Enrollment Decisions Research Articles

Parental action and neoliberal education reform: Crafting a research agenda

ABSTRACT Neoliberal reforms of public education have promoted a role for parents as individual consumers trying to maximize gains for their own children by choosing from a marketplace of schools. A diverse range of scholarship has explored how parents react to this imposed role, challenging neoliberal conceptions of parental choice by revealing the many factors that shape the enrollment decisions parents make and highlighting the ways that existing inequalities are reproduced through systems of market-driven and unregulated “choice.” A separate emerging literature has examined an alternative role for parents under neoliberal regimes—as collective democratic participants in pursuit of more equitable conceptions of public education and largely in opposition to neoliberal education policies. In this paper, we review the academic literature examining these two visions of parental action under neoliberalism, identify limitations in the literature on collective parental action in opposition to neoliberal reforms, and outline a set of research questions for scholars to address to help enhance our understanding of this important domain.

Picking and Choosing Among Phase I Trials : A Qualitative Examination of How Healthy Volunteers Understand Study Risks.

This article empirically examines how healthy volunteers evaluate andmake sense of the risks of phase I clinical drug trials. This is an ethicallyimportant topic because healthy volunteers are exposed to risk but can gain nomedical benefit from their trial participation. Based on in-depth qualitativeinterviews with 178 healthy volunteers enrolled in various clinical trials, we foundthat participants focus on myriad characteristics of clinical trials when assessingrisk and making enrolment decisions. These factors include the short-term andlong-term effects; required medical procedures; the type of trial, including itsdesign, therapeutic area of investigation, and dosage of the drug; the amount ofcompensation; and trust in the research clinic. In making determinations about thestudy risks, participants rely on information provided during the consent process,their own and others’ experiences in clinical trials, and comparisons amongstudies. Our findings indicate that the informed consent process succeeds incommunicating well about certain types of risk information while simultaneouslycreating lacunae that are problematically filled by participants through theircollective experiences and assumptions about risk. We discuss the ethicalimplications of these findings and make recommendations for improving the consentprocess in healthy volunteer trials.

Determinants of Patient and Surrogate Experiences With Acute Care Research Consent: A Key Informant Interview Study.

BackgroundInformed consent for acute myocardial infarction and stroke research is challenging. Time for enrollment decisions is limited, patients and family are usually stressed, and being asked to participate in research is often unexpected. Despite these barriers, patients and surrogates have reported a preference for prospective involvement in research decisions and generally positive views of the consent process. It is unknown what drives positive or negative consent experiences. These data are crucial to making consent processes more context appropriate.Methods and ResultsWe conducted a qualitative interview study with 27 patients and surrogates enrolled in acute myocardial infarction and stroke trials in the past 5 years. Purposive sampling from the P‐CARE (Patient‐Centered Approaches to Research Enrollment) study was based on participant characteristics and responses to initial patient‐centered interviews. In‐depth interviews used open‐ended questions to explore factors influencing consent experiences. Qualitative descriptive analysis was performed utilizing a multilevel coding strategy. Participants identified specific researcher behaviors as important, including expressions of respect, professionalism, and nonpressuring communication. Participants preferred consent conversations focused on risks/benefits and the trial protocol. They had varying views of consent forms and communicated several reasons the form was valuable unrelated to informational content. Participants also valued postenrollment interactions as opportunities to ask questions and learn about the study.ConclusionsBarriers to consent in acute myocardial infarction and stroke trials are unavoidable, but participants identified productive ways to demonstrate respect for patients during enrollment conversations. These include key researcher behaviors, concentrating consent discussions on what participants find most important, and structured postenrollment follow‐up.

Accrual and retention trends among diverse patients in a supportive cancer care trial.

40 Background: Despite reporting similar levels of willingness to participate in clinical trials, minority cancer patients remain underrepresented in research interventions. The purpose of this analysis was to examine participant age, race, and ethnicity as predictors of study interest, eligibility, enrollment decision, and attrition in an intervention providing supportive care for women with cancer. Methods: Patients from the UF&Shands Gynecologic Oncology Service (N = 568) were approached for recruitment to either a six-week cognitive-behavioral intervention for insomnia and pain or a psychoeducational control condition. These women were queried about their willingness to participate in the study, interest level, and reasons for declining participation if they did not wish to enroll in the trial. Among enrolled patients (N = 64), predictors of attrition were explored. Results: Of approached patients, 57.2% were older than age 60, 14.7% were non-White, and 3.2% were Hispanic. Chi-square analyses indicated that there were no significant differences in interest level by age [χ2(2,441) = 2.732, p = .255], race [χ2(2,439) = 2.019, p = .364], or ethnicity [χ2(2,431) = 3.242, p = .198]. Eligible minority patients were significantly more likely to enroll than were non-Hispanic Whites [χ2(1,364) = 4.125, p = .042], with Hispanic recruitment driving this difference (p = .011). Survival analyses demonstrated no differences in attrition hazard based on age (B = -.088, p = .825), race (B = .583, p = .275), or ethnicity (B = -19.518, p = .999) among enrolled patients. Conclusions: In our supportive cancer clinical trial (CCT), there were no significant differences in trial interest across racial and ethnic minority groups. In fact, Hispanics were more likely to enroll than non-Hispanics. Furthermore, neither race nor ethnicity was a significant predictor of trial attrition. Future investigation is needed to better understand racial and ethnic disparities in cancer research enrollment, motivators and barriers to participation in supportive cancer care trials, potential inconsistencies in accrual patterns among minority cancer patients, and best practices for enrolling and retaining diverse participants for supportive CCTs. Clinical trial information: NCT02609880.

