to community assistance programs and investing in community activities. Conclusion Managed care plans have many opportunities to more effectively deliver health promotion interventions. Establishing measurable, evidence-based, consensus standards for such programs could facilitate improved delivery of these services. PMID:26564012
Full Text Available INTRODUCTION: In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. METHODS: The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. RESULTS: The study found significant mean differences between intervention(I and control (C sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031, adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. CONCLUSION: This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be
McDonald, Anne; Frazer, Kate; Duignan, Catriona; Healy, Marianne; Irving, Annette; Marteinsson, Patricia; Molloy, Brenda; McNicholas, Elizabeth
Illuminating the full range of nursing actions is a challenge for nurses globally; the invisibility of nursing and of public health nursing in particular is well documented. Visibility can be enhanced by identifying core functions of nursing and matching corresponding levels of interventions and outcomes. This is a priority for the contemporary Irish public health nursing (PHN) service. In the United States, public health nurses have developed an 'Intervention Wheel' naming public health interventions at community, systems and individual/family levels. This aimed to make visible the core functions of PHN practice. The values and beliefs underpinning the Intervention Wheel have been shown to capture the essence of public health nursing within the European context. In total, US nurses described 17 Wheel interventions by recording stories from practice. Owing to concern that the public health aspect of their role was not only invisible but was at risk of erosion, Irish PHNs decided to replicate this storytelling approach to provide evidence for and authenticate the 17 interventions on the Intervention Wheel from their day-to-day public health practice.
O'Loughlin, J; Renaud, L; Richard, L; Gomez, L S; Paradis, G
This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada. Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years. Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)). Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community. Copyright 1998 American Health Foundation and Academic Press.
Chaet, Alexis V; Morshedi, Bijan; Wells, Kristen J; Barnes, Laura E; Valdez, Rupa
As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author's last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the
Sriranganathan, Gobika; Jaworsky, Denise; Larkin, June; Flicker, Sarah; Campbell, Lisa; Flynn, Susan; Janssen, Jesse; Erlich, Leah
Peer education is used as a health promotion strategy in a number of areas, including sexual health. Although peer education programmes have been around for some time, published systematic evaluations of youth sexual health peer education programmes are rare. This article discusses the advantages and disadvantages of youth sexual health peer…
Cajita, Maan Isabella; Gleason, Kelly T.; Han, Hae-Ra
Background The popularity of mobile phones and similar mobile devices makes it an ideal medium for delivering interventions. This is especially true with heart failure (HF) interventions, in which mHealth-based HF interventions are rapidly replacing their telephone-based predecessors. Purpose This systematic review examined the impact of mHealth-based HF management interventions on HF outcomes. The specific aims of the systematic review are to: (1) describe current mHealth-based HF interventions and (2) discuss the impact of these interventions on HF outcomes. Methods PubMed, CINAHL Plus, Embase, PsycINFO, and Scopus were systematically searched for randomized controlled trials or quasi-experimental studies that tested mHealth interventions in people with HF using the terms Heart Failure, Mobile Health, mHealth, Telemedicine, Text Messaging, Texting, Short Message Service, Mobile Applications, and Mobile Apps. Conclusions Ten articles, representing nine studies, were included in this review. Majority of the studies utilized mobile health technology as part of a HF monitoring system, which typically included a blood pressure measuring device, weighing scale, and an ECG recorder. The impact of the mHealth interventions on all-cause mortality, cardiovascular mortality, HF-related hospitalizations, length of stay, NYHA functional class, LVEF, quality of life, and self-care were inconsistent at best. Implications Further research is needed to conclusively determine the impact of mHealth interventions on HF outcomes. The limitations of the current studies (e.g. inadequate sample size, quasi-experimental design, use of older mobile phone models, etc.) should be taken into account when designing future studies. PMID:26544175
Ridde, V; Olivier de Sardan, J-P
Organizing effective public health interventions is required to improve population health and reduce social inequalities in health. However, measuring their effectiveness is not enough; we must also understand how these interventions are implemented and what role is played by the context and the social actors. Today, it seems that the importance of studying intervention implementation by public health actors (stakeholders, policy makers, donors, and researchers) has not yet been sufficiently considered. In this Tribune, we wish to draw the attention of the public health community, including that interested in interventions in Africa, to the need to analyze their implementation in depth. We must produce empirical and theoretical knowledge about implementation but also train students and young researchers more effectively in this scientific approach, which, although indispensable, has been ignored too long.
Aardoom, Jiska J; Dingemans, Alexandra E; Van Furth, Eric F
This study aimed to review the emerging findings regarding E-health interventions for eating disorders and to critically discuss emerging issues as well as challenges for future research. Internet-based cognitive behavioral therapy and guided self-help have demonstrated promising results in terms of reducing eating disorder psychopathology. Emerging findings also suggest that E-health interventions reach an underserved population and improve access to care. The use of smartphone applications is becoming increasingly popular and has much potential although their clinical utility and effectiveness is presently unknown and requires investigation. Important challenges include the diagnostic process in E-health interventions, the optimization of E-health within existing health care models, and the investigation and implementation of blended care. More high-quality research is needed to bring the field forward and to determine the place for E-health in our health care service delivery systems.
Full Text Available Globally, graduate students have been found to have high prevalence of mental health problems. With increasing severity of mental health problems on university campuses and limited resources for mental health treatment, alternative interventions are needed. This study investigated the use of biofeedback training to help reduce symptoms of stress, anxiety, and depression. A sample of 60 graduate students in public health nursing was randomly assigned to either the biofeedback intervention or the control group. Results indicated that biofeedback intervention was effective in significantly reducing the levels of stress, anxiety, and depression over the 4-week period, while the control group had increases in symptoms of anxiety and depression over the same timeframe. As future leaders in the public health nursing arena, the more psychologically healthy the graduate students in public health nursing are, the better the public health nursing professionals they will be as they go forth to serve the community after graduation.
Full Text Available Background: Healthy lifestyle habits during adolescence can prevent many of the diseases and disabilities in adulthood and later. The aim of the study was to examine the role of education in improving lifestyles among Iranian adolescents.Methods: This group randomized controlled trial was conducted during October 2010 until January 2011 in Tehran. Participants for this study were selected through a random sampling method and divided into intervention and control groups. The intervention group received a six session course on healthy lifestyles and the control group received no intervention. The Adolescent Lifestyle Questionnaire (ALQ was used for collecting data. Data were collected before the intervention, at a two week after participation time point, and a three month follow-up was conducted.Results: Overall, 365 (male: 173, female: 192 adolescents participated in the study. There were significant differences between boys and girls in terms of physical activity and social support (P<0.001. The boys had higher levels of physical activity than girls. Girls received more social support than boys. There were significant differences in the lifestyle scores between the intervention and control groups at follow-up (P<0.001. The educational intervention indicated an improved total lifestyle score (from 123.7(SD.16.1 at baseline to 131.8 (SD.16.7 at two weeks and to 130.5(16.5 at 3 months after education among the intervention group.Conclusions: Adolescents` behaviors may be different in some dimensions among boys and girls. Unhealthy lifestyle habits are prevalent among adolescents. Therefore sex-specified lifestyle education can bring promising results. Further research in the field can reveal the importance of lifestyle intervention programs.
Parker Eleanor J
Full Text Available Abstract Background Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy. Methods/design This is a randomised controlled trial (RCT that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism
Full Text Available Abstract Background Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. Methods The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. Results Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. Conclusion There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as
Romeo, R.; Knapp, M.; Morrison, J.; Melville, C.; Allan, L.; Finlayson, J.; Cooper, S.-A.
Background: High rates of health needs among adults with intellectual disabilities flag the need for information about the economic consequences of strategies to identify and address unmet needs. Health-check interventions are one such strategy, and have been demonstrated to effect health gains over the following 12-month period. However, little…
to-child transmission (PMTCT) interventions is often said to be dependent on the ... This study therefore sought to examine the effect of clinic-based health .... Ensuring behaviour change through health education ... around 30 clinics, mobile clinics and community health ... participants' age, marital status, number of children,.
Grill, Christina; Ahlborg, Gunnar, Jr.; Wikström, Ewa; Lindgren, Eva-Carin
Purpose: This paper aims to illuminate and analyse the participants' experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning of dialogically oriented communication to prevent stress and ill health and to promote health, well-being, learning, and efficiency in the organisation.…
Buhi, Eric R.; Trudnak, Tara E.; Martinasek, Mary P.; Oberne, Alison B.; Fuhrmann, Hollie J.; McDermott, Robert J.
Objective: To perform a systematic review of the literature concerning behavioural mobile health (mHealth) and summarize points related to heath topic, use of theory, audience, purpose, design, intervention components, and principal results that can inform future health education applications. Design: A systematic review of the literature. Method:…
Grill, Christina; Ahlborg, Gunnar, Jr.; Wikström, Ewa; Lindgren, Eva-Carin
Purpose: This paper aims to illuminate and analyse the participants' experiences of the influences of a dialogue intervention. Cooperation and coordination in health care require planning of dialogically oriented communication to prevent stress and ill health and to promote health, well-being, learning, and efficiency in the organisation.…
Buhi, Eric R.; Trudnak, Tara E.; Martinasek, Mary P.; Oberne, Alison B.; Fuhrmann, Hollie J.; McDermott, Robert J.
Objective: To perform a systematic review of the literature concerning behavioural mobile health (mHealth) and summarize points related to heath topic, use of theory, audience, purpose, design, intervention components, and principal results that can inform future health education applications. Design: A systematic review of the literature. Method:…
Olson, Christine M
e- and m-Health communication technologies are now common approaches to improving population health. The efficacy of behavioral nutrition interventions using e-health technologies to decrease fat intake and increase fruit and vegetable intake was demonstrated in studies conducted from 2005 to 2009, with approximately 75% of trials showing positive effects. By 2010, an increasing number of behavioral nutrition interventions were focusing on body weight. The early emphasis on interventions that were highly computer tailored shifted to personalized electronic interventions that included weight and behavioral self-monitoring as key features. More diverse target audiences began to participate, and mobile components were added to interventions. Little progress has been made on using objective measures rather than self-reported measures of dietary behavior. A challenge for nutritionists is to link with the private sector in the design, use, and evaluation of the many electronic devices that are now available in the marketplace for nutrition monitoring and behavioral change.
Friedman, Ann Lorentson; Hughes, Rosemary B.
Complex HIV and AIDS related legal issues confronting mental health professionals are addressed, specifically: living will, statutes, durable power of attorney, durable power of attorney for health care, rational suicide, euthanasia, workplace discrimination, and laws affecting minors. (JBJ)
This commentary focuses on the notion of "what works" to reduce health inequalities. It begins by noting the need for and presence of a wide range of methodologies and approaches internationally. It then argues that it is useful to map out these contributions and those in the present Supplement against a set of principles (Macintyre, 2007) to guide the selection and implementation of public health interventions explicitly aiming to reduce health inequalities. The chosen principles derive largely from efforts to reduce steep and persistent Scottish health inequalities by social class. The commentary summarizes Macintyre's analysis of the main characteristics of public health interventions. It then notes that the present Supplement provides clear examples of population-health interventions and their health impacts that are inequality-reducing. The suggested approach and principles align with calls for the use of structural changes in the environment, early-life interventions, reductions in preventive-care barriers, and a harm-reduction philosophy. The commentary concludes that there remains much to learn and to do in order for public health intervention research to clearly demonstrate how to effectively reduce health inequalities in a lasting manner.
Weist, Mark D.; Bruns, Eric J.; Whitaker, Kelly; Wei, Yifeng; Kutcher, Stanley; Larsen, Torill; Holsen, Ingrid; Cooper, Janice L.; Geroski, Anne; Short, Kathryn H.
All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS)…
Hart, Edward J.; Behr, Mary T.
The purpose of this research project was to determine the effectiveness of a school-based dental health education program which included a parental support component. It was hypothesized that changes in dental health attitudes would be positively affected by the outreach effort to educate parents on the importance of dental health. (JN)
Tramonte, Michael R.
The goals of this presentation were to help mental health professionals learn more about intervening in aviation disasters, learn about the uniqueness of disaster mental health, and share the presenter's mental health disaster experiences as they relate to aviation disasters. Survivors' emotional phases during the disaster recovery process are…
Lie, Silje Stangeland; Karlsen, Bjørg; Oord, Ellen Renate; Graue, Marit; Oftedal, Bjørg
Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. We identified one overall theme: "Losing motivation for intervention participation." This theme was illustrated by four categories related to the participants' experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants' motivation for engagement in the intervention. To maintain motivation, our study points to the importance of
Meerman, Esther E; Brosschot, Jos F; Verkuil, Bart
Somatic complaints are common and form a major burden. Previous studies suggested that such complaints might be increased by 'illness-related memory', for example due to worries about health. In this ambulatory study we tested whether we could decrease somatic complaints through enhancing the activation of health-related memory by a 'positive health'-priming intervention. Forty-three students were randomly assigned to the 'positive health'-group or a control group. Using online measures, participants reported negative affect (NA) and somatic complaints for a period of six days, while each morning performing the priming task. The intervention caused a decrease in somatic complaints but only for participants with low trait NA or low somatosensory amplification. These findings seem to suggest that priming or other interventions directed at activating positive health memory might reduce health complaints, but only in certain subgroups.
Miller, Audrey P; Kameka, Michelle; Young-Whiting, Chanadra
The purpose of this study was to examine the effects of an oral health educational intervention on knowledge and behavior-specific cognitions and affect in caregivers of children from 2 to 5 years of age. This was a descriptive study, with a convenience sample of 425 Head Start caregivers who attended one of 18 oral health educational programs throughout Miami-Dade County. Four research questions addressed the relationship between the oral health educational intervention and prior related behavior, personal factors, behavior-specific cognitions and affect, knowledge, and intent. The educational program was found to have a significant effect on caregivers' knowledge, cognition, affect, and intent to provide oral healthcare to their children. Educational programs have a positive impact on caregivers to increase oral health knowledge and intent to perform preventive oral health-promoting behaviors in this underserved population. Effective educational interventions are necessary in order to increase overall health in children and to decrease oral disease.
Baisch, Mary Jo
Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.
Demyan, Amy L.; Anderson, Timothy
This study examined the effects of a mass-media video intervention on expectations, attitudes, and intentions to seek help from professional mental health care services. A public service announcement-style, mass-media video intervention was developed, with prior empirical research on help-seeking behaviors organized according to the theory of…
Beurs, D. de; Bruinessen, I.R. van; Noordman, J.; Friele, R.; Dulmen, S. van
Background: Although many web-based mental health interventions are being released, the actual uptake by end-users is limited. The marginal level of engagement of end-users when developing these interventions is recognized as an important cause for uptake problems. In this paper we
Beurs, D. de; Bruinessen, I. van; Noordman, J.; Friele, R.; Dulmen, S. van
BACKGROUND: Although many web-based mental health interventions are being released, the actual uptake by end users is limited. The marginal level of engagement of end users when developing these interventions is recognized as an important cause for uptake problems. In this paper, we offer our
Beurs, D. de; Bruinessen, I. van; Noordman, J.; Friele, R.; Dulmen, S. van
BACKGROUND: Although many web-based mental health interventions are being released, the actual uptake by end users is limited. The marginal level of engagement of end users when developing these interventions is recognized as an important cause for uptake problems. In this paper, we offer our percep
Naslund, John A; Aschbrenner, Kelly A; Kim, Sunny Jung; McHugo, Gregory J; Unützer, Jürgen; Bartels, Stephen J; Marsch, Lisa A
Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Walton, Gregory M; Cohen, Geoffrey L
A brief intervention aimed at buttressing college freshmen's sense of social belonging in school was tested in a randomized controlled trial (N = 92), and its academic and health-related consequences over 3 years are reported. The intervention aimed to lessen psychological perceptions of threat on campus by framing social adversity as common and transient. It used subtle attitude-change strategies to lead participants to self-generate the intervention message. The intervention was expected to be particularly beneficial to African-American students (N = 49), a stereotyped and socially marginalized group in academics, and less so to European-American students (N = 43). Consistent with these expectations, over the 3-year observation period the intervention raised African Americans' grade-point average (GPA) relative to multiple control groups and halved the minority achievement gap. This performance boost was mediated by the effect of the intervention on subjective construal: It prevented students from seeing adversity on campus as an indictment of their belonging. Additionally, the intervention improved African Americans' self-reported health and well-being and reduced their reported number of doctor visits 3 years postintervention. Senior-year surveys indicated no awareness among participants of the intervention's impact. The results suggest that social belonging is a psychological lever where targeted intervention can have broad consequences that lessen inequalities in achievement and health.
Rominov, Holly; Pilkington, Pamela D; Giallo, Rebecca; Whelan, Thomas A
Interventions targeting parents' mental health in the perinatal period are critical due to potential consequences of perinatal mental illness for the parent, the infant, and their family. To date, most programs have targeted mothers. This systematic review explores the current status and evidence for intervention programs aiming to prevent or treat paternal mental illness in the perinatal period. Electronic databases were systematically searched to identify peer-reviewed studies that described an intervention targeting fathers' mental health in the perinatal period. Mental health outcomes included depression, anxiety, and stress as well as more general measures of psychological functioning. Eleven studies were identified. Three of five psychosocial interventions and three massage-technique interventions reported significant effects. None of the couple-based interventions reported significant effects. A number of methodological limitations were identified, including inadequate reporting of study designs, and issues with the timing of interventions. The variability in outcomes measures across the studies made it difficult to evaluate the overall effectiveness of the interventions. Father-focused interventions aimed at preventing perinatal mood problems will be improved if future studies utilize more rigorous research strategies.
Singla, Rashmi; Rasmussen, Louise Mubanda
Global health intervention from North to South: (Academic) preparation of students By Rashmi Singla & Louise Mubanda Rasmussen, Roskilde University, Denmark This chapter discusses how to conduct before- intervention preparation of students based on a pioneer course collaboration between...... the subjects Health Promotion and International Development Studies at Roskilde University. The focus is on agents of intervention from the Global North with Global South targets. The theoretical framework of the course includes, among others approaches from cultural psychological (Valsiner), critical...... psychiatry/ psychology (Fernando), culture-centered health communication (Dutta) and medical anthropology (Farmer, Nguyen & Lock). The course is framed around a critical conceptualization of globalisation covering spatial and ideological dimensions (Fassin). Today’s practice of global health interventions...
Full Text Available Martin Gerdin and colleagues argue that disaster health interventions and decision-making can benefit from an evidence-based approach Please see later in the article for the Editors' Summary.
Huijg, J.M.; Zouwe, N. van der; Crone, M.R.; Verheijden, M.W.; Middelkoop, B.J.C.; Gebhardt, W.A.
Background: The introduction of efficacious physical activity (PA) interventions in routine primary health care (PHC) is a complex process. Understanding factors influencing the process can enhance the development of successful introduction strategies. Purpose: The aim of this qualitative study was
Results indicate that this mHealth intervention is engaging and promising for increasing PA among adolescents with ADHD, and warrant further study. Implications for improving ADHD symptoms and overall functioning for this undertreated population are discussed.
