Predictors Of Positive Change Research Articles

Evaluation of health-related quality of life in patients receiving outpatient parenteral antimicrobial therapy (OPAT) in a UK setting

ABSTRACT Background Studies assessing the benefits of outpatient parenteral antimicrobial therapy (OPAT) have paid less attention to patient-centered factors such as patients’ experiences and their health-related quality of life (HRQoL). Research design and methods Prospective before-and-after quasi-experimental study enrolled adult patients receiving OPAT at a tertiary hospital in Derbyshire, UK, between October 2022 and October 2023. Consenting patients completed paired EQ-5D-3 L questionnaires before OPAT initiation and upon completion of therapy or 30 days after its commencement (whichever occurred first). Changes and predictors of change in HRQoL indicators and associations with clinical outcomes (treatment failure, adverse events, and 30-day unplanned readmission) were examined. Results Health state index and visual analogue scale (EQ VAS) scores of 162 enrolled patients at baseline were significantly lower than the UK population averages, but the patients experienced significant improvements in both scores and in four EQ-5D dimensions (mobility, self-care, usual activities, and pain/discomfort). Baseline health index and EQ VAS scores were significant independent predictors of positive changes in HRQoL scores. Conclusions OPAT is associated with improved patient-reported quality of life and facilitates early return to work or school. Nevertheless, it is crucial to closely monitor patients with a lower baseline quality of life to optimize their overall OPAT experience.

Hope, optimism, and pessimism as predictors of positive and negative psychological changes related to the COVID-19 pandemic in Slovak adults.

Positive and negative changes in outlook represent psychological changes that are the results of the cognitive processing of stressful and traumatic events by an individual. The objectives of the study were (1) to determine the level of occurrence and types of positive and negative changes in connection with the COVID-19 pandemic among adults in Slovakia and (2) to study the role of personality factors such as hope (dispositional and perceived) and life orientation (optimism and pessimism) in the prediction of positive and negative changes in adults during the fourth pandemic wave. A Short Form of the Changes in Outlook Questionnaire (CiOQ-S), the Dispositional Hope Scale (DHS), the Perceived Hope Scale (PHS), and the Life Orientation Test (LOT-R) were administered. The research sample consisted of 102 participants, whose ages ranged from 20 to 65 years (Mage = 38.90, SD = 14.28). The research design was quantitative, exploratory, and confirmatory. In total, 95% of participants reported positive changes related to COVID-19. Concurrently, up to 70% of these participants also reported negative changes from the impact of the pandemic. Only 25% of participants reported positive changes without noticing any negative perception of the consequences of the pandemic. Overall, 68% of participants reported negative changes related to COVID-19. Only 29% of participants reported negative changes without noticing any positive perception of the consequences of the pandemic. In total, up to 86% of participants agreed with experienced psychological changes (positive or negative) as a result of the COVID-19 pandemic. The high prevalence of positive changes along with the relatively high prevalence of negative changes related to the COVID-19 pandemic outline the question of whether reported positive changes represent real or illusory growth. Optimism and pessimism were found to be significant independent predictors of positive changes related to the COVID-19 pandemic. Hope was identified as a significant independent predictor of negative changes related to the COVID-19 pandemic.

Experience of Wondering Awe and Perception of Nature as a Resource during the COVID-19 Pandemic—Findings from a Cross Sectional Survey of Participants in Jerusalem

During the COVID-19 pandemic most people had to cope with the negative implications of the lockdowns, and perceived times of social isolation and loneliness, and thus low wellbeing. Among the best predictors of positive changes of pandemic related attitudes and behaviors was the experience of pausing in wondering awe with subsequent feelings of gratitude. As these observations came from a secular society with a Christian background, we now aimed to analyzed to what extend Jewish people from Israel were experiencing such moments of wondering awe during the COVID-19 pandemic, and how these perceptions are related to their psychological wellbeing. For that purpose, between June and July 2021 a cross-sectional survey with standardized questionnaires was applied among 147 participants from Jerusalem. Those with high wellbeing and those who can rely on their faith as a resource to cope with the pandemic were more intensively perceiving moments of Awe/Gratitude. Awe/Gratitude and a low perception of COVID-19 related stressors were the best predictors of participants’ psychological wellbeing. Against our expectation, Awe/Gratitude was not significantly associated with the experience of nature and enjoying reflective times of silence. Both resources, Awe/Gratitude as a an experiential aspect of spirituality and Nature/Silence as a source to encounter the sacred in one’s life, are relevant and should be supported.

