Intervention Group Members Research Articles

WEB-BASED INTERVENTION FOR MAORI UNIVERSITY STUDENTS WITH HAZARDOUS DRINKING: DOUBLE-BLIND, MULTI-SITE RANDOMISED CONTROLLED TRIAL

BackgroundLike many indigenous peoples, New Zealand Māori bear a heavy burden of alcohol-related harm relative to their non-indigenous compatriots, and disparities are greatest among young adults. We tested the effectiveness...

Nutrition Education Via a Touchscreen: A Randomized Controlled Trial in Latino Immigrant Parents of Infants and Toddlers

ObjectiveTo investigate whether educational modules presented on a touchscreen computer increase immediate nutrition and feeding knowledge in low-income, Spanish-speaking Latino immigrant parents. MethodsThis was a randomized controlled trial conducted in an urban pediatric clinic with a sample of low-income, Spanish-speaking Latino parents of children <3 years randomly assigned to the intervention (n = 80) and control groups (n = 80). Intervention group members viewed 5 modules on nutrition and feeding presented on an interactive platform using a touchscreen computer. Modules contained text, pictures, and audio. Content was drawn from Bright Futures Guidelines. The primary outcome was a parental total summed knowledge score based on correct responses to 19 questions related to module content. Domain-specific scores were also analyzed. ResultsIntervention and control groups did not differ on demographic characteristics. Participants were of varied Latino origins, mean age was 27.5 years, 41% reported a <7th grade education, and 65% reported that they rarely/never use a computer. Compared with the control group, the intervention group had a superior mean total summed knowledge score (72.3% vs 90.8%, P < .001). Mean domain-specific summed knowledge scores were also greater in the intervention arm compared with the control for all 5 domains. These results did not differ on the basis of participant education level. 71% (n = 57) of intervention arm participants planned to change something based on what they learned from the computer program, and 80% reported that they will (n = 49) or may (n = 15) talk to their child’s doctor about what they learned in the modules. ConclusionsResults of this pilot study add to the growing literature on the use of this technology for health education in low-income Latino immigrants. Despite low education levels and computer experience, findings suggest that immediate parental knowledge was enhanced supporting the need for a more rigorous evaluation of this technology and its impact on health behaviors.

Health Care Access Affects Attitudes About Health Outcomes and Decisions to Apply for Social Security Disability Benefits

This article reports on qualitative findings from a mixed methods study that explored the efficacy of providing enhanced health benefits and services to people with chronic health conditions to reduce their application rates to federal disability programs. Comparing an intervention and control group, the study found that those who received enhanced benefits had reduced health decline. To explore reasons for this reduction, authors conducted focus groups with a sample of participants from both groups. Four themes emerged: (a) Due to the effects of their conditions, most participants believed their health would worsen over time; (b) Intervention group members said their health deterioration would be slowed or prevented, while control group members worried about more rapid decline and the future; (c) Intervention group members related their beliefs about continued health to their ability to access care; (d) Control group members were more likely than intervention group members to indicate they applied or were interested in applying for social security disability benefits. These themes suggest that people who believe they have access to quality health care feel their health can and will improve over time. If health care reform leads to the availability of more comprehensive coverage for people with potentially disabling conditions, growth in federal disability programs may slow.

Examining the Effect of Microcredit on Poverty in Malaysia

This study employs a cross-sectional design with stratified random sampling method to examine if the microcredit programme of the Amanah Ikhtiar Malaysia (AIM) improves the income of hardcore poor households. This study uses a quasi-experimental approach and selected control and treatment group members from AIM’s client’s base — new and old clients respectively. It is evident that the AIM’s microcredit programme increased the household’s income and reduced the poverty rate among their hardcore poor clients in Peninsular Malaysia. Findings of the study indicate the effectiveness of microcredit in eradicating poverty. This programme should, therefore, focus on diversifying their products and services in order to increase outreach and decrease inactive borrowers and dropouts.

The Pitfalls of Work Requirements in Welfare-to-Work Policies: Experimental Evidence on Human Capital Accumulation in the Self-Sufficiency Project

This paper investigates whether policies that encourage recipients to exit welfare for full-time employment influence participation in educational activity. The Self-Sufficiency Project (‘SSP’) was a demonstration project where long-term welfare recipients randomly assigned to the treatment group were offered a generous earnings supplement if they exited welfare for full-time employment. We find that treatment group members were less likely to upgrade their education along all dimensions: high-school completion, enrolling in a community college or trade school, and enrolling in university. Thus, ‘work-first’ policies that encourage full-time employment may reduce educational activity and may have adverse consequences on the long-run earnings capacity of welfare recipients. We also find that there was a substantial amount of educational upgrading in this population. For instance, among high-school dropouts at the baseline, 19% completed their diploma by the end of the demonstration. Finally, we simulate the consequences of the earnings supplement in the absence of adverse effects on educational upgrading. Doing so alters the interpretation of the lessons from the SSP demonstration.

