Evaluation Of Such Programs Research Articles

Feasibility Evaluation of a Parenting Group for Latina Survivors of Intimate Partner Violence.

Intimate partner violence (IPV) is a pervasive concern among Latina women that requires accessible and culturally appropriate services for survivors, including programs to support parenting in the context of IPV. Evaluations of such programs are sparse, limiting understanding of how agencies can best serve Latina survivors who are parents. We conducted a feasibility study of a parenting group for Latina IPV survivors that included an analysis of administrative data, focus groups with program participants (n = 17), and interviews with facilitators (n = 4). Findings center on demand, acceptability, implementation, and recommendations. Overall, the program was well received, and results include suggestions to enhance the program.

Introducing a self-managed early communication resource for parents – A mixed methods feasibility study of the Swedish “ComAlong online”

Background Web-based programmes offer parents of children with communication difficulties promising access to parent-mediated, early interventions. However, empirical evaluations of such programmes are limited. This study focused on parents and used mixed methods to examine the feasibility of ComAlong online. Methods ComAlong online is a Swedish, self-managed web-resource teaching parents supportive strategies to promote child communication. Data of different types were collected from a total of 71 parents: ten individual parent interviews, 21 pre-questionnaires and 10 post-questionnaires, and finally 50 anonymous digital evaluation surveys. Descriptive statistics and deductive qualitative content analysis were used. Results Findings indicate that parents perceived improved child communication and own competence after using the ComAlong online. The most valued parts included podcasts with experts and videos of parent-child interaction. Parents reported that the resource was easy to use, but they wanted to have gained access to the resource when the child was younger. Suggestions for changes included adding a chat function with experts, a parent net forum, and the possibility of creating personalised playlists of videos and podcasts. Evaluation of the research process revealed difficulties in recruiting parents from local child healthcare services and parents of children not yet with a diagnosis. Conclusions This study supports the potential for self-managed, web-based resources to disseminate evidence-based parent training for supporting early communication development. Importantly, parents lack individual guidance from experts and contact with other parents. Also, measures need to be made to disseminate the resources within local child healthcare services.

Assessing the importance-performance analysis of adaptive capacity programs for sustainable mangrove conservation in the Taman Nasional Bali Barat conservation area

Mangroves, which are vital for maintaining the stability of coastal ecosystems, are facing increasing threats from global changes. This highlights the urgent need for effective adaptive capacity programs. This study focuses on the evaluation of such programs within Taman Nasional Bali Barat, Indonesia, specifically looking at their effectiveness in promoting sustainable mangrove conservation. To obtain a comprehensive understanding of the community's involvement and perspectives, a survey was conducted, including a wide range of local stakeholders, not just those already involved in conservation efforts. The findings revealed that programs that prioritize flexibility, learning, and agency are crucial, but are currently underperforming. Interestingly, there was a significant variation in the willingness to participate among different groups. Fishermen and students displayed negative tendencies, while limited interest communities (a population segment historically less engaged in conservation), those with previous experiences with conservation programs, those seeking advice on marine activities, and those influenced by policies showed positive and significant responses. For example, tourist operators also exhibited a significantly positive engagement. Based on the analysis, this study provides targeted policy recommendations to enhance stakeholder engagement, improve program flexibility, and emphasize educational efforts. These recommendations aim to strengthen the adaptive capacity for sustainable mangrove management in the face of ongoing global changes.

Multivariate mixed-effects ordinal logistic regression models with difference-in-differences estimator of the impact of WORTH Yetu on household hunger and socioeconomic status among OVC caregivers in Tanzania.