Reconsidering the concept of sustainability: personal adaptability dynamics as predictor of positive change

The article deals with the attempt to reconstruct the concept of sustainable development in the context of the COVID-19 pandemic. The literature review supported the idea that the studies devoted to the features of sustainability in social systems are extremely fragmentary. The authors provided a holistic vision of the process of sustainable development in terms of a dialectical self-organization of open living systems. To accomplish this goal, a number of studies have been conducted at different stages of the COVID-19 pandemic. The findings confirmed a strong relationship between the psychological and social level of adaptation (as a manifestation of the adaptability/sustainability of the individual) to the conditions of the pandemic. This helps considering indicators of psychological stability as a predictor of social sustainability. The prospect of the further research consists in the reinterpretation of the current world in terms of a rhythmic, emergent, hybrid and innovative (REHI-world) self-organization of open living systems.

Can Fear of COVID-19 Be Predicted by Religiosity and Trust in Institutions among Young Adults? A Prospective Cross-National Study

The aim of this study was to reveal whether religiosity and trust in institutions are longitudinal predictors of change in fear of COVID-19 (FCV-19) across Poland, Germany, Slovenia, and Israel among young adults over a three-month period. The representative sample consisted of 1723 participants between the ages of 20 and 40 years (M = 30.74, SD = 5.74) across Poland (n = 446), Germany (n = 418), Slovenia (n = 431), and Israel (n = 428). The first measurement was carried out in February 2020 and the second was conducted in May/June 2020. A repeated-measures, two-way, mixed-factor ANOVA was performed to examine changes over time (T) and across countries (C) as well as the interaction of time and country (TxC) for FCV-19, religiosity, and trust in institutions. The results showed a significant decrease over time and differences between countries in all variables, as well as in TxC for FCV-19 and trust in institutions. Linear generalized estimating equations (GEEs) were used to assess the longitudinal change between T1 and T2 in FCV-19, including religiosity and trust in institutions as predictors, country as a factor, and gender and age as confounders. Female gender, religiosity, and trust in institutions were found to be significant longitudinal predictors of change in FCV-19. Country was a significant moderator of the relationship between trust in institutions and FCV-19, with the highest result achieved in Poland. Religiosity and trust in institutions were positive predictors of change in fear of COVID-19 among young adults across countries. Religious and governmental institutions should take this into consideration when communicating with believers and citizens during challenging situations.

Early life predictors of positive change during the coronavirus disease pandemic

BackgroundThe COVID-19 pandemic is a crisis unprecedented in its size and scope. Yet studies of resilience suggest most individuals will successfully negotiate this challenge and some may even experience growth and positive change. Some evidence suggests that the capacity to enact positive change in the face of adversity may be shaped by early life experiences.MethodsIn a subset of 374 participants (57% female, mean age = 29 years) in the Study of Early Child Care and Youth Development (SECCYD), a longitudinal, birth cohort, prospective models were tested to determine whether early life adversities in family and neighborhood contexts predict positive change events in response to the COVID-19 pandemic. Childhood family and neighborhood contexts were assessed using a combination of self-report questionnaires and US Census data. Adulthood positive change events (e.g., becoming more appreciative of things usually taken for granted) were assessed using the Epidemic-Pandemic Impacts Inventory (EPII).ResultsIn regression analyses, neighborhood disadvantage in childhood, measured both by objective and subjective assessments, predicted a higher number of positive change events in response to the COVID-19 pandemic (β = .18, p = .004 and β = .15, p = .006, respectively). Examination of the positive change event subscales showed neighborhood disadvantage in childhood predicted increases in events related to ‘perspective taking and charitable giving’ (β = .20, p = .022 and β = .17, p = .002, respectively) and improved ‘social relationships’ (β = .18, p = .004 and β = .13, p = .020, respectively), but not to positive ‘health behaviors’ (ps > .05). All associations were independent of sociodemographic factors and childhood family dysfunction.ConclusionsFindings suggest that neighborhood disadvantage in childhood may shape prosocial responses to stress in adulthood, potentially through early life adaptions to stress that are protective when facing adversity. There are several notable implications of the study findings. Although adversity in early life has clear negative impacts, it is possible that adversity experiences may also provide opportunities to develop adaptive strategies that foster resilience and growth when facing stress. Intervention efforts should consider leveraging such stress-adapted strengths to reduce the many negative impacts of early life adversity.

