Empirical and Theoretical Conclusions of an Analysis of Outcomes of HIV-Prevention Interventions

ABSTRACT— Over two decades of HIV-prevention attempts have generated a most impressive ecological data set for the test of behavioral-change and persuasion theories in the domain of condom use. An analysis of this evidence has yielded five important empirical and theoretical conclusions. First, interventions are more successful at achieving immediate knowledge and motivational change than they are at achieving immediate behavioral change. Second, the immediate motivational change decays over time, whereas behavior change increases over the same period. Third, interventions that engage audiences in particular activities, such as role-playing condom use, are more effective than presentations of materials to passive audiences. Fourth, interventions consistent with the theories of reasoned action and planned behavior, with self-efficacy models, and with information-motivation and behavioral-skills models prove effective, whereas interventions designed to induce fear do not. Fifth, expert intervention facilitators are more effective than lay community members in almost all cases. When populations are unempowered, expert facilitators are particularly effective, and they are most effective if they also share the gender and ethnicity of the target audience.     

Toward a Science of Transdisciplinary Action Research

This paper offers a conceptual framework for establishing a science of transdisciplinary action research. Lewin's (1951) concept of action research highlights the scientific and societal value of translating psychological research into community problem-solving strategies. Implicit in Lewin's formulation is the importance of achieving effective collaboration among behavioral researchers, community members and policy makers. The present analysis builds on Lewin's analysis by outlining programmatic directions for the scientific study of transdisciplinary research and community action. Three types of collaboration, and the contextual circumstances that facilitate or hinder them, are examined: (1) collaboration among scholars representing different disciplines; (2) collaboration among researchers from multiple fields and community practitioners representing diverse professional and lay perspectives; and (3) collaboration among community organizations across local, state, national, and international levels. In the present analysis, transdisciplinary action research is viewed as a topic of scientific study in its own right to achieve a more complete understanding of prior collaborations and to identify strategies for refining and sustaining future collaborations (and their intended outcomes) among researchers, community members and organizations.     

The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study

This study used qualitative methods to understand dementia caregivers’ experience of personal and therapeutic factors contributing to outcome following REACH VA, a behavioral intervention designed to alleviate caregiver burden and depressive symptoms. Caregivers and their interventionists were queried about their experiences of the treatment in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. The following themes emerged reflecting aspects of the intervention caregivers and interventionists found helpful: self-care, shared goals, psychoeducation, and stress-management skills. Some caregivers and interventionists found the provision of problem-solving skills to be helpful and others did not. Finally, some caregivers and interventionists reported that interpersonal support/bearing witness, insight, emotional transformation, and the discussion of interpersonal process were useful when part of the intervention or, when not included, would have been helpful. While behavioral interventions tend to be highly structured, interventionists’ ability to work flexibly within the protocol and tailor it to the caregiver’s needs was related to positive treatment response. The beneficial aspects of this treatment represent multiple theoretical orientations highlighting the importance of transtheoretical models of therapeutic action.     

Profile of the Membership of the Society for Personality Assessment: Comparisons Between 1987 and 1990

In this study, we report the findings of a 1990 survey of the membership of the Society for Personality Assessment (SPA) and compare these results with a similar survey conducted in 1987. A four-page questionnaire was sent to approximately 1,800 SPA members; 900 surveys were returned, for a 50% response rate. Information was obtained on professional activities, occupational setting, theoretical orientation, and various demographic characteristics. Clinical practice was reported as the primary professional activity of the vast majority of SPA members; more than 40% of the 1990 sample indicated private practice as their primary job setting, compared to 35% in I987. A larger proportion of SPA members are also now working in private/clinical practice, medical centers, and outpatient community clinics than in 1987. Although a psychodynamic-psychoanalytic orientation continues to be the dominant theoretical perspective of SPA members, the proportion of members with a cognitive-behavioral orientation has increased substantially since 1987. We concluded that SPA members are now more involved in clinical practice, and that the SPA has become more ecumenical in theoretical perspective as the membership has more than doubled over the past 3 years.     

Profile of the membership of the Society for Personality Assessment: comparisons between 1987 and 1990

In this study, we report the findings of a 1990 survey of the membership of the Society for Personality Assessment (SPA) and compare these results with a similar survey conducted in 1987. A four-page questionnaire was sent to approximately 1,800 SPA members; 900 surveys were returned, for a 50% response rate. Information was obtained on professional activities, occupational setting, theoretical orientation, and various demographic characteristics. Clinical practice was reported as the primary professional activity of the vast majority of SPA members; more than 40% of the 1990 sample indicated private practice as their primary job setting, compared to 35% in I987. A larger proportion of SPA members are also now working in private/clinical practice, medical centers, and outpatient community clinics than in 1987. Although a psychodynamic-psychoanalytic orientation continues to be the dominant theoretical perspective of SPA members, the proportion of members with a cognitive-behavioral orientation has increased substantially since 1987. We concluded that SPA members are now more involved in clinical practice, and that the SPA has become more ecumenical in theoretical perspective as the membership has more than doubled over the past 3 years.     

