Small-scale Intervention Research Articles

Spiritual sensitivity in the classroom: a teaching experiment in Finnish upper secondary religious education

The interest to research spirituality in the classroom has been constant over the last decade. However, empirical research into classroom pedagogy and the lived experience of religious education has been scarce. This study describes a small-scale intervention that aimed to promote students’ spiritual reflection in Finnish upper secondary school RE classes by using stimulating tasks. One class (N = 23) of upper secondary school students (16–18 years of age) participated in the study. Analysis of students’ responses after the silent reflection moments suggested that the tasks were successful in eliciting some level of spiritual reflection for most of the students. In this article, we describe the experiment and the content and nature of this reflection, as well as discuss the advantages and challenges of spiritually sensitive teaching methods in a classroom of heterogeneous worldviews.

DINO (Diet In Nutrients Out) – an integrated dietary assessment system

The current paper describes Diet In Nutrients Out (DINO), an integrated dietary assessment system incorporating dietary data entry and nutritional analysis within one platform for use in dietary assessment in small-scale intervention studies to national surveys. DINO contains >6000 food items, mostly aggregated composites of branded foods, across thirty-one main food groups divided into 151 subsidiary groups for detailed reporting requirements, with fifty-three core nutrient fields. MRC Human Nutrition Research (HNR), Cambridge, UK and MRC Keneba, Gambia. DINO is used across dietary assessment projects at HNR and MRC Keneba. DINO contains macro- and micronutrients as well as additional variables of current research and policy interest, such as caffeine, whole grains, vitamin K and added sugars. Disaggregated data are available for fruit, vegetables, meat, fish and cheese in composite foods, enabling greater accuracy when reporting food consumption or assessing adherence to dietary recommendations. Portion sizes are categorised in metric and imperial weights, with standardised portion sizes for each age group. Regular reviews are undertaken for portion sizes and food composition to ensure contemporary relevance. A training programme and a checking schedule are adhered to for quality assurance purposes, covering users and data. Eating context questions are integrated to record where and with whom the respondent is eating, allowing examination between these factors and the foods consumed. An up-to-date quality-assured system for dietary assessment is crucial for nutritional surveillance and research, but needs to have the flexibility to be tailored to address specific research questions.

Helping Vietnamese university learners to become more autonomous

Autonomy is an important educational goal in international universities in countries with Confucian heritage cultures, such as Vietnam. However, approaches taken to support autonomy can sometimes be limited by over-generalizations about culture, dependence on pre-packaged materials, and a focus on technical practice. This can result in the slow development of learner autonomy. We report on an attempt to stimulate autonomous practices among EAP learners in Vietnam. This collaborative action research first focused on discovering how learners perceived and experienced autonomy, with data collected through questionnaire and focus groups. Data were analysed and discussed with teachers, autonomy levels identified, and strong autonomy-supporting strategies selected for use. Priorities included developing goal setting and self-reflection. An independent learning journal that included focused autonomy-supporting tasks was developed, trialled, and evaluated. Although this was a small-scale intervention, it provided evidence that socially mediated support for autonomy can help Vietnamese university learners take greater control over their own learning.

Chimney stoves modestly improved indoor air quality measurements compared with traditional open fire stoves: results from a small-scale intervention study in ru

Background: Nearly half of the world’s population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. Ai...

Adaptation of an obesity intervention program for pediatric cancer survivors (NOURISH-T).

Pediatric cancer survivor (PCS) rates have increased dramatically over the past several decades. Despite increased survival, research now indicates that overweight/obesity rates among PCS are greater than that in the general pediatric population. This article outlines a five-phase pilot study for the purpose of adapting a comprehensive parent psycho-educational intervention (NOURISH) to address the specific issues that contribute to overweight/obesity in PCS. The pilot consisted of medical record review of body mass indices (BMIs) among PCS to determine prevalence of overweight/obesity, health care provider (HCP) focus groups, parent focus groups, parent interviews, and pilot of the proposed six-session intervention (NOURISH-T). Study findings indicated the following: (1) High rates of overweight/obesity in PCS; (2) A great need for intervention expressed by HCPs and parents; (3) Interest in such a program by parents; and (4) Implementation of a small-scale intervention in a clinic is likely feasible.