The Effects of Work-integrated Education and International Study Exchange Experience on Academic Outcomes

ABSTRACT In this paper, we report on the analysis of data collected from 684 students majoring in Accounting and Finance, to examine the relationship between academic outcomes and Work-integrated Education (WIE) and International Study Exchange (ISE) experiences. Both WIE and ISE are common elements of undergraduate business education because of the benefits to students’ skills development they provide, particularly in the areas of graduate attribute development. This study examined the relationship between the change in students’ academic performance and the amount and type of WIE a student undertook and whether or not they participated in an ISE. Findings showed that both completing a higher amount of WIE and undertaking an ISE are positive predictors of change in a student’s grade point average. In addition, students who undertook industry-relevant WIE or WIE sourced by the school had higher grades on graduation. As well as benefits to overall academic achievement, the results showed that students who participated in ISE had significantly higher grades in the final year, major project, as well as a higher grade on graduation. Furthermore, undertaking an ISE and also doing extra WIE had the greatest effect on change in GPA. These findings strongly suggest that relevant WIE and ISE experiences are valuable for helping students be academically more successful when they return to study at their home institution.

Article 4: Impact assessment of supervision performance assessment and recognition strategy (SPARS) to improve supply chain management in health facilities in Uganda: a national pre and post study

BackgroundTo strengthen medicines management capacity, including supply chain management, at public sector health facilities in Uganda, the Ministry of Health introduced a multipronged supervision, performance assessment, and recognition strategy (SPARS). The aim of this study was to assess the impact of SPARS on improving supply chain management. A series of four papers on SPARS described the SPARS concept, its impact on overall and domain practices and appropriate medicines use, and now in the fourth paper describing the effect on supply chain management.MethodsDistrict-based health workers trained as supervisors build facility-level capacity in medicines management using an indicator-based performance assessment followed by targeted supervisory visits. From 2010 to 2013, 1222 SPARS visits were implemented, and the SPARS performance indicator scores determined. This article assesses impact on 13 indicators in three of the five SPARS domains—stock management, storage management, and ordering and reporting quality—using a pre–post design. We also explored factors that may have influenced these outcomes.ResultsBetween the first and last visit within one year of SPARS implementation, we found an average improvement of 16 percentage points (p < 0.001) in supply chain management measures across all levels of care. The improvement in scores for stock management, storage management, and ordering and reporting was 22 (ns), 16 (p < 0.001), and 11 (p = 0.032) percentage points, respectively. The study identified the key predictors of positive change as a low initial indicator score, frequent supervisory visits, and engagement of the district health officer.ConclusionsThe multipronged SPARS approach was effective in building supply chain management capacity in lower-level health care facilities with statistically significant improvements in supply chain management overall and in almost all stock and storage- management and ordering and reporting measures after one year of implementation. We recommend broad dissemination of the SPARS approach as an effective strategy to strengthen supply chain management in low-income countries.Trial registration: The study did not involve or use human participants or identifiable personal data, human tissue, or animals and thus did not require ethical approval or a waiver. It is a study implemented in collaboration with the Ministry of Health and does not require trial registration.

Predictors of change in housing status over 12months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada.

Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.

Healthy Life Centres: a 3-month behaviour change programme’s impact on participants’ physical activity levels, aerobic fitness and obesity: an observational study

ObjectivesIndividuals with low socioeconomic status and multimorbidity tend to have lower physical activity (PA) levels than the general population. Primary care is an important setting for reaching high-risk individuals to...

Perceived facilitators and predictors of positive change and posttraumatic growth following a first episode of psychosis: a mixed methods study using a convergent design

BackgroundThis study aimed to identify predictors and perceived facilitators of positive change and posttraumatic growth in persons with a first episode of psychosis using a mixed methods convergent design.MethodsIn the quantitative component, 94 participants completed measures of posttraumatic growth and predictors of posttraumatic growth. The qualitative component involved in-depth interviews with 12 participants.ResultsQuantitative results revealed that being hospitalized for psychosis, spiritual coping, positive reframing and subjective recovery were significant predictors of posttraumatic growth. Qualitative findings revealed that positive change was perceived to be facilitated by the psychosis itself; receiving mental health services; drawing on personal and social resources and strategies; healing and recovering; a meaning-making and knowledge gaining process; and normative developmental processes.ConclusionsPosttraumatic growth following a first episode of psychosis may therefore be facilitated by complex person-environment interactions.

