Higher Enrollment Rates Research Articles

Factors associated with participation and completion of a survey-based study

PurposeThe Healthy Work Place (HWP) study investigated methods to improve clinicians’ dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice.Design/methodology/approachIn total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed.FindingsIn total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418).Social implicationsMore providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout.Originality/valueThere is limited research on clinicians’ workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.

Residential segregation and educational attainment of children from regional migrant families in China

AbstractThis paper studies the residential segregation effects on educational attainment of children from regional migrant families in China. We find that if migrant families live in segregated communities with fewer local residents, the school dropout rate of the children living with their parents in the host cities is higher and their high school enrollment rate is lower. We employ a unique set of nationwide survey data of regional migrants in China in 2012 and 2013 that comprises more than 150,000 individuals in each year. We first use the ratio of migrants over the total population residing in a community to measure segregation. When the ratio increases by 10%, the school dropout rate of migrant children increases by 4.7% from the mean value. Secondly, we identify segregation from the housing type of the migrant family. When they reside in the dorms provided by their employers or in the workplace, they will also be surrounded by many migrant colleagues. We find that living in such places increases the “not‐going‐to‐high‐school rate” of migrant children by 35% from the mean value. Our subsample analysis indicates that the segregation effects only exist in the samples of male migrant children and rural hukou families.

A pilot investigation of the effect of electronic cigarettes on smoking behavior among opioid-dependent smokers

IntroductionCompared to the general population, smoking rates are 2–4 times higher among individuals with opioid use disorders (OUDs). These smokers also have poor long-term cessation rates, even with pharmacotherapy or other interventions. Low success rates with traditional approaches may prompt smokers with OUDs to try more novel products like electronic cigarettes (ECIGs). This pilot study was designed to examine the feasibility, acceptability, and effect of ECIGs on smoking behavior among smokers with OUD. MethodsParticipants (N = 25) were daily smokers receiving buprenorphine/naloxone for OUD at an outpatient clinic. They were randomized to use a second-generation ECIG (0 or 18 ng/ml nicotine) ad libitum for two weeks while completing assessments via text messaging daily, and also via in-person visits at baseline, end of the two-week intervention, and a 4-week follow-up. ResultsFeasibility was evidenced by high enrollment (93.9%) and retention (70.9%) rates. ECIG adherence was relatively high as measured by self-report (80.6% active, 91.7% placebo), while the average volume of liquid used per week was low (~3 ml). Both ECIG doses produced reductions in self-reported cigarettes per day that were not supported by average carbon monoxide levels. Biologically-confirmed smoking abstinence was observed in 8% of participants. ConclusionsPreliminary results suggest that smokers with OUD are interested in using ECIGs, but their adherence may be less than ideal. Poor medication adherence rates are often observed in this disparate population, and future work should consider the use of other ECIG device types and a combination of methods to verify and quantify ECIG use.

Policy constructions, immigrants’ social rights and gender: The case of Swedish childcare policies

This article explores how policy constructions shape policy outcomes for immigrant women and men, focusing on two Swedish childcare policies: (1) parental leave and (2) childcare services. It sheds light on the dynamics between policy constructions and (1) the gender differentiation in immigrants’ social entitlements, (2) the gender differentiation in social entitlements of the Swedish-born population and (3) differences and similarities between the two. Among the major findings is that the universal construction of childcare services and parental insurance promotes parity in immigrant and Swedish-born parents’ utilization. Immigrant families have high enrolment rates in childcare programmes and their rates approach or equal those of non-immigrant families. In the case of parental benefits, over 40 percent of immigrant mothers would be ineligible without the universal construction, and a huge immigrant/ethnic divide in entitlement would exist. Second, a gender differentiation characterizes the claiming of parental benefits, and the differentiation is sharper for immigrant parents. Third, the ethnicity benefit differential is much wider for mothers’ parental leave benefits than for fathers’ benefits. Fourth, despite universal policy constructions, immigrants’ weaker attachment to the labour market affects their social rights, and the effect is greater for immigrant women.