Although most of the livelihood programmes target women, those that involve women and men have been evaluated as though men and women were a single homogenous population, with a mere inclusion of gender as an explanatory variable. This study evaluated the impact of WORTH Yetu (an economic empowerment intervention to improve livelihood outcomes) on household hunger, and household socioeconomic status (SES) among caregivers (both women and men) of orphaned and vulnerable children (OVC) in Tanzania. The study hypothesized that women and men respond to livelihood interventions differently, hence a need for gender-disaggregated impact evaluation of such interventions. This is a secondary analysis of longitudinal data, involving caregivers' baseline (2016-2019) and follow-up (2019-2020) data from the USAID Kizazi Kipya project in 25 regions of Tanzania. Two dependent variables (ie, outcomes) were assessed; household hunger which was measured using the Household Hunger Scale (HHS), and Socioeconomic Status (SES) using the Principal Component Analysis (PCA). WORTH Yetu, a livelihood intervention implemented by the USAID Kizazi Kipya project was the main independent variable whose impact on the two outcomes was evaluated using multivariate analysis with a multilevel mixed-effects, ordinal logistic regression model with difference-in-differences (DiD) estimator for impact estimation. The analysis was based on 497,293 observations from 249,655 caregivers of OVC at baseline, and 247,638 of them at the follow-up survey. In both surveys, 70% were women and 30% were men. Their mean age was 49.3 (±14.5) years at baseline and 52.7 (±14.8) years at the follow-up survey. Caregivers' membership in WORTH Yetu was 10.1% at the follow-up. After adjusting for important confounders there was a significant decline in the severity of household hunger by 46.4% among WORTH Yetu members at the follow-up compared to the situation at the baseline (adjusted Odds Ratio (aOR) = 0.536, 95% Confidence Interval (CI) [0.521, 0.553]). The decline was 45.7% among women (aOR = 0.543 [0.524, 0.563]) and 47.5% among men (aOR = 0.525 [0.497, 0.556]). Regarding SES, WORTH Yetu members were 15.9% more likely to be in higher wealth quintiles at the follow-up compared to the situation at the baseline (aOR = 1.159 [1.128, 1.190]). This impact was 20.8% among women (aOR = 1.208 [1.170, 1.247]) and 4.6% among men (aOR = 1.046 [0.995, 1.101]). WORTH Yetu was associated with a significant reduction in household hunger, and a significant increase in household SES among OVC caregivers in Tanzania within an average follow-up period of 1.6 years. The estimated impacts differed significantly by gender, suggesting that women and men responded to the WORTH Yetu intervention differently. This implied that the design, delivery, and evaluation of such programmes should happen in a gender responsive manner, recognising that women and men are not the same with respect to the programmes.

Strategies to develop an LGBTQIA+-inclusive adolescent sexual health program evaluation.

Adolescent sexual health interventions are increasingly incorporating content that is inclusive of LGBTQIA+ youth (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other marginalized sexualities and genders). Evaluations of such programs must also be inclusive to enhance the validity of evaluation results and avoid further marginalization. We present strategies for increasing LGBTQIA+-inclusivity based on our evaluation of SafeSpace, a sexual health curriculum. To design an LGBTQIA+-inclusive program evaluation, we leveraged LGBTQIA+ research staff's insights, pursued a parental consent waiver, developed an inclusive recruitment plan, and crafted demographic and sexual behavior survey measures with input from youth and equity experts. We conducted a pilot study with 42 youth ages 14-17 to assess the feasibility and efficacy of our strategies. We obtained a parental consent waiver and recruited a majority LGBTQIA+ pilot study sample (62%). Using themes from cognitive interviews with youth and experts regarding inclusive framing and use of plain language, we refined demographic measures and expanded sexual behavior measures. Findings suggest that the strategies used to enhance LGBTQIA+-inclusivity in our evaluation of SafeSpace were effective in respectfully and more accurately capturing a fuller range of experiences and identities of LGBTQIA+ and cis-straight youth. The strategies and survey measures developed for this study can be applied to increase LGBTQIA+-inclusivity in other adolescent sexual health program evaluations.

Violent Event Severity Tool for Reporting Violent Incidents.

To explore the usefulness of the Violent Event Severity Tool (VEST). The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data. Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents. Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed. The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.

Measuring Up: A Dialogical Model for Assuring a Reparative Process

International law obliges governments to assure adequate and effective reparations for human rights violations. To date, most evaluations of such programs focus on outcomes while overlooking the process of how the state engaged victims, or not, in the determination of what they needed to feel repaired. A consensus now points toward the need to better involve beneficiaries in reparations programs in the process of determining these outcomes, yet there remains a need to better understand how to assure meaningful and effective participation. In response, the authors present an expansive view of the right to participation that would oblige governments to assure the quality of this participation in all stages of reparation programming, including design, implementation, and evaluation. They argue that reparative processes are, in themselves, forms of reparation, which go toward citizen restitution. They offer preliminary guidelines on how to assure reparative processes, as well as their evaluation, through a dialogical model that helps reorient the view of “victims” to being active agents in determining not only appropriate reparations but also larger transformations. Reparative processes shift the focus of evaluation to look beyond outcomes and toward the quality of the design and implementation processes, which, if flawed, may ultimately undermine the overall impact of any reparation program.

