Improve Participation Rates Research Articles

57. The power of power: Comparative evaluations of medical residency training across teaching sites and programs at the University of Torontos

To meet accountability and accreditation requirements, teaching partners and the faculty postgraduate office required more robust and integrated feedback on teaching and assessment. The web-based evaluation system known as POstgraduate Web Evaluation and Registration (POWER) was implemented in 2004/05 by most residency training programs, using their existing forms and scoring scales. At start up, over 250 different evaluation forms and 85 varying scoring scales were in operation across programs for the In-Training Evaluation Reports (ITERs) and resident-completed evaluations for Rotation Evaluation Scores (RES) and Teaching Effectiveness Scores (TES). 
 The POWER Evaluation Working Group was formed to develop a methodology to gather and consolidate evaluations to report on medical residents, their teachers, and rotations in a clear, consistent user-friendly format, map general questions against CanMEDS roles and Family Medicine principles, and convert all scoring scales to a consistent 5 point Likert scale. A standardized naming protocol was developed to map rotation services to individual teaching sites.
 The 2004/05 analysis of these evaluations (2004/05 Annual POWER Report: Lessons Learned) provide baseline data to begin monitoring trends in resident and faculty performance, assess the quality of programs and identify areas for improvement by CanMEDS standards and CFPC principles. Mean scores, standard deviations and number of evaluations were presented by teaching site and program.
 Consolidation of evaluations by program and teaching site provides valuable feedback to hospitals and programs wishing to standardize and improve their assessment systems, and to postgraduate medical offices who must maintain evaluation standards and illustrate trends for accreditation purposes. Future activities include: standardizing evaluation forms starting July 2007, improving scoring consistency and accuracy, improve participation rates and timeliness of responses, develop a procedure/case log tracking system, and trend analysis.
 Afrin LB, Arana GW, Medio FJ, Ybarra AF, Clarke HS Jr. Improving oversight of the graduate medical education enterprise: one institution’s strategies and tools. Academic Medicine 2006 (May); 81(5):419-25.
 Benjamin S, Robbins LI, Kung S. Online Sources for assessment and evaluation. Academic Psychiatry 2006 (Nov-Dec); 30(6):498-504.
 Rosenberg ME, Watson K, Paul J Miller W, Harris I, Valdivia TD. Development and Implementation of a web-based evaluation system for an internal medicine residency program. Academic Medicine 2001 (Jan); 76(1):92-5.

Assessing participation bias in a population‐based study of measles‐mumps‐rubella vaccine immunity in children and adolescents aged 12–18

The purpose of our study was to determine whether specific characteristics were associated with study participation in a group of children residing in Olmsted County, MN. We compared 346 participants and 848 non-participants from a study examining associations between human leukocyte antigen gene variants and immunity following measles-mumps-rubella (MMR) vaccination by demographic characteristics, MMR vaccination history and length of time in the Olmsted County health care system. We also compared the frequency and reasons for health care visits between participants and non-participants by comparing diagnostic codes for all visits that had occurred between 1999 and 2001. Characteristics were compared using chi-square and t-tests, followed by multivariable logistic regression. Study participants were more likely to be white/Caucasian, to have received their first MMR vaccination at a younger age, and to have had more health care visits (especially for acute respiratory illnesses, vaccinations, or other acute conditions such as fainting and headaches) than study non-participants. These results suggest that frequent use of local health care systems by children and parents may increase comfort levels with local physicians and physician researchers, thereby improving participation rates in research studies among these populations. However, special efforts may be necessary to improve research participation among children who are infrequent users of the health care systems of interest.