Understanding the Enrollment Decisions of Associate Degree Nursing Students: A Qualitative Study

Given the current push toward the Bachelor of Science in Nursing (BSN) preparation for registered nurses, a significant proportion of students choose the Associate Degree in Nursing (ADN) prelicensure nursing education. This descriptive qualitative study seeks to provide insight into enrollment decisions of ADN nursing students, including their initial decision to pursue nursing, their understanding of the benefits of earning a BSN, and their plans toward future BSN completion. Ultimately, nontraditional student status exerted a compelling influence regarding the decision to choose ADN prelicensure preparation.

Moving to safety and staying in school: The effects of violence on enrollment decisions in Mexico

AbstractThere is a vast literature documenting negative impacts of crime on human capital accumulation, which has focused on large‐scale armed conflicts affecting both individuals and infrastructure. However, there is much less evidence in contexts where violence is not accompanied by the destruction of infrastructure. To fill this gap, this paper studies the effects of Mexico's War on Drugs (WoD) on individuals’ schooling decisions. Our results show only small effects of violence on total enrollment of children and young adults, in contrast to recent studies which find significant negative effects for some specific age‐by‐gender groups. Our analysis, which aims to assess the overall impacts of the WoD on enrollment decisions and takes advantage of various rounds of administrative data, the population census, and labor force surveys, shows that many families responded to the increase in violence by migrating to less affected municipalities. However, we find that their education decisions have been quite robust as greater violence did not affect their probability of being enrolled in school. In the long term, however, it is still possible that the increase in violence affects human capital accumulation through indirect effects arising in skill acquisition in early childhood and other stages.

E-POSTERS - OUTCOME MEASURES: EP.51Expert advice to improve clinical trials: from TACT to ACT

The TREAT-NMD Advisory Committee for Therapeutics (TACT), established in 2009, is a unique multi-disciplinary international group of academic and industry drug development experts. TACT meets twice a year to review and give advice on the translational and development pathway of therapeutic programs in rare neuromuscular diseases. Due to the success of TACT, we are now replicating the model for paediatric diseases, as part of the IMI2 project - Conect4Children (c4c). An ACT 'tool-kit' will be produced to support other disease networks in establishing their own advisory committees for therapeutics (ACTs). This will be disseminated through the European Joint Programme co-fund for rare diseases (EJP). We aim to replicate the TACT model in other, paediatric disease areas, to provide world-leading, expert advice and support to researchers and industry on translation from pre-clinical data to therapy approval, including clinical trial design. We will be producing a 10th anniversary paper evaluating the impact of previous TACT applications over the past ten years. We will support the set-up of large multi-stakeholder meetings, which include a wide range of drug development experts including clinicians, regulatory experts, academics, statisticians, toxicologists and patient representatives. We plan to create an ACT 'tool-kit' to allow other disease networks to set-up their own therapeutic advisory committees. Key findings: Feedback from previous applicants in the neuromuscular field has demonstrated that TACT has helped them to prepare for discussions with regulators, inform study design - including selection of endpoints and go/no-go decisions, enrolment and dosing decisions. TACT has reviewed over 50 applications in 9 years from academic groups and industry. Replicating the TACT model in other disease areas, particularly paediatric areas, will support better clinical trial design and guidance through the translational research pipeline. This will have a significant impact on patients.

Do Fictional Forensic and Criminal Investigation Television Shows Influence Students’ Enrollment Decisions?

Research on ‘the CSI effect’ is accumulating and accounts for a substantive body of knowledge not just in the United States of America, but also elsewhere in the world. The paper investigates one aspect of the CSI effect whereby university faculties offering forensic or criminal investigative curricula are seeing an increase in the number of students enrolling. A research study was conducted on first-year students of the Faculty of Criminal Justice and Security (Slovenia) in which they were directly asked to state the extent to which TV series and films influenced their enrollment decision. The results indicate that some students were motivated by TV series and films, although more detailed statistical inquiries only provide partial and limited support for such claims. Therefore, a more in-depth research study is required to provide better insights into this dimension of the CSI effect.

Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California.

To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were "passively enrolled" into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.

Attitudes Regarding Enrollment in a Genetic Research Project: An Informed Consent Simulation Study Comparing Views of People With Depression, Diabetes, and Neither Condition.

In this study, participants with a self-reported history of depression, diabetes, or no illness underwent a simulated informed consent process for a hypothetical genetic study related to depression or diabetes. Participants completed a survey assessing their perceived understanding of the research process, perceptions of its risks and benefits, their satisfaction with the informed consent process, and their readiness to make a hypothetical enrollment decision. All participants indicated strong readiness to make an enrollment decision regarding the research characterized in the simulation. Participants reported understanding the consent process relatively well and being generally satisfied with it. Greater concerns were expressed regarding psychosocial risks than biological risks for genetic studies on mental disorders. Our study documented positive attitudes toward volunteering for research that involved the collection of genetic data.

P2‐042: DECIDING TO PARTICIPATE IN AN ALZHEIMER'S DISEASE SECONDARY PREVENTION TRIAL: THE PARTICIPANT PERSPECTIVE

Multiple Alzheimer's disease (AD) secondary prevention trials are currently underway to evaluate promising therapies. Trial eligibility often requires prospective participants to be cognitively unimpaired, learn something about their AD risk, and enroll with a study partner. Little is known about how individuals make enrollment decisions, such as their motivations, perceptions of risk, and reactions to being ineligible. Moreover, it is unknown how they select study partners and how, if at all, they include study partners in enrollment decisions. Data are collected as part of the Study of Knowledge and Reactions to ApoE Testing (SOKRATES 2). SOKRATES 2 participants are cognitively unimpaired adults aged 60–75 who learned their Apolipoprotein E (ApoE) genotype as part of screening and eligibility for the Alzheimer's Prevention Initiative's Generation Program trials, which are testing treatments to prevent the onset of cognitive and functional declines related to AD in individuals at increased genetic risk. The sample was recruited to be balanced on age, gender, and ApoE genotype. Interviews were conducted with 70 individuals following ApoE disclosure. Initial interviews were conducted 3 months post-disclosure. Follow-up interviews—conducted 12-months after the initial interview—are currently underway. The follow-up structured interview guide includes questions about study partner selection and trial-related decision making. All interviews are being recorded, transcribed, and analyzed in NVivo 12.0. The University of Pennsylvania IRB approved this study. Results show that the majority of individuals reached the decision to participate alone and did not engage others, including their potential study partner, in trial-related decision-making. Common reasons for participating include desire for personal medical benefit, AD family history, and advancing science for others’ benefit. Although there are risks associated with the Generation Studies’ experimental treatments and procedures, participants did not consider participation particularly risky. Individuals ultimately ineligible to participate reported experiencing disappointment and, in some instances, resentment and anger. Understanding how individuals decide whether or not to participate in AD secondary prevention trials, whom they engage in trial-related decision making, and how they feel if they are not eligible is important for designing recruitment and engagement strategies.

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work we introduce a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time. We allow differential effects of an intervention to vary over time and encourage these effects to be more similar for closer time points by utilizing a fused lasso penalty. Our approach allows for flexible modeling of temporally changing intervention effects while also borrowing strength in estimation over time. We utilize our approach to construct a personalized enrollment decision rule for a complex case management intervention in a large health system and demonstrate that the enrollment decision rule results in improvement in health outcomes and care costs. The proposed methodology could have broad usage for the analysis of different types of long-term interventions or treatments including other interventions commonly implemented in health systems.

Funding Mechanisms for Higher Education: A Marketing Perspective

This paper develops an analytical model to investigate the impact of governmental funding of higher education on educational outcomes including tuition, graduation rates, and enrollment. Assuming that students make an enrollment decision based on tuition, graduation rate, and labor market prospects, we show that push and pull funding strategies are equally effective in lowering net tuition and in increasing enrollment, the expected graduation rate, and social welfare without compromising the academic standards. We also show that a policy change from enrollment-based funding to performance-based funding raises graduation rates but does not necessarily improve the performance of the education system.