Brief telephone counselling is effective for caregivers who do not experience any major life events \u2013 caregiver-related outcomes of the German day-care study

BackgroundTo date, there has been a dearth of scientifically tested, established intervention concepts focussed on supporting informal caregivers and embedded in routine health care structures. The aim of this study was to assess effects of a brief telephone intervention for caregivers of persons with cognitive impairment (PCIs) on caregivers’ depressiveness and subjective burden.MethodsA two-arm cluster-randomised controlled intervention study was carried out at 32 German day-care centres. During the six-month intervention period, informal caregivers in the intervention group (n = 205) received counselling in three phone calls focussed on stress reduction, development of self-management strategies, and how to deal with challenging behaviours. Both the control group (n = 154) and the intervention group were free to take part in any support programmes offered by the German Health Care System (TAU). Caregivers’ subjective burden and depressiveness were measured with the Burden Scale for Family Caregivers – short version (BSFC-s) and the WHO-5 Well-Being Index (WHO-5). Outcomes were assessed by means of computer-assisted telephone interviews (CATIs) at baseline and at the end of the six-month intervention phase. Multiple regression analyses were used to show the influence of group allocation.ResultsAfter the intervention phase, group allocation was not found to significantly predict caregivers’ subjective burden or depressiveness. The baseline scores (p < 0.001) were the only significant predictors of change in both outcomes. However, sensitivity analyses for caregivers who did not experience any events that they felt were major (in a negative or positive sense) during the six months (n = 271) showed that group allocation (p < 0.05) was a significant predictor of positive change in both outcomes (BSFC-s: Δ-1.3, [− 2.4, − 0.3], Cohen’s d = 0.27; WHO-5: Δ1.5, [0.4, 2.7], Cohen’s d = 0.26). Effect sizes were highest in the subgroup of caregivers of people with mild dementia (BSFC-s: Cohen’s d = 0.43; WHO-5: Cohen’s d = 0.42).ConclusionsA “low-dose” psychoeducative telephone intervention designed to empower caregivers is effective, especially in an early stage, if the overlap between the effect of the intervention and the effect of events that are experienced as major events in the caregiver’s life is considered.Trial registrationIdentifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).

Childhood Origins of Young Adult Environmental Behavior

Prospective, longitudinal analyses revealed that over a 12-year period from ages 6 to 18, individuals who grew up with mothers with more proenvironmental attitudes engaged in more proenvironmental behavior as young adults. A similar marginal association was uncovered between mothers’ proenvironmental behaviors and the proenvironmental behavior of their young adult offspring. Maternal educational attainment, but not political ideology, was also associated with more proenvironmental behavior as children matured. Moreover, childhood time spent outdoors was positively associated with increased environmentally responsible behavior in young adulthood. Interestingly, one’s own childhood proenvironmental behavior and attitude, at least as assessed at age 6, bear little on one’s eventual proenvironmental behavior as a young adult. Finally, among this set of childhood factors, maternal education and childhood time spent outdoors were independent predictors of positive changes in environmental behavior from early childhood to young adulthood.

Predictors of Positive Changes in Children with Divorced Parents: Focused on Moderating Effects of Family Incomes

Predictors of Positive Changes in Children with Divorced Parents: Focused on Moderating Effects of Family Incomes

The Effect of the Move More Pack on the Physical Activity of Cancer Survivors: Protocol for a Randomized Waiting List Control Trial with Process Evaluation.

