Two-part Intervention Research Articles

Developing and Testing a Two-Part Intervention: Enhancing Dementia Instruction and Tool in Home Hospice Care.

Family care partners (FCP) of persons living with dementia provide extensive care and experience significant stress. Hospice nurses and social workers seldom receive training to help FCP. This article describes the development and pilot testing of Enhancing Dementia Instruction and Tool in Home Hospice Care (EDITH-HC). This intervention provides 1) instructional videos for clinicians about dementia-specific end-of-life care and 2) a worksheet for clinicians and FCP to complete together to identify and address FCP stressors and concerns. EDITH-HC development involved co-developing and revising draft intervention materials based on two rounds of structured input from FCP (n = 10), hospice nurses and social workers (n = 5), and research/content experts (n = 4); and a single-arm pilot test of the intervention to assess initial feasibility and acceptability (n = 13). Initial pilot testing indicates the intervention is feasible and acceptable. A larger randomized pilot study to determine feasibility and acceptability is underway.

Improving verbal communication for oncology patients who self-identify as having low/marginal health literacy.

177 Background: Within our academic oncology institute, patient’s health-related social needs (HRSN) are identified through the new patient intake questionnaire (NPIQ). 28% (n=2787) of patients who completed the NPIQ (n=9836) reported low/marginal health literacy (HL). While reviewing the HRSN data, it was discovered that there was no formal process to support patients who reported having low/marginal HL. While printed and online health materials use standard reading levels, verbal communications are not individualized to patients’ literacy needs. As an integral member of the interdisciplinary team, Oncology Nurse Navigators (ONNs) communicate vital and complex health information with patients throughout the cancer continuum. This quality improvement project explored the impact ONNs could have with patients who self-identify as having low/marginal HL. Methods: To assess ONN HL knowledge and communication strategies for patients with low/marginal HL, a survey was conducted in March 2024. Findings revealed a HL knowledge gap across all disease programs. For project manageability, our team piloted HL interventions to the sarcoma disease group where 33% of patients (n=223) responded to the NPIQ as having low/marginal HL. Two-part intervention included: 1) creation of a HL training and tools for ONNs (e.g., teach-back method; scripting; reference materials) and 2) development of Epic Smartphrase acknowledging training and tools were utilized. Results: To understand ONNs knowledge of where to find patient HL score in Epic, we conducted a survey (n=69; response rate=43%). 94% of ONNs reported not knowing where to access HL information. The first intervention was training-based. ONN trainings (n=2) were held from 3/12/2024 to 5/14/2024. At baseline, 0% of ONNs (n=4) used HL tools, as they were not in existence. At first reassessment, 75% of ONNs reported using the HL tools to communicate with patients. Part two of the intervention (in-progress) is the creation of a Smartphrase to document when ONNs altered patient communication. Data on Smartphrase usage are forthcoming. Conclusions: Providing HL training and tools to ONNs equips them to 1) identify patients who have low/marginal HL, and 2) conduct conversations with patients at an appropriate literacy level.

Using digital communication tools to improve interprofessional collaboration and satisfaction in a student-run free clinic.

Interprofessional collaboration can improve the quality of care in complex health conditions often seen in underserved populations. Communication is key to effective collaboration, and digital communication tools can enhance information sharing, collaboration, and satisfaction between professionals, especially when teams are distanced. In a semirural student-run free clinic that provides care to uninsured and underinsured patients with multifaceted health issues, there is a gap in communication and collaboration across interprofessional teams because of the frequent rotation of various staff, part-time hours, and electronic health record (EHR) function and interoperability limitations. The aim of this nurse practitioner-led quality improvement project was to determine whether implementing digital communication tools could enhance communication and improve provider collaboration and satisfaction during clinical decision-making among the several interprofessional teams at the student-run free clinic. Digital communication tools were implemented in a two-part intervention: (1) virtual case conferences to discuss patient care plans and (2) an EHR-linked tool to document the care plans. Survey evaluation across six virtual case conferences found above-average ratings for collaboration, satisfaction, and usability of the EHR-linked tool. There was a 15.78% improvement in global collaboration from the first to third conference, with a sustained improvement of 11.49%. Satisfaction improved by 4.62% from the first to the fourth conference. Digital communication tools can facilitate efficient communication and collaboration among staff while providing a more streamlined approach to patient care. These technologies can be useful in similar settings, especially when teams are distanced.

