Large-scale Educational Intervention Research Articles

“Infographing” Dementia Prevention: A Co-Design Approach

ABSTRACT Designing effective public health messages is challenging, particularly when communicating complex and relatively new health messages such as dementia risk prevention which are still largely unfamiliar to the public. The accessibility of these messages, especially for individuals who speak English as an additional language, remains uncertain in large scale educational interventions. A key strategy to enhance the communication of evidence-based information is to co-design infographics that optimize the accessibility and impact of visual health messages. This paper reports on the co-design process of infographing dementia prevention messages. Qualitative data were analyzed using reflective thematic analysis to generate three themes reflecting the message design preferences of participants: “all hands on deck,” “charting the course,” and “get on board.” This work supports the crucial need to engage the target audience via co-design when creating visual messages as meaningful and accessible educational tools that will resonate with the intended audience. Doing so may help health communicators navigate the creation of visual messages across diverse health domains and populations.

Knowledge, Attitude, and Intention of Rural Elderly About Influenza Preventive Behaviors, Fasa, Iran, 2019

Background & Aims: Influenza is one of the leading causes of death in the world, especially in the elderly. This study examined the knowledge, attitudes, and intention of rural elderly about influenza prevention behaviors. Materials and Methods: In this cross-sectional study was performed on 140 rural older people who were selected by multi-stage random sampling in Fasa, Iran. A questionnaire was developed to inform about individuals’ knowledge, attitude, and practice on influenza prevention measures. Data were analyzed using frequency descriptive statistics and the Chisquare test by SPSS-21. Results: A total of 61 men (mean age of 69.32±6.81) and 71 women (mean age of 69.04±7.52) responded to the questionnaire. The mean score of knowledge in women (6.8±2.1) was significantly higher than in men (5.8±2.7). The mean score of knowledge in illiterate people (6.45±2.43) compared to literate people (6.08±2.58) showed no significant differences. In addition, the differences between the mean score of attitudes in both men (5.67±5.67) and women (6.05±29.59) were not significant. Likewise, there were no significant differences between the mean scores of attitudes in the literate (28.74±5.74) and illiterate (29.87±5.89) elderly. The mean scores of intention in men and women were 6.18±1.76 and 6.13±1.53, respectively, which was not significantly different. Finally, the mean scores of intention in literate (5.85±2.14) and illiterate (6.25±1.42) participants were not significantly different. Conclusion: The knowledge, attitude, and intention of rural elderly about influenza prevention behaviors are not satisfactory, and large-scale educational interventions are required in this regard, especially in rural areas.

Randomized control trials in education (RCTs): What is their contribution to education theory about teaching?

Random Controlled Trials (RCTs) have become one of the most sought-after approaches to impact evaluations of large-scale educational interventions in developed and developing countries. In this paper, we examine the contribution of RCT-based evaluations of large-scale early grade interventions to education theory about teaching. After a brief introduction of the development context of RCT-based evaluations, we examine the research model of RCTs in education and some of the knowledge claims made by RCT scholars, with specific attention to their claims about changing modes of teaching. We then introduce, briefly, five multi-pronged interventions to improve early grade reading in three developing countries (India, Kenya, and South Africa). Finally, we discuss two key educational ideas about teaching supported by these early grade interventions and locate them in education theory about teaching. Our argument is that these ideas about teaching are not new; they are debated by education researchers and because RCTs' evaluation research does not provide empirical analysis of these ideas, it cannot be integrated by teacher educators and education researchers into knowledge about teaching and teacher education and development. Teaching is not seen as an empirical object to be theorised by this massive growing research field. If collaboration and dialogue were to emerge between development economists, education researchers, and teacher educators, RCTs' findings of educational interventions could contribute to what is already known in educational theory about teaching.