Implementation and experimental evaluation of school-based intervention programs promoting adolescent mental health: Lessons learned

Targeted school-based programs seem to be a promising approach to help adolescents in need. Nevertheless, successful implementation and evaluation of such programs is challenging. However, there is limited knowledge about (overcoming) the challenges of implementation and experimental evaluation of school-based programs. The goal of the present paper is, therefore, to improve future research by describing the challenges encountered and lessons learned during two randomized controlled trials (RCTs) to study the effectiveness of two skills-training programs reducing school or social stress. In this way, we aim to inform others who plan to implement and evaluate such programs in schools using an RCT design. Some of the challenges encountered apply to all effectiveness studies, such as the recruitment and retention of participants; others are more “intervention at school” specific, such as scheduling the programs and assessments. Our experiences show that it is possible to effectively implement and evaluate targeted programs promoting adolescent mental health in secondary schools with RCTs, even during a worldwide health pandemic, but that it requires investing sufficient time in keeping close and regular contact as well as clear communication between the involved parties. Moreover, high levels of flexibility are needed in adjusting scheduled meetings for intervention and research while keeping track of the entire process for each school and individual participant.

Evaluating a research training programme for frontline health workers in conflict-affected and fragile settings in the middle east

BackgroundHealth Research Capacity Building (HRCB) is key to improving research production among health workers in LMICs to inform related policies and reduce health disparities in conflict settings. However, few HRCB programmes are available in the MENA region, and few evaluations of HRCB globally are reported in the literature.MethodsThrough a qualitative longitudinal design, we evaluated the first implementation of the Center for Research and Education in the Ecology of War (CREEW) fellowship. Semi-structured interviews were conducted with fellows (n = 5) throughout the programme at key phases during their completion of courses and at each research phase. Additional data was collected from supervisors and peers of fellows at their organizations. Data were analysed using qualitative content analysis and presented under pre-identified themes.ResultsDespite the success of most fellows in learning on how to conduct research on AMR in conflict settings and completing the fellowship by producing research outputs, important challenges were identified. Results are categorized under predefined categories of (1) course delivery, (2) proposal development, (3) IRB application, (4) data collection, (5) data analysis, (6) manuscript write-up, (7) long-term effects, and (8) mentorship and networking.ConclusionThe CREEW model, based on this evaluation, shows potential to be replicable and scalable to other contexts and other health-related topics. Detailed discussion and analysis are presented in the manuscript and synthesized recommendations are highlighted for future programmes to consider during the design, implementation, and evaluation of such programmes.

Finding help and hope in a peer-led reentry service hub near a detention centre: A process evaluation.

When people leave correctional institutions, they face myriad personal, social and structural barriers to reentry, including significant challenges with mental health, substance use, and homelessness. However, there are few reentry programs designed to support people's health, wellbeing, and social integration, and there are even fewer evaluations of such programs. The purpose of this article is to report the qualitative findings from an early process evaluation of the Reintegration Centre-a peer-led service hub designed to support men on the day they are released from custody. We conducted semi-structured qualitative interviews and examined quantitative service intake data with 21 men who accessed the Reintegration Centre immediately upon release. Participants encountered significant reentry challenges and barriers to service access and utilization. The data suggest that the peer-led service hub model enhanced the service encounter experience and efficiently and effectively addressed reentry needs through the provision of basic supports and individualized service referrals. Notably, the Reintegration Centre's proximity to the detention centre facilitated rapid access to essential services upon release, and the peer-support workers affirmed client autonomy and moral worth in the service encounter, fostering mutual respect and trust. Locating reentry programs near bail courts and detention centres may reduce barriers to service access. A peer-led service hub that provides immediate support for basic needs along with individualized service referrals is a promising approach to reentry programs that aim to support post-release health, wellbeing, and social integration. A social system that fosters cross-sectoral collaboration and continuity of care through innovative funding initiatives is vital to the effectiveness and sustainability of such reentry programs.

A Qualitative Study of Preclinical Medical Students Randomized to Patient-Partnered vs Traditional Clinical Experiences.