Predicting enrollment in two randomized controlled trials of nonpharmacologic interventions for youth with primary mood disorders

BackgroundAs recruitment and retention are often challenging in randomized controlled trials (RCTs), this study sought to identify predictors of participation (i.e., trial enrollment). MethodThese analyses identified predictors of enrollment among 119 youth, ages 7–14, with a primary mood disorder, who screened eligible for the Omega-3 and Therapy pilot studies; 95 (79.8%) actually participated in the treatment. ResultsYouth who received some form of travel assistance (16.0%) almost uniformly enrolled in the treatment portion of the RCT. Youth who lived further away from the study site (p = .047) or whose primary caregiver never married (p = .01) were less likely to enroll. Of note, socioeconomic status (SES) variables (parent education and child insurance status) did not significantly predict enrollment, suggesting that study incentives or accommodations may have adequately addressed barriers commonly associated with SES. LimitationsDue to the fairly high trial enrollment rate (approximately 80%), there likely was limited power to detect some differences between groups. Generalizability may be limited to youth with a primary mood disorder diagnosis. ConclusionsDespite retaining a large proportion of the youth who screened eligible, participant self-selection is a limitation of any RCT. A silent inclusion criterion of any RCT is willingness to be randomized.

Enrolling Underserved Women in mHealth Programs: Results From Text4baby Outreach Campaigns.

Public health practitioners have increasingly leveraged technology-based communication to get health information into the hands of hard-to-reach populations; however, best practices for outreach and enrollment into mobile health (mHealth) programs are lacking. This article describes enrollment results from campaigns focused on enrolling underserved pregnant women and mothers in Text4baby-a free, mHealth service-to inform outreach strategies for mHealth programs. Text4baby participants receive health and safety information, interactive surveys, alerts, and appointment reminders through at least three weekly texts and a free app-timed to users' due date or babies' birth date. Text4baby worked with partners to implement national, state, and community-based enrollment campaigns. Descriptive statistics were used to compare baseline enrollment prior to a campaign with enrollment during a campaign to generate enrollment estimates. Enrollment rates were calculated for campaigns for which the number targeted/reached was available. National television campaigns resulted in more than 10,000 estimated enrollments. Campaigns that were integrated with an existing program and text-based recruitment had the highest enrollment rates, ranging from 7% to 24%. Facebook advertisements and traditional media targeting providers and consumers were least effective. mHealth programs should consider text-based recruitment and outreach via existing programs; additional research is needed on return on investment for different outreach strategies and on the effectiveness of different outreach strategies at reaching and enrolling specific target populations.

Feasibility of a sexual health program for women receiving pelvic radiation therapy for gynecologic and lower GI cancers.

135 Background: Long term effects of pelvic radiation for women include vaginal stenosis, leading to distress regarding sexual function. The NCCN guidelines recommend asking patients about sexual function at frequent intervals. NCCN recommends the use of vaginal dilators for women who have had pelvic radiation. Vaginal dilators have been widely recommended to minimize these long term effects. However, current evidence demonstrates poor adherence (less than 50%) of vaginal dilator use. Methods: A sexual health clinic was implemented at the radiation oncology department of a large academic medical center. This initiative consisted of three visits with a nurse practitioner over a twelve week period. The first visit was completed prior to the start of radiation, consisted of sexual history, completion of the PROMIS sexual health survey, and education regarding vaginal stenosis. The importance of the use of vaginal dilators following the completion of radiation was emphasized.. The second visit occurred at the completion of radiation and consisted of the PROMIS sexual health survey, and reinforcement of the use of vaginal dilators. Patients were instructed to begin use of vaginal dilators two weeks later. Each patient was given a set of four vaginal dilators, and a vaginal dilator diary. The third visit was completed six to eight weeks post treatment and consisted of completion of the PROMIS sexual health survey, review of the vaginal dilator diary, discussion of patient progress, and reinforcement of education. Results: From August 2016 to September 2017, 38 patients were approached and all completed the first visit (100%). Twenty-three patients completed the second visit (61%). Thirteen patients have completed all three visits (35%). At the end of three visits 11 (85%) of 13 patients were using vaginal dilators, and three had become sexually active. Conclusions: This program demonstrates a high enrollment and completion rate, as well as an important survivorship issue for women undergoing pelvic radiation. The reinforcement of long term effects of radiation enabled patients to understand the importance of using vaginal dilators in to maintain vaginal health and maintain sexual function.

