Levels Of Participant Engagement Research Articles

Implementing peer support into practice in mental health services: a qualitative comparative case study

BackgroundPeer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.MethodsThis was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.ResultsIn high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.ConclusionsThis study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.Trial registrationISRCTN registry number ISRCTN10043328, registered 28 November 2016.

212 Community engaged telehealth care access for Latino farmworkers

OBJECTIVES/GOALS: Historically, Latino farmworkers have lacked access to healthcare. 1 Telehealth promises to bridge this gap in hardly-reached populations. 2 We evaluated the impacts of ACTIVATE, a community-engaged project co-developed withcommunityp artnersAmplaHealth, and a local grower. METHODS/STUDY POPULATION: Mixed-methods outcome evaluation included attitudes survey, knowledge tests, attendance records, exit interviews, and participant observations. Attitudes survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model 3, measured Latino farmworkers’ telehealth acceptability. Pre/Post knowledge tests measured participant knowledge gained on telehealth and mental health services. Semi-structured exit interviewsidentifiedthe impacts of incentives, Promotora training, and health education curricula on participants and community partners. Structured participant observation as certained the level of participant engagement and Promotora facilitation skills. RESULTS/ANTICIPATED RESULTS: Results [https://drive.google.com/file/d/1jQpQdDM3dIR_PzMc1xXPh45Jvz8uBka6/view] On what aspects of the project worked well: “This project really helped us… to make it a priority, to do [health education] workshops. When I was hired, we went out to a few farms and shared information about our services, but it wasn’t anything hugely structured like what you proposed. We hadn’t done a whole lot of Promotora health education prior to this project.” -Ampla Health Administrator The most significant change observed: “Their attitudes… I feel that the very first session, I saw how they were more laid back, not really answering questions, just listening to us. And then the second one… they were more talkative and the very last one they were more comfortable sharing.” -Promotora DISCUSSION/SIGNIFICANCE: Attendence and participant engagement increased over time. Results from the evaluation point to greater telehealth acceptability among participants, increased health education capacity among Ampla Health, and farm worker cohesiveness at the workplace.

“I Felt Frightened and Then I Started Singing”: Songs at Russian Protest Actions

This article explores the role of songs in Russian protests. Data are drawn from ethnographic observations made at protests held between 2015 and 2022, mostly in Moscow and St. Petersburg, as part of the project, “Monitoring Contemporary Folklore,” based at the Russian Presidential Academy of National Economy and Public Administration. The authors consider materials from 240 protests. Viewing protests as an act of communication, the article analyzes the circumstances for song performances and suggests a hypothesis for songs’ communicative goals. The article additionally demonstrates how song choice changes from common 1980’s protest songs to new tracks that gained later popularity. The article demonstrates how song production depends on the types of protests and the levels of participant engagement.

Effectiveness of a school-based mental health intervention for school teachers in urban Pakistan: a randomized controlled trial

BackgroundSchools have a major role in promoting children’s physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers’ knowledge and beliefs about psychological problems influence the way they deal with their students’ mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization’s Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore.MethodsTeachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention.ResultsCompared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher’s self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months.ConclusionThis study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools.Trail Registration: ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register.clinicaltrials.gov.

Engagement in small group interactions involving persons with primary progressive aphasia

Purpose: In group therapy, participant engagement is integral for achieving effective and meaningful interactions. Engagement is necessary not only for ensuring participation in the group, but also for promoting overall life engagement. Although engagement is vital to group therapy, it has remained largely unstudied, particularly in treatment for persons with primary progressive aphasia. Methods: Using samples from a videotaped small group interaction involving two graduate student clinicians and two persons with primary progressive aphasia, conversational actions contributing to engagement were identified and analyzed via content analysis and principles of conversation analysis. Results: Conversational actions resulting in engagement included clinician-appointed turns, participant affirmation, and member support. These conversational actions were found to maintain and/or increase wavering levels of participant engagement. Discussion: Findings for the study yielded clinical applications for clinician promotion of engagement during small group interactions involving persons with primary progressive aphasia to increase participant involvement and maximize therapeutic outcomes.

Pre-Outpatient Group Education and Assessment in Chronic Pain: A Systematic Review.