Longitudinal patient-partnered experiences may promote medical student empathy, but evaluation of such programs is limited. The aim of this study was to compare areas of learning among first-year medical students randomized to a patient-centered track (PCT) or traditional track (TT) longitudinal clinical experience. PCT students (n=24) were paired with 2 patients and a physician to participate in their patients' care across multiple settings. TT students (n=56) were paired with a physician preceptor and participated in caring for a variety of patients in a single setting. This qualitative study used a phenomenological approach to template analysis, examining and comparing student reflective essays for areas of learning. Three domains of learning emerged: 1) Focus of learning (biomedical, patient-centered); 2) Roles and relationships (clinical skills, relationship-building, teaching from preceptor and patients); and 3) Context of care (health systems science, interprofessional care). PCT students described patient-centered learning, relationship-building, and patients' role as teachers. In contrast, TT students emphasized biomedical learning, clinical skills development, and teaching from physician preceptors. Longitudinal patient-partnered clinical experiences provide rich opportunities for preclinical students to cultivate empathy and develop patient-centered values.

Recommend Friends for Miles: Effective Referral Marketing Strategies in Frequent Flyer Programs

ABSTRACT Previous research demonstrated the effectiveness of referral programs in boosting firm performance. However, referrers’ evaluations of such programs are under-examined. This study fills this gap by conducting two studies. Study 1 finds that psychological closeness between a referrer and a referee enhance the referrer’s evaluation of the program. Study 2 reveals that the relationship between such psychological closeness and the referrer’s evaluation is contingent on referral reward type (material vs. experiential). This study advances previous research in referral marketing by drawing on the experience recommendation theory and construal level theory. Referral marketing managers shall note that encouraging existing customers to refer their close others is particularly effective when referral messages highlight material rewards, instead of experiential rewards.

Evaluation Methods in Community Microgrant Programs for Health Promotion: A Scoping Review.

Evaluating community-based health promotion programs is an essential aspect of public health programming to ensure evidence-based practices, justify limited resource allocation, and share knowledge about promising strategies. Community microgrant schemes represent a viable strategy to strengthen local health promotion, yet limited guidance exists surrounding the evaluation of such programs. This research aimed to map methods used in evaluating community microgrants programs for health promotion. A scoping review in accordance with Joanna Briggs Institute methodology. Peer-reviewed academic and gray literature, which evaluated processes and/or outcomes of nonprescriptive community-based microgrant program for health promotion in high-income countries. Literature was identified through MEDLINE, Scopus, CINAHL, and EMBASE databases, Google and DuckDuckGo browsers, and hand-searching key reference lists. Articles were screened by title, abstract, and then full-text. Review findings were mapped according to included sources' evaluation methodologies. Eighteen academic publications describing 14 microgrant programs met the inclusion criteria. These spanned the years 1996 to 2020 and were located across 5 countries. Evaluation methods were very similar in terms of design (mixed-methods case studies) and focus (both processes and outcomes) and yet varied widely with regard to measurements and data collection. Few made explicit the use of an evaluation framework, chose to involve stakeholders in the evaluation process, or discussed application and dissemination of evaluation findings. Community-based microgrant programs for health promotion are a promising model in diverse settings and with various health priorities and targets, yet robust evaluations of their implementation and effectiveness are lacking. The review highlights the need to further develop and support evaluation practices in public health, even in small-scale programs with limited budgets.

Evaluating a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer (ExerciseGuide UK): protocol for a single group feasibility and acceptability study

BackgroundLung cancer is the leading cause of cancer-related death globally. Physical activity and exercise provide unequivocal benefits to those living with and beyond lung cancer. However, few of those living with and beyond cancer meet the national physical activity guidelines. Various barriers exist for this population’s engagement in physical activity and exercise, such as the lack of knowledge and lack of tailored information, little access to exercise specialists, fatigue, and mobility challenges. Digitally delivered programmes have the potential to address several of these barriers, with techniques like “computer-tailoring” available to enable the delivery of tailored content at a time and place that is convenient. However, evaluation of such programmes is needed prior to implementation. This protocol describes a single group study that will examine the feasibility and acceptability of an online tool (ExerciseGuide UK) that provides those living with and beyond lung cancer web-based computer-tailored physical activity prescription and modules underpinned by behaviour change theories.MethodsThirty-five individuals diagnosed with lung cancer, or cancer affecting the lung (e.g. pleural mesothelioma), will be recruited into a single-intervention arm. The platform will provide tailored resources and a personalised physical activity programme using IF-THEN algorithms. Exercise prescription will be tailored on factors such as self-reported specific pain location, exercise history, and current physical fitness. In addition, modules grounded in behaviour change will supplement the physical activity programme and will focus on topics such as exercise benefits, safety, goal setting, and tracking. The primary outcome will be assessed using pre-established criteria on feasibility and mixed-methods approach for acceptability.Secondary outcomes will explore changes in the physical activity, quality of life, anxiety, and depression.DiscussionThis manuscript describes the protocol for a study examining the feasibility and acceptability of a web-based computer-tailored physical activity intervention for those living with and beyond lung cancer. The publication of this protocol aims to increase the transparency of the methods, report pre-determined criteria, and aid replication of the study and associated materials. If feasible and acceptable, this intervention will inform future studies of digital-based interventions.Trail registrationClinicalTrails.gov, NCT05121259. Registered on November 16, 2021.