When "no" might not quite mean "no"; the importance of informed and meaningful non-consent: results from a survey of individuals refusing participation in a health-related research project

BackgroundLow participation rates can lead to sampling bias, delays in completion and increased costs. Strategies to improve participation rates should address reasons for non-participation. However, most empirical research has focused on participants' motives rather than the reasons why non-participants refuse to take part. In this study we investigated the reasons why older people choose not to participate in a research project.MethodsFollow-up study of people living in Tayside, Scotland who had opted-out of a cross-sectional survey on activities in retirement. Eight hundred and eighty seven people aged 65–84 years were invited to take part in a home-based cross-sectional survey. Of these, 471 refused to take part. Permission was obtained to follow-up 417 of the refusers. Demographic characteristics of people who refused to take part and the reasons they gave for not taking part were collected.Results54% of those invited to take part in the original cross-sectional survey refused to do so. However, 61% of these individuals went on to participate in the follow-up study and provided reasons for their original refusal. For the vast majority of people initial non-participation did not reflect an objection to participating in research in principle but frequently stemmed from barriers or misunderstandings about the nature or process of the project itself. Only 28% indicated that they were "not interested in research". The meaningfulness of expressions of non-consent may therefore be called into question. Hierarchical log-linear modelling showed that refusal was independently influenced by age, gender and social class. However, this response pattern was different for the follow-up study in which reasons for non-participation in the first survey were sought. This difference in pattern and response rates supports the likely importance of recruitment issues that are research and context specific.ConclusionAn expression of non-consent does not necessarily mean that a fully informed evaluation of the pros and cons of participation and non-participation has taken place. The meaningfulness of expressions of non-consent may therefore be a cause for concern and should be subject to further research. Many reasons for non-participation may be specific to a particular research topic or population. Information sheets should reflect this by going beyond standardised guidelines for their design and instead proactively seek out and address areas of concern or potential misunderstanding. The use of established behavioural theory in their design could also be considered.

Factors That Influence Physical Activity Participation Among High- and Low-SES Youth

Researchers have rarely addressed the relationship between socioeconomic status (SES) and physical activity from the perspective of youth. To illuminate the factors that youth from low and high-SES areas consider important to increase physical activity participation among their peers, 160 youth (12-18 years) participated in small focus group interviews. Guiding questions centered on the general theme, "If you were the one in charge of increasing the physical activity levels of kids your age, what would you do?" Findings show that environmental factors (i.e., proximity, cost, facilities, and safety) are very important for youth living in low-SES areas to ensure participation in physical activity. Results also show that intrapersonal (i.e., perceived skill, competence, time) and social factors (i.e., friends, adult support) must be considered to help improve participation rates among both high- and low-SES youth.

Stigma and other determinants of participation in TANF and Medicaid.

We developed a conceptual framework to examine the association between stigma, enrollment barriers (e.g., difficult application), knowledge, state policy, and participation in the Temporary Assistance to Needy Families (TANF) and adult Medicaid programs. Survey data from 901 community health center patients, who were potential and actual participants in these programs, indicated that while images of the Medicaid program and its recipients were generally positive, stigma associated with welfare stereotypes reduced both TANF and Medicaid enrollment. Expectations of poor treatment when applying for Medicaid, enrollment barriers, and misinformation about program rules were also associated with reduced Medicaid enrollment. States that enacted strict welfare reform policies were potentially decreasing TANF participation, while states with more simplified and generous programs were potentially increasing Medicaid participation. The results suggest that the image of the adult Medicaid program remains tied to perceptions about welfare and provides guidance to policymakers about how to improve participation rates.

An investigation of the relation between religion and exercise motivation.

The present study sought to investigate whether traditional secular or faith-based program factors were more responsible for motivating women (N = 220, M age = 44.6 yr.) to participate in Christian exercise programs. Based on the results of a pilot study, the Christian Exercise Program Questionnaire was developed and mailed to the study participants. The internal reliability of the questionnaire was excellent as indicated by Cronbach coefficient alpha. As expected, those aspects of the exercise program that were faith-based, e.g., modest clothing, noncompetitive, and worshipful atmosphere. were considered more important than traditional secular factors, e.g., personal trainers and childcare, in the decision to enroll in the program (t219 = 9.23, p < .001). The findings suggest exercise programs that incorporate faith-based practices may appeal to a segment of the population and provide an alternative strategy for improving participation rates in physical activity.