The Impact of Low-Skill Refugees on Youth Education

This paper examines the impact of Syrian refugees on high school enrollment rates of native youth in Turkey. Syrian refugees are, on average, less skilled and more willing to work in low-pay informal jobs than Turkish natives. Refugees can influence native youth’s school enrollment likelihood negatively through educational ex- perience. But, at the same time, they can affect enrollment rates positively as they escalate competition for jobs with low-skill requirements. Using micro data from 2006 to 2016 and employing quasi-experimental methods, I find that high- school enrollment rates increased 2.7-3.6 percentage points among native youth in refugee- receiving regions. Furthermore, a one-percentage point increase in the refugee-to-population ratio in a region generates around 0.4 percentage point increase in native’s high school enrollment rates. Most of the increase in high school enrollment comes from young males with lower parental backgrounds, which is consistent with the hypothesis that the main mechanism operates through the low-skill labor market. The regressions control for (i) variables proxying parental investment in human capital such as parental education, being in an intact family, and household size, (ii) regional economic activity, and (iii) regional availability of high schools and high school teachers.

Application of Confidence Intervals for Parameters of Nonparametric Spline Truncated Regression on Index Development Gender in East Java

The Gender Development Index (GDI) is an index that measures the achievement of human basic capability development for the health, education and economic sectors within a region by considering equality between men and women. In this research GDI with the factors that are suspected to affect it will be modeled using nonparametric spline truncated regression, because the results of scatterplot pattern of GDI with some predictor variables not to follow a certain pattern. Determination of predictor variables that significantly influence GDI by using confidence interval obtained high school enrollment rate of female population, morbidity of female population, percentage of last aid of birth by medical, and female labor-force participation rate have significantly influenced to GDI in East Java.

Social Security Disability Insurance Enrollment and Health Care Employment.

To examine the relationship between Social Security Disability Insurance (SSDI) enrollment and health care employment. State-year level data from government and other publicly available sources for all states (2000-2014). Population-weighted linear regression analyses model associations between each health care employment measure and each SSDI enrollment measure (i.e., SSDI overall, physical, or mental health enrollment rates), controlling for factors associated with health care employment, state fixed effects, and secular time trends. Data are gathered from publicly available sources. A one standard deviation increase in SSDI enrollment per 100,000 population is associated with a statistically significant 2.6 and 4.5 percent increase in the mean employment rate per 100,000 population for health care practitioner and technical occupations and health care support occupations, respectively. The size of this relationship varies by the type of disabling condition for SSDI enrollment (physical versus mental health). Social Security Disability Insurance enrollment is significantly associated with health care employment at the state level. Quantifying the magnitude of this relationship is important given high SSDI enrollment rates as well as evolving policy and demographic shifts related to the SSDI program.

“Road to School: Primary School Participation in Korea, 1911–1960”

This article situates South Korea’s economic success in the latter part of the 20th Century within the framework of the emergence of universal primary education. In particular, it examines the history of primary school enrollment in Korea from the onset of Japanese colonial rule in 1910 until the emergence of universal primary school education in the early 1960s. A high enrollment rate was unusual for countries that had an annual income similar to South Korea, which was about one hundred u.s. dollars per person in 1960. Although income was a factor in shaping the access of Koreans to primary education, especially in the colonial era, the authors conclude that it was only one and not the most important factor that determined this process. Other important issues that the article assesses are the Japanese colonial legacy, children’s access to schools, Korea’s Confucian legacy, industrialization, and land reform. Of these factors, the authors argue, the colonial legacy had a mixed impact on access to primary schools, while land reform played a significant role in influencing the movement toward universal primary education in the Republic of Korea.