Criteria-Based Assessment of a Teleophthalmology Diabetic Retinopathy Evaluation Program in a Primary Care Setting.

Background:Studies have shown that teleophthalmology programs using a nonmydriatic camera in primary care settings can improve rates of diabetic retinopathy (DR) screening. However, such programs are not yet widespread due to common challenges in sustainability.Purpose:To comprehensively evaluate clinical and operational measures of an urban primary care clinic's 1-year pilot teleophthalmology DR evaluation program.Materials and Methods:This retrospective analysis used five metrics to evaluate the program: clinical diabetic retinal exam (DRE) rate, visual acuity and pathology, camera utilization, billing and insurance reimbursements, and outcomes of follow-up referrals.Results:Two hundred eleven patients were screened over 14 months. The DRE rate had more than doubled (34-75%). Of the patients, 55.9% had vision better than 20/50 in each eye and 21% with at least 1 eye worse than or equal to 20/70. DR was noted in 11% of patients. The program's first few months saw greatest camera use. Government and Medicare Advantage insurers were significantly (p < 0.001) less likely to reimburse than commercial insurers. Twenty-seven percent of patients screened had documented follow-up with an eye care provider within 16 months of their screening. Patients diagnosed with DR or recommended follow-up within 1 month were significantly (p < 0.001) more likely to schedule an appointment.Discussion:Challenges to program sustainability include efficient utilization, reimbursement from governmental insurers, and adherence to follow-up recommendations.Conclusions:Assessing teleophthalmology programs with the aforementioned five metrics allows for a comprehensive evaluation of impact and sustainability. This may be utilized to standardize the implementation and evaluation of such programs across diverse settings.

What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study.

ObjectivesGlobal health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme.Design, settings and participantsThis study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data.Outcome measuresParticipants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end.ResultsMany of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs.ConclusionsThe findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.

Engaging Frontline Physicians in Value Improvement: A Qualitative Evaluation of Physician-Directed Reinvestment.

PurposePhysicians can limit upward trending healthcare costs, yet legal and ethical barriers prevent the use of direct financial incentives to engage physicians in cost-reduction initiatives. Physician-directed reinvestment is an alternative value-sharing arrangement in which a health system reinvests a portion of savings attributed to physician-led cost reduction initiatives back into professional areas of the physicians’ choosing. Formal evaluations of such programs are lacking.MethodsTo understand the impact of Stanford Health Care’s physician-directed reinvestment in its first year (2017–2018) on physician engagement, adherence to program requirements around safety and fund use, and factors facilitating program dissemination, semi-structured qualitative interviews with physician participants, non-participants, and administrative stakeholders were conducted July-November 2019. Interview transcripts were qualitatively analyzed through an implementation science lens. To support contextual analysis of the qualitative data, a directional estimation of the program’s impact on cost from the perspective of the health system was calculated by subtracting annual maintenance cost (derived from interview self-reported time estimates and public salary data) from internal cost accounting of the total savings from first year cohort to obtain annual net benefit, which was then divided by the annual maintenance cost.ResultsPhysician participation was low compared with the overall physician population (n=14 of approximately 2300 faculty physicians), though 32 qualitative interviews suggested deep engagement across physician participants and adherence to target program requirements. Reinvestment funds activated intrinsic motivators such as autonomy, purpose and inter-professional relations, and extrinsic motivators, such as the direction of resources and external recognition. Ongoing challenges included limited physician awareness of healthcare costs and the need for increased clarity around which projects rise above one's existing job responsibilities. Administrative data excluding physician time, which was not directly compensated, showed a direct cost savings of $8.9M. This implied an 11-fold return on investment excluding uncompensated physician time.ConclusionA physician-directed reinvestment program appeared to facilitate latent frontline physician innovation towards value, though additional evaluation is needed to understand its long-term impact.