A comprehensive strategy for dementia from primary prevention to end‐stage management

A comprehensive strategy for dementia from primary prevention to end‐stage management

Effect of Salt Reduction Intervention Program Using an Electronic Salt Sensor and Cellular Phone on Blood Pressure Among Hypertensive Workers

We investigated the effectiveness of a workplace intervention program that utilized self-monitoring of daily salt excretion by an electronic salt sensor and sent personalized e-mail advice via cellular phone. Forty-one hypertensive male workers were assigned to intervention and control groups, then counseled together. Intervention group members were asked to measure daily salt excretion and received e-mail advice. After 4 weeks, a greater decrease of blood pressure (BP) was observed in the intervention group, with significant reductions to daily salt excretion and home BP. The new intervention program is considered useful for BP control among hypertensive workers.

Building Family Partnerships: The Journey From Preservice Preparation to Classroom Practice

This study reports the relationship of an undergraduate course in family and community relations to the teaching practices of 1st-, 2nd-, and 3rd-year elementary and early childhood education graduates of a mid-sized Midwestern university. Sixty students were surveyed using the Peabody Family Involvement Survey (Katz & Bauch, 1999), with a treatment group (n = 21) having taken the course, and a control group (n = 39) who did not, in order to both quantify and qualify a difference in practices based on preservice preparation. Quantitative measures indicated minimal differences between groups. Qualitatively, however, treatment group members reported engaging families in creative, less standardized levels of involvement than members of the control group. Treatment group members articulated a theoretical and practical understanding of the benefits of family involvement. They emphasized importance of collaboration between home and school, while control group members expressed frequent antagonism and ambivalence toward families.

Effects of Individual Development Accounts on Asset Purchases and Saving Behavior: Evidence from a Controlled Experiment

We evaluate the first controlled field experiment on Individual Development Accounts (IDAs). Including their own contributions and matching fund, treatment group members in the Tulsa, Oklahoma program could accumulate $6,750 for home purchase or $4,500 for other qualified uses. Almost all treatment group members opened accounts, but many withdrew all funds for unqualified purposes. Among renters at the beginning of the experiment, the IDA increased homeownership rates after 4 years by 7-11 percentage points and reduced non-retirement financial assets by $700-$1000. The IDA had almost no other discernable effect on other subsidized assets, overall wealth or poverty rates.

The Impact of Proactive Chronic Care Management on Hospital Admissions in a German Senior Population

An increase in chronic disease prevalence is contributing to health care cost growth and decreased quality of life in industrialized nations worldwide. Inadequate management of chronic diseases is a leading cause of hospitalizations and, thus, avoidable expenditures. In this study, we evaluated the impact of nurse-delivered care calls, the primary intervention of a proactive chronic care management (CCM) program, in a population aged 65 and older in Germany. In this analysis, hospital admission rates were evaluated among program enrollees who were diagnosed with diabetes, heart failure, coronary heart disease, or chronic obstructive pulmonary disease. The Intervention group comprised those members who participated in care calls (n=13,486), whereas the Comparison group included enrollees who did not participate in these calls (n=4,582). Changes in admission rates were calculated between the year prior to and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, a 6.0% decrease in admissions was observed among Intervention group members compared with an 18.9% increase among Comparison group members (P ≤ 0.0001). This decrease in admissions was driven by participants with the highest levels of risk. In addition, a dose-response relationship was observed in which admissions decreased with an increased number of care calls (P=0.0001). These results indicate that proactive CCM interventions are effective in reducing hospital admission rates in a senior population with chronic disease.

Examining heterogeneity in residual variance to detect differential response to treatments.

Individual differences in response to treatments have been a long-standing interest in education, psychology, and related fields. This article presents a conceptual framework and hierarchical modeling strategies that may help identify the subgroups for whom, or the conditions under which, a particular treatment is associated with better outcomes. The framework discussed in this article shows how differences in residual dispersion between treatment and control group members can signal omitted individual characteristics that may interact with treatments (Bryk & Raudenbush, 1988) and sensitizes us to individual- and cluster-level confounders of inferences concerning dispersion in quasi-experimental studies in multilevel settings. Based on the framework, hierarchical modeling strategies are developed to uncover interactions between treatments and individual characteristics, which are readily applicable to various settings in multisite evaluation studies. These strategies entail jointly modeling the mean and dispersion structures in hierarchical models. We illustrate the implementation of this framework through fully Bayesian analyses of the data from a study of the effectiveness of a reform-minded mathematics curriculum.

