Multifaceted Intervention Program Research Articles

Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai

Purpose To evaluate the effectiveness of a youth-friendly intervention in promoting one safe sex behavior—contraception and condom use among unmarried young people aged 15–24 years in Shanghai, China. Methods The study was conducted in two towns of a suburban area of Shanghai (one as the intervention and the other as the control), with comparable socio-cultural-economic and demographic characteristics. The intervention intended to build awareness and offer counseling and services related to sexuality and reproduction among unmarried youths, in addition to the routine program activities, which were exclusively provided in the control site. Baseline surveys were conducted in both sites before the implementation of the intervention, and similar surveys were conducted in both sites 20 months after the intervention had been initiated to test the feasibility and effectiveness of the intervention. In total, 1220 unmarried young people from the intervention site and 1007 from the control site, including 1304 out-of-school youths and 923 high school students, were recruited, and about 92% of them were successfully followed up. Four main measures were examined (i.e., ever contraceptive use, current regular contraceptive use, ever condom use, and contraceptive use at onset of sexual intercourse—if it occurred during the course of the intervention). The reasons for nonuse of contraceptives, the status of joint decision on contraception and the first method used were also assessed. Data were analyzed using Logistic regression models with dichotomous measures of contraceptive use and Generalized Estimating Equations (GEEs) with repeated measures. Results At baseline, there was no statistical difference in contraceptive use between the intervention and control groups. After intervention, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than that in the control group ( p < .001). A group × time interaction effect ( p < .0001) was found for regular contraceptive use and ever condom use. Logistic regression analysis with dichotomous measures of contraceptive use and GEEs with repeated measures showed similar results. The regular contraceptive use and ever condom use were correlated with subject's occupation and family economic status, respectively. After adjusting for demographic factors, the subjects from the intervention group were 14.58 (OR) times as likely to use contraceptives at onset of intercourse as those from the control group (95%CI: 8.55–24.87, p < .0001). Similar results were found for both females and males. Conclusions A multifaceted intervention program that provided information and skills, as well as counseling and services, appears to have positive influences on contraceptive practice and condom use among unmarried young females and males in suburban Shanghai.

The Canadian asthma primary prevention study: outcomes at 2 years of age

BackgroundAvoidance of individual risk factors have not been successful in preventing the development of asthma. ObjectiveWe sought to determine the effectiveness of a multifaceted intervention program in primary prevention of asthma in high-risk infants. MethodsWe identified 545 high-risk infants on the basis of an immediate family history of asthma. Families were randomized into intervention or control groups. Intervention measures included avoidance of house dust mite, pet allergen, and environmental tobacco smoke. Breast-feeding was encouraged with formula supplementation if necessary, and introduction of solid foods was delayed. ResultsAt 2 years of age, 19.5% of the children had asthma, and 14.7% had atopy (positive skin test response to one or more common allergens). Significantly fewer children had asthma in the intervention group compared with in the control group (16.3% vs 23.0%), with 60% less persistent asthma at 2 years. There was a 90% reduction for recurrent wheeze in the intervention group compared with that seen in the control group. Exposure to maternal environmental tobacco smoke during pregnancy or the first year was a risk factor for asthma at 2 years of age. A positive skin test response, particularly to food, at 12 months predicted asthma at 2 years. There was no significant difference for atopy between the intervention and control groups, but daycare reduced atopy at 2 years. ConclusionThis multifaceted intervention program during a window of opportunity in the first year of life was effective in preventing asthma in high-risk children at 2 years of age. Future studies with this cohort at school age are important.

Do leaves have to fall in their Autumn? A falls prevention strategy in action in the south east of South Australia

The costs of falls in terms of individual suffering and to the community are high, and these costs will increase markedly as the population ages. The aim of this study into falls prevention in persons 65 years and over in the south east of South Australia, 1 April 2000-31 March 2002, was to develop and implement a multifaceted intervention program to limit the incidence of falls and to lessen the extent of falls injury in a population of elderly people. Studies in the early to mid-1990s identified that approximately one-third of people aged 65 years and over, living in the community, report one or more falls in the previous 12 months. In residential aged care and in hospital settings, the annual falls rate in this age group can be as high as 50%. The number and severity of falls injuries also increases with advancing age and with the increased incidence of osteoporosis. A total of 2148 falls were reported over the 2 years of the study from this South Australian rural region's population of 7553 people aged 65 years and over, with marked variations in number from month to month, but with no overall trend. The rate of hospital admission after a fall decreased from 12% in the first 12 months to 7% in the second. The total fracture rate decreased from 7% in the first 12 months to 4% in the second. Both reductions are statistically significant (p < 0.001). Comparison of yearly hip fracture rates before and during the 2 years revealed a reduction of 35%. This regional falls prevention strategy was associated with a decrease in reported falls injury over 2 years although it had no overall effect on the frequency of falls. A useful way to implement such a strategy was identified, as were factors necessary to achieving a reduction in fractures. The value of hip protectors as a cheap, safe, effective and immediate protection against serious injury was confirmed.

Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital.