BackgroundPhysical activity can improve many common side effects of cancer treatment as well as improve physical function and quality of life (QOL). In addition, physical activity can improve survival rate and reduce cancer recurrence. Despite these benefits, only 23% of cancer survivors in England are active to recommended levels. Cancer survivors are interested in lifestyle behavior change. Home-based interventions offer a promising means for changing physical activity behavior. Prediagnosis levels of physical activity and self-efficacy have been reported to be predictors of physical activity behavior change. The Move More Pack, which has undergone revision, is a printed resource with supporting Internet-based tools that aims to increase the physical activity of cancer survivors in the United Kingdom. The revised Move More Pack is underpinned by the theory of planned behavior and the social cognitive theory.ObjectiveThe aim of this proposed study was to investigate the effect of the revised Move More Pack, supported by Internet-based tools, on physical activity, self-efficacy, and health-related QOL (HRQOL) of cancer survivors in the United Kingdom.MethodsThis study is a two-arm waiting list randomized control trial with embedded process evaluation. A sample of 99 participants per arm will be recruited by invitation through an email database of cancer survivors held by UK charity Macmillan Cancer Support and an advert placed on the Macmillan Cancer Support Facebook page. Each participant is randomized to receive brief physical activity information and the UK guidelines for physical activity, or brief physical activity information and the revised Move More Pack with supporting Internet-based tools. The intervention and control arm will be followed up at 12 weeks to identify changes in self-reported physical activity, self-efficacy, and HRQOL based on Web-based questionnaires. The control arm will receive the revised Move More Pack at 12 weeks with follow-up at 24 weeks. The intervention arm is followed up at 24 weeks to determine maintenance of reported changes. Subgroup analyses will be completed based on participants’ prediagnosis level of physical activity and baseline self-efficacy as possible predictors of positive changes. Use of each component of the revised Move More Pack will be assessed using a 4-point Likert scale. Semistructured phone interviews will evaluate the use and perceived usefulness of the revised Move More Pack.ResultsParticipant recruitment started in March 2017. Projected completion of this study is October 2018.ConclusionsThis study’s findings will identify if the proposed low-cost broad reach intervention improves physical activity, self-efficacy, and the HRQOL of cancer survivors. The process evaluation is designed to contextualize the use and perceived usefulness of the revised Move More Pack, help augment its efficient distribution, and identify potential improvements to its design.

Death Attitudes and Changes in Existential Outlook in Parents of Vulnerable Newborns

This study is an Actor-Partner Interdependence Model analysis of the relation of death attitudes with changes in outlook in 59 parent couples of neonatal intensive care newborns. Death attitudes effects with changes in outlook were mostly intrapersonal and they mainly occurred in fathers, though between gender differences were not usually significant. Death avoidance and neutral death acquiescence were positive predictors of positive changes in outlook, and fear of death and neutral death acquiescence were respective positive and inverse predictors of negative changes. Multidimensional measures of death attitudes and personal change should be used when studying these domains of psychological functioning.

Resilient parenting of children at developmental risk across middle childhood.

This paper focuses on factors that might influence positive parenting during middle childhood when a parent faces formidable challenges defined herein as "resilient parenting." Data were obtained from 162 families at child age 5 and 8 years. Using an adapted ABCX model, we examined three risk domains (child developmental delay, child ADHD/ODD diagnosis, and low family income) and three protective factors (mother's education, health, and optimism). The outcome of interest was positive parenting as coded from mother-child interactions. We hypothesized that each of the risk factors would predict poorer parenting and that higher levels of each protective factor would buffer the risk-parenting relationship. Positive parenting scores decreased across levels of increasing risk. Maternal optimism appeared to be a protective factor for resilient parenting concurrently at age 5 and predictively to age 8, as well as a predictor of positive change in parenting from age 5 to age 8, above and beyond level of risk. Maternal education and health were not significantly protective for positive parenting. Limitations, future directions, and implications for intervention are discussed.

Impact of nutrition on muscle mass, strength, and performance in older adults

Dear Editors, The recent review byMithal et al. [1] highlights the increasing attention given to the role of adequate nutrition in ameliorating the age-related decline of skeletal muscle mass and function in older adults, known as sarcopenia. The authors identify protein and vitamin D as important factors in the maintenance of muscle mass during ageing, and the EuropeanWorking Group on Sarcopenia in Older People (EWGSOP) have encouraged a focus on these nutrients in particular in their recommendations for future research [2]. The Tasmanian Older Adult Cohort (TASOAC) study was not mentioned by the authors but is one of the few prospective cohort studies to examine associations of nutrient status with both muscle mass and strength in older adults. In this cohort of community-dwelling adults aged 50 to 80 years at baseline, participants who failed to meet the Australian recommended dietary intake for protein had lower appendicular lean mass (ALM), and those with serum 25-hydroxyvitamin D (25OHD) levels ≤50 nmol/L had lower relative ALM, lower-limb strength, and lower-limb muscle quality (strength normalised to muscle mass), than participants with normal dietary protein or 25OHD statuses, respectively [3, 4]. In longitudinal analyses, we observed that total energy-adjusted dietary protein intake was a positive predictor of change in dual-energy X-ray absorptiometry-assessed ALM over 2.6± 0.4 years, but no association was observed between protein intake and change in knee extensor strength [3]. Conversely, we have also reported that baseline serum 25OHD levels positively predicted change in lower-limb strength and muscle quality over 2.6 years, but were not associated with change in muscle mass [4]. Mithal et al. also provide evidence for the potential benefit of alkali-producing diets and those high in antioxidants in attenuating sarcopenia progression [1]. Our finding that higher baseline dietary potassium intake was a positive predictor of change in ALM, even after adjustment for protein intake, is supportive of other research suggesting that alkaline diets may have a role in the maintenance of muscle mass in older adults [5]. However, we observed inconsistent associations for antioxidants with ALM; beta-carotene was not associated with ALM,while vitamin Cwas positively associated with ALM in cross-sectional analyses only. Higher baseline intake of zinc, which appears to demonstrate antioxidant properties [6], was an independent positive predictor of change in ALM over 2.6 years [3]. Data from a growing number of observational and intervention studies internationally are providing evidence supporting adequate nutrition as a primary target in the prevention of age-associated declines in muscle mass and function. Clinical trials are now required to document the effects of dietary nutrients which have demonstrated promise for reducing and preventing sarcopenia progression, and to develop public health strategies for promoting healthy eating in the ageing community.