Programa de intervención online para alumnado universitario con discapacidad visual en tiempos de Covid

Attention to people with disabilities, in this case visual impairment, is particularly relevant to achieve an inclusive educational context in any university. During the period of confinement and social distancing of the current pandemic, it was necessary to adapt the face-to-face psychoeducational counselling programmes to their needs. The purpose of this paper is to present the whole process followed in the virtual reorganisation of a care programme for visually impaired students developed at the Student Support Centre of the University of Alicante. A design-based methodology based on educational practice has been used. The results confirmed that the new counselling in the online format fostered a stimulating environment with highly active interactions between counsellor and students, self-regulation conducive to learning and interpersonal and communication skills using the virtual format. It was concluded that proper planning, development and evaluation of such programmes can enrich the psychosocial and educational development of students. However, more progress needs to be made in the digitalisation of university counselling and to strengthen the online modality in the current context of a 21st century technological society.

Evaluation of a youth mental health literacy and action program: Protocol for a cluster controlled trial

Mental illness accounts for 16% of the global burden of disease and injury for young people. Mental health literacy (MHL) and action refers to mental health knowledge, where to seek help, and ways to promote positive mental health. There are promising outcomes and effectiveness from youth MHL and action programs in promoting positive mental health and reducing mental illness stigma. Evaluation of such programs in Australia are scarce. This paper outlines the protocol to implement a mental health literacy and action program, called Youth Education and Support (YES) program, in Australian secondary schools using a cluster controlled trial. Students across grades seven to ten will be recruited via their school and allocated to the intervention (YES program). Individuals will be recruited via advertisements for a control group. Measures include the Youth Mental Health Literacy scale (YMHL), General Help Seeking Questionnaire (GHSQ), Actual Help Seeking Questionnaire (AHSQ), and 14-Item Resilience Scale (RS-14). Qualitative questionnaires, and a fidelity instrument will also be used to assess the YES program. Measurements for the YES program will be taken for pre (before program), post (final session of program), three months, and one year follow up timepoints. The YES program has been evaluated in a pre-post study in the USA which demonstrated desirable outcomes for increasing MHL among youth. Health education within the Australian curriculum does not wholly include MHL and action, therefore programs such as YES need to be implemented and evaluated to address the mental health needs of youth.Trial number: ACTRN12621000325808 on the Australian New Zealand Clinical Trials Registry. Protocol amendment number: 01.

Evaluating an integrated care pathway for frail elderly patients in Norway using multi-criteria decision analysis

BackgroundTo provide value-based care for patients with multi-morbidity, innovative integrated care programmes and comprehensive evaluations of such programmes are required. In Norway, a new programme called “Holistic Continuity of Patient Care” (HCPC) addresses the issue of multi-morbidity by providing integrated care within learning networks for frail elderly patients who receive municipal home care services or a short-term stay in a nursing home. This study conducts a multi-criteria decision analysis (MCDA) to evaluate whether the HCPC programme performs better on a large set of outcomes corresponding to the ‘triple aim’ compared to usual care.MethodsProspective longitudinal survey data were collected at baseline and follow-up after 6-months. The assessment of HCPC was implemented by a novel MCDA framework. The relative weights of importance of the outcomes used in the MCDA were obtained from a discrete choice experiment among five different groups of stakeholders. The performance score was estimated using a quasi-experimental design and linear mixed methods. Performance scores were standardized and multiplied by their weights of importance to obtain the overall MCDA value by stakeholder group.ResultsAt baseline in the HCPC and usual care groups, respectively, 120 and 89 patients responded, of whom 87 and 41 responded at follow-up. The average age at baseline was 80.0 years for HCPC and 83.6 for usual care. Matching reduced the standardized differences between the groups for patient background characteristics and outcome variables. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders. The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological well-being, and social relationships and participation. Results were consistent with sensitivity analyses using Monte Carlo simulation.ConclusionFrail elderly with multi-morbidity represent complex health problems at large costs for society in terms of health- and social care. This study is a novel contribution to assessing and understanding HCPC programme performance respecting the multi-dimensionality of desired outcomes. Integrated care programmes like HCPC may improve well-being of patients, be cost-saving, and contribute to the pursuit of evidence based gradual reforms in the care of frail elderly.