Moderators Of Treatment Efficacy Research Articles

Interventions to improve treatment adherence among adolescents: A meta-analysis

AIM: To examine the overall effectiveness of interventions designed to improve medical treatment adherence among adolescent patients. METHODS: PubMed and PsycINFO databases were searched to retrieve and analyze empirical journal articles (from 1948-2013). Only peer-reviewed, English language journals that defined a measure of adherence (or compliance), assessed an intervention aimed at improving adherence among adolescents, and provided information to calculate an r effect size were included. Studies were excluded if they lacked assessment of the effectiveness of interventions on improving adherence in adolescents as compared to no interventions or standard care. Case studies or journal articles that examined substance abuse or psychological disorders were also excluded. Analyses were conducted with fixed and random-effects methods, and moderators of intervention efficacy were also examined. RESULTS: For each study that met the inclusion criteria (n = 45), an effect size r , reflecting the strength and direction of the interventions’ relationship to adherence was recorded; a positive r indicated that the intervention increased adolescent adherence, whereas a negative r indicated that the intervention decreased adolescent adherence. The overall effectiveness of adolescent adherence interventions was positive and significant (unweighted mean r = 0.27, 95%CI: 0.21-0.33, P = 0.001). Moderator analyses at the fixed effects level revealed that interventions were less effective when adolescents reported their adherence behaviors, when the type of adherence regimen was a medication regimen, and when the type of intervention was cognitivemodification based. CONCLUSION: These findings contribute to understanding interventions for enhancing adolescent adherence. Future research should continue to examine the specific challenges faced by adolescents and create targeted interventions.

Long-term outcomes of a randomized controlled trial on brief alcohol interventions for job-seekers

In the past three decades, two paths of how to understand and support health behavior change have been followed: stage-tailored models and continuum models. Our aim was to investigate the comparative efficacy of a stage-tailored intervention and a non-stage-tailored intervention of the same intensity in reducing alcohol use and alcohol problem severity among job-seekers with unhealthy alcohol use. The interventions were based on the most prominent representative models, the transtheoretical model of behavior change (TTM) and the theory of planned behavior (TPB). A total of 1,243 proactively recruited job-seekers with unhealthy alcohol use (64% male, M=30 years, 76% not motivated to change) were assigned by random to three study groups: (1) individualized stage-tailored feedback letters based on the TTM, (2) individualized non-stage-tailored feedback letters based on the TPB, and (3) assessment only (controls). Both intervention groups received up to two interventions. All groups were followed-up three, six and 15 months after baseline. Piecewise latent growth models were conducted to investigate change in alcohol use and severity from baseline to month 3 and month 3 to 15. Initial motivation was tested as a moderator of intervention efficacy. All groups reduced alcohol use and severity significantly in the short term. In the long term and when including motivation as a covariate, the stage-tailored group produced a significantly greater reduction than the two other groups. Initial motivation was a significant moderator of intervention efficacy. Neither intervention was generally more or less effective than the other. The efficacy of the interventions largely depended upon the initial motivation to change alcohol use: the lower the motivation to change, the more likely the individuals were to benefit from the stage-tailored intervention; and the higher the motivation to change, the more likely the individuals were to benefit from the non-stage-tailored intervention.

Efficacy of Group Treatments for Alcohol Use Disorders: A Review

This paper reviews the efficacy and processes of change within group treatments for alcohol use disorders (AUD). Methodologically rigorous studies examining group treatment for interviewer-diagnosed AUD include evaluations of cognitive-behavioral group treatments that focus on skills for relapse prevention (i.e., coping skills training, coping and social skills training), interactional group therapy, combined pharmacological and group interventions, and group cue exposure treatment. Given the depth of research examining the efficacy of individual treatments for AUD there is a need for further development and evaluation of group treatments that include rigorous clinician-administered diagnostic assessment, implement a control group or active treatment comparison, randomly assign participants to condition, report the racial and ethnic composition of the sample, explore mediators and moderators of intervention efficacy, and implement a manualized treatment protocol. Evaluation of process variables within group treatments for AUD and well designed treatment development studies are also needed to better understand how well established individual treatments for alcohol use disorders can be adapted to function effectively in a group format.

Incident-specific and individual-level moderators of brief intervention effects with mandated college students.