Abstract CN03-01: Predictors of change in colorectal cancer screening decision stage among participants in a randomized, controlled trial of genetic and environmental risk assessment

Abstract Purpose. This report presents findings from a randomized, controlled trial of colorectal cancer (CRC) genetic and environmental risk assessment (GERA). Predictors of positive change in CRC screening decision stage (SDS) were identified among participants who completed a baseline and follow-up survey. Methods. A total of 493 primary care patients who were 50 to 79 years of age, were eligible for CRC screening were randomized to a GERA Group (n=328) or a usual care Control Group (n=165). GERA Group participants underwent decision counseling about GERA, had a blood draw to assess CRC risk, and received risk feedback (modestly-elevated or average risk) based on the combined presence of SNPs 677C&amp;gt;T and/or 1298A&amp;gt;C of the methylenetetrahydrofolate reductase (MTHFR) gene and serum folate level. Participants received a CRC screening kit and completed a follow-up telephone survey. Univariable analyses and multivariable regression were performed to determine if baseline screening sociodemographic and lifestyle factors, knowledge, psychosocial factors, stress about CRC, SDS, and risk status predicted self-reported change in SDS. Results. Participants were: female (56%), white (61%), 50 to 59 years of age (66%), &amp;gt; high school education (71%), and married (55%). Overall, SDS was as follows: decided against (1%), undecided (11%), and decided to do (87%) screening. 38% of participants exhibited a positive change in SDS to a higher decision stage, including actual screening. Positive SDS change by study group was: GERA Group (39%) and Control Group (34%). Multivariable analyses for all participants showed that knowledge was a positive predictor (p=0.006) of SDS change, as were lower CRC stress and lower SDS (p=0.023 and p&amp;lt;0.001, respectively). 12% of GERA Group participants had an elevated risk for CRC. Positive SDS change in the GERA Group by risk status was: elevated risk (36%) and average risk (42%). In the GERA Group, knowledge was a positive, nonsignificant predictor (p=0.107) of SDS change, while lower CRC stress and lower SDS were significant positive predictors (p=0.038 and p&amp;lt;0.001, respectively). Conclusion. Exposure to GERA and feedback indicating modestly-elevated risk influenced change in SDS among participants who had greater knowledge about CRC screening, reported lower CRC stress, or had decided against about or were uncertain about CRC screening. Citation Format: Ronald E. Myers, Sharon Manne, Karen Ruth, James Cocroft, Randa Sifri, Barry Ziring, David Weinberg. Predictors of change in colorectal cancer screening decision stage among participants in a randomized, controlled trial of genetic and environmental risk assessment. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr CN03-01.

Changes in Student Motivation During Online Learning

Self-directed e-learning (SDEL) refers to electronic learning environments where there are often no peer learners or instructors regularly available. Past studies suggest that lack of time and lack of motivation are primary causes of learner attrition in online settings. However, little is known about what influences motivational change during SDEL. We surveyed 368 adult learners from both higher education and corporate settings who had used commercial SDEL products. Results from stepwise regression analysis indicated that the best predictors of motivation to begin SDEL were perceived relevance, reported technology competence, and age. The best predictors of motivation during SDEL were perceived quality of instruction and learning (e-learning is right for me) and motivation to begin. Motivation during SDEL was the best predictor of positive change in motivation, which in turn predicted learner satisfaction with SDEL. Instructional design principles for sustaining learner motivation in SDEL are identified from the findings of the present study.