A Qualitative Study of Participation in Cardiac Rehabilitation Programs in an Integrated Health Care System.

Despite strong incentives to use cardiac rehabilitation (CR), patient participation is low in the Veterans Health Administration (VHA). This is paradoxical given that VHA is an integrated health care system that offers a range of CR programs which should logically reduce barriers to access to CR participation. The purpose of this study was to better understand the contextual factors that influence patient participation in CR and how patients consider factors together when making decisions about CR participation. Using a qualitative study design we examined patient and provider perceptions of CR across six VHA medical centers with high- and low-enrollment rates between December 2014 and October 2015. We conducted semistructured interviews with CR eligible patients who had both enrolled and not enrolled in CR (n = 16), cardiology providers who could refer patients to CR and CR staff who provided CR services (n = 15). Data were analyzed using grounded thematic techniques. We identified program and patient-specific factors related to CR participation. The four program factors were: program responsiveness to patient needs, CR schedule, specialized CR program equipment, and the CR program social environment. Program factors were primarily discussed by individuals associated with sites that had high CR enrollment rates. The patient-specific factor that promoted participation was patient perceptions of CR benefits. Disincentives to participation included competing conditions or obligations, logistical/cost challenges, convenience, and fear of exercise. CR participation entailed a complex process in which patients balanced factors that reinforced patient perceptions that CR was beneficial against factors that acted as disincentives to participation. CR participation was influenced by both program and patient factors. Patients weighed factors that fostered perceptions that CR was beneficial against factors that served as disincentives to CR participation when considering CR participation. High-enrollment sites may be better at countering disincentives to participate and/or improve patient perceptions of CR. Actionable ways to improve CR participation include encouraging providers to strongly and frequently endorse CR, educating patients about the importance and benefits of CR, emphasizing how exercises are individualized, supervised and monitored, educating patients about how CR is safe and effective, how CR offers peer support, and structuring CR programs to be responsive to patient needs in terms of duration, frequency, schedule, and location.

Factors Associated With Time to Site Activation, Randomization, and Enrollment Performance in a Stroke Prevention Trial

Multicenter clinical trials attempt to select sites that can move rapidly to randomization and enroll sufficient numbers of patients. However, there are few assessments of the success of site selection. In the CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials), we assess factors associated with the time between site selection and authorization to randomize, the time between authorization to randomize and the first randomization, and the average number of randomizations per site per month. Potential factors included characteristics of the site, specialty of the principal investigator, and site type. For 147 sites, the median time between site selection to authorization to randomize was 9.9 months (interquartile range, 7.7, 12.4), and factors associated with early site activation were not identified. The median time between authorization to randomize and a randomization was 4.6 months (interquartile range, 2.6, 10.5). Sites with authorization to randomize in only the carotid endarterectomy study were slower to randomize, and other factors examined were not significantly associated with time-to-randomization. The recruitment rate was 0.26 (95% confidence interval, 0.23-0.28) patients per site per month. By univariate analysis, factors associated with faster recruitment were authorization to randomize in both trials, principal investigator specialties of interventional radiology and cardiology, pre-trial reported performance >50 carotid angioplasty and stenting procedures per year, status in the top half of recruitment in the CREST trial, and classification as a private health facility. Participation in StrokeNet was associated with slower recruitment as compared with the non-StrokeNet sites. Overall, selection of sites with high enrollment rates will likely require customization to align the sites selected to the factor under study in the trial. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02089217.