Martin, Corby K; Gilmore, L Anne; Apolzan, John W; Myers, Candice A; Thomas, Diana M; Redman, Leanne M
Synonymous with increased use of mobile phones has been the development of mobile health (mHealth) technology for improving health, including weight management. Behavior change theory (eg, the theory of planned behavior) can be effectively encapsulated into mobile phone-based health improvement programs, which is fostered by the ability of mobile phones and related devices to collect and transmit objective data in near real time and for health care or research professionals and clients to communicate easily. To describe SmartLoss, a semiautomated mHealth platform for weight loss. We developed and validated a dynamic energy balance model that determines the amount of weight an individual will lose over time if they are adherent to an energy intake prescription. This model was incorporated into computer code that enables adherence to a prescribed caloric prescription determined from the change in body weight of the individual. Data from the individual are then used to guide personalized recommendations regarding weight loss and behavior change via a semiautomated mHealth platform called SmartLoss, which consists of 2 elements: (1) a clinician dashboard and (2) a mobile phone app. SmartLoss includes and interfaces with a network-connected bathroom scale and a Bluetooth-connected accelerometer, which enables automated collection of client information (eg, body weight change and physical activity patterns), as well as the systematic delivery of preplanned health materials and automated feedback that is based on client data and is designed to foster prolonged adherence with body weight, diet, and exercise goals. The clinician dashboard allows for efficient remote monitoring of all clients simultaneously, which may further increase adherence, personalization of treatment, treatment fidelity, and efficacy. Evidence of the efficacy of the SmartLoss approach has been reported previously. The present report provides a thorough description of the SmartLoss Virtual Weight
Mauriello, Leanne M; Van Marter, Deborah F; Umanzor, Cindy D; Castle, Patricia H; de Aguiar, Emma L
To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption. A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4. Women were recruited from six locations of federally funded health centers across three states. Participants (N = 335) were English- and Spanish-speaking women at up to 18 weeks gestation. The treatment group received three interactive sessions focused on two priority health behavior risks. The sessions offered individually tailored and stage-matched change strategies based on the transtheoretical model of behavior change. The usual care group received March of Dimes brochures. The primary outcome was the number of behavior risks. Stage of change and continuous measures for all behaviors also were assessed. Data were analyzed across all time points using generalized estimating equations examining repeated measures effects. Women in the treatment group reported significantly fewer risks than those in usual care at 1 month (.85 vs. 1.20, odds ratio [OR] = .70) and 4 months postpartum (.72 vs. .91, OR = .81). Healthy Pregnancy is an evidence-based and personalized program that assists pregnant women with reducing behavior risks and sustaining healthy lifestyle behaviors. © 2016 by American Journal of Health Promotion, Inc.
Full Text Available Background: Women’s beliefs are one of the main reasons for not undergoing Pap-test for cervical cancer prevention. Health education programs could help change these beliefs and motivate women to adopt a preventive health behavior.Objectives: This study aims to assess the modification in women’s beliefs and behavior about cervical cancer prevention after the implementation of a health education intervention.Methodology: A health education intervention for cervical cancer prevention was implemented to 300 women in two prefectures of southern Greece. The experimental group received a 120-minute health education intervention, based on the Health Beliefs Model (HBM including a lecture, discussion and leaflets. The hypotheses were a will this brief intervention change women’s beliefs (perceived susceptibility to cervical cancer, benefits and barriers ofundergoing the Pap-test? b will this change in beliefs sustain in six months follow-up period? and c will women undergo pap-test in six months period? The women filled in an anonymous questionnaire, based on the Health Belief Model (HBM, before, immediately after and six months after the program.Results: The health education intervention significantly modified women’s beliefs and behaviors towards pap-test. The greater changes in women’s beliefs were observed in their sense of susceptibility towards the disease and the benefits of prevention which were sustained or improved after six months. Perceived barriers to undergo the Paptest, pain, embarrassment, and worry for the results decreased immediately after the program but started relapsingin the six month follow up period. Moreover, 88.1% of the women answered that they had underwent a Pap-test during the following six months.Conclusions: This health education intervention modified women’s beliefs and behavior about cervical cancer prevention. Short, low cost, health education interventions for breast cancer prevention to women can be
Full Text Available Inactivity and an unhealthy diet amongst others have led to an increased prevalence of overweight and obesity even in young children. Since most health behaviours develop during childhood health promotion has to start early. The setting kindergarten has been shown as ideal for such interventions. “Join the Healthy Boat” is a kindergarten-based health promotion programme with a cluster-randomised study focussing on increased physical activity, reduced screen media use, and sugar-sweetened beverages, as well as a higher fruit and vegetable intake. Intervention and materials were developed using Bartholomew’s Intervention Mapping approach considering Bandura’s social-cognitive theory and Bronfenbrenner’s ecological framework for human development. The programme is distributed using a train-the-trainer approach and currently implemented in 618 kindergartens. The effectiveness of this one-year intervention with an intervention and a control group will be examined in 62 kindergartens using standardised protocols, materials, and tools for outcome and process evaluation. A sample of 1021 children and their parents provided consent and participated in the intervention. Results of this study are awaited to give a better understanding of health behaviours in early childhood and to identify strategies for effective health promotion. The current paper describes development and design of the intervention and its implementation and planned evaluation. Trial Registration. The study is registered at the German Clinical Trials Register (DRKS, Freiburg University, Germany, ID: DRKS00010089.
Wartha, Olivia; Dreyhaupt, Jens; Lämmle, Christine; Friedemann, Eva-Maria; Kelso, Anne; Kutzner, Claire; Hermeling, Lina
Inactivity and an unhealthy diet amongst others have led to an increased prevalence of overweight and obesity even in young children. Since most health behaviours develop during childhood health promotion has to start early. The setting kindergarten has been shown as ideal for such interventions. “Join the Healthy Boat” is a kindergarten-based health promotion programme with a cluster-randomised study focussing on increased physical activity, reduced screen media use, and sugar-sweetened beverages, as well as a higher fruit and vegetable intake. Intervention and materials were developed using Bartholomew's Intervention Mapping approach considering Bandura's social-cognitive theory and Bronfenbrenner's ecological framework for human development. The programme is distributed using a train-the-trainer approach and currently implemented in 618 kindergartens. The effectiveness of this one-year intervention with an intervention and a control group will be examined in 62 kindergartens using standardised protocols, materials, and tools for outcome and process evaluation. A sample of 1021 children and their parents provided consent and participated in the intervention. Results of this study are awaited to give a better understanding of health behaviours in early childhood and to identify strategies for effective health promotion. The current paper describes development and design of the intervention and its implementation and planned evaluation. Trial Registration. The study is registered at the German Clinical Trials Register (DRKS), Freiburg University, Germany, ID: DRKS00010089. PMID:28303253
Wasilewski, Marina B; Stinson, Jennifer N; Cameron, Jill I
For the growing proportion of elders globally, aging-related illnesses are primary causes of morbidity causing reliance on family members for support in the community. Family caregivers experience poorer physical and mental health than their non-caregiving counterparts. Web-based interventions can provide accessible support to family caregivers to offset declines in their health and well-being. Existing reviews focused on web-based interventions for caregivers have been limited to single illness populations and have mostly focused on the efficacy of the interventions. We therefore have limited insight into how web-based interventions for family caregiver have been developed, implemented and evaluated across aging-related illness. To describe: a) theoretical underpinnings of the literature; b) development, content and delivery of web-based interventions; c) caregiver usage of web-based interventions; d) caregiver experience with web-based interventions and e) impact of web-based interventions on caregivers' health outcomes. We followed Arksey and O'Malley's methodological framework for conducting scoping reviews which entails setting research questions, selecting relevant studies, charting the data and synthesizing the results in a report. Fifty-three publications representing 32 unique web-based interventions were included. Over half of the interventions were targeted at dementia caregivers, with the rest targeting caregivers to the stroke, cancer, diabetes and general frailty populations. Studies used theory across the intervention trajectory. Interventions aimed to improve a range of health outcomes for caregivers through static and interactive delivery methods Caregivers were satisfied with the usability and accessibility of the websites but usage was generally low and declined over time. Depression and caregiver burden were the most common outcomes evaluated. The interventions ranged in their impact on health and social outcomes but reductions in perception of
Marta M. Jankowska
Full Text Available Background: Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions. Objective: We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions. Design: Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes. Results: Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health. Conclusion: Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions.
Sorrell, Jeanne M
New research is providing health care professionals with evidence for the effectiveness of mindfulness meditation as an intervention for older adults. Recent studies have provided evidence that meditation results in observable changes in brain structure related to memory, sense of self, empathy, and stress. Health care professionals should consider mindfulness training as a helpful intervention for older adults with problems such as depression, anxiety, chronic pain, loneliness, and caregiver burden.
Martin, Emily C.; Basen-Engquist, Karen M.; Cox, Matthew G.; Lyons, Elizabeth J.; Carmack, Cindy L.; Blalock, Janice A.; Demark-Wahnefried, Wendy
Background Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors? interest for more...
Payne, Hannah E; Lister, Cameron; West, Joshua H; Bernhardt, Jay M
Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. We conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. The 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. The lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices.
Stathopoulou, G.; Powers, M.B.; Berry, A.C.; Smits, J.A.J.; Otto, M.W.
Associations between exercise and mental well-being have been documented repeatedly over the last two decades. More recently, there has been application of exercise interventions to clinical populations diagnosed with depression, anxiety, and eating disorders with evidence of substantial benefit. No
Ronckers, Emma T; Groot, Wim; Steenbakkers, Mieke; Ruland, Erik; Ament, Andre
BACKGROUND: Little is known about the costs of community programmes to prevent cardiovascular diseases. The present study calculated the economic costs of all interventions within a Dutch community programme called Hartslag Limburg, in such a way as to facilitate generalisation to other countries. I
Nieuwenhuijsen, K.; Bultmann, U.; Neumeyer-Gromen, A.; Verhoeven, A.C.; Verbeek, J.H.; van der Feltz-Cornelis, C.M.
BACKGROUND: Work disability such as sickness absence is common in people with depression. OBJECTIVES: To evaluate the effectiveness of interventions aimed at reducing work disability in depressed workers. SEARCH STRATEGY: We searched the CCDANCTR-Studies and CCDANCTR-References on 2/8/2006, Cochrane
Wallace, L M; Brown, K E; Hilton, S
Researchers in the field of health psychology have increasingly been involved in translating a body of knowledge about psychological factors associated with health-relevant behaviours, into the development and evaluation of interventions that seek to apply that knowledge. In this paper we argue that a changing economic and political climate, and the strong behavioural contribution to disease morbidity and mortality in developed nations, requires health psychologists to plan more rigorously for, and communicate more effectively, about how health promotion, social cognition and behaviour change interventions will have impact and be increasingly embedded into health services or health promotion activity. We explain academic and wider socio-economic uses of 'impact' in health services research. We describe the relationship between impact and dissemination, and impact as distinct from, but often used interchangeably with the terms 'implementation', 'knowledge transfer' and 'knowledge translation' (KT). The evidence for establishing impact is emergent. We therefore draw on a number of impact planning and KT frameworks, with reference to two self- management interventions, to describe a framework that we hope will support health psychologists in embedding impact planning and execution in research. We illustrate this further in an on-line annexe with reference to one of our own interventions, Mums-and-MS (see Supplemental Material).
Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo
Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…
Eisenstein, Eric L.; Anstrom, Kevin J.; Macri, Jennifer M.; Crosslin, David R.; Johnson, Frederick S.; Kawamoto, Kensaku; Lobach, David F.
Health information professionals recognize the need to demonstrate that the benefits of health information technological (HIT) interventions outweigh their costs. However, such cost-benefit analyses are rarely conducted for HIT interventions, due in part to the lack of a standard methodology. In this study, we describe how the U.S. Public Health Service’s guidelines for health economic analyses can be used to evaluate HIT interventions. This framework is described in the context of an economic analysis we are conducting for three HIT interventions to be implemented in a community-based health network caring for Medicaid beneficiaries in Durham County, North Carolina. At present, the 17,779 patients in our study cost Medicaid more than $5 million per month. In sensitivity analyses, we demonstrate that if our information intervention redirects just 10% of low-severity emergency room encounters to outpatient encounters, it will result in $12,523 of monthly savings to the local health system. PMID:16779034
Augustsson, Hanna; von Thiele Schwarz, Ulrica; Stenfors-Hayes, Terese; Hasson, Henna
The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.
YA-QIONG YAN; YONG-YOU LIU; YUE-FENG ZENG; YI-WEI CUI; JI-WEI LEI; ZENG-ZHEN WANG
Objective To investigate the social mental state of drug addicts in a compulsive drug abuse treatment center;evaluate the effectiveness of integrated program for the prevention of abuse relapse and improvement of drug addicts' psychological health.Methods The study subjects were addicts from the Wuhan Compulsive Drug Abuse Treatment Center between October 2003 and June 2004,who satisfied the inclusion criteria.A non-randomized control-intervention study design was adopted.Volunteers willing to take part in intervention were put into the intervention group with their full awareness and willingness to prevent drug abuse relapse.The control group was composed of the addicts who were willing to prevent relapse and to be followed up after their discharge. Results The effectiveness of the integrated intervention program in promoting addicts' psychological health:before the intervention,the scores of Self-Rating Anxiety Scale(SAS),the positive and negative dimensionalities of Simple Coping Style Questionnaire(SCSQ)and Chinese Perceived Stress Scales(CPSS)had no significant differences between the intervention group and the control group.After the intervention,exccpt that the SCSQ's positive dimensionality in the intervention group was significantly higher than that in the control group,other indices in the intervention group were lower.Before and after the intervention.the psychological health level in both the groups was lower than that in the normal population;there were significant differences between addicts and normal subjects in regards with all of the indices above. Conclusion Drug abuse was associated closely with addicts' social mental factors.The integrated intervention program can alleviate anxiety and stress,reduce co-morbid mental disorders and effectively improve their coping style.In conclusion,the program can promote addicts' psychological health significantly.
Daponte, Antonio; Bernal, Mariola; Bolívar, Julia; Mateo, Inmaculada; Salmi, Louis-Rachid; Barsanti, Sara; Berghmans, Luc; Piznal, Ewelina; Bourgueil, Yann; Marquez, Soledad; González, Ingrid; Carriazo, Ana; Maros-Szabo, Zsuzsanna; Ménival, Solange
The current social and political context is generating socio-economic inequalities between and within countries, causing and widening health inequalities. The development and implementation of interventions in primary health care (PHC) settings seem unavoidable. Attempts have been made to draw up adequate criteria to guide and evaluate interventions but none for the specific case of PHC. This methodological article aims to contribute to this field by developing and testing a set of criteria for guiding and evaluating real-life interventions to reduce health inequalities in PHC settings in European regions. A literature review, nominal group technique, survey and evaluation template were used to design and test a set of criteria. The questionnaire was answered by professionals in charge of 46 interventions carried out in 12 European countries, and collected detailed information about each intervention. Third-party experts scored the interventions using the set of evaluation criteria proposed. Nine criteria to guide and evaluate interventions were proposed: relevance, appropriateness, applicability, innovation, quality assurance, adequacy of resources, effectiveness in the process, effectiveness in results and mainstreaming. A working definition was drawn up for each one. These criteria were then used to evaluate the interventions identified. The set of criteria drawn up to guide the design, implementation and evaluation of interventions to reduce health inequalities in PHC will be a useful instrument to be applied to interventions under development for culturally, politically and socio-economically diverse PHC contexts throughout Europe. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Salam, Rehana A; Faqqah, Anadil; Sajjad, Nida; Lassi, Zohra S; Das, Jai K; Kaufman, Miriam; Bhutta, Zulfiqar A
Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Shaw, Ryan J; Steinberg, Dori M; Zullig, Leah L; Bosworth, Hayden B; Johnson, Constance M; Davis, Linda L
mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs. 1F31 NR012599. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Corlew, D Scott
The measurement of the burden of disease and the interventions that address that burden can be done in various units. Reducing these measures to the common denominator of economic units (i.e., currency) enables comparison with other health entities, interventions, and even other fields. Economic assessment is complex, however, because of the multifactorial components of what constitutes health and what constitutes health interventions, as well as the coupling of those data to economic means. To perform economic modeling in a meaningful manner, it is necessary to: (1) define the health problem to be addressed; (2) define the intervention to be assessed; (3) define a measure of the effect of the health entity with and without the intervention (which includes defining the counterfactual); and (4) determine the appropriate method of converting the health effect to economics. This paper discusses technical aspects of how economic modeling can be done both of disease entities and of interventions. Two examples of economic modeling applied to surgical problems are then given.
Wahlbeck, Kristian; Cresswell-Smith, Johanna; Haaramo, Peija; Parkkonen, Johannes
To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health. Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions. Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted. The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.
M.M. Martínez-Delgado; C. Ramírez-López
Objective: To promote awareness of healthy lifestyles, to help decrease the risk factors that cause cardiovascular disease, obesity, diabetes, hypertension and hyperlipidemia, through Health Education (HE...
Agriculture remains a dangerous industry, even as agricultural science and technology continue to advance. Research that goes beyond technological changes to address safety culture and policy are needed to improve health and safety in agriculture. In this commentary, I consider the potential for anthropology to contribute to agricultural health and safety research by addressing three aims: (1) I briefly consider what the articles in this issue of the Journal of Agromedicine say about anthropologists in agricultural health and safety; (2) I discuss what anthropologists can add to agricultural health and safety research; and (3) I examine ways in which anthropologists can participate in agricultural health and safety research. In using their traditions of rigorous field research to understand how those working in agriculture perceive and interpret factors affecting occupational health and safety (their "emic" perspective), and translating this perspective to improve the understanding of occupational health professionals and policy makers (an "etic" perspective), anthropologists can expose myths that limit improvements in agricultural health and safety. Addressing significant questions, working with the most vulnerable agricultural communities, and being outside establishment agriculture provide anthropologists with the opportunity to improve health and safety policy and regulation in agriculture.
Stange Kurt C
Full Text Available Abstract Background Those attempting to implement changes in health care settings often find that intervention efforts do not progress as expected. Unexpected outcomes are often attributed to variation and/or error in implementation processes. We argue that some unanticipated variation in intervention outcomes arises because unexpected conversations emerge during intervention attempts. The purpose of this paper is to discuss the role of conversation in shaping interventions and to explain why conversation is important in intervention efforts in health care organizations. We draw on literature from sociolinguistics and complex adaptive systems theory to create an interpretive framework and develop our theory. We use insights from a fourteen-year program of research, including both descriptive and intervention studies undertaken to understand and assist primary care practices in making sustainable changes. We enfold these literatures and these insights to articulate a common failure of overlooking the role of conversation in intervention success, and to develop a theoretical argument for the importance of paying attention to the role of conversation in health care interventions. Discussion Conversation between organizational members plays an important role in the success of interventions aimed at improving health care delivery. Conversation can facilitate intervention success because interventions often rely on new sensemaking and learning, and these are accomplished through conversation. Conversely, conversation can block the success of an intervention by inhibiting sensemaking and learning. Furthermore, the existing relationship contexts of an organization can influence these conversational possibilities. We argue that the likelihood of intervention success will increase if the role of conversation is considered in the intervention process. Summary The generation of productive conversation should be considered as one of the foundations of
Hernández, Alma A; Grineski, Sara E
This study explores the efficacy of an environmental health intervention in several poor colonias in Ciudad Juárez (Mexico). Parents of children with respiratory problems were given environment-friendly products intended to replace hazardous products used in the home, as well as information about environmental health. Parents were surveyed before and after to measure the effectiveness of the intervention and to gauge perceptions. There was a significant reduction in hazardous chemical use (eg, cleaning products and pesticides) and breathing problems. While the intervention focused on changing in-home behaviors, open-ended responses revealed that parents were most concerned about outdoor environmental conditions over which they had less control.