Life History Collages

This study evaluated the effects of person-centered life history collages on nursing staff knowledge about individual residents living with dementia and staff perceptions of individualized care practices. Thirty-six nursing staff participants (18 experimental and 18 control) who cared for 5 residents with dementia in two nursing homes were recruited. Intervention staff members were exposed to life history collages for 4 weeks. Pretest and posttest data were analyzed using multivariate analysis of covariance and analysis of covariance. While intervention group members' knowledge of residents' family, jobs/careers, and likes/dislikes/interests improved significantly at posttest, F(3, 26) = 6.80, p < 0.01, and at 3 weeks postintervention, F(3, 23) = 9.85, p < 0.001, perceptions of individualized care/person-centered care practices did not. Potential reasons for this lack of improvement are identified and discussed. Directions for future research are also provided.

The Impact of Postdischarge Telephonic Follow-Up on Hospital Readmissions

Abstract Recurrent hospitalizations are responsible for considerable health care spending, although prior studies have shown that a substantial proportion of readmissions are preventable through effective discharge planning and patient follow-up after the initial hospital visit. This retrospective cohort study was undertaken to determine whether telephonic outreach to ensure patient understanding of and adherence to discharge orders following a hospitalization is effective at reducing hospital readmissions within 30 days after discharge. Claims data were analyzed from 30,272 members of a commercial health plan who were discharged from a hospital in 2008 to determine the impact of telephonic intervention on the reduction of 30-day readmissions. Members who received a telephone call within 14 days of discharge and were not readmitted prior to that call comprised the intervention group; all other members formed the comparison group. Multiple logistic regression was used to determine the impact of the intervention on 30-day readmissions, after adjusting for covariates. Results demonstrated that older age, male sex, and increased initial hospitalization length of stay were associated with an increased likelihood of readmission (P < 0.001). Receipt of a discharge call was associated with reduced rates of readmission; intervention group members were 23.1% less likely than the comparison group to be readmitted within 30 days of hospital discharge (P = 0.043). These findings indicate that timely discharge follow-up by telephone to supplement standard care is effective at reducing near-term hospital readmissions and, thus, provides a means of reducing costs for health plans and their members.

An analysis of the impact of the self-sufficiency project on wages

We measure the impact of the Self-Sufficiency Project (a randomized welfare-to-work experiment in Canada; henceforth, SSP) on relative wage progression. SSP provided a generous 3-year earnings supplement to treatment group members who found a full-time job within a year of the start of the experiment (take-up group). We estimate the treatment on the treated for two sub-groups of the take-up group: the incentivized and non-incentivized groups. Using an econometric model of wage determination, we find evidence of large and significant relative wage progression of approximately 9 percentage points during the 3-year supplement period for the incentivized group. The impact for the non-incentivized group is much smaller (at most 3 percentage points). There is also some limited information that the non-incentivized group in New Brunswick and the incentivized groups in both New Brunswick and British Columbia continued to work more after the 3-year supplement period ended.

Skills Training to Support Patients considering place of End-Of-Life Care: A Randomized Control Trial

The effect of a program to train clinicians to support patients making decisions about place of end-of-life care was evaluated. In all, 88 oncology and/or palliative care nursing and allied health providers from three Ontario health networks were randomly assigned to an education or control condition. Quality of decision support provided to standardized patients was measured before and after training, as were participants' perceptions about the acceptability of the training program and their intentions to engage in patient decision support. Compared to controls, intervention group members improved the quality of decision support provided and were more likely to address a wider range of decision-making needs. Intervention group members scored higher on a knowledge test of decision support than controls and rated the components as acceptable. Improvements in the quality of decision support can be made by providing training and practical tools such as a patient decision aid.

Reducing Six-Month Inpatient Psychiatric Recidivism and Costs Through Case Management

The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program. The six-month recidivism rate for BG members was 49.67% compared to 22.07% among IG members. Forward stepwise regression results indicated a significant main effect for the ICM intervention on inpatient psychiatric costs. Inpatient psychiatric costs for the six-month outcome period were $4,982.90 lower per member in the IG group. Additional models demonstrated that the ICM intervention was associated with significantly lower inpatient substance abuse costs and psychiatric emergency department costs. There were no statistically significant increases in utilization associated with the ICM intervention. After factoring in program costs, it is estimated that the ICM services contributed to almost $1,500,000 in cost savings over the six-month outcome period. The ICM intervention was associated with significant reductions in inpatient, psychiatric six-month readmission rates and associated costs among adult members who are at elevated risk of inpatient, psychiatric recidivism. The intervention, enrollment process, and measurement strategies can be adapted for use by health plans looking to reduce psychiatric costs.