For U.S. biomes, climate change will decrease vegetative productivity

One recurrently forecast effect of global climate change is that, in general, precipitation patterns will become more extreme, with fewer, larger storms and longer dry spells in between. The aftermath of this shift, borne out by the effect the changing water availability will have on vegetative productivity, however, is less well known. Previous research showed that productivity changes with the total annual precipitation, but the measured effect of a shift to a more extreme distribution is less consistent. Research seeking to understand this aspect of the changing precipitation pattern question has typically been conducted through small‐scale or short‐duration intervention experiments, where the availability of rainwater is artificially manipulated. This makes extrapolating the research to other climes or biomes difficult.

‘It’s helped me with my anger and I’m realising where I go in life’: the impact of a Scottish youth work / schools intervention on young people’s responses to social strain and engagement with anti-social behaviour and gang culture

Moral panics relating to anti-social youth have accelerated in recent years, and there has been an increasing recognition that preventing problematic behaviour is more effective than sanctions once it occurs. Drawing upon General Strain Theory, this paper explores the social pressures that might stimulate anti-social behaviour and gang culture. It explores the impact of schools/youth work partnerships, focusing upon empirical data arising from a small-scale educational intervention involving vulnerable young people (aged 11–12) in Glasgow. The findings illustrate that the 35 young people who participated in the initiative gained an increase in social capital, changed their reactions to social strains and demonstrated a change in their self-reported participation in anti-social behaviour. However, the participants continued to view teachers and youth workers as two distinct groups with differing ideologies, and a collaborative ‘border-crossing’ pedagogy was never fully realised. The paper draws upon the insights to identify future implications for policy, practice and research.

Chimney stoves modestly improved Indoor Air Quality measurements compared with traditional open fire stoves: results from a small-scale intervention study in rural Peru

Nearly half of the world's population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. We compare carbon monoxide (CO) and particulate matter (PM2.5) exposures and kitchen concentrations in households with study-promoted intervention (OPTIMA-improved stoves and control stoves) in San Marcos Province, Cajamarca Region, Peru. We determined 48-h indoor air concentration levels of CO and PM2.5 in 93 kitchen environments and personal exposure, after OPTIMA-improved stoves had been installed for an average of 7 months. PM2.5 and CO measurements did not differ significantly between OPTIMA-improved stoves and control stoves. Although not statistically significant, a post hoc stratification of OPTIMA-improved stoves by level of performance revealed mean PM2.5 and CO levels of fully functional OPTIMA-improved stoves were 28% lower (n = 20, PM2.5, 136 μg/m(3) 95% CI 54-217) and 45% lower (n = 25, CO, 3.2 ppm, 95% CI 1.5-4.9) in the kitchen environment compared with the control stoves (n = 34, PM2.5, 189 μg/m(3), 95% CI 116-261; n = 44, CO, 5.8 ppm, 95% CI 3.3-8.2). Likewise, although not statistically significant, personal exposures for OPTIMA-improved stoves were 43% and 17% lower for PM2.5 (n = 23) and CO (n = 25), respectively. Stove maintenance and functionality level are factors worthy of consideration for future evaluations of stove interventions.

Using Rasch measurement theory to assess three depression scales among adults with epilepsy

People with chronic conditions, such as epilepsy, are at a high risk for depression; however depression is often under-recognized and undertreated. Depression scales, including one specific to people with epilepsy, have been used for screening in this population, although none have been assessed with Rasch measurement theory. This study used Rasch analyses in order to evaluate and compare the psychometric properties of the modified Beck Depression Inventory, the Patient Health Questionnaire, and the Neurological Disorders Depression Inventory for Epilepsy in a sample of people with epilepsy and depression who participated in an intervention designed to reduce depressive symptoms. A secondary purpose was to assess item functioning across time. The sample includes 44 participants in the Project UPLIFT program who completed the assessments before and after taking part in the intervention. Results of the Rasch analysis indicate that the three depression scales functioned as intended. There was good overall targeting between the items and the sample, acceptable model-data fit, and good reliability of separation for persons, items, and time. The participants experienced a significant decrease in depressive symptoms from pretest to posttest. This study illustrates the value of using model-based measurement with the Rasch model to combine items across the three depression scales. It also demonstrates an approach for analyzing and evaluating the results of small scale intervention programs, such as the UPLIFT program.