The Reach and Impact of Birthright Israel: What We Can Learn from Pew’s “Jewish Americans in 2020”

The Pew Research Center’s 2020 survey of American Jews is a valuable resource to scholars of American Jewry, enabling interrogation of questions using data that no other source can reliably provide. One set of questions pertains to the reach and impact of Birthright Israel, the largest extant Jewish educational program targeted at Jewish young adults, on American Jews. Pew’s nationally representative sample provides important validation of previous findings regarding Birthright’s impact on participants and extends the generalizability of what has been learned. In this paper we use data from the 2020 Pew survey to assess the program’s “reach” into different segments of the American Jewish population and to extend the validity of existing findings regarding the program’s impact on participants’ attitudes and behaviors related to Israel and Jewish life. Pew’s data estimate that around 20% of American Jews ages 18–46 have participated in Birthright, and that among Jewish parents with a grown child, nearly 30% have an adult child who participated in the program. After controlling for preexisting differences between participants and those who have never been to Israel, Pew’s data also confirm that Birthright has a significant impact on a broad set of Jewish outcomes. These results support a more optimistic view of the future for US Jewry and suggest that the investment in large-scale educational interventions can substantially alter the trajectory of the American Jewish community writ large.

The Paradox of Empathy and Data: Measuring Outcomes of Empathic Communication Education.

This article addresses the nursing professional development practitioner's role in the design and management of the evaluation process used for a large-scale educational intervention developed to improve patient satisfaction with the use of empathic communication skills. The scope of this educational activity and the direct alignment with organizational priorities necessitated that a robust and comprehensive evaluation strategy be implemented to demonstrate the connection from the education to performance and, ultimately, organization-level results.

Dilemmas of Leadership and Capacity Building in a Research–Practice Partnership

Background Research–practice partnerships (RPPs) are proliferating in education, generating increasing interest and posing many challenges. In this study, we shed light on the challenge of supporting practitioners> leadership and building capacity in an RPP. In the RPP literature, practitioner leadership is often highlighted as both a way to improve design development and enactment and as imperative for capacity building and sustainability. However, cultivating leadership also creates challenges which have not yet been adequately explored. Purpose We explore these challenges and related dilemmas in a large-scale Israeli RPP designed to cultivate teacher leadership and build district capacity. We investigate how local actors asserted their leadership, the resources they drew upon, and the dilemmas this posed for us as researchers in an RPP. We critically reflect on how we addressed these dilemmas, and the consequences and implications of our courses of action. Setting This study explores our partnership with two large Israeli districts, as part of a state-wide professional development reform supported by the Ministry of Education and a philanthropic foundation. The partnership aims to support teachers> collaborative, reflective inquiry on teaching and learning, in weekly in-school meetings facilitated by in-school leading teacher. The partnership began six years ago and currently includes 158 schools (458 leading teachers). Research Design We use linguistic ethnographic methods to analyze leadership assertion in three focal cases, representing three different leadership roles, at different levels of the system: (1) a leading teacher demonstrating creative non-compliance in the team meetings she facilitated, (2) a coach exercising her voice and authority in her professional development workshops, (3) and a district manager independently shaping structures. Data Collection Data were collected during the first three years of the RPP, including (participant) observations, audio-recordings, and field notes of in-school meetings, professional development workshops, interviews, and informal conversations. Findings and Conclusions The analysis shows that leadership assertion played an important role in constructing actors’ identities as competent leaders but posed dilemmas for us, such as how to acknowledge leaders> expertise while also maintaining program integrity. The case studies underscore the difficulties involved in managing a partnership in a large-scale educational intervention and the challenges to maintaining productive dialogue with different partners. The paper advances our understanding of the complexities involved in supporting leadership at different levels of the system, in day-to-day interaction, and at multiple micro and macro contexts in which it unfolds, in particular in a large-scale RPP.

Nursing Education Intervention Effects on Pain Intensity of Nursing Home Residents with Different Levels of Cognitive Impairment: A Cluster-Randomized Controlled Trial.