Work Will Not Save Us: An Asian American Crip Manifesto

Drawing together disability justice, Asian American studies, and feminist/ queer-of-color labor analysis, this collaboratively authored essay forwards an anti-work manifesto shaped by our lived experiences as sick, disabled and queer Asian American scholars laboring in the academic-industrial complex. This essay offers a two-part intervention: first, it aims to expand nascent conversations on disability politics and its relationship to racial capitalism, and second, it puts forth a critique of the Asian American emphasis on achievement as an instrument of belonging and potential inoculation against racialized violence. It also unfolds in two parts: first, a section on why we refuse work, and second, a section on how to perform this refusal.
 
 As we come to this essay from our respective positionalities in contingent, tenure-stream, and tenured academic loci, as well as from our shared investments in feminist and queer frameworks, the first section mobilizes feminist and queer disability analysis to interrogate the fraught investments in work shared across Asian American and Disability Studies, addressing the complexities of gendered, contingent, care, and service work within the academic landscape (and particularly as we have experienced them). The second section offers a survival guide for navigating the labor demands placed on racialized, queer, and/ or disabled scholars, channeling Asian American rage to move beyond saying “no” and toward saying “fuck off.”

An Overview of the CRoME Lab's MedSMA℞T Families Intervention for Promoting Opioid Medication Safety among Adolescents and Parents.

As the opioid epidemic unrelentingly places profound weight on pharmacists, youth, parents, and the nation at large, innovative interventions are critical to prevent potential misuse and untimely death. Adolescents are especially vulnerable to misuse behaviors due to knowledge, attitudinal, and social influences. To best resonate with adolescents, appropriate tools and technologies must be developed and deployed. Few educational tools are more ubiquitous to adolescents than video games. Video games, specifically serious games, have the potential to connect with adolescents and impart critical knowledge related to opioid safety. Engaging youth, parents, and pharmacists in the design, refinement, and evaluation of a serious game is novel and necessary for building a robust, efficacious game. This commentary describes the conceptualization, inception, development, and evaluation of a novel opioid medication safety intervention, MedSMA℞T Families. This two-part intervention is comprised of an adolescent-tailored serious game entitled MedSMA℞T: Adventures in PharmaCity, and a family-focused tool named the personalized Family Medication Safety Plan. This intervention is the first theory-based, family-focused opioid medication safety toolkit co-designed by an interdisciplinary team of researchers, game developers, behavioral health scientists, pharmacists, student pharmacists, addiction medicine physician, adolescent health physician, parents, and teens. Responses from key stakeholders (pharmacists, parents, and teens) have demonstrated positive attitudes and impressions towards both components of the MedSMA℞T Families intervention. Empirical evidence of efficacy from two separate studies denotes improvement in key concepts related to safe behavior in adolescents. Findings to date support the widespread use, implementation, and dissemination of this efficacious intervention to supporting safe opioid prescription practices in families with adolescents. In this paper, we outline and summarize our process of intervention development and use of longitudinal data to validate each step of our process. Future directions include mobile compatibility, refinement based on key stakeholder feedback, and dissemination in various clinical settings where opioid medications are prescribed and dispensed such as emergency departments, pharmacies, hospitals, and clinics.