Pathways to Education: An Integrated Approach to Helping At-Risk High School Students

Pathways to Education is a comprehensive youth support program developed to improve academic outcomes among those entering high school from very poor social-economic backgrounds. The program includes proactive mentoring to each student, daily tutoring, group activities, career counseling, and college transition assistance, combined with immediate and long-term incentives to reinforce a minimum degree of mandatory participation. The program began in 2001 for entering Grade 9 students living in Regent Park, the largest public housing project in Toronto, and expanded in 2007 to include two additional Toronto projects. In all three locations, participation rates quickly rose, to more than 85 percent, even though parents and students were required to commit in writing to conditions and high expectations of the program. Comparing students from other housing projects before and after the introduction of the program, high school graduation and post secondary enrollment rates rose dramatically for Pathways eligible students, in some cases by more than 50 percent.

The Feasibility of Using Facebook, Craigslist, and Other Online Strategies to Recruit Young African American Women for a Web-Based Healthy Lifestyle Behavior Change Intervention.

Reports describing successful recruiting of minority participants are available; however, they focus largely on traditional strategies. Internet and mobile devices are widely used, providing alternative approaches, yet less information is available describing the success of these approaches. This article (1) evaluates the feasibility of using online advertising as a recruiting modality for a healthy lifestyle behavior change intervention targeting young African American women and (2) describes lessons learned to better inform researchers for future directions. African American women, aged 18 to 45 years, with untreated prehypertension and Internet access were eligible for a 12-week randomized study providing physical activity or nutrition behavior change education delivered via online modules. Traditional strategies included flyers, tabletop cards, blood pressure screenings, health fairs, and clinics. Online-related strategies included posting ads on Facebook, Craigslist, and on the university Web site, intranet, and "on-hold" telephone line. Descriptive statistics were used to identify frequency of recruitment strategies. χ Analysis was used to assess differences between enrolled and nonenrolled inquiries. Among all 176 inquiries, the most frequented strategies were the university Web site (44%), blood pressure screenings (15%), Facebook/Craigslist (13%), and clinics (12%). Enrollment rates differed across recruitment strategies (χ P = .046). The 3 highest enrollment rates were (1) employee in-services (100%), (2) flyers/tabletop cards (31.6%), and (3) word of mouth/physician referral (25%). Online-related strategies are convenient and have great potential for reaching large numbers of people. However, the actual rate of participants successfully enrolled online was proportionally smaller when compared with traditional recruiting strategies.

Trends in Texas high school student enrollment in mathematics, science, and CTE-STEM courses

BackgroundIn the context of Texas of the USA, House Bill 5 signifies a major policy shift requiring entering high school students starting in fall 2014 to choose an endorsement, like science, technology, engineering, and mathematics (STEM) being one of them, to provide students with earlier exposure to a coherent course sequence. As we barely understand students’ choices before the endorsement requirement, this study explored 6 years of data (2008–2013) on high school student enrollment rates in mathematics, science, and career and technical education (CTE)-STEM courses to set out the baseline of the trends in STEM course enrollment in Texas.ResultsThe enrollment rates of the STEM-related courses had wide variations by types of courses, gender, and race/ethnicity. Overall, student enrollment rates increased across time in selective and advanced mathematics, science, and CTE-STEM courses, which indicates a promising prospect for the STEM pipeline. However, there were exceptions in several courses with gender and racial/ethnic differences in the trends. Gender disparity was greater in advanced science courses than advanced mathematics courses, and collectively, gender gap in CTE-STEM courses increased greater than advanced mathematics and advanced science courses across years. While racial/ethnic differences were constant across years in both advanced mathematics and advanced science courses, the differences were rising in CTE-STEM courses in recent years.ConclusionsAs little is known about students’ preferences in course-taking in STEM courses at the state level, the findings on the trends in students’ STEM course-taking, disaggregated by gender and race/ethnicity, can provide needed insights on what institutional K-12 changes would be effective for impacting the STEM pipeline.

What Do Enrolment Data Say About Education, Using Bourdieu's Approach?