PurposePain management in nursing homes is challenging and pain prevalence remains high. The objective of this study was to improve the pain situation of nursing home residents following a nursing-related educational intervention within a cluster-randomized controlled trial (2016–2018).ParticipantsClusters were nursing homes from one nursing home operator in Bavaria, Germany. Nursing home residents who were permanently registered in the facilities, at least 60 years of age, and who themselves or their legal guardians provided informed consent were included.InterventionIn addition to the implementation of pain nurses and pain care assistants, staff of the intervention group received an educational intervention in pain management, containing classroom (quality circles) and web-based training for nurses.MethodsBased on the Mini-Mental State Examination (MMSE), residents were either interviewed (MMSE 10–30) using self-report instruments or observed (MMSE 0–9) by proxy assessment. The primary outcome in residents able to self-report was maximum pain intensity according to Brief Pain Inventory (BPI); in those not able to self-report treatment-relevant pain above cut-off (≥2) on the Pain Assessment in Advanced Dementia (PAINAD).ResultsOut of 20 randomly selected clusters, 9 nursing homes from the control, and 6 nursing homes from the intervention group participated. Multilevel linear (n=347 residents, MMSE 10–30) and logistic regression (n=222 residents, MMSE 0–9) analyses were conducted. Maximum pain intensity was higher after intervention (B=1.32, p<0.01), decreased with a better quality of life (B=−0.07, p<0.001), and was lower when dementia diagnoses were present (B=−1.12, p<0.01). PAINAD scores before and after intervention did not differ significantly (OR=0.89, p=0.724), but chances to exhibit treatment-related pain were higher with decreasing MMSE (OR=0.94, p<0.05).ConclusionWhile no significant positive intervention effect was measured, findings suggest nurses’ raised awareness towards pain management. Overall results indicate that large-scale educational interventions seem to be less effective in complex nursing home settings without also including specific individual-based intervention measures.

Expanding Goals of Care Conversations Across a Health System: The Mapping the Future Program

ContextClinician failure to discuss goals of care (GOC) with seriously ill patients remains prevalent. Small-scale educational interventions have demonstrated improvement in physician communication skills, but it is unknown if these results translate into practice changes. ObjectivesTo implement a large-scale educational intervention that would facilitate increased GOC discussions in at-risk patients, increase clinician confidence in having GOC discussions, and prove to be sustainable. MethodsThe Mapping the Future courses were four-to-eight-hour trainings, with brief lectures and demonstrations followed by practice with simulated patient cases. Participants completed precourse and postcourse surveys, including demographic information, self-confidence in a variety of communication tasks, willingness to initiate GOC discussions, barriers to GOC discussions, and self-perceived skill at having GOC conversations. We compared the rate of documentation of GOC discussions with at-risk inpatients in three hospitals for physicians who had taken the course and those who had not. ResultsOver a two-year period, we trained 512 clinicians in 42 sessions. After the course, participants felt that they had improved in all the skills that we taught and agreed that they would be more likely to initiate GOC conversations. Trained physicians were more likely than their nontrained colleagues to document a GOC discussion with at-risk patients (30.8% vs. 27.2%; P = 0.0001). ConclusionA large-scale educational intervention involving simulated patient cases increased GOC documentation across a health system. Other programs might consider collaboration with quality improvement specialists to measure the impact of education and situate it within other system changes to support increased GOC discussions.

An Empirical Unraveling of Lord's Paradox

ABSTRACTLord's Paradox occurs when a continuous covariate is statistically controlled for and the relationship between a continuous outcome and group status indicator changes in both magnitude and direction. This phenomenon poses a challenge to the notion of evidence-based policy, where data are supposed to be self-evident. We examined 50 effect size estimates from 34 large-scale educational interventions and found that impact estimates are affected in magnitude, with or without reversal in sign, when there is substantial baseline imbalance. We also demonstrated that multilevel modeling can ameliorate the divergence in sign and/or magnitude of effect estimation, which, together with project specific knowledge, promises to help those who are presented with conflicting or confusing evidence in decision-making.

Impact of a large-scale educational intervention program on venous blood specimen collection practices

BackgroundPhlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists’ adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists’ VBSC practical performance.MethodsThe present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups.ResultsEvaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0–0.39, p = 0.016-0.961).ConclusionsThe present study demonstrated several significant improvements on phlebotomists’ adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.