79 Exploring Wayfinding Challenges in the Paediatric Emergency Department Using a Human-centred Design Approach

Abstract Background Wayfinding is defined as the way people orient themselves in and navigate a physical space. Wayfinding systems may include cues in the built environment, printed information and signage, and human interactions (1). The unfamiliar environment and processes of the paediatric emergency department (ED) can cause increased patient and caregiver stress, anxiety, and dissatisfaction with the healthcare system (2). Even though improved wayfinding can improve trust, communication, and patient safety (3,4), it has been a longstanding challenge in the ED. This challenge was magnified during the COVID-19 pandemic, as the ED had to create temporary rooms and waiting areas to accommodate higher patient volumes and social distancing. Objectives The aim of this project was to explore wayfinding challenges in the paediatric ED and use a human-centred design approach to create an improved wayfinding system. Design/Methods We followed a human-centred design methodology (5,6). Three site visits were conducted to observe the workflow of the paediatric ED. Semi-structured and unstructured interviews were conducted in-person with key stakeholders and subject matter experts, including flow support staff, information and registration clerks, physicians, triage and bedside nurses, and security staff. We synthesized the data using content analysis. The objective of the analysis was to transform themes into actionable design opportunities (7). Themes were used to guide ideation sessions with the research team. Results There were specific gaps in wayfinding and common points of confusion for caregivers, including the lack of any map, lack of standardized naming and colour-coding for certain ED locations, unintuitive naming for key locations, cluttered and contradictory or absent signage, and a lack of accessible information for patients who may have visual impairments or reduced English language proficiency. Specific areas of challenge included the triage and line up process, the location of bathrooms, and understanding the process of the ED visit. To address these challenges, our team followed an iterative approach of ideation and creating a low-fidelity prototype of a wayfinding system using visual mock-ups. We also created a map of the ED, signage for the entrance, a journey map (see Figure 1, below) and an informational pamphlet for families. Conclusion Wayfinding is an important part of the care experience for children and their families. Many stakeholders validated that patient flow in the ED needed improvement and that the pandemic had further exacerbated existing challenges. Next steps include implementing our wayfinding solution and evaluating its impact. Figure 1. Journey Map REFERENCES 1. Madson M, Goodwin K. Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department. HERD. 2021 Oct;14(4):429-441. 2. Maqbool T, Raju S, In E. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic. BMJ Qual Improv Rep. 2016 Jan 14;5(1):u209473.w3887. 3. Zamani Z. Effects of Emergency Department Physical Design Elements on Security, Wayfinding, Visibility, Privacy, and Efficiency and Its Implications on Staff Satisfaction and Performance. HERD. 2019 Jul;12(3):72-88. 4. Naccarella L, Raggatt M, Redley B. The Influence of Spatial Design on Team Communication in Hospital Emergency Departments. HERD. 2019 Apr;12(2):100-115. 5. Bubric K, Harvey G, Pitamber T. A User-Centered Approach to Evaluating Wayfinding 00Systems in Healthcare. HERD. 2021 Jan;14(1):19-30. Journal Of Library User Experience 6. Lorusso L, Lee JH, Worden EA. Design Thinking for Healthcare: Transliterating the Creative Problem-Solving Method into Architectural Practice. HERD. 2021;14(2):16-29. 7. Thomas DR.. A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation 2006;27(2):237-246.

Toward more accurate documentation in neurosurgical care.

Accurate clinical documentation is foundational to any quality improvement endeavor as it is ultimately the medical record that is measured in assessing change. Literature on high-yield interventions to improve the accuracy and completeness of clinical documentation by neurosurgical providers is limited. Therefore, the authors sought to share a single-institution experience of a two-part intervention to enhance clinical documentation by a neurosurgery inpatient service. At an urban, level I trauma, academic teaching hospital, a two-part intervention was implemented to enhance the accuracy of clinical documentation of neurosurgery inpatients by residents and advanced practice providers (APPs). Residents and APPs were instructed on the most common neurosurgical complications or comorbidities (CCs) and major complications or comorbidities (MCCs), as defined by Medicare. Additionally, a "system-based" progress note template was changed to a "problem-based" progress note template. Prepost analysis was performed to compare the CC/MCC capture rates for the 12 months prior to the intervention with those for the 3 months after the intervention. The CC/MCC capture rate for the neurosurgery service line rose from 62% in the 12 months preintervention to 74% in the 3 months after intervention, representing a significant change (p = 0.00002). Existing clinical documentation habits by neurosurgical residents and APPs may fail to capture the extent of neurosurgical inpatients with CC/MCCs. An intervention that focuses on the most common CC/MCCs and utilizes a problem-based progress note template may lead to more accurate appraisals of neurosurgical patient acuity.