Downey, Laura H; Castellanos, Diana Cuy; Yadrick, Kathy; Threadgill, Paula; Kennedy, Betty; Strickland, Earline; Prewitt, T Elaine; Bogle, Margaret
Since its inception, capacity building has been a stated goal of the Delta Nutrition Intervention Research Initiative, a tri-state collaboration in the Lower Mississippi Delta to address high rates of chronic disease. Textual analysis of project documents identifies and describes strategies carried out to foster capacity building. Strategies to build community capacity include fostering participation, cultivating leadership opportunities, training community members as co-researchers, securing community resources, and implementing the intervention together. Incorporating capacity-building approaches in health promotion and nutrition-intervention programming in rural communities provides a means to enhance potential for sustainability of health outcomes and developed effectiveness.
Morrison, Ann Judith; Manresa-Yee, Cristina; Knoche, Hendrik Ole
the responsive vibroacoustic environment and the vibrotactile vest. We found compelling evidence to support further exploration into vibrotactile and vibroacoustic solutions for improving health and well-being. Conclusions: The work demonstrates capacity for health and well-being solutions with multiple use...
Ell, Kathleen; Oh, Hyunsung; Wu, Shinyi
Objective: Safety net care systems are experiencing unprecedented change from the "Affordable Care Act," Patient-Centered Medical Home (PCMH) uptake, health information technology application, and growing of mental health care integration within primary care. This article provides a review of previous and current efforts in which social…
Smedley, Brian D; Syme, S. Leonard
... on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. i Copyrightthe cannot be not from book, paper however, version for formatting, original authoritative the typesetting-specific the as from created pu...
Chaudhury, Sumona; Kirk, Catherine M; Ingabire, Charles; Mukunzi, Sylvere; Nyirandagijimana, Beatha; Godfrey, Kalisa; Brennan, Robert T; Betancourt, Theresa S
Few evidence-based interventions exist to support parenting and child mental health during the process of caregiver HIV status disclosure in sub-Saharan Africa. A secondary analysis of a randomized-controlled trial was conducted to examine the role of family-based intervention versus usual social work care (care as usual) in supporting HIV status disclosure within families in Rwanda. Approximately 40 households were randomized to family-based intervention and 40 households to care as usual. Parenting, family unity, and child mental health during the process of disclosure were studied using quantitative and qualitative research methods. Many of the families had at least one caregiver who had not disclosed their HIV status at baseline. Immediately post-intervention, children reported lower parenting and family unity scores compared with those in the usual-care group. These changes resolved at 3-month follow-up. Qualitative reports from clinical counselor intervention sessions described supported parenting during disclosure. Overall findings suggest adjustments in parenting, family unity, and trust surrounding the disclosure process. Family-based intervention may support parenting and promote child mental health during adjustment to caregiver HIV status disclosure. Further investigation is required to examine the role of family-based intervention in supporting parenting and promoting child mental health in HIV status disclosure.
Molina, Antonio J; Fernández, Tania; Fernández, Daniel; Delgado, Miguel; de Abajo, Serafín; Martín, Vicente
To examine the effectiveness of a tobacco control course on the improvement of knowledge, attitudes and beliefs about smoking among health sciences' students. This was a quasi-experimental study of community intervention carried out during the years 2005-2008, at 2 university health science centres in northwest Spain. A total of 290 students on the intervention and 256 on the control campus took part in the study. The intervention consisted of a course on the prevention and control of tobacco use offered only on the intervention campus. Data were collected before the intervention and 6 months afterwards. After the course, significant differences between groups were observed in the improvement of knowledge, attitudes and perceived ability to act in tobacco control. The introduction of training concerning smoking through active methodologies had a positive impact on the knowledge, attitudes and beliefs about tobacco of students. Copyright © 2011 Elsevier Ltd. All rights reserved.
Smith, Peter G; Richard H. Morrow; David A Ross
Before new interventions can be used in disease control programmes, it is essential that they are carefully evaluated in “field trials”, which may be complex and expensive undertakings. Descriptions of the detailed procedures and methods used in trials that have been conducted in the past have generally not been published. As a consequence, those planning such trials have few guidelines available and little access to previously accumulated knowledge. In this book the practical issues of trial...
Alaimo, Katherine; Beavers, Alyssa W; Crawford, Caroline; Snyder, Elizabeth Hodges; Litt, Jill S
The article presents a framework for understanding the relationship between community garden participation, and the myriad ways gardens and participation lead to emotional, social, and health impacts. Existing empirical research relating community gardens to health behaviors, such as physical activity and diet, and longer-term chronic disease-related outcomes is summarized. The research areas discussed include the effects of community garden participation on individual, social, emotional, and environmental processes; health behaviors including diet and physical activity; and health outcomes such as self-rated health, obesity, and mental health. Other mechanisms through which community gardens may affect population health are described. Applying a multitheoretical lens to explore associations between community garden participation and health enables us to delineate key aspects of gardening that elicit positive health behaviors and multifactorial health assets that could be applied to designing other types of health interventions.
Prost, Stephanie Grace; Ai, Amy L; Ainsworth, Sarah E; Ayers, Jaime
Adult obesity in the United States has risen to epidemic proportions, and mental health professionals must be called to action. The objectives of this article were to (a) synthesize outcomes of behavioral health interventions for adult obesity in recent meta-analyses and systematic reviews (MAs/SRs) as well as randomized controlled trials (RCTs) and further, (b) evaluate the role of mental health professionals in these behavioral health interventions. Articles were included if published in English between January 1, 2004, and May 1, 2014, in peer-reviewed journals examining behavioral health interventions for adults with obesity. Data were subsequently extracted and independently checked by two authors. Included MAs/SRs utilized motivational interviewing, financial incentives, multicomponent behavioral weight management programs, as well as dietary and lifestyle interventions. Behavioral health interventions in randomized controlled trials (RCTs) were discussed across 3 major intervention types (educational, modified caloric intake, cognitive-based). Regarding the 1st study objective, multiple positive primary (e.g., weight loss) and secondary outcomes (e.g., quality of life) were found in both MAs/SRs and RCTs. However, the majority of included studies made no mention of interventionist professional background and little inference could be made regarding the effects of professional background on behavioral health intervention outcomes for adults facing obesity; an important limitation and direction for future research. Future studies should assess the effects of interventionist profession in addition to primary and secondary outcomes for adults facing obesity. Implications for mental health professionals' educational curricula, assessment, and treatment strategies are discussed.
Zandiyeh, Zahra; Zare, Elaheh; Mehrabi, Tayebeh; Shiri, Mansour
Introduction: Improving the health of the elderly must be based on their special needs that can be achieved through self-needs assessments through education, which is one of the most important tools in the field of health improvement. The aim of the present study was to evaluate the effect of need-oriented educational interventions on the general health of the elderly living in nursing homes. Materials and Methods: The present study is a clinical trial conducted among the elderly living at the Sadeghieh nursing home of Isfahan, Iran. Seventy elderly people who satisfied the inclusion criteria were selected and divided into two groups of case and control. The case group went through 8 sessions of group therapy for educating participants who were previously investigated through needs assessment. The control group received the usual health care. The general health level of the participants was evaluated before and 1 week and 1 month after the intervention using Goldberg's general health questionnaire. Data were analyzed using Chi-square test, independent t-test, paired t-test, Mann–Whitney test, and variance analysis. Results: The score of general health had no significant difference between both the groups before the intervention, however, the difference in the score between both the groups 1 week and 1 month after the intervention was significant (1 week after the intervention, the scores were 15.6 and 30.3, and 1 month after the intervention, the scores were 16 and 32.2, respectively) (P < 0.001). Conclusions: Need-oriented educational intervention is an effective, safe, and inexpensive method for improving the general health of the elderly living in nursing homes.
Fernando, S; Kanthi, R D F C; Johnson, N W
According to National Oral Health Survey reports and research, Early Childhood Caries has been identified as a serious public health problem in Sri Lanka. More than 65% of preschool-aged children have dental decay and only 2% of them have had treatment. With proper interventions and commitment from public health personnel and responsible community leaders this should be a largely preventable disease. An intervention study was conducted among preschool teachers in the District of Colombo, Sri Lanka, to assess their influence on oral health promotion in the school environment. All the available 52 preschools and all 72 teachers registered under a local government authority were involved in the study. Preschools were divided into intervention group and control group based on geographically defined areas. The intervention included training preschool teachers using a manual covering health education, health promotion, incorporation of oral-health-friendly activities into the preschool curriculum, and hands-on experience of oral examination. Pre- and post- assessments were conducted with a 6 month interval. After 6 months, the median oral health knowledge score of the intervention group improved from 55 to 72 (p = 0.005) and the mean score for oral health related practices from 32 to 35 (p = 0.032). The variables: oral-health-friendly preschool environment (p = 0.02), availability of brushing facilities (p = 0.005) and availability of information, education and communication materials related to oral health (p = 0.004) were significantly different between the two groups after 6 months. Oral health promotion activities can be effectively instilled in a pre-school environment by the education of teachers.
Beratarrechea, Andrea; Moyano, Daniela; Irazola, Vilma; Rubinstein, Adolfo
mHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.
Sutton, Roberta; Lahuerta, Maria; Abacassamo, Fatima; Ahoua, Laurence; Tomo, Maria; Lamb, Matthew R; Elul, Batya
Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited. The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions-modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders-and 3 structural interventions-point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered-extent each intervention was delivered as planned-and dose received-participant acceptability-of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data. For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention. Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.
Mitrani, Victoria B; McCabe, Brian E; Gonzalez-Guarda, Rosa M; Florom-Smith, Aubrey; Peragallo, Nilda
HIV and intimate partner violence (IPV) risks are linked in Hispanic women, so integrated interventions can efficiently produce meaningful change. Integrated interventions for Hispanic women are promising, but factors that put Hispanic women at risk for HIV and violence may also impede engagement with interventions. This study examined barriers and facilitators of engagement in a group educational intervention, SEPA (Salud, Educación, Prevención y Autocuidado [Health, Education, Prevention, and Self-Care]), for Hispanic women. A total of 274 Hispanic women from South Florida in the SEPA condition of a randomized controlled trial completed baseline measures of violence, depression, familism, Hispanic stress, acculturation, and demographics, and 57% of the women engaged (attended two of five sessions). Education, IPV, and acculturation predicted engagement. Understanding engagement advances intervention development/refinement. Hispanic women who experience relationship violence are open to group interventions. Further program development and outreach work are needed to connect women with low education, who are particularly vulnerable.
Crowe, Marie; Jordan, Jennifer; Burrell, Beverley; Jones, Virginia; Gillon, Deborah; Harris, Shirley; Wilkinson, Amanda
The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older. The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self-management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease-specific. Quantitative systematic review. Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods (EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for assessing the weight of evidence. Medline, CINAHL, PubMed and PsycINFO 1999-2014. Twelve studies were included in the review (n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization. While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low. © 2016 John Wiley & Sons Ltd.
Langford, Rebecca; Panter-Brick, Catherine
Health interventions increasingly rely on formative qualitative research and social marketing techniques to effect behavioural change. Few studies, however, incorporate qualitative research into the process of program evaluation to understand both impact and reach: namely, to what extent behaviour change interventions work, for whom, in what contexts, and why. We reflect on the success of a community-based hygiene intervention conducted in the slums of Kathmandu, Nepal, evaluating both maternal behaviour and infant health. We recruited all available mother-infant pairs (n = 88), and allocated them to control and intervention groups. Formative qualitative research on hand-washing practices included structured observations of 75 mothers, 3 focus groups, and 26 in-depth interviews. Our intervention was led by Community Motivators, intensively promoting hand-washing-with-soap at key junctures of food and faeces contamination. The 6-month evaluation period included hand-washing and morbidity rates, participant observation, systematic records of fortnightly community meetings, and follow-up interviews with 12 mothers. While quantitative measures demonstrated improvement in hand-washing rates and a 40% reduction in child diarrhoea, the qualitative data highlighted important equity issues in reaching the ultra-poor. We argue that a social marketing approach is inherently limited: focussing on individual agency, rather than structural conditions constraining behaviour, can unwittingly exacerbate health inequity. This contributes to a prevention paradox whereby those with the greatest need of a health intervention are least likely to benefit, finding hand-washing in the slums to be irrelevant or futile. Thus social marketing is best deployed within a range of interventions that address the structural as well as the behavioural and cognitive drivers of behaviour change. We conclude that critiques of social marketing have not paid sufficient attention to issues of health
Zavala-González, Marco Antonio; Cabrera-Pivaral, Carlos Enrique; Orozco-Valerio, María de Jesús; Ramos-Herrera, Igor Martín
To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. Systematic review and meta-analysis. Searches were made in MedLine(©), ScienceDirect(©), Springer(©), SciELO(©), Dialnet(©), RedALyC(©) and Imbiomed(©), in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Full Text Available Background: Prevalence rates in breast cancer have now reached epidemic levels. One of the main reasons behind onset of breast cancer is poor preventive beliefs and behavior of women towards cancer prevention. We examined the effectiveness of health education intervention in two communities of South Greece.Objective: The study investigates the effectiveness of a brief health education intervention on women’s beliefs and behaviour changes concerning breast cancer prevention.Methodology: A 90-minute, one-off encounter, health education study was designed for 300 women from Peloponissos, South Greece. A Health Belief Model questionnaire, was used before the intervention, immediately after and 6-months after the intervention.Results: Despite certain perception-related barriers (embarrassment, anxiety, ect women’s overall beliefs towards breast cancer prevention (perceived susceptibility, perceived benefits and perceived barriers changed positively after the health education intervention and this change was sustained at 6-month follow up. However, specific barriers (embarrassment, fear of pain, anxiety when anticipating tests’ results were not maintained at the same level of post-intervention during the same follow up. During the follow up period, women performed breast self-examination every month (73% and 55.10% had breast examination by a clinician and underwent a mammography.Conclusions: Short, low cost, health education interventions for breast cancer prevention to women can be effective in changing beliefs and behaviour. Tailored interventions are necessary to overcome relapsing of specific barriers. Emphasis should be given on the importance of doctor/nurse role in breast screening.
the 2008 “Investing in Young People's Health and Development: Research that Improves Policies and Programs” in. Abuja ... Different methods have been proposed and used; they ... To improve youth-friendly services, traditional teaching ...
Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal
In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and
Full Text Available In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health
Christensen, Marie Ernst; Thorø, Karsten
Abstract Submission for Brussels 2013 Title: Health Promotion in the Workplace: Aspects of Participatory Contributions of Educational Programs Presenting author: Karsten Thorø Presenting author´s email: KTHO@viauc.dk Authors: K Thorø, ME Christensen Affiliation: Faculty of Health Science, Departm......Abstract Submission for Brussels 2013 Title: Health Promotion in the Workplace: Aspects of Participatory Contributions of Educational Programs Presenting author: Karsten Thorø Presenting author´s email: KTHO@viauc.dk Authors: K Thorø, ME Christensen Affiliation: Faculty of Health Science...... in an area which in a few years will host approx. 25.000 knowledge workers and students focusing on IT, food science, technology, and health. This geographical location gives the students a unique opportunity to engage in practice related work in the fields of health promotion and prevention, thereby...... of 121 participants signed up for fitness classes, jogging teams, dietary guidance, or smoking cessation. The offers were administrated by 30 students. The students report substantial learning outcome from the participation, especially with regard to developing their professional skills, their knowledge...
Pakarinen, Anni; Parisod, Heidi; Smed, Jouni; Salanterä, Sanna
To describe and explore health game interventions that enhance the physical activity self-efficacy of children and to evaluate the effectiveness of these interventions. Physical inactivity among children has increased globally. Self-efficacy is one of the key determinants of physical activity engagement in children. There is a need to explore new and innovative interventions to enhance physical activity self-efficacy that are also acceptable for today's children. Quantitative systematic review. MEDLINE (Ovid), CINAHL, PsychInfo, EMBASE and the Cochrane Library between 1996-2016. A review was conducted in accordance with the Cochrane Collaboration guidelines. A systematic search was done in June 2016 by two independent reviewers according to the eligibility criteria as follows: controlled trial, comparison of digital game intervention with no game intervention control condition, participants younger than 18 years of age and reported statistical analyses of a physical activity self-efficacy outcome measure. Altogether, five studies met the eligibility criteria. Four game interventions, employing three active games and one educational game, had positive effects on children's physical activity self-efficacy. An intervention, employing a game-themed mobile application, showed no intervention effects. The variation between intervention characteristics was significant and the quality of the studies was found to be at a medium level. Although health game interventions seemingly enhance the physical activity self-efficacy of children and have potential as a means of increasing physical activity, more rigorous research is needed to clarify how effective such interventions are in the longer run to contribute to the development of game-based interventions. © 2016 John Wiley & Sons Ltd.
Price, Sarah Kye; Gray, Lisa A.; El-Khoury, Dalia
Home visiting programs recognize the importance of promoting women's mental health during and around the time of pregnancy. However, the process of planning and integrating mental health promotion and intervention into the home visiting setting can seem daunting. Using examples and lessons learned from research and practice, the authors provide a…
Ekman, Björn; Pathmanathan, Indra; Liljestrand, Jerker
For women and children, especially those who are poor and disadvantaged, to benefit from primary health care, they need to access and use cost-effective interventions for maternal, newborn, and child health. The challenge facing weak health systems is how to deliver such packages. Experiences from countries such as Iran, Malaysia, Sri Lanka, and China, and from projects in countries like Tanzania and India, show that outcomes in maternal, newborn, and child health can be improved through integrated packages of cost-effective health-care interventions that are implemented incrementally in accordance with the capacity of health systems. Such packages should include community-based interventions that act in combination with social protection and intersectoral action in education, infrastructure, and poverty reduction. Interventions need to be planned and implemented at the district level, which requires strengthening of district planning and management skills. Furthermore, districts need to be supported by national strategies and policies, and, in the case of the least developed countries, also by international donors and other partners. If packages for maternal, newborn and child health care can be integrated within a gradually strengthened primary health-care system, continuity of care will be improved, including access to basic referral care before and during pregnancy, birth, the postpartum period, and throughout childhood.
Raiha, Teija; Tossavainen, Kerttu; Turunen, Hannele; Enkenberg, Jorma; Kiviniemi, Vesa
The purpose of this investigation was to evaluate the effects of nutrition health intervention on pupils' nutrition knowledge and eating habits from grade seven to grade nine. The study was part of the ENHPS (since 2008, Schools for Health in Europe (SHE)) program in Finland, and more specifically its sub-project titled "From Puijo to the…
Desta, Menelik; Deyessa, Negussie; Fish, Irving; Maxwell, Benjamin; Zerihun, Tigist; Levine, Saul; Fox, Claire; Giedd, Jay; Zelleke, Tesfaye G.; Alem, Atalay; Garland, Ann F.
In Ethiopia there is a severe shortage of child mental health professionals. Identification and intervention for young children's mental health problems is crucial to improve developmental trajectories and reduce the severity of emotional and behavioral disorders. Teachers can play an important role in early problem detection. This role is…
Building community capacity for health promotion in small rural communities is essential if health promotion research is to yield sustainable outcomes. Since its inception, capacity-building has been a stated goal of the Delta Nutrition Intervention Research initiative, a tri-state collaboration in ...
Heijmans, M.; Waverijn, G.; Rijken, M.; Osborne, R.; Rademakers, J.
Health literacy (HL) is an important prerequisite for successful self-management and a determinant of health care use in chronic disease. HL is a multidimensional concept covering several functional, social and psychological dimensions. When developing interventions to improve HL it is an important
Full Text Available Objective. To share experiences from a project that integrates a mental health intervention within a developmental framework of microcredit activity for economically underprivileged women in rural India. Method. The mental health intervention had two components: group counseling and stress management. The former comprised of ventilation and reassurance and the latter strengthening of coping skills and a relaxation technique. Focus group discussions were used to understand women's perception of how microcredit economic activity and the mental health intervention had affected their lives. Results. Women in the mental health intervention group reported reduction in psychological distress and bodily aches and pains. Majority (86% reported that the quality of their sleep had improved with regular practice of relaxation and that sharing their problems in the group had helped them to unburden. The social support extended by the members to each other, made them feel that they were not alone and could face any life situation. Conclusion. The study provided qualitative evidence that adding the mental health intervention to the ongoing economic activity had made a positive difference in the lives of the women. Addressing mental health concerns along with livelihood initiatives can help to enhance both economic and social capital in rural poor women.