Student Factors Influencing STEM Subject Choice in Year 12: a Structural Equation Model Using PISA/LSAY Data

This study investigates factors that influenced the science, technology, engineering and mathematics (STEM) subject enrolment decisions of Year 12 students in Australia. Structural equation modelling (SEM) is used to develop a model using Programme for International Student Assessment (PISA) and Longitudinal Surveys of Australian Youth (LSAY) data with participating students (N = 7442) from 356 schools. An adapted version of the theory of planned behaviour (TPB), a behavioural prediction model, is used as the guiding conceptual framework. Students’ demographic background, attitudes towards science and achievement in science and mathematics at age 15 are used as predictors for subsequent enrolment in STEM subjects in Year 12. Gender, socio-economic status (SES) and immigrant status (native vs. non-native) are shown to be contributing factors. The personal value of science, enjoyment of science, self-concept in science and achievement (mathematics and science) are mediating factors in the model. These findings provide schools, policymakers and educational advisors with a greater understanding of the factors that influence Australian students’ decisions of whether to enrol in a STEM subject at Year 12. Evidence provided allows key stakeholders to take a more targeted approach to enhance STEM participation for students from varying demographic backgrounds.

Understanding How Information Affects Loan Aversion: A Randomized Control Trial of Providing Federal Loan Information to High School Seniors

ABSTRACTAlthough the literature offers evidence of students’ aversion to borrowing for postsecondary education, it offers no insight into whether such attitudes are mutable. Through a blocked, cluster-randomized controlled trial in six diverse high schools in Louisville, Kentucky, we test whether providing student loan and repayment information affects the borrowing attitudes and perceptions of high school seniors. The information treatment involves watching a short video during class that explains federal student loans and the advantages of income-based repayment, compared with control students receiving general information about reading financial aid award letters. Students’ attitudes toward loans are then captured on a survey. Results indicate that information about loans reduces loan aversion, both on our general measure of borrowing attitudes and on our specific measure of borrowing for education—the latter by 5 percentage points, corresponding to a 30% reduction relative to control baseline. We also consider two plausible mechanisms of the treatment effect and provide evidence to suggest that the information intervention improves college enrollment. These results indicate that providing information on income-based repayment options to high school students before they make the college enrollment decision could improve college access to populations who are averse to borrowing.

Optimizing enrollment methods: Lessons learned from an mHealth, pilot HIV prevention randomized controlled trial with sexual minority men.

Using data from eligible participants, we evaluated procedures of a multi-step enrollment process for an mHealth, pilot randomized controlled trial aimed to promote regular HIV testing among at-risk, diverse sexual minority men. Completion rates of eligible participants were calculated and characterized for these enrollment procedures. Among 3058 men who screened, 183 were eligible and 113 enrolled. Two groups emerged: "As planned" (n = 98) followed enrollment directions as designed; "Laggers" (n = 15) did not follow these directions and required additional efforts resulting in mixed results for improving enrollment. Findings suggest the need for pre-determined enrollment decision rules based on available resources.

An Evaluation of the Educational Impact of College Campus Visits: A Randomized Experiment

We hypothesize that a lack of experience with college poses a non-trivial barrier to college access for historically underrepresented students. We study whether visits to a college campus during the eighth grade can reduce these psychological barriers to college access. Using an experimental design, we study whether college visits affect students’ knowledge about college, postsecondary intentions, college-going behaviors, academic engagement, and ninth grade course enrollment decisions. We recruited 885 students across 15 schools who participated in our project during the academic year 2017-2018. We randomized students within schools to either a treatment or control condition. Students in the control condition receive an information packet about college. Students in the treatment condition receive the same information and visit a flagship university three times during their 8th-grade academic year. Students assigned to participate in these campus visits demonstrate higher levels of knowledge about college, higher levels of effort while completing the survey, a higher likelihood of having conversations with school personnel about college, and a decreased desire to attend technical school. Additionally, treated students are more likely to enroll in advanced math and science/social science courses in 9th grade.

ESTIMATING THE HETEROGENEOUS WELFARE EFFECTS OF CHOICE ARCHITECTURE

AbstractWe develop a method that embeds signals about consumers’ knowledge to evaluate prospective choice architecture policies. We analyze three proposals for U.S. Medicare prescription drug insurance markets: (i) menu restrictions, (ii) personalized information, and (iii) defaulting consumers to cheap plans. We link administrative and survey data to identify informed enrollment decisions that proxy for preferences of observationally similar misinformed consumers. Results suggest that each policy yields winners and losers, with the menu restrictions harmful to most but personalized information beneficial to most. These results are robust across signals of consumers’ knowledge but differ from the benchmark that excludes such signals.

In-State College Enrollment and Later Life Location Decisions

State and local policymakers are very interested in how attending college in one’s home state affects the likelihood of living in that state after college. This paper uses cohort-level data from the American Community Survey, decennial censuses, and other sources to examine how birth-state college enrollment affects birth-state residence several years later. Ordinary least squares and instrumental variables estimates both suggest a statistically significant positive relationship. The preferred instrumental variable estimates suggest that a one percentage point increase in birth-state enrollment rates increases later life birth-state residence by roughly 0.41 percentage points. Implications for policy are discussed.

Factors affecting Learner Enrollment Decision in Agriculture- Related Course

Factors affecting Learner Enrollment Decision in Agriculture- Related Course