Brief Motivational Interventions (BMI) and Computer-delivered interventions (CDI) have been successful in reducing drinking behaviors with mandated college students. However, research examining moderators of intervention effects have found mixed results. The current study sought to replicate and extend the research on moderators of intervention efficacy with mandated students. Baseline alcohol-related problems, readiness to change, gender, incident consequences, and participant responses to the event (personal attributions about the incident, aversiveness of the incident) were examined as moderators of intervention and booster condition efficacy on alcohol use and problems. Mandated students (N = 225) were randomized to complete either a BMI or CDI (Alcohol 101; Century Council, 1998), with or without a 1-month booster session, following a campus alcohol sanction. Outcomes were measured three months after baseline. Attributions moderated intervention condition such that participants low in personal attributions for their incident showed significantly less drinking following a CDI than a BMI. Men and individuals who reported low incident aversiveness showed higher drinks per occasion after receiving a booster, while individuals high in alcohol-related problems reported fewer heavy drinking days after completing a booster session. Findings suggest that identifying specific characteristics related to the precipitating event may inform intervention approaches in this high-risk population; however, additional research is needed to offer concrete guidance to practitioners in the field.

Age of Drinking Onset as a Moderator of the Efficacy of Parent‐Based, Brief Motivational, and Combined Intervention Approaches to Reduce Drinking and Consequences Among College Students

The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high-risk population of college students (i.e., former high school athletes). Students were randomized to one of four conditions: assessment only control, combined parent-based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web-administered measures at baseline (summer before starting college) and 10-month follow-up. Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow-up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups. Results suggest the combination of a PBI and a peer-delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.

A systematic review of home-based interventions to prevent and treat postpartum depression

This systematic review evaluated randomized controlled trials assessing home-based psychological interventions to prevent and treat postpartum depression (PPD). Six studies meeting inclusion criteria were identified, five assessing treatments for PPD and one assessing a preventive intervention for PPD. Interventions used cognitive behavioral, psychodynamic, and non-directive counseling approaches. Of the six studies reviewed, four reported statistically significant treatment effects on PPD following the intervention. Each of the three types of psychological interventions were shown to reduce levels of maternal depression. Recommendations for future development and evaluation of home-based psychological interventions for PPD are discussed. These include identification of mediators and moderators of intervention efficacy, exploring strategies for prevention of PPD, and targeting high-risk groups.

Being controlled by normative influences: Self-determination as a moderator of a normative feedback alcohol intervention.

The objectives of this research were to evaluate the efficacy of computer-delivered personalized normative feedback among heavy drinking college students and to evaluate controlled orientation as a moderator of intervention efficacy. Participants (N = 217) included primarily freshman and sophomore, heavy drinking students who were randomly assigned to receive or not to receive personalized normative feedback immediately following baseline assessment. Perceived norms, number of drinks per week, and alcohol-related problems were the main outcome measures. Controlled orientation was specified as a moderator. At 2-month follow-up, students who received normative feedback reported drinking fewer drinks per week than did students who did not receive feedback, and this reduction was mediated by changes in perceived norms. The intervention also reduced alcohol-related negative consequences among students who were higher in controlled orientation. These results provide further support for computer-delivered personalized normative feedback as an empirically supported brief intervention for heavy drinking college students, and they enhance the understanding of why and for whom normative feedback is effective.

Social incompetence in children with ADHD: Possible moderators and mediators in social-skills training

Children with attention-deficit/hyperactivity disorder (ADHD) often encounter problems in social interactions with peers and are confronted with peer rejection and social isolation. The most common approach to social problems in children is social skills training. This intervention concept represents a variable mixture of cognitive-behavioral intervention elements. In this article the outcome of social skills training (SST) for children with ADHD is reviewed. Four experimental SSTs are detected and analyzed for potential mediators and moderators of treatment efficacy. Candidate mediators (social cognitive skills, parenting style and medication-induced reduction of key symptoms) are discussed within an empirical and theoretical context. Candidate moderators (subtype, comorbidity, gender and age) are evaluated for their empirical support. It is argued that, although fragmented, there is ample evidence and knowledge to adapt the SST-paradigm towards the specific needs of children suffering from ADHD and to guide future research towards more effective, “well established” interventions.