Eldridge, Gloria; Weaver, Michael; Villalobos, Gabriela; Stitzer, Maxine; Best, Al
Objectives. We tested the efficacy of a combined pharmacologic and behavioral smoking cessation intervention among women in a state prison in the southern United States. Methods. The study design was a randomized controlled trial with a 6-month waitlist control group. The intervention was a 10-week group intervention combined with nicotine replacement therapy. Two hundred and fifty participants received the intervention, and 289 were in the control group. Assessments occurred at baseline; end of treatment; 3, 6, and 12 months after treatment; and at weekly sessions for participants in the intervention group. Results. The intervention was efficacious compared with the waitlist control group. Point prevalence quit rates for the intervention group were 18% at end of treatment, 17% at 3-month follow-up, 14% at 6-month follow-up, and 12% at 12-month follow-up, quit rates that are consistent with outcomes from community smoking-cessation interventions. Conclusions. Female prisoners are interested in smoking cessation interventions and achieved point-prevalence quit rates similar to community samples. Augmenting tobacco control policies in prison with smoking cessation interventions has the potential to address a significant public health need. PMID:18703440
Full Text Available Abstract Background Too few young people engage in behaviors that reduce the risk of morbidity and premature mortality, such as eating healthily, being physically active, drinking sensibly and not smoking. The present research developed an online intervention to target these health behaviors during the significant life transition from school to university when health beliefs and behaviors may be more open to change. This paper describes the intervention and the proposed approach to its evaluation. Methods/design Potential participants (all undergraduates about to enter the University of Sheffield will be emailed an online questionnaire two weeks before starting university. On completion of the questionnaire, respondents will be randomly assigned to receive either an online health behavior intervention (U@Uni or a control condition. The intervention employs three behavior change techniques (self-affirmation, theory-based messages, and implementation intentions to target four heath behaviors (alcohol consumption, physical activity, fruit and vegetable intake, and smoking. Subsequently, all participants will be emailed follow-up questionnaires approximately one and six months after starting university. The questionnaires will assess the four targeted behaviors and associated cognitions (e.g., intentions, self-efficacy as well as socio-demographic variables, health status, Body Mass Index (BMI, health service use and recreational drug use. A sub-sample of participants will provide a sample of hair to assess changes in biochemical markers of health behavior. A health economic evaluation of the cost effectiveness of the intervention will also be conducted. Discussion The findings will provide evidence on the effectiveness of online interventions as well as the potential for intervening during significant life transitions, such as the move from school to university. If successful, the intervention could be employed at other universities to promote
Clarke, Aleisha M; Kuosmanen, Tuuli; Barry, Margaret M
The rapid growth in the use of online technologies among youth provides an opportunity to increase access to evidence-based mental health resources. The aim of this systematic review is to provide a narrative synthesis of the evidence on the effectiveness of online mental health promotion and prevention interventions for youth aged 12-25 years. Searching a range of electronic databases, 28 studies conducted since 2000 were identified. Eight studies evaluating six mental health promotion interventions and 20 studies evaluating 15 prevention interventions were reviewed. The results from the mental health promotion interventions indicate that there is some evidence that skills-based interventions presented in a module-based format can have a significant impact on adolescent mental health, however, an insufficient number of studies limits this finding. The results from the online prevention interventions indicate the significant positive effect of computerized cognitive behavioral therapy on adolescents' and emerging adults' anxiety and depression symptoms. The rates of non-completion were moderate to high across a number of studies. Implementation findings provide some evidence that participant face-to-face and/or web-based support was an important feature in terms of program completion and outcomes. Additional research examining factors affecting exposure, adherence and outcomes is required. The quality of evidence across the studies varied significantly, thus highlighting the need for more rigorous, higher quality evaluations conducted with more diverse samples of youth. Although future research is warranted, this study highlights the potential of online mental health promotion and prevention interventions in promoting youth wellbeing and reducing mental health problems.
Full Text Available Abstract Background The extent to which a health care intervention causes or facilitates health-related change is a key question in research. The need to quantify such change has led to the development of an increasing number of change indicators, to measure what have come to be known as 'outcomes'. In the context of medical research into the efficacy or effectiveness of an intervention the term 'outcomes' has often been interpreted to mean single endpoints with a linear cause and effect link to an external intervention. Discussion In this paper we present a critical analysis of the nature and interpretation of the 'outcomes' concept and of the assumptions that underpin it. Drawing on our own work and that of others, we analyse the problems that arise when the concept is applied to complex interventions and discuss the use of other models, such as programme theory, as a basis for alternative conceptualisations for indicators of change. Our analysis demonstrates that the interpretation of 'outcomes' that may be appropriate for clinical trials of pharmaceutical products, is problematic when used in evaluations of complex interventions in areas such as complementary medicine, palliative care, rehabilitation, and health promotion. The 'outcomes' concept may impose inappropriate patterns of thought and meaning. We present alternative models, such as those based on programme theory, which conceptualise health-related change as resulting from the interaction between intervention, process and context over time. In this framework both the intervention and the patient are defined as causal factors, because the result of the treatment is dependent on the resources of the patient – such as the body's ability to heal itself – and the impact of the patient's situation. Summary Evaluations based on a model such as programme theory will encompass a wide range of health-related changes that include aspects of process, such as new meanings and understanding
Dawson, Angus J
In this paper I outline and explore some problems in the way that the Nuffield Council of Bioethics' report Public Health: Ethical Issues (2007) presents its 'Intervention Ladder'. They see the metaphor of a ladder both as capturing key normative priorities and as making a real and important contribution to ethical policymaking in public health. In this paper I argue that the intervention ladder is not a useful model for thinking about policy decisions, that it is likely to produce poor decisions and that it is incompatible with the report's stated approach to relevant public health policy values.
In the first contribution to a new section in AJPH that will address critical methodological issues in evaluations of public health interventions, I will discuss topics in study design and analysis, covering the most innovative emerging methodologies and providing an overview of best practices. The methods considered are motivated by public health evaluations, both domestic and global. In this first contribution, I also define implementation science, program evaluation, impact evaluation, and cost-effectiveness research, disciplines that have tremendous methodological and substantive overlap with evaluation of public health interventions--the focus of this section.
Chang, Larry W; Kagaayi, Joseph; Nakigozi, Gertrude; Serwada, David; Quinn, Thomas C; Gray, Ronald H; Bollinger, Robert C; Reynolds, Steven J; Holtgrave, David
A cost analysis study calculates resources needed to deliver an intervention and can provide useful information on affordability for service providers and policy-makers. We conducted cost analyses of both a peer health worker (PHW) and a mHealth (mobile phone) support intervention. Excluding supervisory staffing costs, total yearly costs for the PHW intervention was $8475, resulting in a yearly cost per patient of $8.74, per virologic failure averted cost of $189, and per patient lost to follow-up averted cost of $1025. Including supervisory staffing costs increased total yearly costs to $14,991. Yearly costs of the mHealth intervention were an additional $1046, resulting in a yearly cost per patient of $2.35. In a threshold analysis, the PHW intervention was found to be cost saving if it was able to avert 1.50 patients per year from switching to second-line antiretroviral therapy. Other AIDS care programs may find these intervention costs affordable.
Kalichman, Seth C; Cherry, Charsey; Cain, Demetria; Pope, Howard; Kalichman, Moira; Eaton, Lisa; Weinhardt, Lance; Benotsch, Eric G
Medical information can improve health, and there is an enormous amount of health information available on the Internet. A randomized clinical trial tested the effectiveness of an intervention based on social- cognitive theory to improve information use among people living with HIV/AIDS. Men and women (N = 448) were placed in either (a) an 8-session intervention that focused on Internet information consumer skills or (b) a time-matched support group and were followed to 9 months postintervention. The Internet skills group demonstrated greater Internet use for health, information coping, and social support compared with the control group. The authors conclude that people with HIV infection may benefit from increased access to health information on the Internet and that vulnerability to misinformation and fraud can be reduced through behavioral interventions. Copyright 2006 APA, all rights reserved.
Chadwick, Angelina Lilja; Withnell, Neil
Globally, there is increased recognition of a higher prevalence of physical ill health and mortality in individuals with mental health problems. A review of the literature highlighted the need to address deterioration in physical health of those with mental health problems through better recognition and management on the part of mental health nurses. However, mental health nurses have been found to lack confidence and be unsure of their role within this area. The aim of the project was to develop pre-registration mental health students' confidence to be able to recognise and manage physical health deterioration through the use of high fidelity human patient simulation, the development of contextualised clinical scenarios and additional theory around the A to E mnemonic structured assessment. The project involved 95 third year mental health student nurses, using a self-rating pre and post intervention questionnaire to measure their perceived confidence levels and to evaluate the effectiveness of the learning intervention. Findings demonstrate improved overall confidence levels in recognising and managing physical health deterioration in human patient simulators displaying mental health problems.
Sanou, Anselme Simeon; Awoyale, Florence Adeola; Diallo, Abdoulaye
The health sector is characterized by a human resource base lacking in numbers, specialized skills, and management skills. West African Health Organization (WAHO) recognizes the need within the West Africa sub-region for bilingual professionals who are skilled in public health, management, leadership, and information technology to build human capacity in public health and developed the Young Professionals Internship Program (YPIP). Our study explores the evolution of the programme. YPIP program has successfully carried out its original aims and objectives to equip young professionals with basic principles of public health, management, and leadership, acquire competence in a second official language (French, English, and Portuguese), information and communication technology. Contributing factors towards this successful evaluation included positive ratings and commentary from previous interns about the relevance, usefulness, and quality of the programme, encouraging feedback from WAHO management, trainers, administrators, and intern employers on the impact of the YPIP program on young professionals, supporting evidence that demonstrates increased knowledge in professional skills and language competency.
Light, L; Tenney, J; Portnoy, B; Kessler, L; Rodgers, A B; Patterson, B; Mathews, O; Katz, E; Blair, J E; Evans, S K
The growing evidence linking dietary patterns to the incidence and prevention of chronic disease has prompted a number of prominent health and scientific agencies to publish dietary guidelines for the public. Some dietary guidelines address specific diseases, such as cancer or heart disease; others focus on overall health promotion. This situation has created a demand for nutrition education and information programs for the public. Increasingly, supermarkets are seen as potential sites for effective consumer education. Eat for Health is a joint research study by the National Cancer Institute (NCI) and Giant Food Inc., a regional supermarket chain in the Washington-Baltimore area. The study's goal was to test the feasibility of supermarkets as a site for consumer nutrition education. Eat for Health's educational focus was diet and cancer control issues in the context of dietary patterns that promote health. Particular attention was paid to reduction of fat intake and increases in consumption of dietary fiber from grains, vegetables, and fruits. Analysis of program results is currently underway; data should be available in early 1990.
Quintiliani, Lisa M.; Mann, Devin M; Puputti, Marissa; Quinn, Emily; Bowen, Deborah J.
Background Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. Objective The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation...
Webber, Martin; Fendt-Newlin, Meredith
The association between social networks and improved mental and physical health is well documented in the literature, but mental health services rarely routinely intervene to improve an individual's social network. This review summarises social participation intervention models to illustrate different approaches which practitioners use, highlight gaps in the evidence base and suggest future directions for research. A systematic search of electronic databases was conducted, and social participation interventions were grouped into six categories using a modified narrative synthesis approach. Nineteen interventions from 14 countries were identified, six of which were evaluated using a randomised controlled trial. They were grouped together as: individual social skills training; group skills training; supported community engagement; group-based community activities; employment interventions; and peer support interventions. Social network gains appear strongest for supported community engagement interventions, but overall, evidence was limited. The small number of heterogeneous studies included in this review, which were not quality appraised, tentatively suggests that social participation interventions may increase individuals' social networks. Future research needs to use experimental designs with sufficient samples and follow-up periods longer than 12 months to enable us to make firm recommendations for mental health policy or practice.
Carty, Denise C; Kruger, Daniel J; Turner, Tonya M; Campbell, Bettina; DeLoney, E Hill; Lewis, E Yvonne
Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.
Ickovics, Jeannette R
Big Food: Health, Culture, and the Evolution of Eating broke numerous records for museum attendance, highlighting the public's appetite for public health. During its 10-month run at the Yale Peabody Museum of Natural History, more than 120 000 visitors attended Big Food, including 25 000 students through the museum's public education program, an increase of 30% more than the average student attendance in the past decade. Big Food cost approximately $100 000 to build, comprising printed panels and objects, installation displays (e.g., custom-built cases to house such objects as sugar-sweetened beverages and healthy and diseased organs), temporary walls, video monitors, food products, and more. At less than $1 per visitor, this provided extraordinary public health value.
Nahum-Shani, Inbal; Smith, Shawna N; Spring, Bonnie J; Collins, Linda M; Witkiewitz, Katie; Tewari, Ambuj; Murphy, Susan A
The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment. Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.
Sebbens, Joshua; Hassmén, Peter; Crisp, Dimity; Wensley, Kate
Mental illnesses are as prevalent among elite athletes as in the general population. Despite this, there is little research examining how to enhance mental health literacy or helping behaviors in elite sport environments. A Mental Health in Sport (MHS) workshop was therefore developed and its effects on mental health literacy and confidence studied in 166 coaches and support staff working with elite athletes and teams in Australia. Results indicated that participants increased their knowledge of the signs and symptoms of common mental illnesses and were more confident in helping someone who may be experiencing a mental health problem. We conclude that even a very brief intervention can be effective in improving the mental health literacy and confidence of key persons in elite sport environments, and may promote early intervention and timely referral of elite athletes with mental health concerns to appropriate professionals.
Wilhide Iii, Calvin C; Peeples, Malinda M; Anthony Kouyaté, Robin C
Mobile technology offers new capabilities that can help to drive important aspects of chronic disease management at both an individual and population level, including the ability to deliver real-time interventions that can be connected to a health care team. A framework that supports both development and evaluation is needed to understand the aspects of mHealth that work for specific diseases, populations, and in the achievement of specific outcomes in real-world settings. This framework should incorporate design structure and process, which are important to translate clinical and behavioral evidence, user interface, experience design and technical capabilities into scalable, replicable, and evidence-based mobile health (mHealth) solutions to drive outcomes. The purpose of this paper is to discuss the identification and development of an app intervention design framework, and its subsequent refinement through development of various types of mHealth apps for chronic disease. The process of developing the framework was conducted between June 2012 and June 2014. Informed by clinical guidelines, standards of care, clinical practice recommendations, evidence-based research, best practices, and translated by subject matter experts, a framework for mobile app design was developed and the refinement of the framework across seven chronic disease states and three different product types is described. The result was the development of the Chronic Disease mHealth App Intervention Design Framework. This framework allowed for the integration of clinical and behavioral evidence for intervention and feature design. The application to different diseases and implementation models guided the design of mHealth solutions for varying levels of chronic disease management. The framework and its design elements enable replicable product development for mHealth apps and may provide a foundation for the digital health industry to systematically expand mobile health interventions and validate
Nkonki, L; Tugendhaft, A; Hofman, K
Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.There is a growing body of economic evaluation literature on cost-effectiveness of CHW
de Walque, Damien
Behaviors that pose risks for an individual’s health and that also represent important threats for public health, such as drug use, smoking, alcohol, unhealthy eating causing obesity, and unsafe sex, are highly prevalent in low income countries, even though they are traditionally associated with richer countries. Individual choices are an important part of the risky behaviors. Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors explore how those choices...
Graf, C; Dordel, S
Child and juvenile obesity is increasing worldwide; therefore, effective preventive strategies are warranted. The stepwise project CHILT (Children's Health Interventional Trial) was initiated in 2000 and combines in its multicomponent school-based arm CHILT I health education and physical activity for primary school children to prevent physical inactivity and overweight. The effect on obesity and physical performance was studied in 12 primary schools (intervention schools, IS) compared with 5 control schools (CS). Anthropometric data were recorded. Physical performance was measured by a coordination test for children (the "Körperkoordinationstest für Kinder", KTK) and the 6-minute run. Anthropometric and motoric data of 436 children in IS (55.0% of the population) and 179 children in CS (62.8%) were available at baseline and at follow-up. No difference in the incidence of overweight was found between the IS and CS after 4 years of intervention. Remission of overweight was higher in IS (23.2% versus 19.2%), but not significant. The increase in BMI was significantly lower in IS, in which the program was regularly performed. There was an improvement in selected items of the KTK in IS. In particular, endurance performance tended to be higher at final examination. School-based preventive intervention seems to have a positive influence on physical motor skills and the remission of overweight. To optimize the effects, a consistent and quality assured implementation and the integration of the children's whole environment are warranted.
Full Text Available Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13, cardiovascular diseases (n = 8, and diabetes (n = 6. Intervention strategies included instructional education/counseling (n = 20, workplace environmental change (n = 6, physical activity (n = 10, use of technology (n = 10, and incentives (n = 13. Self-reported data (n = 21, anthropometric measurements (n = 17, and laboratory tests (n = 14 were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.
Robinson, Sally; Robinson, Carol
Purpose: The purpose of this paper is to outline the development of a resource designed to support practitioners, who are not sexual health specialists, but who work with young people who may be at risk of teenage pregnancy or parenthood. Its aim was to enable practitioners to carry out an assessment using a screening tool, and to use educational…
The prevalence of osteoporosis and low bone mass is expected to increase as the United States population ages. High dietary fiber intake has previously been implicated as a risk factor for bone health by binding calcium and thereby reducing its intestinal absorption; however, more recently, interven...
Brown, K E; Newby, K; Caley, M; Danahay, A; Kehal, I
Sexual health service access is fundamental to good sexual health, yet interventions designed to address this have rarely been implemented or evaluated. In this article, pilot evaluation findings for a targeted public health behavior change intervention, delivered via a website and web-app, aiming to increase uptake of sexual health services among 13-19-year olds are reported. A pre-post questionnaire-based design was used. Matched baseline and follow-up data were identified from 148 respondents aged 13-18 years. Outcome measures were self-reported service access, self-reported intention to access services and beliefs about services and service access identified through needs analysis. Objective service access data provided by local sexual health services were also analyzed. Analysis suggests the intervention had a significant positive effect on psychological barriers to and antecedents of service access among females. Males, who reported greater confidence in service access compared with females, significantly increased service access by time 2 follow-up. Available objective service access data support the assertion that the intervention may have led to increases in service access. There is real promise for this novel digital intervention. Further evaluation is planned as the model is licensed to and rolled out by other local authorities in the United Kingdom.
Montoya, Jessica L; Georges, Shereen; Poquette, Amelia; Depp, Colin A; Atkinson, J Hampton; Moore, David J
Mobile health (mHealth) interventions to promote antiretroviral therapy (ART) adherence have shown promise; however, among persons living with HIV who abuse methamphetamine (MA), effective tailoring of content to match the expressed needs of this patient population may be necessary. This study aimed (1) to understand patient perspectives of barriers and facilitators of ART adherence among people with HIV who use MA, and (2) to obtain feedback on the thematic content of an mHealth intervention in order to tailor the intervention to this subgroup. Two separate focus groups, each with 10 HIV+/MA+ individuals, were conducted. Transcribed audio recordings were qualitatively analyzed to identify emergent themes. Inter-rater reliability of themes was high (mean Kappa = .97). Adherence barriers included MA use, misguided beliefs about ART adherence, memory and planning difficulties, social barriers and perceived stigma, and mental heath issues. Facilitators of effective ART adherence were cognitive compensatory strategies, promotion of well-being, health-care supports, adherence education, and social support. Additionally, the focus groups generated content for reminder text messages to be used in the medication adherence intervention. This qualitative study demonstrates the feasibility of using focus groups to derive patient-centered intervention content to address the health challenge at hand in targeted populations.