Cardiac rehabilitation with nurse care management and telephonic interactions at a community hospital: program evaluation of participation and lipid outcomes.

Cardiac rehabilitation (CR) can help patients with heart disease control some risk factors, limit new coronary artery lesions, and decrease death rates. However, participation rates in CR are low. Using a descriptive design, we evaluated a modified CR program in which nurse care managers used telephonic communication with patients in their homes by comparing it to a traditional CR program in a hospital setting. Using multivariate analysis we compared the patient cohorts eligible for each of the programs, and program participants to the nonparticipants for each program. Compared to traditional CR, the modified CR program with nurse care management was associated with significantly improved participation rates (11% vs. 22%) and the apparent overcoming of several well-described barriers to CR participation (distance from the hospital and domestic isolation). Risk factor management, including testing of serum lipids and achieving goals for lipid reduction, for participants in both CR programs was superior to risk factor management for nonparticipants.

Participation behavior of bladder cancer survivors in a medical follow-up survey on quality of life in France.

The objectives were to ascertain the sociodemographic background of bladder cancer survivors acting on their participation behavior to a medical follow-up survey. This population-based quality of life (QOL) survey was realized by mail with 201 survivors (M:F = 171:30, median age = 74 years, range 33-99) randomly selected from the 1731 patients diagnosed between 1990 and 1994 in two regions of France. Response rate was 47.3%. Female and younger survivors were more receptive to the survey than were males and older survivors. Furthermore, survivors who had experienced a cystectomy were more responsive than those who did not. Similarly, the length of time since a major treatment was significant, with a shorter interval associated with a better response. The missing item rate in the QOL questionnaire was 13.8%. Other variables were not significantly associated with acceptance of the survey. Missing items among the responders were found more often in the sub-scale of social/familial well-being (15.6%). The older and male subjects left more questions blank. The reason for this low response rate can be categorized to the following three points: (1) Physically and psychologically not motivated to answer, (2) sensitive and private content of the question, and (3) methodological problem. Clearer concepts of the research would have helped the participants understand the objectives and better relate to the survey. Subsequently, these three issues should be given more attention in organizing questionnaire survey for improved participation rates in future studies.

Relationship between ongoing participation in colorectal cancer screening and method of invitation

Background: As fecal occult blood tests (FOBTs) do riot reliably detect all cancers, methods of increasing the rates of p~.rticipation in repeated screening must be developed in order to maximise the reduction in mortality. Endorsement by primary care practitioner (PCP) improves participation at initial offer (Cole et al, j Meal Screening, 2002 in press), but it is not known if it maintains a higher rate of ongoing participation. Aim: To determine the effect of PCP endorsement on participation rates over three rounds of annual screening based on a fecal immunocbemieal test (FIT) for hemoglobin. Setting: Invatees aged 50-69 years were randomly selected from the patient lists of two urban Adelaide primary care practices Methods: A FIT was offered by mail to 872 invttees in the first round, and subsequently to all who met inclusion criteria, regardless of prior participation status Exclusions: not contactable at address, colonoscopy for any reason in prior five years. Mode of offer varied, from no endorsement or naming of PCP (Endorsed-) to high level endorsement in an invitation letter signed by the PCP (Endorse/+) Subject participation, test positivaty and neoplastic yield were observed across all three screening rounds. Results: Participation at any time throughout the program was signffieantly enhanced by PCP endorsement (see Table). PCP endorsement also maintained the increased rate of participation over the three rounds. Drop-outs (22 % of initial participants in Endorse/and 17% in Endorse/+ in Round 2) were counterbalanced by new participants entering the program, such that overall participation rates did not fall in subsequent rounds. Overall, 4% (38/952) of tests were positive Significant neoplasms (3 with cancers and 8 with adenomas) were found in all rounds, including in subjects who previously returned negative tests. Conclusions: PCP endorsement maintained improved participation rates across three rounds of screening. Screening programs based on FOBI will be most effecuve in reducing mortality when PCPs are involved in repeated offers. This principle might also apply to screening programs based on other methods.