Effect of informational internet web pages on patients’ decision‐making: randomised controlled trial regarding choice of spinal or general anaesthesia for orthopaedic surgery

This study explored whether patients' preference for particular types of anaesthesia could be influenced pre-operatively by giving them the addresses of various relevant websites. Patients at an orthopaedic pre-assessment education clinic completed a questionnaire, which included a short multiple-choice general knowledge quiz about anaesthesia, and also questioned them as to their choice of anaesthesia (general or neuraxial). Patients were randomly assigned to intervention or control groups. Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home. All patients were asked to complete the questionnaires on a second occasion, before surgery. Initially, most patients stated a preference for general anaesthesia. Subsequently, the intervention group altered their preference towards neuraxial anaesthesia compared to the control group (p < or = 0.0001). The increase in median (IQR [range]) anaesthesia knowledge test score was greater in the intervention group (from 10.0 (9.0-12.0 [5.0-14.0]) to 13.0 (11.0-14.0 [6.0-14.0])) than in the control group (from 10.0 (9.0-11.5 [3.0-13.0]) to 11.0 (9.0-12.0 [4.0-14.0]); p = 0.0068).

Reducing burnout in mothers with an intellectually disabled child: an education programme

This paper is a report of a study conducted to examine the effect of participating in an education program on burnout for mothers of children with an intellectual disability. Mothers with an intellectually disabled child are prone to suffer from excessive stress and burnout. There is limited evidence for the effectiveness of education interventions aimed at reducing burnout levels in this population. After baseline screening, mothers who agreed to participate (n = 90) were randomized to an intervention or control group. The intervention group participated in an interactive education programme for 1 hour, in addition to using an educational booklet designed and presented by the researchers. The booklet contained information about the characteristics of intellectually disabled children, the specific health care and education they require, non-profit organizations and foundations providing assistance, and ways in which mothers can cope with stress. The control group received the same intervention separately after completing the post-test. The study was carried out from 2004 to 2005. Intervention group members reported fewer episodes of emotional burnout compared to the control group, indicating that participation in a nursing education programme reduced the level of burnout experienced by mothers who have an intellectually disabled child. There were no effects of the education programme on perceptions of personal success, i.e. mother's feelings of competence and successful achievement in care of their intellectually disabled child. Nurse-administered education should be provided for mothers who have an intellectually disabled child in order to reduce the degree of emotional burnout that these mothers typically experience.

Diabetes Disease Management Results in Hispanic Medicaid Patients

To investigate outcomes of a telephonic nursing disease management program for Medicaid patients with diabetes residing in Puerto Rico. A 12-month, matched-cohort study. Four hundred and ninety (490) intervention group members matched to 490 controls. Disease management diabetes program. For those in the intervention group, the disease management program customized a self-management intervention plan. Medical service utilization, including hospitalizations, emergency department visits, physician evaluation and management visits, selected clinical indicators, and financial impact. The intervention group showed significant effects compared with the control group, including a 48% reduction in inpatient bed days, and a 23% increase in ACE inhibitor use, resulting in a return on investment estimate of 3.8:1. The study demonstrates that a nursing disease management program for diabetes can significantly improve hospitalizations, drug compliance, and vaccinations in a Hispanic Medicaid population.

MassBuilt: effectiveness of an apprenticeship site-based smoking cessation intervention for unionized building trades workers

ObjectiveBlue-collar workers are difficult to reach and less likely to successfully quit smoking. The objective of this study was to test a training site-based smoking cessation intervention.MethodsThis study is a randomized-controlled trial of a smoking cessation intervention that integrated occupational health concerns and was delivered in collaboration with unions to apprentices at 10 sites (n = 1,213). We evaluated smoking cessation at 1 and 6 months post-intervention.ResultsThe baseline prevalence of smoking was 41%. We observed significantly higher quit rates in the intervention versus control group (26% vs. 16.8%; p = 0.014) 1 month after the intervention. However, the effects diminished over time so that the difference in quit rate was not significant at 6 month post-intervention (9% vs. 7.2%; p = 0.48). Intervention group members nevertheless reported a significant decrease in smoking intensity (OR = 3.13; 95% CI: 1.55–6.31) at 6 months post-intervention, compared to controls.ConclusionThe study demonstrates the feasibility of delivering an intervention through union apprentice programs. Furthermore, the notably better 1-month quit rate results among intervention members and the greater decrease in smoking intensity among intervention members who continued to smoke underscore the need to develop strategies to help reduce relapse among blue-collar workers who quit smoking.