Squarcione, S; Matricardi, G; Russo, M R; Caporale, V; Dalla, Villa P; Migliorati, G; Niutta, P; Leonardi, M; Di Giamberardino, L; Capuzzi, T; Marino, G; Laurenzi, R; Romito, P; Bove, M; Montanari, A; Casagrande, M R; Martinez, V; Muccicone, A F; Generali, E; Trotta, C; Chiarenza, R
On 6th April 2009, at 3.32 AM, there was in L'Aquila and in some neighbouring villages, after an earthquake swarm last some months, an earthquake of M(L) = 5.8 (Richter magnitude scale) on depth of 8.8 km. The event was sensed in a very broad area, till in Rome and Ancon. The operative committee of the Civil Protection Department immediately gathered and a first operating group was despatched in the epicentre; the voluntary association of civil protection were in a pre-alarm situation and then were activated. This work want describe all the activities from 6th April 2009 till 31th August 2009, giving too a synthesis of the normative lines in case of catastrophic events typology C, otherwise all that events impossible to manage without national intervention.
Robertson, Michelle; Henning, Robert; Warren, Nicholas; Nobrega, Suzanne; Dove-Steinkamp, Megan; Tibirica, Lize; Bizarro, Andrea
As part of a Research-to-Practice Toolkit development effort by the Center for the Promotion of Health in the New England Workplace, to develop and test a structured participatory approach for engaging front-line employees in the design of integrated health protection and promotion interventions. On the basis of a participatory ergonomics framework, the Intervention Design and Analysis Scorecard (IDEAS) provides a stepwise approach for developing intervention proposals, including root cause analysis and setting evaluation criteria such as scope, obstacles, and cost/benefit trade-offs. The IDEAS was tested at four diverse worksites with trained facilitators. Employees were able to develop and gain management support for integrated interventions at each worksite. The IDEAS can be used effectively by front-line employees to plan integrated interventions in a program dedicated to continuous improvement of employee health protection/promotion and Total Worker Health.
Effectiveness of a Walking Group Intervention to Promote Physical Activity and Cardiovascular Health in Predominantly Non-Hispanic Black and Hispanic Urban Neighborhoods: Findings from the Walk Your Heart to Health Intervention
Schulz, Amy J.; Israel, Barbara A.; Mentz, Graciela B.; Bernal, Cristina; Caver, Deanna; DeMajo, Ricardo; Diaz, Gregoria; Gamboa, Cindy; Gaines, Causandra; Hoston, Bernadine; Opperman, Alisha; Reyes, Angela G.; Rowe, Zachary; Sand, Sharon L.; Woods, Sachiko
Objectives: The purpose of this study was to evaluate the effectiveness of the "Walk Your Heart to Health" ("WYHH") intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk…
Malgady, R G; Rogler, L H; Costantino, G
Culturally sensitive treatments of the special mental health needs of high-risk Puerto Rican adolescents are lacking. The hero/heroine intervention was based on adult Puerto Rican role models to foster ethnic identity, self-concept, and adaptive coping behavior. 90 nonclinical Puerto Rican 8th and 9th graders were screened for presenting behavior problems in school and randomly assigned to an intervention and a control group. After 19 sessions, the intervention significantly increased adolescents' ethnic identity and self-concept and reduced anxiety. Treatment outcomes varied as a function of grade level, sex, and household composition. Self-concept was negatively affected among girls from intact families. The study supports the effectiveness of the culturally sensitive modality as a preventive mental health intervention for high-risk Puerto Rican adolescents, especially from single-parent families.
L. Moore (Laurence); M. Chersich (Matthew); R. Steen (Richard); S. Reza-Paul (Sushena); A. Dhana (Ashar); B. Vuylsteke (Bea); Y. Lafort (Yves); F. Scorgie (Fiona)
textabstractBackground: Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little
Christensen, Marie Ernst; Thorø, Karsten
The Department of Physiotherapy, and the Professional Bachelor Program in Nutrition and Health at VIA University College, Aarhus, Denmark merged on a new campus in an area which soon will host approx. 25.000 worker and students. The geographical location provided a unique opportunity to create...... a pratice-related teaching program focused on health promotion. The project creates a framework for the interaction of theory and practice. Moreover, this blend generates new modes of teaching due to the fact that the teaching is transferred from the usu-al environment to sites where the students experience...... the potential of engaging with real-time media, instead of just practising their professional skills amongst their fellow students. The emerging didactical graphics in the teaching of entrepreneurship are conceptualized as elements where the students take action and thereby develop an active approach...
Mwasa, A; Tchuenche, J M
Cholera, an acute gastro-intestinal infection and a waterborne disease continues to emerge in developing countries and remains an important global health challenge. We formulate a mathematical model that captures some essential dynamics of cholera transmission to study the impact of public health educational campaigns, vaccination and treatment as control strategies in curtailing the disease. The education-induced, vaccination-induced and treatment-induced reproductive numbers R(E), R(V), R(T) respectively and the combined reproductive number R(C) are compared with the basic reproduction number R(0) to assess the possible community benefits of these control measures. A Lyapunov functional approach is also used to analyse the stability of the equilibrium points. We perform sensitivity analysis on the key parameters that drive the disease dynamics in order to determine their relative importance to disease transmission and prevalence. Graphical representations are provided to qualitatively support the analytical results.
Deborah D. DiLiberto
Full Text Available Background: In Uganda, health system challenges limit access to good quality healthcare and contribute to slow progress on malaria control. We developed a complex intervention (PRIME, which was designed to improve quality of care for malaria at public health centres. Objective: Responding to calls for increased transparency, we describe the PRIME intervention's design process, rationale, and final content and reflect on the choices and challenges encountered during the design of this complex intervention. Design: To develop the intervention, we followed a multistep approach, including the following: 1 formative research to identify intervention target areas and objectives; 2 prioritization of intervention components; 3 review of relevant evidence; 4 development of intervention components; 5 piloting and refinement of workshop modules; and 6 consolidation of the PRIME intervention theories of change to articulate why and how the intervention was hypothesized to produce desired outcomes. We aimed to develop an intervention that was evidence-based, grounded in theory, and appropriate for the study context; could be evaluated within a randomized controlled trial; and had the potential to be scaled up sustainably. Results: The process of developing the PRIME intervention package was lengthy and dynamic. The final intervention package consisted of four components: 1 training in fever case management and use of rapid diagnostic tests for malaria (mRDTs; 2 workshops in health centre management; 3 workshops in patient-centred services; and 4 provision of mRDTs and antimalarials when stocks ran low. Conclusions: The slow and iterative process of intervention design contrasted with the continually shifting study context. We highlight the considerations and choices made at each design stage, discussing elements we included and why, as well as those that were ultimately excluded. Reflection on and reporting of ‘behind the scenes’ accounts of intervention
The growth of the Internet, mobile phones, social media and other digital technologies has changed our world in many ways. It has provided individuals with information that was previously only available to a select few. An example of the reach of technology is data that as of October 2012, there are over 6 billion phones worldwide (BBC, 2012). The availability of data in real time has presented hopes of intervening more efficiently and managing health problems by leveraging limited human reso...
Bardus, Marco; Blake, Holly; Lloyd, Scott; Suzanne Suggs, L.
Purpose – The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention. Design/methodology/approach – Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the...
Arneson, Hanna; Ekberg, Kerstin
The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health
R (Heidari Noot
Full Text Available Background: More than 8% of Irans populations are elderly. The greatest challenge in this generation is improvement of health and quality of life. So we decided to perform an interventional study with the aim of promoting the health of the elderly.Methods: This study was a community interventional in Ekbatan Complex. Subjects were elderly. At first, need assessment was done with the participation of 200 elderly by questionnaire. Based on the need assessment, we designed the educational interventions in different fields such as nutrition, mental health, and exercise and then, we compared the results.Results: 0ne hundred elderly participated as interventional group. There were 86% women and 24% of men. Almost 59% were in the 60-69 age group. More than ¼ of the subjects were university graduates. Pre and post interventional groups were matched in age, education and gender. Regarding nutrition, second priority food in women aged 60-69 was rice and after the intervention, it was changed to vegetables (P= 0.05 but in other age groups and in the mens groups no difference were noted.Aerobic exercises in women has increased after the intervention (P= 0.01. With regards to mental health, life satisfaction among women under study has increased from 68% to 90% after the intervention (P= 0.01. Feeling happy most of the time has increased from 53% to 83% in women aged 60-69 (P= 0.01 and in men from 64% to 83% (P= 0.05 respectively.Conclusion: Policymakers should design long-term educational programs to promote the elderly lifestyles.
Sun, Xiaojie; Zhang, Nan; Liu, Kun; Li, Wen; Oksanen, Tuula; Shi, Lizheng
To examine whether workplace social capital improved after implementing a workplace social capital intervention in community health centers in China. This study was conducted in 20 community health centers of similar size in Jinan of China during 2012-2013. Using the stratified site randomization, 10 centers were randomized into the intervention group; one center was excluded due to leadership change in final analyses. The baseline survey including 447 staff (response rate: 93.1%) was conducted in 2012, and followed by a six-month workplace social capital intervention, including team building courses for directors of community health centers, voluntarily public services, group psychological consultation, and outdoor training. The follow-up survey in July 2013 was responded to by 390 staff members (response rate: 86.9%). Workplace social capital was assessed with the translated and culturally adapted scale, divided into vertical and horizontal dimensions. The facility-level intervention effects were based on all baseline (n = 427) and follow-up (n = 377) respondents, except for Weibei respondents. We conducted a bivariate Difference-in-Difference analysis to estimate the facility-level intervention effects. No statistically significant intervention effects were observed at the center level; the intervention increased the facility-level workplace social capital, and its horizontal and vertical dimensions by 1.0 (p = 0.24), 0.4 (p = 0.46) and 0.8 (p = 0.16), respectively. The comprehensive intervention seemed to slightly improve workplace social capital in community health centers of urban China at the center level. High attrition rate limits any causal interpretation of the results. Further studies are warranted to test these findings.
van der Pligt, Paige; Ball, Kylie; Wilkinson, Shelley A; Lappas, Martha; McCarthy, Elizabeth A; Campbell, Karen J
Background Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women’s and health professionals’ views of mHealth in antenatal care are limited. Objective This study aimed to explore women’s and health professionals’ views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some
Full Text Available Objectives: Since the early 1990s there has been an increasing awareness of social and ethnic inequity in health and for the last few years there has also been an increasing focus on disparities in the quality of health services to ethnic minority groups. The aim of this review was to collect and summarise in a systematic and transparent manner the effect of interventions to improve health care services for ethnic minorities.Methods: We searched several medical databases for systematic reviews and randomised controlled trials. Two researchers independently screened for and selected studies, assessed risk of bias, extracted data and graded the quality of the evidence for each outcome in the included studies. The analysis was done qualitatively by describing studies and presenting them in tables.Results: We included 19 primary studies. The interventions were targeted at reducing clinical, structural and organisational barriers against good quality health care services. Eight studies examined the effect of educational interventions in improving outcomes within cross-cultural communication, smoking cessation, asthma care, cancer screening and mental health care. In six comparisons the effect of reminders for improving health care services and patient outcomes within cancer screening and diabetes care was examined. Two studies compared professional remote interpretation services to traditional interpretation services, two studies compared ethnic matching of client and therapist and two studies examined the effect of providing additional support in the form of more personnel in the treatment of diabetes and kidney transplant patients. Most patients were African-Americans and Latin-Americans and all ages were represented.Conclusions: Educational interventions and electronic reminders to physicians may in some contexts improve health care and health outcomes for minority patients. The quality of the evidence varied from low to very low. The quality of
Kwate, Naa Oyo A
The negative health effects of racism have been well documented, but how to intervene to redress these effects has been little studied. This study reports on RISE (Racism Still Exists), a high-risk, high-reward public health intervention that used outdoor advertising to disseminate a "countermarketing" campaign in New York City (NYC). Over 6 months, the campaign advertised stark facts about the persistence of racism in the USA. A probability sample of N = 144 participants from two predominantly Black NYC neighborhoods completed measures of health status, health behaviors, and social attitudes. Three months postintervention, statistically significant declines in psychological distress were seen among study participants who were exposed to the campaign compared to those who were not. There were no changes in other hypothesized outcomes. The campaign also generated significant public discourse, particularly in social media. The results suggest that racism countermarketing campaigns may have promise as a community-based intervention to address health inequalities.
Full Text Available A number of health problems are associated with significant stigma, a social phenomenon in which individuals become the object of negative stereotypes. In addition to experiencing negative reactions from others, stigmatised individuals and groups can experience harmful consequences when they internalise these negative prevailing attitudes. The objective of this paper was to consider the potential to develop Internet-based health-related interventions explicitly targeting the effects of stigma on the individual. A review of the literature was conducted to synthesise current conceptualisations of stigma and self-stigma across a number of groups, and to identify current intervention developments. Self-stigma reduction strategies developed for in-person services include cognitive reframing, myth busting, contact with other members of the stigmatised group, and disclosure promotion. The development and provision of interventions targeting self-stigma within an online environment is in its infancy. Our review considers there to be particular potential of online interventions for this target, associated with the capacity of the Internet to promote having contact with peers within one’s stigmatised group, and for user interaction and empowerment. We conclude that self-stigma is a domain in which there is significant potential for innovation with health-related interventions, and provide a number of recommendations for online intervention development.
Nybo, Lars; Sundstrup, Emil; Jakobsen, Markus D.
PURPOSE:: to determine the effectiveness of brief intense interval training as exercise intervention for promoting health and evaluate potential benefits with reference to common interventions; i.e. prolonged exercise and strength training. METHODS:: 36 untrained men were divided into groups...... in cardiorespiratory fitness was superior in INT (14+/-2% increase in VO2max) compared to the other two exercise interventions (7+/-2% and 3+/-2% increases). The blood glucose concentration 2 hours following oral ingestion of 75 g of glucose was lowered to a similar extent following training in the INT (from 6...
Kelders, Saskia M.; Kok, Robin N.; Gemert-Pijnen, van Julia E.W.C.; Haugtvedt, C.P.; Stibe, A.
While technology based health interventions can be effective, high attrition rates are commonly observed in research and practice and are a major issue in eHealth. Research on adherence has recently gained some scientific attention, but little has been done as to how technology itself engages users.
Full Text Available Experts stress the need to bring the childhood obesity epidemic under control by means of an integrated approach. The implementation of such an approach requires the development of integrated enabling policies on public health by local governments. A prerequisite for developing such integrated public health policies is intersectoral collaboration. Since the development of integrated policies is still in its early stages, this study aimed to answer the following research question: “What interventions can promote intersectoral collaboration and the development of integrated health policies for the prevention of childhood obesity?” Data were collected through a literature search and observations of and interviews with stakeholders. Based on a theoretical framework, we categorized potential interventions that could optimize an integrated approach regarding children's physical activity and diet. The intervention categories included education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement.
This study is a randomized, controlled trial to examine the effect of the health contract intervention, based on the goal attainment theory, on the self-care behavior and physiological indices of renal dialysis patients in Korea. The experimental group (n = 21) underwent health contract intervention for 4 weeks, while the control group (n = 22) received routine care. The data were collected using questionnaires and measurement of physiological indices and analyzed using the SPSS WIN 12.0 program. A P value dialysis sessions were significantly low in the experimental group (P = 0.002, P = 0.017). Therefore, the health contract intervention based on the goal attainment theory proved effective in improving self-care behavior and physiological indices (K, P, mean weight gain) in renal dialysis patients in Korea.
Barrows, Jennifer L; Fleury, Julie
The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of cardiovascular disease, few studies have focused on the efficacy of yoga-based physical activity to promote cardiovascular health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce cardiovascular risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with cardiovascular outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga practices, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing cardiovascular risk.
The aim of nursing education is to prepare students with critical thinking, high interests in profession and high proficiency in patient care. Cooperative learning promotes team work and encourages knowledge building upon discussion. It has been viewed as one of the most powerful learning methods. Technology has been considered an influential tool in teaching and learning. It assists students in gathering more information to solve the problems and master skills better. The purpose of this study was to compare the effect of technology-based cooperative learning with technology-based individual learning in nursing students' critical thinking in catheterization knowledge gaining, error discovering, skill acquisitions, and overall scores. This study used a pretest-posttest experimental design. Ninety-eight students were assigned randomly to one of two groups. Questionnaires and tests were collected at baseline and after completion of intervention. The results of this study showed that there was no significant difference in related catheterization skill performance. However, the remaining variables differed greatly between the two groups. CONCLUSIONS AND APPLICATIONS: This study's findings guide the researchers and instructors to use technology-based cooperative learning more appropriately. Future research should address the design of the course module and the availability of mobile devices to reach student-centered and learn on the move goals. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available Internalizing and externalizing problems present as difficulties in socio-emotional competence and predispose to a wide range of mental and physical health outcomes. This study examines the efficacy of an intervention (Pyramid Plus in strengthening children’s socio-emotional competencies. Participants (294 11 year old children attending schools in Northern Ireland were screened for socio-emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ and before being allocated to attend a Pyramid Club intervention (n = 162, and a waiting list control (n = 122. A 3 × 2 mixed-model design was used: group (intervention group vs. waiting list control × 3 time points (pre- vs. post-intervention vs. 12 weeks follow up to investigate the impact of the Pyramid Plus intervention. Teachers and children completed the SDQ-11-16 years, and children completed the TEIQue-CSF ant all 3 times. SDQ total difficult, internalizing and externalizing scores were reduced significantly, and prosocial and emotional intelligence scores were increased significantly compared to waiting list controls post intervention and at follow up. The Pyramid Plus intervention improves the socio-emotional health of vulnerable children through promoting positive outcomes as well as reducing socio- emotional deficits.
Hill, Briony; Skouteris, Helen; Fuller-Tyszkiewicz, Matthew; McPhie, Skye
This study evaluated: (1) the efficacy of a health coaching (HC) intervention designed to prevent excessive gestational weight gain (GWG); and (2) whether there were improved psychological, motivational, and behavioural outcomes for women in the HC intervention compared to a "usual care" control group. In this quasi-experimental study, 267 pregnant women ≤18 weeks gestation were recruited between August 2011 and June 2013 from two hospital antenatal clinics in Melbourne, Australia. Intervention women received four individual HC and two group HC/educational sessions informed by theories of behaviour change. Women completed questionnaires assessing psychological, motivational and behavioural outcomes at 16-18 (baseline) and 33 (post-intervention) weeks gestation. Weight measures were collected. Compared to usual care, the intervention did not limit GWG or prevent excessive GWG. However, HC women reported greater use of active coping skills post-intervention. Despite lack of success of the HC intervention, given the risks associated with excessive weight gain in pregnancy, health professionals should continue to recommend appropriate GWG.