What role can education play in achieving social transformations? What role has it played over the years? This paper examines one element of this, by looking at enrolment in tertiary education. It is argued that enrolment data help to understand the function of education in elite (re)production, when used with the framework of Bourdieu. The paper is divided into four sections. In the first part, Bourdieu’s theoretical framework is briefly outlined. This will explain the importance of looking at enrolment data for explaining the different functions of tertiary education in different countries and at different points in time. The second section compares the evolution over time of enrolment in Europe and in Sub-Saharan Africa and will zoom in on three African countries as well as three European countries: one country that has low enrolment rates, one with high enrolment rates and a third country with enrolment rates near the average. The paper attempts to illustrate what knowledge of this data means for an understanding of the evolution of the function of education in these countries. This will illustrate the thesis that no discussion on education in Africa is complete without a discussion of the sociological parameters within which such education is provided. The third section looks at one issue that is related to the changing function of tertiary education in society, namely the issue of the medium of instruction. The concluding section outlines some of the challenges for tertiary education in Africa, notably in the language area.

The incidence of the tuition-free high school program in Japan

ABSTRACTThis paper examines the effect of a tuition-free high school program launched in FY2010 in Japan on the high school enrollment rate and household spending. We have some interesting findings. First, the program contributed to improvement in the high school enrollment rate for poorer households. Second, the program stimulated household spending significantly for poorer households relative to richer households. Third, the program altered the composition of household expenditure significantly for richer households with a surge in spending shares in non-tuition education, clothing, and recreational goods.

Pragmatic trial of a Study Navigator Model (NAU) vs. Ambassador Model (N+) to increase enrollment to health research among community members who use illicit drugs

BackgroundAlthough drug use is common in the population, drug users are sometimes excluded from research without justification. Two models of individualized study matching were compared for effectiveness in enrolling people who “endorsed current drug use” and those who “did not” into appropriate research. MethodsParticipants in the NIDA-funded Transformative Approach to Reduce Research Disparities Towards Drug Users study (Navigation Study) were recruited through a Clinical and Translational Science Award (CTSA) community engagement model. Of the 614 community-recruited adults, 326 endorsed current drug use (cases); 288 did not (controls). Participants were randomized to one of two intervention groups: Navigation as Usual (NAU) [individualized study matching through a Study Navigator] or Enhanced Navigation (N+) [individualized study matching plus transportation and other assistance through an Ambassador]. Rates of enrollment into research studies were compared. ResultsAt 90 days, N+ vs. the NAU intervention was associated with higher enrollment among both drug users (36.0% N+ vs. 24.9% NAU) and non-drug users (45.5% N+ vs. 25.2% NAU). NAU attained the same rate of enrollment for users of drugs (24.9%) and non-users (25.2%); N+ had similar rates as well (36.0% drug users vs. 45.5% non-drug users). In addition, high rates of enrollment were achieved among all groups of participants, from 24.9% (drug users in NAU) to 45.5% (non-drug users in N+). ConclusionsBoth the NAU and N+ methods can reduce barriers and help users and non-users become part of the population that participates in research. Working with the local CTSA adds significant value to the research enterprise.

A brief family intervention for depression in primary care

AbstractThis study tested the feasibility and outcomes of a brief psychoeducational intervention for family members of depressed veterans in primary care. Family members of veterans enrolled in TIDES, a VA collaborative care programme for depression in primary care, were invited to participate. High enrolment rates, high treatment retention and completion, and high levels of satisfaction with the intervention indicate that the programme is feasible and acceptable to family members. Veterans showed a decrease in depression severity, improvements in symptom and occupational global functioning, and an increase in general life satisfaction. Family members' attitudes about antidepressant medication use became more positive, and their knowledge of depression increased. There were no changes in behavioural activation or in family functioning. Overall, family members and clinical staff rated the intervention very positively. Staff members did note some obstacles to implementation and made suggestions to overcome identified obstacles.Practitioner points The use of Motivational Interviewing was an important contributor to generating interest in the family programme Family members involved in depression treatment evidence gains in positive attitudes towards medication use and an increased knowledge of depression Systematic training and ongoing contact with clinicians are key factors in improving their confidence and skills in working with families and increasing their commitment to implementing the intervention