Pre-outpatient interventions in chronic pain have the potential to improve patient self-management earlier in primary or secondary care, which may minimize pain chronicity and negative health outcomes. The literature for this is sparse, and there are no existing systematic reviews on this topic. The purpose of this systematic review is to examine the evidence for pre-outpatient group interventions in chronic pain. We identified four studies that looked at this: two randomized control trials, one prospective observational study, and one descriptive study. We identified high-quality evidence that a pre-outpatient group intervention reduces waiting times, moderate-quality evidence that it results in reduced costs per patient, very low-quality evidence that it reduces health care utilization, and very low-quality evidence that it improves service throughput. There were moderate-to-low levels of participant engagement with the initiative, which varied across the included studies. For patient outcome measures, we found no evidence that a pre-outpatient group intervention improves pain intensity, very low-quality evidence that it improves pain-related interference, low-quality evidence that it increases use of pain management strategies and produces high satisfaction levels, low-quality evidence that it improves pain self-efficacy, and no evidence that it improves psychological distress. Group interventions before individual appointments have the potential to provide important improvements in service delivery, including improvements in waiting times and cost per patient. Benefits for patient outcome measures are less clear. Clinical heterogeneity and high levels of bias existed in the included studies. Further research is required so that meaningful conclusions can be made about these interventions.

Improved diabetes control among low-income Mexican Americans through community-clinical interventions: results of an RCT.

IntroductionThis randomized controlled trial investigated community-clinical intervention strategies for a Mexican American population who had not demonstrated control of their diabetes. We tested a control program (Salud y Vida 1.0) supporting diabetes management versus an enhanced version (Salud y Vida 2.0) for reductions in HbA1c at 12 months.Research design and methodsAdults with uncontrolled diabetes (n=353) were enrolled if they had an HbA1c≥9.0% during a program or doctor’s visit between 6 and 36 months of their receipt of SyV 1.0 services, were patients at one of two clinics in local counties, and had an HbA1c≥8.0% at SyV 2.0 baseline enrollment. The control and intervention arms were coordinated by community health workers and the intervention arm included the control program enhanced with medication therapy management; behavioral health services; peer-led support groups; and additional community-based lifestyle programs also open to the family.ResultsAt 12 months, both study arms improved HbA1c (mean, (CI), Control (−0.47 (-0.74 to –0.20)) and intervention (−0.48 (-0.76 to –0.19)). The intervention group maintained HbA1c levels after month 6, whereas control group HbA1c levels slightly increased (adjusted mean from 9.83% at month 6%–9.90% at month 12). Also, HbA1c was examined by level of participant engagement. The high engagement group showed a decreasing trend over the study period, while control and lower engagement groups failed to maintain HbA1c levels at month 12.ConclusionsImproved HbA1c was found among a population that had not demonstrated diabetes management prior; however, mean HbA1c values were above clinical guideline recommendations. The randomized control trial findings provide additional evidence that extended time and intervention supports may be needed for populations experiencing inequities in social determinants of health.Trial registration number NCT04035395.

Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH).

High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.

Factors associated with recruitment, surveillance participation, and retention in an observational study of pregnant women and influenza

BackgroundThis report describes the results of recruitment efforts and the subsequent participation of pregnant women in study activities in a 2010–2012 observational study focused on influenza illness and vaccination in California and Oregon, USA.MethodsSocio-demographic and health characteristics extracted from electronic medical records were compared among pregnant women who enrolled in the study, refused to participate, or were never reached for study invitation. These characteristics plus additional self-reported information were compared between women who enrolled in two study tracks: a prospective cohort vs. women enrolled following an acute respiratory illness (ARI) medical encounter. The characteristics of women who participated in weekly ARI surveillance (cohort enrollees, year one) and a 6-month follow-up interview (all enrollees) were also examined.ResultsIn year one, we reached 51% (6938/13,655) of the potential participants we tried to contact by telephone, and 20% (1374/6938) of the women we invited agreed to join the prospective cohort. Women with chronic medical conditions, pregnancy complications, and medical encounters for ARI (prior to pregnancy or during the study period) were more likely to be reached for recruitment and more likely to enroll in the cohort. Twenty percent of cohort enrollees never started weekly surveillance reports; among those who did, reports were completed for 55% of the surveillance weeks. Receipt of the influenza vaccine was higher among women who joined the cohort (76%) than those who refused (56%) or were never reached (54%). In contrast, vaccine uptake among medical enrollees in year one (54%; 53/98) and two (52%; 79/151) was similar to other pregnant women in those years. Study site, white race, non-Hispanic ethnicity, and not having a child aged < 13 years at home were most consistently associated with joining as a cohort or medical enrollee and completing study activities after joining.ConclusionsWe observed systematic differences in socio-demographic and health characteristics across different levels of participant engagement and between cohort and medical enrollees. More methodological research and innovation in conducting prospective observational studies in this population are needed, especially when extended participant engagement and ongoing surveillance are required.