Patient responses to weekly electronic patient-reported outcomes.

182 Background: Home-based symptom monitoring using patient reported outcomes has been shown to reduce symptom burden and hospitalizations, while improving quality of life and overall. The primary goal of this study was to evaluate the early feasibility of home-based symptom monitoring. Methods: This prospective single-arm pilot study evaluated a two-part education and technology intervention (home-based symptom monitoring) for clinicians treating Multiple Myeloma (MM) and Acute Myeloid Leukemia (AML) patients. Inclusion criteria included patients ≥ 60 who were anticipating a treatment decision. Participants completed a baseline survey and then enrolled into the PROmpt® symptom monitoring platform, which used text or email to prompt weekly symptom surveys. Patients receive an auto-generated self-management plan based on electronic patient reported outcomes (ePRO). If severe symptoms were reported (score of > 7/10), alerts were sent to clinical nurses. Outcomes for this study included proportion of patient approach who agreed to participate, patient completion rates (completion of weekly surveys), compliance rate (completion of total surveys), number of alerts generated, and type of alert. Feasibility was defined as a completion rate of > 70%. Results: Between September 1, 2020 –May 19, 2021; 114 patients were screened, 77 were approached, and 35 were enrolled (18) MM, (17) AML patients. Of non-participants, 11 were not seeking care at the institution, 10 patients were uninterested or did not have a smartphone, 9 patients were ineligible, and 9 were unsure and left with information about the study, 3 declined enrollment. The majority (80%) or participants were ages 60-74; 20% of patients were ages 75+. Over the 13-week period, AML patients completed 195/220 (compliance rate of 89%). The average completion rate was 92%. For MM, 192/233 surveys were completed (82% compliance rate). The average completion rate was 94%. For AML, 9 was the average number of completed surveys and the average number for MM was 8. Over 3 months, there were 294 moderate to severe alerts generated for AML and MM patients. For AML patients, there were 40 fatigue, 25 constipation, 21 pain, 17 decreased appetite, 11 insomnia, 11 rash, 6 anxiety, 7 dyspnea/cough, 7 diarrhea, 5 depression/sadness, 4 nausea/ vomiting, 4 mouth/ throat sores, 3 neuropathy, 3 fever, and 2 alerts for other symptoms. Within a 3 month time span for MM patients, there was 35 pain, 21 constipation, 18 fatigue, 11 rash, 10 neuropathy, 9 anxiety, 7 insomnia, 6 depression/sadness, 4 decreased appetite, 4 other symptom, and 1 nausea/vomiting alert. Conclusions: This study demonstrated early feasibility with over 80% of patient completing their surveys with a high compliance rate. Future analysis will include both final implementation outcomes as well as patient outcomes for all patients within the study.

Cost talk: protocol for a stepped-wedge cluster randomized trial of an intervention helping patients and urologic surgeons discuss costs of care for slow-growing prostate cancer during shared decision-making

BackgroundCosts of care are important to patients making cancer treatment decisions, but clinicians often do not feel prepared to discuss treatment costs. We aim to (1) assess the impact of a conversation-based decision aid (Option Grid) containing cost information about slow-growing prostate cancer management options, combined with urologic surgeon training, on the frequency and quality of patient-urologic surgeon cost conversations, and (2) examine the impact of the decision aid and surgeon training on decision quality.MethodsWe will conduct a stepped-wedge cluster randomized trial in outpatient urology practices affiliated with a large academic medical center in the USA. We will randomize five urologic surgeons to four intervention sequences and enroll their patients with a first-time diagnosis of slow-growing prostate cancer independently at each period. Primary outcomes include frequency of cost conversations, initiator of cost conversations, and whether or not a referral is made to address costs. These outcomes will be collected by patient report (post-visit survey) and by observation (audio-recorded clinic visits) with consent. Other outcomes include the following: patient-reported decisional conflict post-visit and at 3-month follow-up, decision regret at 3-month follow-up, shared decision-making post-visit, communication post-visit, and financial toxicity post-visit and at 3-month follow-up; clinician-reported attitudes about shared decision-making before and after the study, and feasibility of sustained intervention use. We will use hierarchical regression analysis to assess patient-level outcomes, including urologic surgeon as a random effect to account for clustering of patient participants.DiscussionThis study evaluates a two-part intervention to improve cost discussions between urologic surgeons and patients when deciding how to manage slow-growing prostate cancer. Establishing the effectiveness of the strategy under study will allow for its replication in other clinical decision contexts.Trial registrationClinicalTrials.govNCT04397016. Registered on 21 May 2020