Obstacles and challenges in preservice teachers’ explorations with fractions: A view from a small-scale intervention study

In this study, we implemented one-on-one fractions instruction to eight preservice teachers. The intervention, which was based on the principle of Progressive Formalization ( Freudenthal, 1983), was centered on problem solving and on progressively formalizing the participants’ intuitive knowledge of fractions. The objectives of the study were to examine the potential effects of the intervention and to uncover specific difficulties experienced by the preservice teachers during instruction. Results revealed improvement on one measure of conceptual knowledge, but not on a transfer task, which required the teachers to generate word problems for number sentences involving fractions. In addition, the qualitative analysis of the videotaped instructional sessions revealed a number of cognitive obstacles encountered by the participants as they attempted to construct meaningful solutions and represent those solutions symbolically. Based on the findings, specific suggestions for modifying the intervention are provided for mathematics teacher educators.

Convergence at the surface; divergence beneath

In the UK school system social remits - requiring schools to work towards improved social as well as educational outcomes for children - have become significant over the last decade. This study focuses upon the inter-professional issues in the running of one small-scale intervention involving parents and their babies based in schools in an urban setting in the UK. The programme, run over the school year 2007/08, provided a professional framework in which parents from the local community surrounding a school brought their babies into classroom settings to talk about aspects of baby care and development. This professional framework included classroom teachers, one senior cross-school education manager, family health visitors and one senior children's health nurse. Despite agreement about the benefits of the programme there were also clear differences of priority. This paper describes the different perceptions that each of these two sets of professionals - from health and from education - had of the programme, and highlights some critical perspectives that tended to come more from health professionals. It also maps out potential solutions which draw upon recent literature that is similarly focused upon inter-professional and inter-agency service delivery. In so doing it offers valuable insights to professionals working in inter-agency collaborations in schools.

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

Chocolate: (un)healthy source of polyphenols?

There is recent epidemiological evidence that chocolate consumption may improve vascular health. Furthermore, several small-scale human intervention studies indicate that habitual chocolate intake enhances the production of vasodilative nitric oxide and may lower blood pressure. It is hypothesized that potential beneficial effects of chocolate on vascular health are at least partly mediated by cocoa polyphenols including procyanidins. Based on cell culture studies, molecular targets of chocolate polyphenols are endothelial nitric oxide synthetase as well as arginase. However, human bioavailability studies suggest that the plasma concentrations of cocoa polyphenols are manifold lower than those concentrations used in cultured cells in vitro. The experimental evidence for beneficial vascular effects of chocolate in human interventions studies is yet not fully convincing. Some human intervention studies on chocolate and its polyphenols lack a stringent study design. They are sometimes underpowered and not always placebo controlled. Dietary chocolate intake in many of these human studies was up to 100g per day. Since chocolate is a rich source of sugar and saturated fat, it is questionable whether chocolate could be recommended as part of a nutrition strategy to promote vascular health.

Flavanols and cardiovascular disease prevention

Diet is a major lifestyle factor in the primary and secondary prevention of numerous chronic diseases, including myocardial infarction, stroke, and diabetes. Epidemiological studies suggest that the beneficial cardiovascular health effects of diets rich in fruits and vegetables are in part mediated by their flavonoid content, with particular benefits provided by one member of this family, the flavanols. This concept is supported by findings from small-scale intervention studies with surrogate endpoints including endothelium-dependent vasodilation, blood pressure, platelet function, and glucose tolerance. Mechanistically, short-term effects on endothelium-dependent vasodilation following the consumption of flavanol-rich foods, as well as purified flavanols, have been linked to an increased nitric oxide bioactivity in healthy humans, and those with increased cardiovascular risk. The critical biological target(s) for flavanols have yet to be identified and the extent to which these acute results are important in the context of long-term human health is unknown. While flavanols represent a promising class of food components with respect to their ability to lower cardiovascular risk the flavanol-rich foods used in many trials have been poorly defined with respect to their flavanol content and flavanol-isomer profile; several studies have lacked appropriate controls, and the long-term randomized controlled intervention trials with flavanol-rich foods are missing. Thus, while the literature regarding flavanols and vascular health is encouraging, more in-depth and well-controlled clinical and experimental studies are needed to better define the potential protective vascular effects of these nutrients and their therapeutic value in cardiovascular medicine.