We tested a low-cost, multifaceted intervention program comprising formulary restriction measures, continued comprehensive education, and guidelines to improve in-hospital use of antibiotics and related costs. In a short-term analysis, total antibiotic consumption per patient admitted, which was expressed as defined daily doses (DDD), decreased by 36% (P < .001), and intravenous DDDs decreased by 46% (P < .01). Overall expenditures for antibiotic treatment decreased by 53% (100 US dollars per patient admitted). The 2 main cost-lowering factors were a reduction in prescription of antibiotics (35% fewer treatments; P < .0001) and more diligent use of 5 broad-spectrum antibiotics (23% vs. 10% of treatments; P = .001). Quality of care was not compromised. A pharmacy-based, prospective, long-term surveillance of DDDs and costs over 4 years showed an ongoing effect. This comprehensive intervention program, which aimed to reduce antibiotic consumption and costs, was highly successful and had long-lasting effects.

Final results of the Maryland WIC food for life program

Background The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. Methods We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. Results Mean differences (intervention–control) in change from baseline were for percent calories from fat −1.62 ± 0.33% ( P < 0.0001), for consumption of fruits and vegetables 0.40 ± 0.11 servings ( P = 0.0003), and for fiber intake 1.01 ± 0.31 grams ( P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. Conclusions Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.

A tailored, multifaceted programme in capitation-based family practices improved appropriate use of preventive care manoeuvres

(2001) CMAJ 164, 757. Lemelin J, Hogg W, Baskerville N. . Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. . Mar...

Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study

There is a considerable gap between obtaining results in randomized trials and implementing them into practice. This is particularly relevant with the high-cost 5HT3 antiemetics, which include ondansetron, dolasetron and granisetron. Randomized trial data suggests that they should be used as a single daily dose during only the first 24 h of chemotherapy because they offer little benefit over less costly agents beyond this period. In this study, six intervention methods (i.e. multifaceted approach) were combined to change physicians' 5HT3 prescribing patterns to comply with evidence-based antiemetic guidelines. A six-step implementation process was adopted, consisting of guideline dissemination, the use of opinion leaders, interactive educational workshops, therapeutic reminders in the form of preprinted orders, clinical interventions by pharmacists for the event of inappropriate antiemetic orders, and physician audit and feedback. Once implemented, the control of emesis was collected in all patients who were enrolled in the intervention program. Multivariable regression analysis was then used to assess whether prescribing within antiemetic guidelines compromised patient care. A total of 195 inpatients were enrolled in the study over the 4-month intervention period. Overall, 88.7% of granisetron prescriptions fulfilled the guidelines with respect to appropriate indication, dosage, and duration of therapy. The multivariable analysis suggested that granisetron prescribing within guidelines did not compromise the control of acute and delayed emesis. In addition, patients who received evidence-based antiemetic therapy experienced a significant reduction in the severity of acute nausea [risk ratio (RR) = 0.69; P=0.03]. The results of this guideline implementation study revealed that a pharmacist-driven multifaceted intervention program for such high-cost agents as 5HT3 antiemetics can promote their use in a clinically appropriate manner and can save unnecessary drug costs without compromising the quality of patient care.

Combating diabetic nephropathy with drug therapy.

Diabetes mellitus is the leading cause of end-stage renal disease and also increases the risk of atherosclerotic vascular disease. Hypertension amplifies both problems. Detection of microalbuminuria, a common and early manifestation of diabetic nephropathy and a marker for cardiovascular risk, permits early treatment to reduce progression of nephropathy and vascular disease in diabetes. Although optimal glycemic control is essential to reduce the risk of nephropathy, aggressive blood pressure lowering to a level of 130/80 mg Hg or below in hypertensive diabetic patients is as important as glycemic control. Initial drug therapy for nephropathy should include an angiotensin-converting enzyme inhibitor (or if contra-indicated, an angiotensin receptor blocker), as several large randomized double-blinded multicenter clinical trials have demonstrated an independent renoprotective effect with renin angiotensin system inhibition. The role of advanced glycation end products in the pathogenesis of renal and vascular disease in diabetes is becoming more clearly established. However, the use of therapeutic strategies directed at blocking their effect still awaits further investigation. A multifaceted intervention program that combines optimal glycemic control, lifestyle modification/cardiovascular prevention guidelines such as lipid control and smoking cessation, with appropriate antihypertensive therapy when indicated, will prevent or delay both the occurrence and progression of diabetic nephropathy.

Development of a cervical cancer control intervention program for Cambodian American women.

Southeast Asian immigrants have lower levels of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with western culture and biomedical concepts of prevention. We completed an ethnographic study (N = 42) focusing on cervical cancer screening among Cambodian American women. We also conducted a community-based survey (N = 413) to examine the generalizability of our qualitative results. This report summarizes the results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of disease; lack of familiarity with western early detection concepts; low levels of knowledge about cervical cancer; concerns about the Pap testing procedure; and health care access issues. In general, the quantitative results confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentations at small group meetings, barrier-specific counseling, use of a Khmer-language video, and tailored logistic assistance (e.g., transportation and medical interpretation). Both the video and presentation provide cultural context while simultaneously addressing multiple barriers to screening (e.g., women's fear of surgery and preference for female providers). Outreach workers are trained to counsel women about 10 potential barriers including avoidance of biomedicine, perceptions that gynecologic exams are embarrassing, and lack of English proficiency. Our results reinforce the importance of considering health problems within the context of a population's traditional belief systems and daily routines.