AN INVESTIGATION OF THE RELATION BETWEEN RELIGION AND EXERCISE MOTIVATION

The present study sought to investigate whether traditional secular or faith-based program factors were more responsible for motivating women (N = 220, M age = 44.6 yr.) to participate in Christian exercise programs. Based on the results of a pilot study, the Christian Exercise Program Questionnaire was developed and mailed to the study participants. The internal reliability of the questionnaire was excellent as indicated by Cronbach coefficient alpha. As expected, those aspects of the exercise program that were faith-based, e.g., modest clothing, noncompetitive, and worshipful atmosphere, were considered more important than traditional secular factors, e.g., personal trainers and childcare, in the decision to enroll in the program (t219 = 9.23, p < .001). The findings suggest exercise programs that incorporate faith-based practices may appeal to a segment of the population and provide an alternative strategy for improving participation rates in physical activity.

Methods of the National Check Bus Project

Prevention at the worksite is considered increasingly important. This paper describes the methods used in a nationwide prevention campaign performed at a large Swiss bank and a Swiss industrial company. The aim of this project was to encourage general health awareness among company employees. We also aimed to provide the companies with general health analyses of their staff as a basis for future health promotion. Furthermore, new screening methods were evaluated in the field of research. Participation in the programme was voluntary and free of charge. The programme targeted all 25,243 employees of the two companies in all regions of Switzerland. A mobile unit was available on site. The programme included a written health questionnaire and medical examinations (e.g., blood pressure, blood tests, ultrasound of the common carotid artery, osteodensitometry, examinations of the eye, etc). Analysis of individual test results, information brochures, and a telephone information service were also provided. Based on the data of the individuals, the "health status" of the employees of the two companies was analysed. The companies did not have access to the data of the individuals. The programme ran from August 1996 to August 1998. With a total of 10,321 persons taking part in the project, the participation rate was 41%. For the different examinations offered, patterns of participation were identifiable that varied with age, hierarchical status within the concern, body mass index, and number of physical complaints of the employee. Some of the variables showed the same trend for different tests, while others showed opposite trends. Participation in worksite health promotion programmes is dependent on a complex system of individual and structural variables that need to be considered when planning worksite health promotion programmes. Consideration of specific target population characteristics, including motivations and incentives as well as structural constraints is likely to improve participation rates in worksite health promotion programmes among employees.

Evaluation of buccal cell collection protocols for genetic susceptibility studies

Buccal cells are increasingly used as a source of quality DNA to improve participation rates in molecular studies. Here, three buccal cell collection protocols were compared to determine factors affecting the yield of cells, total DNA per sample, and DNA yield per cell. In addition, kinetic quantitative polymerase chain reaction (PCR) (TaqMan™) was used to quantify human DNA available for PCR. The method of collection used influenced the overall DNA yield per sample. The collection buffer used influenced the number of cells but not the overall DNA yield per sample. Repeated freezing and thawing did not affect overall DNA yield per sample, DNA yield per cell, or the total number of cells collected. Mouthwashes had the highest DNA yield per sample (20.8 μg) compared with cytobrush samples (1.9 μg from three cytobrushes) and tongue depressors (0.8 μg from three tongue depressors). However, mouthwash samples may contain significant non-human DNA and other contaminants that could interfere with some molecular studies. Spectrometry grossly overestimated the total DNA recovered from mouthwash samples compared with fluorometry or quantitative PCR.

Boy-free zone?

