Incorporation of a successful community-based mammography intervention: dissemination beyond a community trial.

Although a variety of interventions to increase breast cancer screening have been found to be effective in community-based trials, their ultimate contribution depends on the extent to which they are incorporated (i.e., adopted and adapted) by community organizations. From 1990 to 1995, the authors conducted a National Cancer Institute-funded community-based trial that increased screening mammography among women ages 40 and older living in Minneapolis public housing. This study describes the processes by which this intervention, called Friend to Friend, was successfully adopted by the American Cancer Society, Midwest Division, and adapted for use by women throughout the state. The authors offer insights from experience with this translational effort and make recommendations to facilitate collaboration between research and community organizations.     

The educational pyramid: A model for community intervention

Urban adolescents represent a group who are at special risk for a variety of psychological and behavioral problems. A life skills program was implemented with middle and high school students, using an educational pyramid approach to maximize the ecological appropriateness of the intervention and to increase the likelihood that the program will be continued with progressively lessened university facilitation. Additionally, the educational pyramid offers the opportunity for all participants—university faculty, graduate students, collaborating professionals in the community, and high school leaders—to be both teachers and learners.     

The use of structural equation modeling in generative research: Toward the design of a preventive intervention for bereaved children

Describes a generative study of processes which may lead to symptomatology in children who have experienced the death of a parent. Based on existing literature, four putative mediating variables were identified: parental demoralization, family warmth, negative family events, and positive stable family events. Structural equation modeling techniques were used to compare several potential causal models involving these variables. The results were most consistent with a model in which bereavement was not directly related to the child symptomatology, but rather its effects were transmitted through these four mediational mechanisms. The implications of the results of the structural modeling for the design and evaluation of preventive interventions are discussed briefly.     

The intervention selection bias: an underrecognized confound in intervention research

Selection bias can be the most important threat to internal validity in intervention research, but is often insufficiently recognized and controlled. The bias is illustrated in research on parental interventions (punishment, homework assistance); medical interventions (hospitalization); and psychological interventions for suicide risk, sex offending, and juvenile delinquency. The intervention selection bias is most adequately controlled in randomized studies or strong quasi-experimental designs, although recent statistical innovations can enhance weaker designs. The most important points are to increase awareness of the intervention selection bias and to systematically evaluate plausible alternative explanations of data before making causal conclusions.     

Increasing access to psychological therapies for people with psychosis: predictors of successful training

BackgroundCognitive behavioural therapy for psychosis (CBTp) is recommended for people with schizophrenia, but routine delivery remains limited. Obstacles to increasing access include inadequate training, organisational support and supervision, resulting in low levels of staff competence and confidence. This study is a preliminary evaluation of a CBTp training programme, designed to overcome these obstacles and to increase routine delivery of competent CBTp.MethodTraining outcomes for a pilot group and for the first three cohorts to complete training were analysed to identify predictors of successful completion and of therapy delivery after training.ResultsObjective competence was attained by 37 students (out of 58), who delivered therapy to over 160 service users. Successful completion was associated with previous CBT therapy experience. Delivery after one year was associated with working in a therapy rather than a care co-ordination role.ConclusionsThe programme succeeded in training therapists to deliver competent therapy. Our results suggest that preliminary training in CBT for other disorders may improve success rates in CBTp. Despite extensive service liaison, delivery remained problematic for care co-ordinators without role change and provision of dedicated time. The findings should inform future implementation strategies.     

Metacognition reconsidered: Implications for intervention research

Metacognitive training techniques have been used successfully to improve children's problem-solving skills. The concept of metacognition needs further refinement, however, if it is to continue to be useful as an explanatory construct. Specifically, we argue that more attention needs to be paid to how metacognitive abilities are acquired, how this knowledge could be used to help improve the performance of children with learning difficulties, and how metacognition may be related to other self-evaluation processes.This paper was completed with support from the National Institute of Child Health and Human Development (Grant HD05951), and from the Department of Education (Grant 00840068). We would like to express our appreciation and thanks to Joseph Campione and to Annemarie Palinscar, who patiently listened to, and frequently commented upon, the ideas presented in this paper.     