Sensing interstitial glucose to nudge active lifestyles (SIGNAL): feasibility of combining novel self-monitoring technologies for persuasive behaviour change

IntroductionIncreasing physical activity (PA) reduces the risk of developing diabetes, highlighting the role of preventive medicine approaches. Changing lifestyle behaviours is difficult and is often predicated on the assumption that...

Knowledge-exchange in the Pacific: outcomes of the TROPIC (translational research for obesity prevention in communities) project

BackgroundThe Pacific TROPIC (Translational Research for Obesity Prevention in Communities) project aimed to design, implement and evaluate a knowledge-broking approach to evidence-informed policy making to address obesity in Fiji. This paper reports on the quantitative evaluation of the knowledge-broking intervention through assessment of participants’ perceptions of evidence use and development of policy/advocacy briefs.MethodsSelected staff from six organizations - four government Ministries and two nongovernment organizations (NGOs) - participated in the project. The intervention comprised workshops and supported development of policy/advocacy briefs. Workshops addressed obesity and policy cycles and developing participants’ skills in accessing, assessing, adapting and applying relevant evidence. A knowledge-broking team supported participants individually and/or in small groups to develop evidence-informed policy/advocacy briefs. A questionnaire survey that included workplace and demographic items and the self-assessment tool “Is Research Working for You?” (IRWFY) was administered pre- and post-intervention.ResultsForty nine individuals (55% female, 69% 21–40 years, 69% middle-senior managers) participated in the study. The duration and level of participant engagement with the intervention activities varied – just over half participated for 10+ months, just under half attended most workshops and approximately one third produced one or more policy briefs. There were few reliable changes on the IRWFY scales following the intervention; while positive changes were found on several scales, these effects were small (d < .2) and only one individual scale (assess) was statistically significant (p < .05). Follow up (N = 1) analyses of individual-level change indicated that while 63% of participants reported increased research utilization post-intervention, this proportion was not different to chance levels. Similar analysis using scores aggregated by organization also revealed no organizational-level change post-intervention.ConclusionsThis study empirically evaluated a knowledge-broking program that aimed to extend evidence-informed policy making skills and development of a suite of national policy briefs designed to increase the enactment of obesity-related policies. The findings failed to indicate reliable improvements in research utilization at either the individual or organizational level. Factors associated with fidelity and intervention dose as well as challenges related to organizational support and the measurement of research utilization, are discussed and recommendations for future research presented.

Improving the Quality of Auditory Training by Making Tasks Meaningful

Traditional auditory training (AT) typically includes activities that focus on the formal properties of sounds without requiring attention to meaning. After reviewing the psycholinguistic bases for requiring attention to meaning, the authors present a series of examples of how to modify purely form-oriented AT activities so that they become meaning oriented. For example, a purely form-oriented same–different task with /ba/–/pa/ or /ba/–/ba/ can be modified using minimal pairs such as /bear/–/pear/ or /bear/–/bear/ and by requiring listeners to identify appropriate picture pairs in order (i.e., pictures of a bear and then a pear, or of a bear and then another bear). The modified version requires attention to meaning, whereas the original version does not. The authors promote a nonhierarchical and interactive approach to AT in which activities at 3 linguistic levels (word, sentence, and discourse) are included from the beginning and throughout AT, but with activities that are carefully designed to be meaning oriented and in which comprehension is the central focus. In the Summary By Example section, the authors describe an AT program (I Hear What You Mean; Tye-Murray, Barcroft, &amp; Sommers, in press) that was designed to be meaning oriented at the word, sentence, and discourse levels. Specific benefits of providing meaning-based AT, such as higher levels of participant engagement, are highlighted.