The potential contribution of small-scale intervention projects in the field to the national health information system for HIV and sexually transmitted infections: a case study of a multilevel intervention in Guatemala

Guatemala's efforts to fight sexually transmitted infections and HIV/AIDS are compromised by the lack of timely and accurate data. The strengthening of the national Monitoring and Evaluation system is key for a better understanding of the epidemics and the formulation of effective public health responses. This study assessed how health service providers in resource-poor countries can contribute indicators to national health authorities. Review of data sources produced by projects of a NGO harmonizing the identified indicators with national and international standards. During a field visit, they were validated with key stakeholders. Study results are 19 original and 13 harmonized indicators. Findings suggest that small-scale projects can contribute to the strengthening of national health information systems.

Mobilising a disadvantaged community for a cardiovascular intervention: designing PRORIVA in Yogyakarta, Indonesia

Introduction: Cardiovascular disease (CVD) is a burden for developing countries, yet few CVD intervention studies have been conducted in developing countries such as Indonesia. This paper outlines the process of designing a community intervention programme to reduce CVD risk factors, and discusses experiences with regard to design issues for a small-scale intervention.Design process: The design process for the present community intervention consisted of six stages: 1 a baseline risk factor survey, 2 design of a small-scale intervention by using both baseline survey and qualitative data, 3 implementation of the small-scale intervention, 4 evaluation of the small-scale intervention and design of a broader CVD intervention in the Yogyakarta municipality, 5 implementation of the broader intervention and 6 evaluation of the broader CVD intervention. According to the baseline survey, 60% of the men were smokers, more than 30% of the population had insufficient fruit and vegetable intake and more than 30% of the population were physically inactive, this is why a small-scale population intervention approach was chosen, guided both by the findings in the quantitative and the qualitative study.Experiences: A quasi-experimental study was designed with a control group and pre- and post-testing. In the small-scale intervention, two sub-districts were selected and randomly assigned as intervention and control areas. Within them, six intervention settings (two sub-villages, two schools and two workplaces) and three control settings (a sub-village, a school and a workplace) were selected. Health promotion activities targeting the whole community were implemented in the intervention area. During the evaluation, more activities were performed in the low socioeconomic status sub-village and at the civil workplace.

Self-investigation in adolescent chronic fatigue syndrome: Narrative changes and health improvement

Objective A small-scale intervention study into narrative self-investigation in adolescent chronic fatigue syndrome (CFS). Method The self-confrontation method (SCM) is an instrument to assess and change personal life stories. Forty-two adolescents diagnosed with CFS were included and randomly assigned to either 6 or 12 sessions with the SCM. Twenty-five healthy adolescents were assigned to 6 sessions. Outcome was measured directly after the self-investigation procedure at 4 months. Follow-up measurements were made 10 months later. The Checklist Individual Strength and the Child Health Questionnaire were used to measure changes in fatigue, physical and psychosocial functioning. Results Self-investigation resulted in significant changes in participants’ narratives. Moreover, after self-investigation there was a significant improvement in fatigue, physical and psychosocial functioning for the adolescents with CFS. The patients who completed 12 sessions improved most. At follow-up, the positive effects were maintained. Conclusion Self-investigation enables a move beyond the symptoms of CFS in an individualized, patient centered way. Narrative transformation seems to contribute to improved physical and psychosocial outcome in adolescent CFS. Practice implications The SCM allows adolescents to discover (for themselves) factors that might cause or perpetuate their fatigue. The results suggest that self-investigation is a useful instrument in the management of adolescent CFS.