Dialectical Behavior Therapy Skills for Families of Individuals With Behavioral Disorders: Initial Feasibility and Outcomes

Family members of individuals with behavioral disorders are a valuable source of logistical and emotional support for patients. Family members may take on tremendous financial and/or psychological responsibility to care for their loved ones, which can result in poor psychological outcomes for the family and, in turn, impede the recovery of the patient. Dialectical Behavior Therapy (DBT) skills training is an effective treatment that has been utilized with numerous populations, including family members of individuals with behavioral problems, and has shown efficacy in improving various interpersonal outcomes; however, no study has examined feasibility and outcomes of delivering all four unabridged DBT skills modules to this population. Twenty participants attended weekly DBT skills classes for 6 months, where they acquired skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. There were significant pre-post improvements for emotion dysregulation, stress reactivity, and various interpersonal outcomes; there were no significant changes in depression or anxiety. These results suggest that DBT skills may be effective at improving broad clinical domains in a sample of family members of individuals with behavioral problems. This research is the first step in demonstrating that DBT skills might benefit family members of patients with heterogeneous mental health problems and, therefore, fits in to the field’s growing interest in cost-effective transdiagnostic interventions.     

Educational advocacy for children with autism

There exists a great divide between parents' demands for intensive behavioral interventions for their children with autism and the public education system's reluctance to support early intensive behavioral intervention programs. More and more, professionals with expertise in applied behavior analysis are being asked to advocate for effective, early behavioral intervention for autism in education litigation brought about by frustrated parents. The progress made in recent years in the behavioral treatment of children with autism and the schools' lack of adherence to the requirements of IDEA have made it possible for educational policy change through effective advocacy by behavioral interventionists. This paper discusses preparing for educational advocacy on behalf of young children with autism. We explore the personal and emotional reasons why parents choose to engage in the financially risky endeavor of educational litigation. We then outline an approach to developing expert testimony based upon evaluation of the target child and his/her educational history. Issues related to assessment, training, and ethical practice are addressed. Copyright © 2002 John Wiley & Sons, Ltd.     

Logical dynamics of belief change in the community

In this paper we explore the relationship between norms of belief revision that may be adopted by members of a community and the resulting dynamic properties of the distribution of beliefs across that community. We show that at a qualitative level many aspects of social belief change can be obtained from a very simple model, which we call ‘threshold influence’. In particular, we focus on the question of what makes the beliefs of a community stable under various dynamical situations. We also consider refinements and alternatives to the ‘threshold’ model, the most significant of which is to consider changes to plausibility judgements rather than mere beliefs. We show first that some such change is mandated by difficult problems with belief-based dynamics related to the need to decide on an order in which different beliefs are considered. Secondly, we show that the resulting plausibility-based account results in a deterministic dynamical system that is non-deterministic at the level of beliefs.     

Building capability throughout a change effort: leading the transformation of a police agency to community policing

This case describes a change effort to move a police agency to become a community policing organization. The community policing effort was seen as a means to make a transformational change to become a learning organization with the goal of improving the delivery of police services. The case describes the steps taken to meet the new vision of community policing as well as the steps taken to deal with the challenges or realities of trying to make change happen. The lens for this case is the leadership role across the stages of change (exploration, planning, implementation, monitoring and institutionalization) in building capacity within the organization to sustain the change effort. The capacity building focused on incorporating systems thinking into the mindset of the members of the organization, breaking down the command and control mindset by building a new norm around high involvement of committed teams, and developing skill sets to support continuous learning and improvement in order to align organizational systems. A key lesson learned is that effective leaders do not just prepare an organization prior to a change effort. They must have the patience to constantly build the capacity for change among organizational members throughout the various stages of the change effort.     

Meaningful Engagement in Research: Community Residents as Co-creators of Knowledge

Community psychologists have contributed significantly to the body of literature on community-based participatory research (CBPR) and its application in understanding and addressing health and community participation disparities. At the core of CBPR are mutually beneficial partnerships with communities, whereby community members’ voices are heard and they become co-researchers, helping guide the research process. In this article, I argue that for community psychologists to change the landscape of community participation, health, and well-being disparities experienced by many vulnerable populations who often face multiple forms of oppression, CBPR needs to be transformative and emancipatory. Stakeholders must be meaningfully involved as co-creators of knowledge and promoters of social justice embracing a human rights agenda. Drawing from work conducted with Latinx immigrant families with youth who have disabilities, I propose the following strategies moving forward: promoting meaningful participation of community members as co-creators of knowledge; promoting meaningful conversations that matter to communities; promoting civic engagement, activism, and advocacy; promoting an assets- and strengths-based approach to research; and promoting culturally relevant interventions. Community psychologists have the opportunity to make significant contributions to addressing disparities when community residents’ knowledge is valued and recognized.     