Use of Qualitative Methods to Develop a Motivational Video

Elicitation interviews and focus groups were used to develop and assess a video designed to motivate women to seek regular mammography. “Let's Talk About It” is a 13 minute video targeted to low income women. This video is currently being tested as part of a multifaceted intervention program to promote mammography screening in an inner city hospital. The video is built on the format of a “talk show.” Three panelists explain why they have not had a mammogram, and members of the studio audience counter their beliefs and arguments. A member of the studio audience is followed as she goes through the process of having her first mammogram. Finally, a physician answers audience questions about mammography. In this article, we describe the various qualitative methods used to guide development of this video and to assess its relevancy.

The Maryland WIC 5 A Day Promotion Program Pilot Study: Rationale, Results, and Lessons Learned

Although the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves approximately 6.5 million participants nationwide, little research has been conducted to assess the effectiveness of health promotion programs aimed at the prevention of chronic diseases among its participants. Characteristics of the WIC program and the population it serves present numerous challenges to successfully implementing such initiatives. This National Cancer Institute-funded study seeks to increase fruit and vegetable consumption among women enrolled in WIC and women whose children are enrolled in WIC in Maryland. Key behavioral messages, motivators, and strategies tailored to the target population were identified first. The project team then developed a multifaceted intervention program. To assess its effectiveness and to learn about potential logistical problems prior to initiating a large-scale intervention program, we conducted a pilot study in two intervention sites and one control site. The pilot study demonstrated problems in client recruitment and participation. Both intervention sites showed small increases in fruit and vegetable consumption that were not statistically significant. Numerous lessons were learned, demonstrating the utility of conducting such a study prior to implementing a full-scale intervention.

Capodanno Senza Danno: the effects of an intervention program on fireworks injuries in Naples.

To study the effects of a comprehensive, multifaceted intervention program to reduce fireworks-related injuries during the Italian New Year's holiday season, active surveillance was conducted in the 18 public emergency rooms of Naples, Italy, before and after implementation of the program. Preintervention data collected between December 24, 1992, and January 6, 1993, were compared with data collected during the same period in 1993-1994. The number of injuries decreased by 48% from 353 to 183, with the greatest declines seen among 10- to 12-year-olds. The broad-based intervention implemented during the 1993-1994 holiday season appears to have substantially reduced the number of injuries.

Achieving therapeutic goals in insulin-using diabetic patients with non-insulin-dependent diabetes mellitus: A weight reduction-exercise-oral agent approach

Non-insulin-dependent diabetes mellitus (NIDDM) is the most common form of diabetes in the civilized world. Its consequences include microvascular and macrovascular disease, both of which appear to evolve from a common background of obesity and physical inactivity. The current study was undertaken in obese patients with NIDDM to see whether improvements could be made in glycemic control as well as in many cardiovascular risk factors (obesity, hypertension, lipid abnormalities, and physical inactivity) that are typical of this condition. Fifteen obese insulin-using patients with NIDDM (average body mass index, 34.0) were treated with a 500-calorie formula diet for eight to 12 weeks. Administration of insulin and diuretics was discontinued at the onset of the study. A eucaloric diet was begun at eight to 12 weeks and maintained until Week 24. A behaviorally oriented nutrition-exercise program was instituted at the beginning of the study. Glipizide or placebo was added (randomized) at Week 15 if the fasting plasma glucose level in patients exceeded 115 mg/dl. Patients lost an average of 22 pounds over the course of 24 weeks. Frequency and duration of physical activity increased significantly from baseline, as did the maximal oxygen consumption rate. Glycemic control by 15 weeks (without insulin) was similar to baseline (with insulin). With the addition of glipizide at Week 15, both fasting plasma glucose and glucose tolerance improved significantly. This improvement was not observed with placebo. In addition, both systolic and diastolic blood pressure decreased by about 10 mm Hg. There were no significant changes in the levels of serum lipids or glycosylated hemoglobin. In conclusion, a multifaceted intervention program, employing weight reduction, exercise, diet, and glipizide therapy, can be instituted in insulin-using patients with NIDDM, with improvement in glycemic control and in certain risk factors (hypertension, obesity, physical inactivity) for cardiovascular disease.

Preparing Parents for Teenagers: A Step in the Prevention of Adolescent Substance Abuse

Children face an important and often difficult transition as they move from childhood to adolescence. For parents the transition can be almost as difficult and, certainly, as formative. How should parents respond when their children begin experimenting with drugs and alcohol? How do parents help their children with school and career decisions? What rules should parents set about dating and parties? This article presents a primary prevention program, Preparing Parents for Teenagers, which is designed to address the unique needs of parents in this transition period. This parent intervention is part of a multifaceted intervention program entitled: Adolescent Drug Abuse: A social-cognitive approach, funded by a grant from the National Institute on Drug Abuse (1980). The program, designed