Developing a ‘Semi-Systematic’ Approach to Using Large-Scale Data-Sets for Small-Scale Interventions: The ‘Baby Matterz’ Initiative as a Case Study

The appropriateness of using statistical data to inform the design of any given service development or initiative often depends upon judgements regarding scale. Large-scale data sets, perhaps national in scope, whilst potentially important in informing the design, implementation and roll-out of experimental initiatives, will often remain unused for small-scale interventions involving only small numbers of service users or participants. This can be the result of legitimate concerns regarding representativity and rigour. Whilst large data sets may allow for strong claims to made regarding trends and tendencies with the population, a small scale intervention involving perhaps only tens of participants will not offer the opportunity to devise developmental rationales that are supported by such statistical rigour. This creates a situation in which important pilot studies and ‘suck-it-and-see’ interventions are conducted in a basic empirical fashion that does not draw upon the informed reflection that large scale data makes possible. This article will argue that such a situation is not necessary. Through graduated and selective engagement with large-scale data sets it is possible to make good use of what they offer to inform the design and up-scaling of small pilot interventions. The discussion will focus on the case of a small intervention involving just nine parents and their babies conducted in Liverpool schools. More specifically it will consider the ways in which one national data-set, the UK Millennium Cohort Study (MCS), can be used to develop this project. It will do this by way of profiling the MCS in order to both select out those aspects that could or should not be used and those aspects that could be used beneficially to inform the development of the initiative. In the process it will devise a set of criteria that could usefully be adapted for use by others in relation to service situations in which similar issues of scalar mis-match between available data-sets and service design exist.

Psychological Intervention Following Implantation of an Implantable Defibrillator: A Review and Future Recommendations

The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current evidence on the efficacy of psychological intervention in ICD patients and recommendations for future research. We searched the PubMed and PsycInfo databases in the period between January 1980 and April 2007, using a set of a priori determined keywords. Based on the search and a hand search of the reference lists of the included articles, we identified nine studies that fulfilled the inclusion criteria. The majority of studies used a randomized controlled trial design, but studies varied considerably in sample size, response, attrition rate, and type of intervention. However, most interventions were multifactorial, using cognitive behavioral therapy as one of the mainstays of treatment. Overall, psychological interventions seem to have little impact on shocks and heart rate variability. Some studies found a decrease in depressive symptoms and gains in quality of life, but the most notable effects are seen in improved exercise capacity and reductions in anxiety. Effect sizes for changes in anxiety in the intervention group ranged from small to large compared to small in the usual care group, using Cohen's effect size index. Preliminary evidence from small-scale intervention trials suggests that psychological intervention is worthwhile in ICD patients. Nevertheless, large-scale, well-designed trials are warranted to substantiate these findings. A multifactorial approach using a cognitive behavioral component paired with exercise training is likely to be the most successful.

Development of schoolchildren's smoking habits: questionnaire studies in intervention and control groups

The objective of the present study was to describe the development of smoking from the sixth grade (age 12) to the eighth (age 14), for girls and for boys, and to study the effect of a simple anti-smoking intervention carried out in the sixth grade. All the roughly 2000 schoolchildren in Kronoberg County, born in 1982, completed an annual anonymous classroom questionnaire on smoking habits in the years 1994–96. In 1994, there were two visits, each lasting 80 min, by a campaigner from A Non-Smoking Generation to the 59 schools which opted for intervention, and no visits to the 21 schools which declined intervention. Before the intervention there were no differences in the frequency of smokers between the intervention group and the control group. In 2y the proportion of smokers then rose among the girls from 1% to 12% and among the boys from 2% to 7%. Two years after the intervention, the proportion of smokers in the intervention group was approximately two-thirds of that in the control group. When the statistical analysis was based on the individual pupils, the difference between the two groups was statistically significant, but if the schools were used as the unit of analysis, the result was non-significant. Even a small-scale intervention may have an effect on the development of smoking among schoolchildren, but other preventive measures in the schools probably also contributed to the positive development of smoking in the intervention group.