Color Coding the "Labyrinth": How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department.

We report a two-part wayfinding intervention, considering four quality criteria (visibility, usability, efficiency and overall effectiveness) from staff perspectives. Few studies to date have explored wayfinding in the Emergency Department (ED). Yet, as ED usage continues to grow, effective wayfinding in these high-stress, fast-paced environments is likely to become increasingly important. At an adult ED located in the U.S. Southeast, wayfinding has been a persistent problem. We subsequently developed a two-part wayfinding intervention: colored routes to key destinations in the ED and corresponding visitor badges. Quality criteria were formulated using the Donabedian model: visibility (structure), usability (process), efficiency (process), and overall effectiveness (outcome). Assessments consisted of staff surveys, which were distributed from March to early April 2019. The strong ratings across quality criteria, added to affirmative comments from staff, provide evidence that the color coding system made a positive impact on wayfinding. While the results should be generalized with caution, the two-part intervention may be highly portable to other contexts. Future studies might examine the effect of colored routes alone. They might illuminate relations between structure, process, and outcomes as they relate to the assessment of wayfinding. They might also expand wayfinding quality criteria. Ultimately, such studies should improve not only the productivity but also the accessibility and user experience of the ED.

Accountability in Intervention Research: Developing a Fidelity Checklist of a Mental Health Intervention in Prisons.

Adherence to intervention content and delivery protocols is vital in establishing the efficacy of treatment programs for mental illnesses. Using a fidelity tool during interventions can substantially increase the likelihood of clients receiving the most scientifically rigorous treatment. This article outlines the steps taken to develop a fidelity checklist to measure treatment adherence of a two-part intervention delivered in a prison setting. Researchers followed the five-step guide by Feely et al. (Child and Adolescent Social Work Journal, 35(2), 139-152: 2018) and describe the process of developing a fidelity tool to measure treatment adherence to a newly adapted CBT-based intervention designed to maximize uptake for participants with serious mental illnesses. Key decision points are discussed, along with final decisions and contextual considerations. A 26-item checklist was developed to measure treatment adherence related to process, content, and adaptations of the intervention. The checklist follows the structure of the CBT intervention, as well as provides flexibility for the delivery adaptations. Pilot testing of the checklist revealed all sessions were implemented with at least 85% fidelity, and 90% of sessions were implemented with at least 90% fidelity. Raters agreed on the fidelity of a session in 99.6% of sessions. Contextual considerations included the highly secure study setting, reconciling the constant monitoring of a group and creating a treatment environment, the flexibility mandated by the intervention, the relative newness of the intervention, and the limitations based on study aims and resources. These results illustrate how study specific considerations and challenges can be successfully navigated in the development and deployment of a fidelity tool in a real-world setting. The fidelity checklist achieved our goal of measuring treatment adherence for this intervention. In the development of a fidelity tool, we recommend leaving space for raters to note specific considerations that disrupt facilitators' ability to deploy the intervention precisely. Measuring fidelity is imperative for mental health interventions to ensure that the treatment is responsible for the changes observed in clients.