Watt, Melissa H; Wilson, Sarah M; Sikkema, Kathleen J; Velloza, Jennifer; Mosha, Mary V; Masenga, Gileard G; Bangser, Margaret; Browning, Andrew; Nyindo, Pilli M
Obstetric fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an obstetric fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the fistula story; (2) creating a new story about the fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
Full Text Available Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its internal causal relations and mechanisms. The model is broken down to show that it is consistent and adequate in generating accurate description, systematic explanation, and the production of rational knowledge claims about the workability and integration of complex interventions. Results The model explains the normalization of complex interventions by reference to four factors demonstrated to promote or inhibit the operationalization and embedding of complex interventions (interactional workability, relational integration, skill-set workability, and contextual integration. Conclusion The model is consistent and adequate. Repeated calls for theoretically sound process evaluations in randomized controlled trials of complex interventions, and policy-makers who call for a proper understanding of implementation processes, emphasize the value of conceptual tools like the Normalization Process Model.
Dongre, Amol R; Deshmukh, Pradeep R; Garg, Bishan S
To undertake process documentation (PD) of two health education interventions for tribal school children (6-14 years) and adolescent girls (12-19 years) in rural central India. The present participatory process documentation exercise was undertaken at Kasturba Rural Health Training Center, (KRHTC), Anji, which is a field practice area of the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The various steps identified for process documentation were decided after reviewing the monthly and annual reports of KRHTC, training reports, published research papers, flipbooks and daily diaries of health educators. In order to get the health educators' perceptions, a free listing and pile sort exercise on the domain of 'perceived advantages of the present approach' was undertaken, followed by a semi-structured Focus Group Discussion (FGD) with the educators. A two-dimensional scaling and hierarchical cluster analysis was completed with the pile sort data to get the collective picture of perceived advantages. The health education interventions were need-based, focusing on a target audience. The approach was community-based and has the potential to stimulate an action-experience-learning cycle of health educators and community members by stimulating their creative potential. The health educators found locally-developed handmade flipbooks with relevant messages and culturally sensitive pictures to be facilitating factors. The present study provided process documentation of two health education interventions which could be useful to both governmental and non-governmental organizations working in resource poor rural settings of developing countries.
Soto Mas, F; Cordova, C; Murrietta, A; Jacobson, H E; Ronquillo, F; Helitzer, D
The National Action Plan to Improve Health Literacy emphasizes the importance of community-based opportunities for education, such as English as a second language (ESL) programs. It recommends collaborations among the adult literacy and ESL communities. However, limited attention has been given to researching the effectiveness of community-based interventions that combine ESL and health literacy. The purpose of this study was to explore the feasibility of using different community settings for improving health literacy among adult Spanish speakers through an English language program. The study used a pre-experimental, single arm pretest-posttest design, and implemented the Health Literacy and ESL Curriculum. A collaborative was established between the community and university researchers. Participants were recruited at three distinctive sites. Health literacy was assessed using the Spanish version of the Test of Functional Health Literacy in Adults (TOFHLA). Analysis included descriptive and paired-group t test. Forty-nine participants completed the intervention and post-tests (92% retention rate). Overall--all sites--posttest scores significantly improved for total TOFHLA, raw numeracy, and reading comprehension (p reading comprehension significantly improved in some sites. Results suggest that community sites are viable venues for delivering health literacy/language instruction to Spanish speaking adults. The study also points to community engagement and ESL programs as two essential components of effective health literacy interventions among Spanish speakers.
Ben-Zeev, Dror; Schueller, Stephen M; Begale, Mark; Duffecy, Jennifer; Kane, John M; Mohr, David C
The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions "in the wild", with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system "bugs and glitches"), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether.
Postma, Julie; Karr, Catherine; Kieckhefer, Gail
Community health worker (CHW)-delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; (2) delivered by a CHW; (3) delivered to families with children with asthma; and (4) addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies. Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model
Michie, Susan; Yardley, Lucy; West, Robert; Patrick, Kevin; Greaves, Felix
Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom's Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key
Yardley, Lucy; West, Robert; Patrick, Kevin; Greaves, Felix
Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom’s Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key
Full Text Available Abstract Background With the date for achieving the targets of the Millennium Development Goals (MDGs approaching fast, there is a heightened concern about equity, as inequities hamper progress towards the MDGs. Equity-focused approaches have the potential to accelerate the progress towards achieving the health-related MDGs faster than the current pace in a more cost-effective and sustainable manner. Ghana's rate of progress towards MDGs 4 and 5 related to reducing child and maternal mortality respectively is less than what is required to achieve the targets. The objective of this paper is to examine the equity dimension of child and maternal health outcomes and interventions using Ghana as a case study. Methods Data from Ghana Demographic and Health Survey 2008 report is analyzed for inequities in selected maternal and child health outcomes and interventions using population-weighted, regression-based measures: slope index of inequality and relative index of inequality. Results No statistically significant inequities are observed in infant and under-five mortality, perinatal mortality, wasting and acute respiratory infection in children. However, stunting, underweight in under-five children, anaemia in children and women, childhood diarrhoea and underweight in women (BMI Conclusion Significant Inequities are observed in many of the selected child and maternal health outcomes and interventions. Failure to address these inequities vigorously is likely to lead to non-achievement of the MDG targets related to improving child and maternal health (MDGs 4 and 5. The government should therefore give due attention to tackling inequities in health outcomes and use of interventions by implementing equity-enhancing measure both within and outside the health sector in line with the principles of Primary Health Care and the recommendations of the WHO Commission on Social Determinants of Health.
Full Text Available The growth of the Internet, mobile phones, social media and other digital technologies has changed our world in many ways. It has provided individuals with information that was previously only available to a select few. An example of the reach of technology is data that as of October 2012, there are over 6 billion phones worldwide (BBC, 2012. The availability of data in real time has presented hopes of intervening more efficiently and managing health problems by leveraging limited human resources. It also has an impact in changing the roles of providers and patients and in legal and ethical issues including privacy in digital health interactions. This paper will discuss why digital technology has received recent attention in the area of mental health, present some applications of technology for mental health to date, explore the challenges to full implementation in clinical settings, and present future opportunities for digital technologies.El crecimiento del Internet, los teléfonos móviles, las redes sociales y otras tecnologías digitales ha cambiado nuestro mundo de muchas maneras. Ha proporcionado a las personas con la información que antes sólo estaba disponible para un grupo selecto, por ejemplo a partir de octubre de 2012. Un ejemplo del alcance de la tecnología son los datos que dicen que hay más de 6 millones de teléfonos en todo el mundo (BBC, 2012. La disponibilidad de los datos en tiempo real a presentado la esperanza de intervenir de manera más eficiente y manejar los problemas de salud los recursos humanos limitados. También tiene un impacto en el cambio de los roles de los proveedores y los pacientes y en aspectos legales y éticos, incluyendo la privacidad en las interacciones de salud digital. Este artículo discutirá unas razones por cual la tecnología digital ha recibido atención recientemente en el área de salud mental, presentará algunas aplicaciones de la tecnología para mejorar la salud mental hasta la fecha
Full Text Available Paediatric patients diagnosed with cancer will experience a myriad of different physical and psychological disturbances and/or sequelae, secondary to their disease and treatment. Concerning mental health, it is common that a sizable amount of them will experience some level of distress, feelings of fear, uncertainty about recurrence or progression, and also certain degree of grief and loss. Despite these being normal and expected reactions to cancer if circumscribed and time-limited, recent review studies indicate that up to 40% of oncology patients will end up developing depression
de Beurs, Derek; van Bruinessen, Inge; Noordman, Janneke; Friele, Roland; van Dulmen, Sandra
Although many web-based mental health interventions are being released, the actual uptake by end users is limited. The marginal level of engagement of end users when developing these interventions is recognized as an important cause for uptake problems. In this paper, we offer our perceptive on how to improve user engagement. By doing so, we aim to stimulate a discourse on user involvement within the field of online mental health interventions. We shortly describe three different methods (the expert-driven method, intervention mapping, and scrum) that were currently used to develop web-based health interventions. We will focus to what extent the end user was involved in the developmental phase, and what the additional challenges were. In the final paragraph, lessons learned are summarized, and recommendations provided. Every method seems to have its trade-off: if end users are highly involved, availability of end users and means become problematic. If end users are less actively involved, the product may be less appropriate for the end user. Other challenges to consider are the funding of the more active role of technological companies, and the time it takes to process the results of shorter development cycles. Thinking about user-centered design and carefully planning, the involvement of end users should become standard in the field of web-based (mental) health. When deciding on the level of user involvement, one should balance the need for input from users with the availability of resources such as time and funding.
Full Text Available Background and Aim: Maintaining a huge elderly health, health promotion and community development is very important. Workers' health status is largely influenced by their working conditions and job. Work in mines, including those considered threats to workers' health. Materials and Methods: A number of 45 workers in each of the control and intervention groups participated in a quasi-experimental study. Demographic information and data related to HAM constructs and safety were collected through a HAM questionnaire and the safe operation checklist 3 months after the intervention. Cronbach's alpha coefficients were used to confirm properties of the tools. Educational intervention accompanied was applied in the form of four training classes. The Data were analyzed based on distribution of variables. Results: Before the intervention, there was no significant difference between the two groups in terms of demographics and the study main variables. After training, however, results showed significant changes of mean scores of attitude (P<0.001, norms (P<0.001, belief (P<0.001, intention (P<0.001, knowledge (P<0.001 in the experimental group. Conclusion: The research results show that HAM educational intervention is able to change workers’ awareness, attitude, norm, belief, and intention towards unsafe behavior and improve their safety performance.
Bender, Melinda S; Nader, Philip R; Kennedy, Christine; Gahagan, Sheila
Obesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children. A community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother-child dyads enrolled from a large California urban health center. A one-group, pretest-posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention. At postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher. Findings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI.
Kure-Biegel, Nanna; Schnohr, Christina Warrer; Hindhede, Anette Lykke
BACKGROUND: Individual-based interventions aim to improve patient self-management of chronic disease and to improve lifestyle among people at high risk, to reduce the prevalence of diseases contributing to health inequality. The present study investigates risk factors for uncompleted health...... among people with low education (OR 1.82, 95 % CI 0.66; 5.03). Qualitative elaboration of these findings points to low self-control in jobs and a higher degree of comorbidity and treatment of diseases among the lower educated as determinants for not completing, but not lower motivation or less positive...... attitude toward the intervention itself. CONCLUSIONS: This study indicates a social difference in dropout, and if dropout is to be prevented, there is a need to acknowledge factors such as organization of the intervention, lack of job flexibility, and comorbidity. If these factors are not addressed, people...
Rathbone, Amy Leigh; Prescott, Julie
The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient's mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. A total of 27
Ciara E O'Reilly
Full Text Available In 2009, basic care packages (BCP containing health products were distributed to HIV-infected persons in Ethiopia who were clients of antiretroviral therapy clinics. To measure health impact, we enrolled clients from an intervention hospital and comparison hospital, and then conducted a baseline survey, and 7 bi-weekly home visits. We enrolled 405 intervention group clients and 344 comparison clients. Intervention clients were more likely than comparison clients to have detectable chlorine in stored water (40% vs. 1%, p<0.001, soap (51% vs. 36%, p<0.001, and a BCP water container (65% vs. 0%, p<0.001 at every home visit. Intervention clients were less likely than comparison clients to report illness (44% vs. 67%, p<0.001 or health facility visits for illness (74% vs. 95%, p<0.001, and had lower median illness scores (1.0 vs. 3.0, p<0.05. Participation in the BCP program appeared to improve reported health outcomes.
McCarroll, Rebecca; Eyles, Helen; Mhurchu, Cliona Ni
Unhealthy eating is a major risk factor for chronic disease. However, many current strategies to promote healthy eating are not sustainable over the longer-term. More cost-effective wide-reaching initiatives are urgently needed. Mobile health (mHealth) interventions, delivered via mobile devices, could provide a solution. This systematic review summarized the evidence on the effect of mHealth interventions for promoting healthy eating in adults. A comprehensive systematic search of five scientific databases was conducted using methods adapted from the Cochrane Handbook. Eligible studies were randomized controlled trials (RCTs), published up to 1 July 2016, which examined healthy eating interventions delivered via mobile device. Of 879 articles identified, 84 full text articles were potentially eligible and further assessed, and 23 included. Narrative review results indicated small positive effects of mHealth interventions on healthy eating (5/8 trials) and weight loss (5/13 trials). However, the current evidence base is insufficient (studies are of poor quality) to determine conclusive positive effects. More rigorous RCTs with longer-term (>6months) follow-up are warranted to determine if effects are maintained. Copyright © 2017. Published by Elsevier Inc.
Scrivens, E; Cunningham, D; Charlton, J; Holland, W W
Interest in the measurement of the impact of health services has been increasing for three main reasons. Policy makers and service providers wish to be reassured that they are: (i) benefitting the public for whom the service is provided; (ii) in times of economic recession and limited resources, achieving the 'best value for money'; and (iii) given the need to make economies in health expenditures, maintaining standards of the health care. Recent developments in information for the evaluation of health services have tended to emphasis the control and monitoring of expenditure in preference to the control and monitoring of quality. There is concern that this might lead to adverse consequences for patients and for the health service as a whole in that the quality of services provided might deteriorate. Health interventions are considered to be successful if they result in a beneficial change in the health of the population for whom they are provided. If the health of the population is not improved, or maintained, questions are raised about either the appropriateness of the intervention in relation to health policies which have been selected, or about the quality of the care which has been provided. Because of this, it is necessary to monitor both the outcome of a heath intervention in terms of the change in the level of health of the population, and also to measure the quality and the effectiveness of the care provided. Health services research has, over the years, developed a number of different types of measures which can be applied to health services and has suggested a number of applications for such measures in terms of the impact on the health of patients and the general population and the quality and effectiveness of health services. The first section of this paper reviews a selection of measures for both health and the effects of health interventions and discusses their applicability as management tools. The use to which such measures are put obviously
Lee, Hee Yun; Koopmeiners, Joseph S; McHugh, Jennifer; Raveis, Victoria H; Ahluwalia, Jasjit S
To test the feasibility and efficacy of a culturally-tailored mobile health intervention designed to increase knowledge about, intent to obtain, and receipt of the HPV vaccine. A 7-day text message HPV intervention was developed using a quasi-experimental research design for 30 Korean-American women. Participants demonstrated significant increases in knowledge of HPV with an intent to get vaccinated within one year, and 30% of participants received the first dose of the HPV vaccine. Mobile health technology could be a promising tool in reducing the cancer burden for underserved populations.
Riley, William T.; Serrano, Katrina J.; Nilsen, Wendy; Atienza, Audie A.
Recent advances in mobile and wireless technologies have made real-time assessments of health behaviors and their influences possible with minimal respondent burden. These tech-enabled real-time assessments provide the basis for intensively adaptive interventions (IAIs). Evidence of such studies that adjust interventions based on real-time inputs is beginning to emerge. Although IAIs are promising, the development of intensively adaptive algorithms generate new research questions, and the intensive longitudinal data produced by IAIs require new methodologies and analytic approaches. Research considerations and future directions for IAIs in health behavior research are provided. PMID:26086033
Jennings, Larissa; Gagliardi, Laina
Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women's empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities. A systematic literature review was conducted to examine the empirical evidence of changes in men and women's interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study's characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences. Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple's health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women's decision-making, social status, and access to health resources. However
Slade, Mike; Bird, Victoria; Le Boutillier, Clair; Farkas, Marianne; Grey, Barbara; Larsen, John; Leamy, Mary; Oades, Lindsay; Williams, Julie
There is an emerging evidence base about best practice in supporting recovery. This is usually framed in relation to general principles, and specific pro-recovery interventions are lacking. To develop a theoretically based and empirically defensible new pro-recovery manualised intervention--called the REFOCUS intervention. Seven systematic and two narrative reviews were undertaken. Identified evidence gaps were addressed in three qualitative studies. The findings were synthesised to produce the REFOCUS intervention, manual and model. The REFOCUS intervention comprises two components: recovery-promoting relationships and working practices. Approaches to supporting relationships comprise coaching skills training for staff, developing a shared team understanding of recovery, exploring staff values, a Partnership Project with people who use the service and raising patient expectations. Working practices comprise the following: understanding values and treatment preferences; assessing strengths; and supporting goal-striving. The REFOCUS model describes the causal pathway from the REFOCUS intervention to improved recovery. The REFOCUS intervention is an empirically supported pro-recovery intervention for use in mental health services. It will be evaluated in a multisite cluster randomised controlled trial (ISRCTN02507940). © The Royal College of Psychiatrists 2015.
Greco, Giulia; Lorgelly, Paula; Yamabhai, Inthira
Public health programmes tend to be complex and may combine social strategies with aspects of empowerment, capacity building and knowledge across sectors. The nature of the programmes means that some effects are likely to occur outside the healthcare sector; this breadth impacts on the choice of health and non-health outcomes to measure and value in an economic evaluation. Employing conventional outcome measures in evaluations of public health has been questioned. There are concerns that such measures are too narrow, overlook important dimensions of programme effect and, thus, lead to such interventions being undervalued. This issue is of particular importance for low-income and middle-income countries, which face considerable budget constraints, yet deliver a large proportion of health activities within public health programmes. The need to develop outcome measures, which include broader measures of quality of life, has given impetus to the development of a variety of new, holistic approaches, including Sen's capability framework and measures of subjective wellbeing. Despite their promise, these approaches have not yet been widely applied, perhaps because they present significant methodological challenges. This paper outlines the methodological challenges for the identification and measurement of broader outcomes of public health interventions in economic evaluation in low-income and middle-income countries. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.
Jane L. Phillips
Full Text Available Aims and Objectives. This paper provides an overview of the applicability of the PRECEDE-PROCEED Model to the development of targeted nursing led chronic illness interventions. Background. Changing health care practice is a complex and dynamic process that requires consideration of social, political, economic, and organisational factors. An understanding of the characteristics of the target population, health professionals, and organizations plus identification of the determinants for change are also required. Synthesizing this data to guide the development of an effective intervention is a challenging process. The PRECEDE-PROCEED Model has been used in global health care settings to guide the identification, planning, implementation, and evaluation of various health improvement initiatives. Design. Using a reflective case study approach, this paper examines the applicability of the PRECEDE-PROCEED Model to the development of targeted chronic care improvement interventions for two distinct Australian populations: a rapidly expanding and aging rural population with unmet palliative care needs and a disadvantaged urban community at higher risk of cardiovascular disease. Results. The PRECEDE-PROCEED Model approach demonstrated utility across diverse health settings in a systematic planning process. In environments characterized by increasing health care needs, limited resources, and growing community expectations, adopting planning tools such as PRECEDE-PROCEED Model at a local level can facilitate the development of the most effective interventions. Relevance to Clinical Practice. The PRECEDE-PROCEED Model is a strong theoretical model that guides the development of realistic nursing led interventions with the best chance of being successful in existing health care environments.
M. Vera Hernández
Full Text Available En el presente artículo se revisa la bibliografía reciente en evaluación cuantitativa de intervenciones no experimentales, poniendo especial énfasis en su aplicación a la economía y la gestión sanitarias. En particular, se han descrito las técnicas de matching y de doble diferencia combinada con matching. El parámetro elegido como objeto de la estimación es la ganancia media para los participantes en la intervención, bajo la hipótesis de heterogeneidad en las ganancias no observables que produce la intervención entre los individuos elegibles. Se ha llevado a cabo una exposición no técnica de las metodologías descritas con el espíritu de fomentar al lector una lectura más profunda de la bibliografía relevante.This paper summarizes recent literature on quantitative techniques for the evaluation of non experimental reforms. We closely look at the application of the methods to health economics and health management. The methods of matching and difference in differences combined with matching have been analysed in greatest detail. We have focused our attention on the estimation of the average treatment for the treated as the relevant parameter to be estimated. Along the paper, we have assumed that gains from the reform are heterogeneous in non observable variables across eligible individuals. The methods are described in a non technical manner to motivate further reading.