Mate Marote: A flexible automated framework for large-scale educational interventions

There is big consensus that computer games may be an effective way of learning and many initiatives are being developed where aspects from cognitive sciences are being applied in the development of these games. In this article, we present Mate Marote, a flexible framework for large-scale educational interventions. Based on the delivery programs of computers to each student in Argentinian schools, we developed an environment that provides activities/games and registers usage statistics. This framework keeps installation up-to-date connecting with a central server as Internet connection is detected, synchronizing new activities, version updates and usage history. As a first testbed intervention, we deployed three games in La Rioja province (Argentina), where OLPC is the official program. These games were focused on training inhibitory control, working memory and planning skills. We found that usage statistics of games replicate previous results found at the laboratory, showing that this platform works as an intervention framework despite its unsupervised nature.

Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention

Venous blood specimen collection is a common health care practice that has to follow strict guidelines, non-compliance among sampling staff may compromise patient safety. We evaluated a large-scale 2 h educational intervention that emphasised guideline adherence to assess possible improvements of venous blood specimen collection practices. Blood specimen haemolysis is usually caused by inadequate venous blood specimen collection and handling, reflecting overall pre-analytical handling. We monitored haemolysis of serum samples with haemolysis index corresponding to ≥ 150 mg/L of free haemoglobin for specimens sent from 11 primary health care centres and analysed on a Vitros 5,1 clinical chemistry analyser before (2008, n = 6652 samples) and after (2010, n = 6121 samples) the intervention. The total percentage of haemolysed specimens was 11.8 % compared to 10.5 % (p = 0.022) before the intervention. As groups, rural primary health care centres demonstrated a significant reduction [Odds ratios (OR) = 0.744] of haemolysed specimens after intervention, whereas urban primary health care centres demonstrated a significant increase (OR = 1.451) of haemolysis. A large-scale 2 h educational intervention to make venous blood specimen collection staff comply with guideline practices had minor effects on collection practices. Educational interventions may be effective in wards/care centres demonstrating venous blood specimen collection practices with larger deviations from guidelines.

The impact of the promise of scholarships and altering school structure on college plans, preparation, and enrollment

The Washington State Achiever (WSA) program was a large-scale educational intervention of scholarships, mentoring, and school redesign designed to encourage students from moderate and low income families to attend college in Washington State. Using a quasi-experimental design based on pre- and post-intervention surveys of high school seniors in program and non-program schools, we find a significant WSA effect on educational outcomes, net of the demographic and socioeconomic composition of students across schools. Across the three intervention high schools, the program is strongly significant in one school, significant after a lag in another school, and not significant in a third. We speculate about the potential reasons for the differential program effect across high schools.

Experimental designs for multiple-level responses, with application to a large-scale educational intervention

Educational research often studies subjects that are in naturally clustered groups of classrooms or schools. When designing a randomized experiment to evaluate an intervention directed at teachers, but with effects on teachers and their students, the power or anticipated variance for the treatment effect needs to be examined at both levels. If the treatment is applied to clusters, power is usually reduced. At the same time, a cluster design decreases the probability of contamination, and contamination can also reduce power to detect a treatment effect. Designs that are optimal at one level may be inefficient for estimating the treatment effect at another level. In this paper we study the efficiency of three designs and their ability to detect a treatment effect: randomize schools to treatment, randomize teachers within schools to treatment, and completely randomize teachers to treatment. The three designs are compared for both the teacher and student level within the mixed model framework, and a simulation study is conducted to compare expected treatment variances for the three designs with various levels of correlation within and between clusters. We present a computer program that study designers can use to explore the anticipated variances of treatment effects under proposed experimental designs and settings.

METHODOLOGICAL CONSIDERATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH

METHODOLOGICAL CONSIDERATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH

Smokeless tobacco and health in India and South Asia.

South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had age-adjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two- to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.

Choosing a Future: Strategies for Designing and Evaluating New Programs

The authors argue that large scale educational interventions at the national level should incorporate evaluation as an integral part of program development. They suggest several statistical techniques which developers could use. Until now, the thrust of evaluation has been to take a total program and judge it as either worthy or unworthy. In contrast, the authors propose an approach which searches for those few versions which are working well, so that they can be improved and recreated in future centers. The Head Start experience illustrates many of the authors' points.