The smartphone in self-regulated learning and student success: clarifying relationships and testing an intervention

This two-part observational and intervention study addressed the role of the smartphone in self-regulated learning (SRL) and student success as measured by achievement. Smartphone usage among students has been identified as contributing to lower academic achievement in a variety of settings. What is unclear is how smartphone usage contributes to lower outcomes. This study surveyed participants’ self-regulated learning skills and smartphone usage at the beginning and end of the term for first semester undergraduates. A regression analysis demonstrated that when controlling for prior achievement, general SRL measures had a positive impact on first semester achievement. Smartphone related SRL did not have a direct impact on achievement. The second part of the study evaluated the efficacy of a brief intervention to ameliorate factors contributing to lower achievement. Students were presented with either SRL strategies, awareness and attention strategies or career planning guidance (control). A regression analysis of the brief intervention resulted in modest gains in SRL but did not influence achievement.

A health risk assessment and early alcohol intervention program for non-mandated students

Objective We examined the effects of a two-part intervention including an online health risk assessment with personalized feedback and a brief in-person alcohol intervention for high-risk students. Participants Participants were 1,987 sophomore students, with 259 completing the alcohol intervention and 91 completing all follow-up surveys. Methods Students were invited to take an initial online health assessment covering a range of health behaviors and subsequent 3-month follow-up survey. Students who reported high-risk alcohol behaviors on the assessment were invited to participate in two one-on-one sessions utilizing motivational interviewing. Follow-up surveys occurred 3, 6 and 12 months later. Results Students who completed the health risk assessment reported knowledge and behavior changes. Students who completed the in-person alcohol intervention showed significant reductions in alcohol risk behavior 3-, 6- and 12-months post-intervention. Conclusions A two-part intervention for non-mandated students including a health risk assessment and one-on-one intervention shows promise in reducing alcohol risk.

Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study.

PurposeOpioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.MethodsThe study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants’ intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.ResultsFifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.ConclusionAn intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.

Designing the relational team development intervention to improve management of mental health in primary care using iterative stakeholder engagement

BackgroundTeam-based models of care are efficacious in improving outcomes for patients with mental and physical illnesses. However, primary care clinics have been slow to adopt these models. We used iterative stakeholder engagement to develop an intervention to improve the implementation of team-based care for this complex population.MethodsWe developed the initial framework for Relational Team Development (RELATED) from a qualitative study of Primary Care Providers’ (PCPs’) experiences treating mental illness and a literature review of practice facilitation and psychology clinical supervision. Subsequently, we surveyed 900 Colorado PCPs to identify factors associated with PCP self-efficacy in management of mental illness and team-based care. We then conducted two focus groups for feedback on RELATED. Lastly, we convened an expert panel to refine the intervention.ResultsWe developed RELATED, a two-part intervention delivered by a practice facilitator with a background in clinical psychology. The facilitator observes PCPs during patient visits and provides individualized coaching. Next, the facilitator guides the primary care team through a practice change activity with a focus on relational team dynamics.ConclusionThe iterative development of RELATED using stakeholder engagement offers a model for the development of interventions tailored to the needs of these stakeholders.Trial registrationNot applicable.

Delivering Information Literacy via Facebook: Here Comes the Spinach!

Abstract
 Objective – Information literacy (IL) skills are critical to undergraduate student success and yet not all students receive equal amounts of curriculum-integrated IL instruction. This study investigated whether Facebook could be employed by libraries as an additional method of delivering IL content to students. To test whether students would engage with IL content provided via a library Facebook page, this study compared the engagement (measured by Facebook’s reach and engagement metrics) with IL content to the library’s normal marketing content. 
 Methods – We ran a two-part intervention using the University of Canterbury Library’s Facebook page. We created content to help students find, interpret, and reference resources, and measured their reception using Facebook’s metrics. Our first intervention focused on specific courses and mentioned courses by name through hashtagging, while our second intervention targeted peak assessment times during the semester. Statistics on each post’s reach and engagement were collected from Facebook’s analytics.
 Results – Students chose to engage with posts on the library Facebook page that contain IL content more than the normal library marketing-related content. Including course-specific identifiers (hashtags) and tagging student clubs and societies in the post further increased engagement. Reach was increased when student clubs and societies shared our content with their followers. 
 Conclusion – This intervention found that students engaged more with IL content than with general library posts on Facebook. Course-targeted interventions were more successful in engaging students than generic IL content, with timeliness, specificity, and community being important factors in building student engagement. This demonstrates that academic libraries can use Facebook for more than just promotional purposes and offers a potential new channel for delivering IL content.