The efficacy of postdivorce intervention programs for children: A meta-analytical review

Preventive postdivorce interventions aim to help children cope with divorce and promote their adjustment. Nevertheless, questions remain regarding the concrete outcomes of these interventions and the intervention characteristics that influence them. This meta-analysis of 30 studies analyzes the efficacy of postdivorce interventions on children's symptomatology, personal resources, and adaptation to divorce. Likewise, it explores whether the intervention impacts the putative mediators from the family context and whether the characteristics of the studies themselves also influence the results. Using a data set of N = 4344 individuals, 258 effect sizes were calculated. Random effects analyses evidenced the impact of the interventions on specific variables instead of on children's global adjustment. There were no significant effects on children's mental health outcomes, and none of these effects were qualified by the moderators that were examined. Preventive postdivorce interventions had significant effects, specifically on children's divorce adjustment and self-esteem. The study of the moderators found that the interventions were generally homogeneous, and only one of the 20 moderators examined had a significant effect. Based on children's age, the interventions had an impact on family functioning only when they involved younger children, but this result should be interpreted with caution due to the small sample of studies. This meta-analysis provides evidence of the relevance of postdivorce interventions to critical variables as well as information about the role of the intervention characteristics in the effects and makes suggestions for future research on divorce interventions that encompass both practical and empirical developments.     

Increasing community independence for adolescents with spina bifida

This project sought to determine if a community-based habilitation program focusing on normalization and individual goal setting was effective in enhancing levels of independence in teenagers with spina bifida (myelomeningocele). The results of our formal and informal evaluation suggest that the program was effective. Using the goal-attainment scale for formal evaluation, the program averaged a score of 50.8, which reflects slightly better than expected outcomes. The greatest strength in the program was support and socialization among the teenagers. In addition, recommendations for practitioners in programming for teenagers are provided.     

Conductive education: the case for further research

This paper presents the case for further research into Conductive Education arguing that the Department of Education report (Bairstow, Cochrane and Hur, 1993) by attempting to evaluate the practice of Conductive Education has in relying upon an experimental research strategy produced a narrow construction of the methods and practice of Conductive Education. The timing and methodologies used in the report are questioned and attention is drawn to developments in child disability research that challenge the manner in which researchers construct the lives of children with disabilities. Recommendations for the research community suggest that future studies move away from experimental or quasi-experimental research designs towards understanding of the child in its entirety and to accept the importance of the perspectives of service users, particularly the parents. ©1997 John Wiley & Sons, Ltd.     

The emerging relationship of psychology and the Internet: proposed guidelines for conducting Internet intervention research

The Internet is rapidly developing into an important medium of communication in modern society, and both psychological research and therapeutic interventions are being increasingly conducted using this new communication medium. As therapeutic interventions using the Internet are becoming more prevalent, it is becoming increasingly important to conduct research on psychotherapeutic Internet interventions to assist in the development of an appropriate standard of practice regarding interventions using this new medium. In this article, we examine the Internet and the current psychological uses which are being initiated using this medium. Ethical concerns related to the psychological use of the Internet are discussed, and guidelines are proposed for the conduct of Internet intervention research.     

Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults.

This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.     

The state of educational intervention research as viewed through the lens of literacy intervention

The characteristics of educational intervention research are reviewed: Educational intervention research is inspired by diverse theories, targeted at a variety of simple to very complex interventions, and includes a variety of methods and measurements. Some interventions have been studied much more than others, with the more studied ones often summarized in meta‐analyses and other integrative reviews. The study of some of the more complex interventions pose new ethical challenges. Although some intervention research impacts educational practice and policy, much more could and probably should.