Marquard, Jenna L; Zayas-Cabán, Teresa
The goal of this paper is to describe the successful application of a use case-based evaluation approach to guide the effective design, evaluation and redesign of inexpensive, commercial, off-the-shelf consumer health informatics (CHI) interventions. Researchers developed four CHI intervention use cases representing two distinct patient populations (patients with diabetes with high blood pressure, post-bariatric surgery patients), two commercial off-the-shelf CHI applications (Microsoft HealthVault, Google Health), and related devices (blood pressure monitor, pedometer, weight scale). Three patient proxies tested each intervention for 10 days. The patient proxies recorded their challenges while completing use case tasks, rating the severity of each challenge based on how much it hindered their use of the intervention. Two independent evaluators categorized the challenges by human factors domain (physical, cognitive, macroergonomic). The use case-based approach resulted in the identification of 122 challenges, with 12% physical, 50% cognitive and 38% macroergonomic. Thirty-nine challenges (32%) were at least moderately severe. Nine of 22 use case tasks (41%) accounted for 72% of the challenges. The study used two patient proxies and addressed two specific patient populations and low-cost, off-the-shelf CHI interventions, which may not perfectly generalize to a larger number of proxies, actual patient populations, or other CHI interventions. CHI designers can employ the use case-based evaluation approach to assess the fit of a CHI intervention with patients' health work, in the context of their daily activities and environment, which would be difficult or impossible to evaluate by laboratory-based studies.
Coll-Planas, Laura; Nyqvist, Fredrica; Puig, Teresa; Urrútia, Gerard; Solà, Ivan; Monteserín, Rosa
Observational studies show that social capital is a protective health factor. Therefore, we aim to assess the currently unclear health impact of social capital interventions targeting older adults. We conducted a systematic review based on a logic model. Studies published between January 1980 and July 2015 were retrieved from MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Web of Science. We included randomised controlled trials targeting participants over 60 years old and focused on social capital or its components (eg, social support and social participation). The comparison group should not promote social capital. We assessed risk of bias and impact on health outcomes and use of health-related resources applying a procedure from the Canadian Agency for Drugs and Technologies in Health (CADTH) based on vote-counting and standardised decision rules. The review protocol was registered in PROSPERO (reference number CRD42014015362). We examined 17 341 abstracts and included 73 papers reporting 36 trials. Trials were clinically and methodologically diverse and reported positive effects in different contexts, populations and interventions across multiple subjective and objective measures. According to sufficiently reported outcomes, social capital interventions showed mixed effects on quality of life, well-being and self-perceived health and were generally ineffective on loneliness, mood and mortality. Eight trials with high quality showed favourable impacts on overall, mental and physical health, mortality and use of health-related resources. Our review highlights the lack of evidence and the diversity among trials, while supporting the potential of social capital interventions to reach comprehensive health effects in older adults. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Hansen, Helena; Metzl, Jonathan M
Structural competency provides a language and theoretical framework to promote institutional-level interventions by clinical practitioners working with community organizations, non-health-sector institutions, and policy makers. The special collection of articles on structural competency in this issue of Academic Medicine addresses the need to move from theory to an appraisal of core educational interventions that operationalize the goals of and foster structural competency. In this Commentary, the authors review the role of clinical practitioners in enhancing population-level health outcomes through collaborations with professionals in fields outside medicine, including the social sciences and law. They describe the core elements of structural competency in preclinical and clinical education, as illustrated by the articles of this special collection: perceiving the structural causes of patients' disease, envisioning structural interventions, and cultivating alliances with non-health-sector agencies that can implement structural interventions. Finally, the authors argue that preparing trainees to form partnerships will empower them to influence the social determinants of their patients' health and reduce health inequalities.
Full Text Available Introduction: The study was carried out in Cruz del Eje Department, Cordoba Province, Argentina. It was based on diagnosis of conceptions of health, concentration of fluoride in drinking water and accessibility to dental coverage in 71 rural schools. Additionally, parents and teachers’ conceptions of general and oral health, dental clinical status and sialochemistry of students from eight schools were considered. Objective: To evaluate a community intervention strategy for promoting oral health in rural contexts. Through the participation of the teacher as a mediator of healthy pattern, this strategy was developed. Methods: In order to elaborate oral health promoting strategies, educational workshops, epistolary communication and on site tutorials meetings were implemented. Specific health projects to be added to the Educational Institutional Programs, as a contextualized mediating strategy for promoting oral health were designed by teachers. The strategy was evaluated comparing dental caries increase (CI detected the previous year and the one following the implementation of the educational plans. Mac Nemar's test was applied, and p<0.05 was set to indicate statistical differences between both periods. Results: A 30.43% CI (p<0.0001 was observed the year before implementing the educational programs as well as a CI reduction to 17.39% (p=0.0002 a year after their application. Conclusion: The drop off in 57.14% of the CI in rural areas, confirms the intervention strategy of designed for this particular context.Keywords: community intervention, oral health promotion, rural communities.
Hammett, T M; Gaiter, J L; Crawford, C
More than 6 million people are under some form of criminal justice supervision in the United States on any given day. The vast majority are arrested in and return to urban, low-income communities. These are men, women, and adolescents with high rates of infectious diseases such as HIV/AIDS, other sexually transmitted diseases (STDs), and tuberculosis (TB), as well as substance abuse and other health problems. A review of recent literature indicates that an increasing problem for these populations is that they have had little prior access to primary health care or health interventions, and many are returning to their communities without critical preventive health information and skills, appropriate medical services, and other necessary support. Periods of incarceration and other criminal justice supervision offer important opportunities to provide a range of health interventions to this underserved population, and general evaluations show the potential for this strategy. Public health and criminal justice agencies have the expertise and should collaborate to provide interventions needed by incarcerated populations. Moreover, many recently released inmates require primary care for HIV/AIDS, other STDs, and TB. Consequently, timely discharge planning is essential, as are linkages with community-based organizations and agencies that can provide medical care, health education, and necessary supportive services.
Okanlawon, F A; Asuzu, M C
Adolescents' reproductive health needs and problems have become contemporary concerns globally. Of great concern is the high rate of sexually transmitted infections including HIV/AIDS arguably influenced by lack of reproductive health knowledge. The study aimed at examining the effect of peer education on school adolescents' reproductive health knowledge in Saki, Southwestern, Nigeria, in a nurse-led concurrently controlled community interventional study. The study employed pre - and post - intervention (quasi - experimental) design. The experimental group was exposed to the peer education programme for six months. Pre and post differential data in the experimental and control groups were compared and analysed using analysis of covariance. The intervention had significant effect on adolescents in the experimental group compared with the control group in the area of knowledge of reproductive health issues (F1,519) = 37.117, (p reproductive health knowledge. It is recommended that community health nurses as well as other community workers should embrace peer education approach as a strategy to empower adolescents with reproductive health knowledge.
Older adults generally have low health and computer literacies, making it challenging for them to function well in the eHealth era where technology is increasingly being used in health care. Little is known about effective interventions and strategies for improving the eHealth literacy of the older population. The objective of this study was to examine the effects of a theory-driven eHealth literacy intervention for older adults. The experimental design was a 2 × 2 mixed factorial design with learning method (collaborative; individualistic) as the between-participants variable and time of measurement (pre; post) as the within-participants variable. A total of 146 older adults aged 56-91 (mean 69.99, SD 8.12) participated in this study during February to May 2011. The intervention involved 2 weeks of learning about using the National Institutes of Health's SeniorHealth.gov website to access reliable health information. The intervention took place at public libraries. Participants were randomly assigned to either experimental condition (collaborative: n = 72; individualistic: n = 74). Overall, participants' knowledge, skills, and eHealth literacy efficacy all improved significantly from pre to post intervention (P 0.8 with statistical power of 1.00 even at the .01 level in all cases). When controlling for baseline differences, no significant main effect of the learning method was found on computer/Web knowledge, skills, or eHealth literacy efficacy. Thus, collaborative learning did not differ from individualistic learning in affecting the learning outcomes. No significant interaction effect of learning method and time of measurement was found. Group composition based on gender, familiarity with peers, or prior computer experience had no significant main or interaction effect on the learning outcomes. Regardless of the specific learning method used, participants had overwhelmingly positive attitudes toward the intervention and reported positive changes in
Maar, Marion A; Yeates, Karen; Perkins, Nancy; Boesch, Lisa; Hua-Stewart, Diane; Liu, Peter; Sleeth, Jessica; Tobe, Sheldon W
To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension-Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and
Smith, Brendan T; Smith, Peter M; Harper, Sam; Manuel, Douglas G; Mustard, Cameron A
Reducing health inequalities has become a major public health priority internationally. However, how best to achieve this goal is not well understood. Population health intervention research has the potential to address some of this knowledge gap. This review argues that simulation studies can produce unique evidence to build the population health intervention research evidence base on reducing social inequalities in health. To this effect, the advantages of using simulation models over other population health intervention research methods are discussed. Key questions regarding the potential challenges of developing simulation models to investigate population health intervention research on reducing social inequalities in health and the types of population health intervention research questions that can be answered using this methodology are reviewed. We use the example of social inequalities in coronary heart disease to illustrate how simulation models can elucidate the effectiveness of a number of 'what-if' counterfactual population health interventions on reducing social inequalities in coronary heart disease. Simulation models are a flexible, cost-effective, evidence-based research method with the capacity to inform public health policy-makers regarding the implementation of population health interventions to reduce social inequalities in health.
Hattingh, H Laetitia; Kelly, Fiona; Fowler, Jane; Wheeler, Amanda J
Community pharmacists are in an ideal position to promote and provide mental health medication management services. However, formalised or structured pharmacy services to support consumers with mental health conditions are scarce. Australian mental health consumers indicated a need for targeted community pharmacy mental health services which presented an opportunity to develop an intervention that were integrated with remunerated professional services. The study aimed to pilot a mental health medication management intervention in Australian community pharmacies. Pharmacists worked in partnership with consumers, carers and mental health workers over three to six months to set and support achievement of individual goals related to medicines use, physical health and mental wellbeing. This paper provides a comparison of community pharmacies that successfully delivered the intervention with those that did not and identifies facilitators and challenges to service implementation. One hundred pharmacies opted to pilot the delivery of the intervention in three Australian states (Queensland, Western Australia and northern New South Wales). Of those, 55 successfully delivered the intervention (completers) whilst 45 were unsuccessful (non-completers). A mixed methods approach, including quantitative pharmacy surveys and qualitative semi-structured interviews, was used to gather data from participating pharmacies. Following intervention development, 142 pharmacists and 21 pharmacy support staff attended training workshops, received resource kits and ongoing support from consumer and pharmacist mentors throughout intervention implementation. Baseline quantitative data was collected from each pharmacy on staff profile, volume of medicines dispensed, the range of professional services delivered and relationships with health professionals. At the completion of the study participants were invited to complete an online exit survey and take part in a semi-structured interview that
Full Text Available Given the high importance of dietary sodium (salt as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation.Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ (2.3 million citizens, aged 35+ years which has detailed individual-level administrative cost data.Of the most feasible interventions, the largest health gains were from (in descending order: (i mandatory 25% reduction in sodium levels in all processed foods; (ii the package of interventions performed in the United Kingdom (UK; (iii mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv media campaign (as per a previous UK one; (v voluntary food labelling as currently used in NZ; (vi dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a "sinking lid" on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000-255,000, and from a salt tax. All the interventions produced net cost savings (except counseling--albeit still cost-effective. Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion. Also the salt tax would raise revenue (up to NZ$ 452 million/year. Health gain per person was greater for Māori (indigenous population men and women compared to non-Māori.This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions. They could also reduce ethnic inequalities in health.
Nghiem, Nhung; Blakely, Tony; Cobiac, Linda J; Pearson, Amber L; Wilson, Nick
Given the high importance of dietary sodium (salt) as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation. Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ) (2.3 million citizens, aged 35+ years) which has detailed individual-level administrative cost data. Of the most feasible interventions, the largest health gains were from (in descending order): (i) mandatory 25% reduction in sodium levels in all processed foods; (ii) the package of interventions performed in the United Kingdom (UK); (iii) mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv) media campaign (as per a previous UK one); (v) voluntary food labelling as currently used in NZ; (vi) dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a "sinking lid" on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000-255,000), and from a salt tax. All the interventions produced net cost savings (except counseling--albeit still cost-effective). Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion). Also the salt tax would raise revenue (up to NZ$ 452 million/year). Health gain per person was greater for Māori (indigenous population) men and women compared to non-Māori. This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions). They could also reduce ethnic inequalities in health.
A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: The DQIP study protocol
Full Text Available Abstract Background High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable. Methods/design We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the INPS Vision clinical IT system, and have agreed to have relevant medication-related data to be automatically extracted from their electronic medical records. All practices (clusters that agree to take part will receive the data-driven quality improvement in primary care (DQIP intervention, but will be randomised to one of 10 start dates. The DQIP intervention has three components: a web-based informatics tool that provides weekly updated feedback of targeted prescribing at practice level, prompts the review of individual patients affected, and summarises each patient's relevant risk factors and prescribing; an outreach visit providing education on targeted prescribing and training in the use of the informatics tool; and a fixed payment of 350 GBP (560 USD; 403 EUR up front and a small payment of 15 GBP (24 USD; 17 EUR for each patient reviewed in the 12 months of the intervention. We hypothesise that the DQIP intervention will reduce a composite of nine previously validated measures of high-risk prescribing. Due to the nature of the intervention, it is not possible to blind practices, the core research team, or the data analyst. However, outcome assessment is entirely objective and automated. There will
Kurti, Allison N; Dallery, Jesse
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one's diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health.
KURTI, ALLISON N.; DALLERY, JESSE
The use of mobile devices is growing worldwide in both industrialized and developing nations. Alongside the worldwide penetration of web-enabled devices, the leading causes of morbidity and mortality are increasingly modifiable lifestyle factors (e.g., improving one’s diet and exercising more). Behavior analysts have the opportunity to promote health by combining effective behavioral methods with technological advancements. The objectives of this paper are (1) to highlight the public health gains that may be achieved by integrating technology with a behavior analytic approach to developing interventions, and (2) to review some of the currently, under-examined issues related to merging technology and behavior analysis (enhancing sustainability, obtaining frequent measures of behavior, conducting component analyses, evaluating cost-effectiveness, incorporating behavior analysis in the creation of consumer-based applications, and reducing health disparities). Thorough consideration of these issues may inspire the development, implementation, and dissemination of innovative, efficacious interventions that substantially improve global public health. PMID:25774070
Chalmers, Darlene; Dell, Colleen Anne
The use of animal-assisted interventions in therapeutic programs is a growing phenomenon. Animal-assisted interventions (AAIs) involve a variety of species (dogs, cats, horses, domesticated birds, etc.) in primary health care. Despite their increasing application in a wide range of therapeutic services, the empirical evidence base of AAIs is limited. The authors of this paper propose that the public health framework of One Health can be adapted to advance AAI research. One Health's perspective on the environment is primarily ecological. The environmental impact on the human-animal interactions within AAIs, however, incorporates social, cultural, political, and economic factors. The environment has received minimal attention in AAI research. The authors discuss how this framework has been used in their prior AAI research and work with Indigenous people. Applying this framework to AAIs may guide future AAI research.
van Scheppingen, Arjella R; de Vroome, Ernest M M; Ten Have, Kristin C J M; Bos, Ellen H; Zwetsloot, Gerard I J M; van Mechelen, W
To examine the effectiveness of an organizational large-scale intervention applied to induce a health-promoting organizational change process. A quasi-experimental, "as-treated" design was used. Regression analyses on data of employees of a Dutch dairy company (n = 324) were used to examine the effects on bonding social capital, openness, and autonomous motivation toward health and on employees' lifestyle, health, vitality, and sustainable employability. Also, the sensitivity of the intervention components was examined. Intervention effects were found for bonding social capital, openness toward health, smoking, healthy eating, and sustainable employability. The effects were primarily attributable to the intervention's dialogue component. The change process initiated by the large-scale intervention contributed to a social climate in the workplace that promoted health and ownership toward health. The study confirms the relevance of collective change processes for health promotion.
Background Severe untreated dental decay affects a child’s growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children’s eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity. Methods The study will be a randomised controlled study with parents and their new-born child/ren who are seen at 6–12 weeks of age by a child/community health nurse. Consenting parents will complete a questionnaire on oral health knowledge, behaviours, self-efficacy, oral health fatalism, parenting stress, prenatal and peri-natal health and socio-demographic factors at study commencement and at 12 and 36 months. Each child–parent pair will be allocated to an intervention or a standard care group, using a computer-generated random blocks. The standard group will be managed through the standard early oral health screening program; “lift the lip”. The intervention group will be provided with tailored oral health counselling by oral health consultants trained in MI and AG. Participating children will be examined at 24, and 36 months for the occurrence of dental decay and have their height and weight recorded. Dietary information obtained from a food frequency chart will be used to determine food and dietary patterns. Data analysis will use intention to treat and per protocol analysis and will use tests of independent
Arrow, Peter; Raheb, Joseph; Miller, Margaret
Severe untreated dental decay affects a child's growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children's eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity. The study will be a randomised controlled study with parents and their new-born child/ren who are seen at 6-12 weeks of age by a child/community health nurse. Consenting parents will complete a questionnaire on oral health knowledge, behaviours, self-efficacy, oral health fatalism, parenting stress, prenatal and peri-natal health and socio-demographic factors at study commencement and at 12 and 36 months. Each child-parent pair will be allocated to an intervention or a standard care group, using a computer-generated random blocks. The standard group will be managed through the standard early oral health screening program; "lift the lip". The intervention group will be provided with tailored oral health counselling by oral health consultants trained in MI and AG.Participating children will be examined at 24, and 36 months for the occurrence of dental decay and have their height and weight recorded. Dietary information obtained from a food frequency chart will be used to determine food and dietary patterns. Data analysis will use intention to treat and per protocol analysis and will use tests of independent proportions and means. Multivariate
Wang, Daojuan; Moini, Hamid
The purpose of this chapter is to provide an updated review of what is known about the performance of technology-based mergers and acquisitions (TBM&As) and their determinants. This review brings together papers published from 1990 to 2012 in top-rated academic journals within nearly all fields...
Wang, Daojuan; Moini, Hamid
The purpose of this chapter is to provide an updated review of what is known about the performance of technology-based mergers and acquisitions (TBM&As) and their determinants. This review brings together papers published from 1990 to 2012 in top-rated academic journals within nearly all fields...
Full Text Available Globally, over 5% of world’s population (More than 360 million population, have disabling hearing loss according to new global estimates on prevalence; 91% of these are adults and 9% of these are children. Overall, prevalence of disabling hearing loss in children all over the world is 1.7%.1 Prevalence of hearing loss in South Asia in pediatric age group is 2.4%. Consequences of hearing impairment include inability to interpret speech sounds, often producing a reduced ability to communicate, delay in language acquisition, economic and educational disadvantage, social isolation and stigmatization. Fifty percent of hearing loss is preventable through public health actions.1 From time to time, public and private sector enterprises plan at both, small and large scale to help people with hearing impairment. But still the services available and implementation status of actions to combat ear disorders is in naïve stage. The earlier the parent/family accept the fact of impairment and follow a well-planned rehabilitation program under professional supervision, the better are the chances for the child and the family to lead a more normal life.