Some promising dimensions for behavioral community technology

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.     

Modeling stage-sequential change in ordered categorical responses

Although few would dispute the usefulness of looking at behavioral change from a stage-sequential perspective, until recently the lack of appropriate modeling techniques has hampered rigorous empirical tests of stage theories. In particular, for behavioral measurements that are ordinal, there is a need for methods that represent the underlying change processes in the form of qualitative and discontinuous shifts. This article introduces a stage-sequential ordinal model by postulating that at any point in time there are a finite number of latent stages. Panel members may shift among these stages over time. The authors show that the stage-sequential model provides a general approach for both the analysis of ordinal time-dependent data and tests of various competing theories and hypotheses about psychological change processes. An analysis of a 5-year study concerning attitudes toward alcohol consumption by teenagers is presented to illustrate the modeling approach.     

The Need for Action When Conducting Intervention Research: The Multiple Roles of Community Psychologists

In choosing to implement empowering interventions with marginalized populations, community psychologists often have to merge research and action. We present three case stories that exemplify empowerment efforts in the context of a multi-year school intervention designed to develop the advocacy skills of ethnic minority students' with disabilities and promote attainment of transition-related goals. In the process of implementing the intervention, our research team had to instigate change, advocate, and/or mediate in multiple conflictual interactions between the various stakeholders in the schools. We faced both positive and negative consequences for our actions. We discuss the responsibilities of community psychologists in the process of empowering others and the implications for the practice of community research.     

Are we going to close social gaps in HIV? Likely effects of behavioral HIV-prevention interventions on health disparities

Although experimental behavioral interventions to prevent HIV are generally designed to correct undesirable epidemiological trends, it is presently unknown whether the resulting body of behavioral interventions is adequate to correct the social disparities in HIV-prevalence and incidence present in the United States. Two large, diverse-population meta-analytic databases were reanalyzed to estimate potential perpetuation and change in demographic and behavioral gaps as a result of introducing the available behavioral interventions advocating condom use. This review suggested that, if uniformly applied across populations, the analyzed set of experimental (i.e. under testing) interventions is well poised to correct the higher prevalence and incidence among males (vs. females) and African-Americans and Latinos (vs. other groups), but ill poised to correct the higher prevalence and incidence among younger (vs. older) people, as well as men who have sex with men, injection-drug users, and multiple partner heterosexuals (vs. other behavioral groups). Importantly, when the characteristics of the interventions most efficacious for each population were included in the analyses of behavior change, results replicated with three exceptions. Specifically, after accounting for interactions of intervention and facilitator features with characteristics of the recipient population (e.g. gender), there was no behavior change bias for men who have sex with men, younger individuals changed their behavior more than older individuals, and African-Americans changed their behavior less than other groups.     

Traditional Beliefs Concerning Health and Illness Among Members of the Circassian Community in Israel

Objective: To understand the cultural context of illness in a homogeneous ethnic community, the Circassians. This is the first study of health perceptions and beliefs among Circassians. The Circassians arrived in Palestine from the Caucasus Mountain region more than a century ago. They constitute an endogamous group, whose members live in relative cultural isolation in two small villages in northern Israel, preserving their language and traditions. Design: Twenty-one elderly community members (men and women) were interviewed using open-ended interviews. Results: It was found that kutze (internal bodily resilience) is the central health-related concept and as such constitutes the main building block of a healthy and resilient community. Conclusions: By focusing on this specific community, the relationships between health beliefs and social organization were explored. Our findings highlight the need for the development of treatment approaches and/or health education that are deeply embedded in the cultural context, with special emphasis on the group's value infrastructure, life habits and health-related beliefs when studying various ethnic populations.     

论社区卫生服务机构与城市大中型医院的协调发展

对当前社区卫生服务机构与城市大中型医院协调发展中存在的问题及原因进行了分析,在功能定位、制度层面、筹资及服务提供机制、社区卫生服务机构自我建设以及综合配套改革等方面提出改进建议,并对社区卫生与医院协调发展的现有模式进行了探讨,以期构建科学合理、切实维护群众健康的城市卫生服务体系。     

Making the Connections: Community Capacity for Tobacco Control in an Urban African American Community

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community’s capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action. At the time this study was conducted, all authors were at Columbia University Mailman School of Public Health.     

Can Interventionists Be Neo-Russellians? Interventionism,the Open Systems Argument,and the Arrow of Entropy

Several proponents of the interventionist theory of causation have recently argued for a neo-Russellian account of causation. The article discusses two strategies for interventionists to be neo-Russellians. First, I argue that the open systems argument—the main argument for a neo-Russellian account advocated by interventionists—fails. Second, I explore and discuss an alternative for interventionists who wish to be neo-Russellians: the statistical–mechanical account. Although the latter account is an attractive alternative, it is argued that interventionists are not able to adopt it straightforwardly. Hence, to be neo-Russellians remains a challenge for interventionists.