Putting veterans with heart failure FIRST improves follow-up and reduces readmissions

BackgroundDespite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early...

Writing Prompts Help Improve Expression of Conceptual Understanding in Chemistry.

To improve the writing performance of secondary school students in chemistry assessments, a set of activities was developed. First, through document analysis of written tests, five categories of frequent mistakes in answers were identified: poor punctuation (capital letters, periods), missing key answer components (omitting concepts necessary to answer the question), incomplete reasoning (logical steps are missing), unclear use of antecedents (meanings of pronouns such as “it” are difficult to discern), and poor connectives (words like “because” are lacking or used incorrectly). After this, five strategies were formulated: focus on punctuation, repeat key question components, show complete reasoning, minimize use of references, and check use of connectives. Second, a two-part intervention study was conducted. In Part A, a written prompt (arrow symbol with the word “LANGUAGE”) placed in front of context-based questions was implemented to find out if that could help students avoid making any of those mistakes. Following promising effects on the performance of 99 students, the intervention was extended with a Part B to find out if, in addition to the prompt, bonus points (for each prompt question one bonus point was awarded if the answer was formulated correctly in terms of language use) and language support (prompt card listing the five strategies, and supportive assignments) could be of extra help to students. The findings suggest that the writing performance of students can be improved by increasing students’ awareness through a simple written prompt, providing language support, and awarding bonus points for properly formulated answers to chemistry test questions.

A Depression Prevention Intervention for Adolescents in the Emergency Department

PurposeTo evaluate acceptability and feasibility of a theoretically based two-part (brief in-person + 8-week automated text message) depression prevention program, “intervention for DepressiOn and Violence prevention in the Emergency department” (iDOVE), for high-risk adolescents. MethodsEnglish-speaking emergency department (ED) patients (age 13–17, any chief complaint) were sequentially approached for consent on a convenience sample of shifts and screened for inclusion based on current depressive symptoms and past-year violence. After consent, baseline assessments were obtained; all participants were enrolled in the two-part intervention (brief in-ED + 8-week two-way text messaging). At 8 weeks, quantitative and qualitative follow-up assessments were obtained. Measures included feasibility, acceptability, and preliminary data on efficacy. Qualitative data were transcribed verbatim, double coded, and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t tests. ResultsAs planned, 16 participants (eight each gender) were recruited (75% of those who were eligible; 66% nonwhite, 63% low income, mean age 15.4). The intervention had high feasibility and acceptability: 93.8% completed 8-week follow-up; 80% of daily text messages received responses; 31% of participants requested ≥1 “on-demand” text message. In-person and text message portions were rated as good/excellent by 87%. Qualitatively, participants articulated: (1) iDOVE was welcome and helpful, if unexpected in the ED; (2) the daily text message mood assessment was “most important”; (3) content was “uplifting”; and (4) balancing intervention “relatability” and automation was challenging. Participants' mean ΔBDI-2 (Beck Depression Inventory) from baseline to 8-week follow-up was −4.9, (p = .02). ConclusionsThis automated preventive text message intervention is acceptable and feasible. Qualitative data emphasize the importance of creating positive, relevant, and interactive digital health tools for adolescents.

School-Based Behavioural Consultation for School-Refusal Behaviour

<p>Through three case reports, the present study explores a school-based behavioural consultation for school-refusal behaviour. A two-part intervention was established in this study. The first part consisted of a school counsellor providing behavioural consultation for school-refusal behaviour to the parents and school staff and the second part used an attendance process which parents and school staff escorted children who are unwilling to engage in treatment process to school. Through a series of intervention, all participants were able to attend school from the first week of intervention, and a school-based behavioural consultation using escorting school attendance was effective in treating these children. In addition, this study found that all the parties involved in this process should spend most of their energy during the first crucial week of intervention.<strong></strong></p>