The hypothesis that fewer boys than girls participate in home-to-home exchanges with schools abroad is examined. The results of a survey of 28 secondary schools in 6 LEAs appear to support the hypothesis. Following on from this, possible reasons for the gender difference in participation rates are considered, together with measures which might lead to improved participation rates by boys.

Collaborative partnerships in evaluation and experimental rehabilitation research.

Changes in rehabilitation and clinical practice, the recognition of the role of clients in achieving rehabilitation goals, and client participation in decision-making and administration of service delivery have contributed to the development of new methodologies for research and evaluation. In this paper, the traditional relationship between researchers and subjects in traditional rehabilitation evaluation and research is contrasted with relationships between researchers and clients-consumers in newer methodologies. The limitations and challenges to these models are discussed. Collaborative research, characterized by shared power and non-hierarchical authority between client-consumers and researchers, is described as an alternative model for experimental and evaluative research. Collaborative relationships provide a structure for building upon the knowledge and expertise of each research partner. The authors draw upon their own experience of collaborative research partnerships and models of research partnerships are described. Research developed and conducted in a collaborative partnership can include quantitative and qualitative approaches, maintain traditional scientific perspectives of objectivity, reliability and replicability, and improve participation rates, continuity of involvement for longitudinal studies and utilization of researched methods into practice.

American All-Mail Balloting: A Decade's Experience

Many roots of American public administration are found in political and electoral reform. Its early developments were not based on theory but had their genesis in issue-by-issue situations. Electoral processes were and continue to be legitimate objects of public administration concern, the more especially so because elections and the way they are administered are a base on which representative democracy stands. The recent emphasis on civism in public administration offers an opportunity to reemphasize electoral processes which have integral importance to the political system. With declining percentages of eligible voters casting ballots in American elections it may soon be the case where we give an election and hardly anybody comes. All-mail or optional mail balloting elections offer an opportunity to reverse this deplorable decline. Uniquely among the nations of the world, local governments in the United States have conducted approximately 1,000 all-mail ballot elections in eight states in the past decade.I All-mail ballot elections are becoming routine in seven of the eight, New York being the exception where only one experimental election was held in Rochester. At least one contested election for city council seats has been held, in Gresham, Oregon.2 In round numbers, approximately 80 elections by all-mail balloting have been held in Kansas, 400 in Oregon, 350 in California, 40 in Montana, 12 in Washington, 15 in Missouri, and 6 in Nebraska, the most recent state to adopt enabling legislation. This article does not deal with the technical processes of holding mail-ballot elections. Each state's procedures vary somewhat from the others governing such matters as the number of days prior to the election by which ballots must be delivered, the time during which ballots are returnable, processes for counting the ballots, necessity for local ordinances to supplement state authorization, training for conducting elections including signature verification, ballot receptions, procedures for recounts, batching and data entry, and similar activities involved in election administration. This article concentrates on the three most important benefits from an array of advantages. These include (1) a decrease in overall costs of holding elections; (2) increased voter participation/convenience; and (3) an increase in the integrity of elections as a result of more time for voters to consider issues before casting their ballots. It also facilitates the ability of the elderly, infirm, handicapped, and those temporarily unable to participate on a specific time and date to vote. All-mail balloting is, however, a barrier to voting by those with no fixed address, but in-person voting at polling places rarely deals with that issue either. * This article summarizes the results of nearly 1,000 elections conducted entirely by mail in the United States in the past decade. It focuses on three of the main advantages of this uniquely American method of election administration: (1) markedly improved participation rates and increased convenience for the handicapped and others unable to get to the polls for in-person elections, (2) lower election administration costs per eligible voter or eligible voter voting, (3) increased integrity of the electoral processes. Presently operable in seven states, all-mail balloting has great promise for more truly determining the will of the majority through greater participation in free and fair elections-the bedrock of democracy. As election administrators and legislators become more familiar with the experience, it is reasonable to anticipate greater use of all mail balloting, particularly at the local level. This new way of doing one piece of the public's business is squarely in the tradition of American public administration reforms.