Bird, Victoria J; Le Boutillier, Clair; Leamy, Mary; Williams, Julie; Bradstreet, Simon; Slade, Mike
The feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage. To develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessment. A focused narrative review of studies assessing implementation blocks and enablers was conducted with thematic analysis and vote counting used to determine candidate items for the measure. Twenty purposively sampled studies (15 trial reports, 5 protocols) were included in the psychometric evaluation, spanning different interventions types. Cohen's kappa (κ) was calculated for interrater reliability and test-retest reliability. In total, 95 influences on implementation were identified from 299 references. The final measure - Structured Assessment of FEasibility (SAFE) - comprises 16 items rated on a Likert scale. There was excellent interrater (κ = 0.84, 95% CI 0.79-0.89) and test-retest reliability (κ = 0.89, 95% CI 0.85-0.93). Cost information and training time were the two influences least likely to be reported in intervention papers. The SAFE reporting guidelines include 16 items organised into three categories (intervention, resource consequences, evaluation). A novel approach to evaluating interventions, SAFE, supplements efficacy and health economic evidence. The SAFE reporting guidelines will allow feasibility of an intervention to be systematically assessed.
Leslie B. Hammer
Full Text Available The goal of this study was to test the effectiveness of a workplace intervention targeting work-life stress and safety-related psychosocial risk factors on health and safety outcomes. Data were collected over time using a randomized control trial design with 264 construction workers employed in an urban municipal department. The intervention involved family- and safety-supportive supervisor behavior training (computer-based, followed by two weeks of behavior tracking and a four-hour, facilitated team effectiveness session including supervisors and employees. A significant positive intervention effect was found for an objective measure of blood pressure at the 12-month follow-up. However, no significant intervention results were found for self-reported general health, safety participation, or safety compliance. These findings suggest that an intervention focused on supervisor support training and a team effectiveness process for planning and problem solving should be further refined and utilized in order to improve employee health with additional research on the beneficial effects on worker safety.
Nathália Luíza Ferreira
Full Text Available Objective: To assess the effectiveness of nutritional intervention in overweight women undergoing Primary Health Care.Methods: An intervention study was conducted with overweight adult and elderly women aged 20 years or older (body mass index ≥25.0 kg/m² and ≥27.0 kg/m², respectively who were subjected to 12 months of individual nutritional monitoring. The effectiveness of the intervention was assessed by dietary, health, and anthropometric indicators.Results: Most of the 71 individuals were adults with a low income and poor level of education. After the intervention, there was an increase in number of meals and in the frequency of breakfasting. Moreover, there were more fruits and vegetables consumed, in addition to a decrease in household availability of salt, sugar, oil, and fried foods consumption. An improvement in health and weight self-perception was observed, as well as a decrease in body mass and abdominal adiposity, in particular among those participating in several consultations (n >9.Conclusion: The proposed nutritional intervention was effective and viable for improving the care of overweight individuals and those suffering from destabilized comorbidities, and may be extended to other contexts.
Full Text Available Abstract Background Shared Mental Health care between Psychiatry and Primary care has been developed to improve the care of common mental health problems but has not hitherto been adequately evaluated. The present study evaluated a consultation-liaison intervention with two objectives: to explore long-term GP opinions (relating to impact on their management and on patient medical outcome and to determine the secondary referral rate, after a sufficient time lapse following the intervention to reflect a "real-world" primary care setting. Methods All the 139 collaborating GPs (response rate: 84.9% were invited two years after the intervention to complete a retrospective telephone survey for each patient (181 patients; response rate: 69.6%. Results 91.2% of GPs evaluated effects as positive for primary care management (mainly as support and 58.9% noted positive effects for patient medical outcome. Two years post-intervention, management was shared care for 79.7% of patients (the GP as the psychiatric care provider and care by a psychiatrist for 20.3% patients. Secondary referral occurred finally in 44.2% of cases. Conclusion The intervention supported GP partners in their management of patients with common mental health problems. Further studies are required on the appropriateness of the care provider.
Duijzer, Geerke; Jansen, Sophia C; Haveman-Nies, Annemien; van Bruggen, Rykel; Ter Beek, Josien; Hiddink, Gerrit J; Feskens, Edith J M
All over the world, prevalence and incidence rates of type 2 diabetes mellitus are rising rapidly. Several trials have demonstrated that prevention by lifestyle intervention is (cost-) effective. This calls for translation of these trials to primary health care. This article gives an overview of the translation of the SLIM diabetes prevention intervention to a Dutch real-life setting and discusses the role of primary health care in implementing lifestyle intervention programmes. Currently, a 1-year pilot study, consisting of a dietary and physical activity part, performed by three GPs, three practice nurses, three dieticians and four physiotherapists is being conducted. The process of translating the SLIM lifestyle intervention to regular primary health care is measured by means of the process indicators: reach, acceptability, implementation integrity, applicability and key factors for success and failure of the intervention. Data will be derived from programme records, observations, focus groups and interviews. Based on these results, our programme will be adjusted to fit the role conception of the professionals and the organization structure in which they work.
Lam, O L T; McGrath, C; Bandara, H M H N; Li, L S W; Samaranayake, L P
The oral cavity serves as a reservoir of Staphylococcus aureus for infection of the lower respiratory tract and cross-infection to other patients. This systematic review was designed to examine the effectiveness of oral health promotion interventions on this pathogen. The PubMed, ISI Web of Science, and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral and oropharyngeal carriage of S. aureus. Oral health promotion interventions on oral reservoirs of S. aureus in both systemically healthy and medically compromised groups consisted of oral hygiene interventions only. There was a lack of evidence pertaining to the effectiveness of mechanical oral hygiene interventions against this pathogen. Chlorhexidine delivered in oral hygiene products such as mouthrinses, gels, and sprays appeared to have some utility against S. aureus, although some studies found equivocal effects. There was a dearth of studies investigating the efficacy of other chemical agents. Although many chemical agents contained in oral hygiene products have proven in vitro activity against S. aureus, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remain to be confirmed by further high-quality randomized controlled trials.
Peng, Roger D.; Butz, Arlene M.; Hackstadt, Amber J.; Williams, D'Ann L.; Diette, Gregory B.; Breysse, Patrick N.; Matsui, Elizabeth C.
Recent intervention studies targeted at reducing indoor air pollution have demonstrated both the ability to improve respiratory health outcomes and to reduce particulate matter (PM) levels in the home. However, these studies generally do not address whether it is the reduction of PM levels specifically that improves respiratory health. In this paper we apply the method of principal stratification to data from a randomized air cleaner intervention designed to reduce indoor PM in homes of children with asthma. We estimate the health benefit of the intervention amongst study subjects who would experience a substantial reduction in PM in response to the intervention. For those subjects we find an increase in symptom-free days that is almost three times as large as the overall intention-to-treat effect. We also explore the presence of treatment effects amongst those subjects whose PM levels would not respond to the air cleaner. This analysis demonstrates the usefulness of principal stratification for environmental intervention trials and its potential for much broader application in this area. PMID:27695203
Hammer, Leslie B.; Truxillo, Donald M.; Bodner, Todd; Rineer, Jennifer; Pytlovany, Amy C.; Richman, Amy
The goal of this study was to test the effectiveness of a workplace intervention targeting work-life stress and safety-related psychosocial risk factors on health and safety outcomes. Data were collected over time using a randomized control trial design with 264 construction workers employed in an urban municipal department. The intervention involved family- and safety-supportive supervisor behavior training (computer-based), followed by two weeks of behavior tracking and a four-hour, facilitated team effectiveness session including supervisors and employees. A significant positive intervention effect was found for an objective measure of blood pressure at the 12-month follow-up. However, no significant intervention results were found for self-reported general health, safety participation, or safety compliance. These findings suggest that an intervention focused on supervisor support training and a team effectiveness process for planning and problem solving should be further refined and utilized in order to improve employee health with additional research on the beneficial effects on worker safety. PMID:26557703
Airhihenbuwa, Collins O; Ford, Chandra L; Iwelunmor, Juliet I
Theories about health behavior are commonly used in public health and often frame problems as ascribed or related to individuals' actions or inaction. This framing suggests that poor health occurs because individuals are unable or unwilling to heed preventive messages or recommended treatment actions. The recent United Nations call for strategies to reduce the global disease burden of noncommunicable diseases like diabetes requires a reassessment of individual-based approaches to behavior change. We argue that public health and health behavior intervention should focus more on culture than behavior to achieve meaningful and sustainable change resulting in positive health outcomes. To change negative health behaviors, one must first identify and promote positive health behaviors within the cultural logic of its contexts. To illustrate these points, we discuss stigma associated with obesity and human immunodeficiency virus and acquired immune deficiency syndrome. We conclude that focusing on positive behaviors and sustaining cultural and personal transformations requires a culturally grounded approach to public health interventions, such as that provided by the PEN-3 model.
Iranagh, Jamileh Amirzadeh; Rahman, Hejar Abdul; Motalebi, Seyedeh Ameneh
BACKGROUND/OBJECTIVES Nutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women. SUBJECTS/METHODS Cluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-we...
Urinary incontinence is a common health problem that carries with it a significant burden. Nearly twice as many men suffer from this problem than women, and studies have demonstrated that help-seeking behavior is more challenging for men. This information sheet is based on a systematic review and focuses on the best-available evidence regarding educational interventions to raise men's awareness of bladder and bowel health. It also provides recommendations for practice.
Danaher, Brian G.; Brendryen, Håvar; Seeley, John R.; Tyler, Milagra S.; Woolley, Tim
mHealth interventions that deliver content via mobile phones represent a burgeoning area of health behavior change. The current paper examines two themes that can inform the underlying design of mHealth interventions: (1) mobile device functionality, which represents the technological toolbox available to intervention developers; and (2) the pervasive information architecture of mHealth interventions, which determines how intervention content can be delivered concurrently using mobile phones, personal computers, and other devices. We posit that developers of mHealth interventions will be better able to achieve the promise of this burgeoning arena by leveraging the toolbox and functionality of mobile devices in order to engage participants and encourage meaningful behavior change within the context of a carefully designed pervasive information architecture. PMID:25750862
Brian G. Danaher
Full Text Available mHealth interventions that deliver content via mobile phones represent a burgeoning area of health behavior change. The current paper examines two themes that can inform the underlying design of mHealth interventions: (1 mobile device functionality, which represents the technological toolbox available to intervention developers; and (2 the pervasive information architecture of mHealth interventions, which determines how intervention content can be delivered concurrently using mobile phones, personal computers, and other devices. We posit that developers of mHealth interventions will be able to better achieve the promise of this burgeoning arena by leveraging the toolbox and functionality of mobile devices in order to engage participants and encourage meaningful behavior change within the context of a carefully designed pervasive information architecture.
Steinke, Jessica; Root-Bowman, Meredith; Estabrook, Sherry; Levine, Deborah S; Kantor, Leslie M
Sexual and gender minority youth (SGMY) have unique risk factors and worse health outcomes than their heterosexual and cisgender counterparts. SGMY's significant online activity represents an opportunity for digital interventions. To help meet the sex education and health needs of SGMY and to understand what they consider important, formative research was conducted to guide and inform the development of new digital health interventions. Semistructured interviews, in-person focus groups, and online focus groups were conducted with 92 youths (aged 15-19 years) who self-identify as nonheterosexual, noncisgender, questioning, and/or have engaged in same-sex sexual behavior. Data were coded and analyzed using inductive thematic analysis. Thematic analysis revealed that SGMYs are often driven online by experiences of isolation, stigmatization, and lack of information and are looking for a supportive, validating community and relevant, accurate information. Gender minority youths felt that they faced a larger number of and more extreme incidences of discrimination than sexual minority youths. Most youths described interpersonal discrimination as having substantial negative effects on their mental health. Any digital intervention for SGMY should focus on mental health and well-being holistically rather than solely on risk behaviors, such as preventing HIV. Interventions should include opportunities for interpersonal connection, foster a sense of belonging, and provide accurate information about sexuality and gender to help facilitate positive identity development. Content and delivery of digital interventions should appeal to diverse sexualities, genders, and other intersecting identities held by SGMY to avoid further alienation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: The increasing proportion of elderly people with respective care requirements and within the total population stands against aging personnel and staff reduction in the field of health care where employees are exposed to high load factors. Health promotion interventions may be a possibility to improve work situations and behavior. Methods: A systematic literature search is conducted in 32 databases limited to English and German publications since 1990. Moreover, internet-searches are performed and the reference lists of identified articles are scanned. The selection of literature was done by two reviewers independently according to inclusion and exclusion criteria. Data extraction and tables of evidence are verified by a second expert just like the assessment of risk of bias by means of the Cochrane Collaboration’s tool. Results: We identified eleven intervention studies and two systematic reviews. There were three randomized controlled trials (RCT and one controlled trial without randomization (CCT on the improvement of physical health, four RCT and two CCT on the improvement of psychological health and one RCT on both. Study duration ranged from four weeks to two years and the number of participants included from 20 to 345, with a median of 56. Interventions and populations were predominantly heterogeneous. In three studies intervention for the improvement of physical health resulted in less complaints and increased strength and flexibility with statistically significant differences between groups. Regarding psychological health interventions lead to significantly decreased intake of analgesics, better stress management, coping with workload, communication skills and advanced training. Discussion: Taking into consideration the small to very small sample sizes, other methodological flaws like a high potential of bias and poor quality of reporting the validity of the results has to be considered as limited. Due to the heterogeneity
Buchberger, Barbara; Heymann, Romy; Huppertz, Hendrik; Friepörtner, Katharina; Pomorin, Natalie; Wasem, Jürgen
The increasing proportion of elderly people with respective care requirements and within the total population stands against aging personnel and staff reduction in the field of health care where employees are exposed to high load factors. Health promotion interventions may be a possibility to improve work situations and behavior. A systematic literature search is conducted in 32 databases limited to English and German publications since 1990. Moreover, internet-searches are performed and the reference lists of identified articles are scanned. The selection of literature was done by two reviewers independently according to inclusion and exclusion criteria. Data extraction and tables of evidence are verified by a second expert just like the assessment of risk of bias by means of the Cochrane Collaboration's tool. We identified eleven intervention studies and two systematic reviews. There were three randomized controlled trials (RCT) and one controlled trial without randomization (CCT) on the improvement of physical health, four RCT and two CCT on the improvement of psychological health and one RCT on both. Study duration ranged from four weeks to two years and the number of participants included from 20 to 345, with a median of 56. Interventions and populations were predominantly heterogeneous. In three studies intervention for the improvement of physical health resulted in less complaints and increased strength and flexibility with statistically significant differences between groups. Regarding psychological health interventions lead to significantly decreased intake of analgesics, better stress management, coping with workload, communication skills and advanced training. Taking into consideration the small to very small sample sizes, other methodological flaws like a high potential of bias and poor quality of reporting the validity of the results has to be considered as limited. Due to the heterogeneity of health interventions, study populations with differing job
Gurman, Tilly A; Rubin, Sara E; Roess, Amira A
Mobile health (mHealth) technologies and telecommunication have rapidly been integrated into the health care delivery system, particularly in developing countries. Resources have been allocated to developing mHealth interventions, including those that use mobile technology for behavior change communication (BCC). Although the majority of mobile phone users worldwide live in the developing world, most research evaluating BCC mHealth interventions has taken place in developed countries. The purpose of this study was to conduct a systematic review of the literature to determine how much evidence currently exists for mHealth BCC interventions. In addition to analyzing available research for methodological rigor and strength of evidence, the authors assessed interventions for quality, applying a set of 9 standards recommended by mHealth experts. The authors reviewed 44 articles; 16 (36%) reported evaluation data from BCC mHealth interventions in a developing country. The majority of BCC mHealth interventions were implemented in Africa (n = 10) and Asia (n = 4). HIV/AIDS (n = 10) and family planning/pregnancy (n = 4) were the health topics most frequently addressed by interventions. Studies did not consistently demonstrate significant effects of exposure to BCC mHealth interventions on the intended audience. The majority of publications (n = 12) described interventions that used two-way communication in their message delivery design. Although most publications described interventions that conducted formative research about the intended audience (n = 10), less than half (n = 6) described targeting or tailoring the content. Although mHealth is viewed as a promising tool with the ability to foster behavior change, more evaluations of current interventions need to be conducted to establish stronger evidence.
Luk, Edwin K; Hutchinson, Anastasia F; Tacey, Mark; Irving, Louis; Khan, Fary
The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.
Hansen, Lars Jørgen; Drivsholm, Thomas B
This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. Two reviewers independently extracted data and assessed study quality. Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention
Parry, David; Carter, Philip; Koziol-McLain, Jane; Feather, Jacqueline
Consumer eHealth products are often used by people in their own homes or other settings without dedicated clinical supervision, and often with minimal training and limited support--much as eCommerce and eGovernment applications are currently deployed. Internet based self-care systems have been advocated for over a decade as a way to reduce costs and allow more convenient care, and--because of the expectation that they will be used to reduced health cost--, by increasing self-care and avoiding hospitalization. However, the history of consumer eHealth interventions is mixed, with many unsuccessful implementations. Many consumer eHealth products will form part of a broader complex intervention, with many possible benefits and effects on both individuals and society. This poster describes a model of consumer eHealth assessment based on multiple methods of usability evaluation at different stages in the design and fielding of eHealth systems. We argue that different methods of usability evaluation are able to give valuable insights into the likely effects of an intervention in a way that is congruent with software development processes.
Full Text Available Abstract Background Maternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives. Methods Relevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted. Results Thirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice. Conclusions This review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice.
Maibach, Edward W; Roser-Renouf, Connie; Leiserowitz, Anthony
The understanding that global climate change represents a profound threat to the health and well-being of human and nonhuman species worldwide is growing. This article examines the potential of communication and marketing interventions to influence population behavior in ways consistent with climate change prevention and adaptation objectives. Specifically, using a framework based on an ecologic model of public health, the paper examines: (1) the potential of communication and marketing interventions to influence population behaviors of concern, including support for appropriate public policies; (2) potential target audiences for such programs; and (3) the attributes of effective climate change messages. Communication and marketing interventions appear to have considerable potential to promote important population behavior change objectives, but there is an urgent need for additional translational research to effectively harvest this potential to combat climate change.
Parsapure, Roxana; Rahimiforushani, Abbas; Majlessi, Fereshteh; Montazeri, Ali; Sadeghi, Roya; Garmarudi, Gholamreza
Vaginitis is one of the most common diseases in reproductive-aged women (15 - 49 years of age). Side effects of vaginitis can affect other aspects of health, which could be prevented by promoting a healthy lifestyle related to vaginal health. This study aimed at determining the impact of health-promoting educational intervention on lifestyle (nutrition behaviors, physical activities, and mental health) related to vaginal health among reproductive-aged women with vaginitis. The data set was collected as part of an experimental study conducted on 350 reproductive-aged women with vaginitis. Participants were selected through a stratified two-stage clustered sampling and simple randomization from 10 attending health centers affiliated with Kermanshah University of Medical Sciences in five regions (North, South, East, West, and Center) of Kermanshah (a city in western Iran) in 2015. Two clinics in each region were selected; patients from the first center were chosen as the intervention group and patients from the second center made up the control group. To collect data, a questionnaire including socio-demographic and lifestyle questions was used. The questionnaire was designed and validated via the psychometric process. Educational intervention was performed over twenty sessions of 25 to 35 minutes. The intervention group was followed up with face-to-face education, a pamphlet, phone contact, and by social media. The control group continued the routine treatment without contacting the intervention group. Data were collected from both groups before the intervention and six months after the intervention. Data were analyzed using the SPSS-20 package, using the independent t-test, paired t-test, chi-square test, and analysis of covariance (ANCOVA) test. The confidence interval was 95% and P vaginal health in the intervention group (28.48 ± 0.38) and control group (23.65 ± 1.23) was significant (P 0.05). The independent t-test did not show significant statistical