A mixed-methods process evaluation of a goal management intervention for patients with polyarthritis

Process evaluations of newly developed interventions are necessary to identify effective and less effective intervention components. First aim of this study was to identify key components of a psychosocial goal management intervention from the perspective of participants, and second aim was to evaluate the intervention’s fidelity. A mixed-methods approach was applied to 24 interviews with participants post-intervention and 16 audio recordings of random training sessions. Participants experienced three key components: (1) the content, in which specific exercises helped to raise awareness and (intention to) change goal management behaviour, (2) person-focused approach, specifically, the nurse as trainer and personal fit of the approach, and (3) social mechanisms, including facilitating group processes and interpersonal processes. Adherence to the protocol by the trainers was high, while differences were found in the degree to which they were able to apply the intended collaborative approach and psychological communication skills. The applied design provided valuable insights into the processes that took place. Both the effects experienced by participants in relationship to the content, approach and social mechanisms as well as the strengths and weaknesses found with regard to fidelity provide insights that can inform the development and implementation of person-focused interventions.     

Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial

Objective: Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence.

Design: 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls).

Main Outcome Measures: Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures.

Results: Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change.

Conclusion: Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.     

Conscious Motivations of Adolescent Visual Artists and Creative Writers: Similarities and Differences

This exploratory study was designed to expand the field’s understanding of talented adolescent visual artists and creative writers and their conscious motivations for engaging in these creative activities. Accordingly, 233 talented high school visual arts (n = 151) and creative writing (n = 82) students were asked to rate the degree to which they believed their creative activities were motivated by each of a wide range of possible motivations. The students in both fields reported being very strongly motivated by the opportunities their activities provided them to use their imaginations, feel free, sense that they were being their “true” selves, regulate their emotions, capture moments in time, deepen their self-understanding, express themselves, improve their skills, and enhance their self-esteem. Some of these motivations correspond closely to those highlighted by theories of intrinsic motivation, competence motivation, and self-actualization, several are similar to those which have been reported by professional artists and writers, and some suggest that the students may have derived important psychological benefits from their creative activities. Theoretically plausible differences between the motivational profiles of the visual and creative writing students were identified and discussed.     

Blaming the Victim: University Student Attitudes Toward Bullying

Numerous studies have examined adolescent attitudes toward bullying, but limited research has explored college students’ attitudes toward victims of bullying. Using data collected from three southern universities (n = 1,135), the current research investigates demographic, experiential, and behavioral factors that are likely to influence whether university students attribute blame to bullying victims. Findings indicate that most university students report prosocial attitudes toward bullying. Victim blaming and minimizing attitudes were most common among males, heterosexuals, and those with a history of prior bullying perpetration during junior high or high school. Individuals reporting a higher frequency of drug use were significantly more likely to support victim blaming attitudes, and those who engaged in more frequent alcohol use were significantly more likely to minimize bullying.     

Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services.

Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service.

Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process.

Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases.

Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed.     

Human participants challenges in youth-focused research: perspectives and practices of IRB administrators

The purpose of this research was to understand institutional review board (IRB) challenges regarding youth-focused research submissions and to present advice from administrators. Semistructured self-report questionnaires were sent via e-mail to administrators identified using published lists of universities and hospitals an Internet searches. Of 183 eligible institutions, 49 responded. One half indicated they never granted parental waivers. Among those considering waivers, decision factors included research risks, survey content, and feasibility. Smoking and substance abuse research among children was generally considered more than minimal risk. These findings are consistent with those from a study conducted by Mammel and Kaplan (1995), which investigated IRB practices concerning protocols involving adolescent participants. IRBs and investigators need to become aware of regulations' flexibility to ensure adequate participant protection. Investigators need to limit jargon and assumptions about participants' understanding of research objectives.     

Dimensions of family connectedness among adolescents with Mexican, Chinese, and European backgrounds

Multiple dimensions of adolescents' connectedness with their families were investigated among 489 9th-grade students (M = 14.86 years) from families with Mexican, Chinese, and European backgrounds. Participants reported on various aspects of their family relationships and completed diary checklists of daily behaviors for a 2-week period. Adolescents from European backgrounds reported levels of family identification and dyadic closeness with parents similar to or greater than those reported by their peers. For adolescents from Mexican and Chinese backgrounds, particularly those from immigrant families, family connectedness included a stronger emphasis on family obligation and assistance. The extent to which family demographic variables, including parental level of education and residence in a single-parent family, accounted for group differences was examined.     

Analysis of factors that affect responding in a two-response chain in children with developmental disabilities

A sequence of behaviors consisting of appropriate responses, inappropriate responses, or a combination of both can be linked together in a behavior chain. Several operant processes may disrupt behavior chains. For example, one or more members of the behavior chain may be affected when reinforcement is withheld for the last response in the chain (extinction), when the last response is reinforced even if it occurs without the other responses in the chain (unchaining), or when access to the terminal reinforcer is available independent of responding (satiation). However, few studies have examined the effects of these types of procedures on responding that occurs in the context of behavior chains. The purpose of this study was to examine the effects of three clinically relevant procedures and processes (i.e., extinction, satiation, and unchaining) on behaviors that occur as part of a behavior chain. Overall, extinction and satiation resulted in a decrease in both responses in the chain. During the unchaining procedure, decreases were observed in the first response in the chain but not in the second response.     

Improving student bus-riding behavior through a whole-school intervention

We describe a multicomponent intervention to improve bus-riding behavior of students attending an urban public school. The intervention was developed with technical assistance consultation that emphasized collaboration among students, school personnel, and bus drivers. The primary intervention procedures were identifying appropriate behaviors during transportation ("bus rules"), training bus drivers to deliver positive reinforcement, and rewarding student performance through a weekly school-based lottery. Disruptive bus behaviors, as measured by discipline referrals and suspensions, decreased with intervention relative to baseline phases in an ABAB reversal design. These positive results were maintained over the long term, with school personnel assuming responsibility for intervention in the absence of ongoing consultation.     

Size and reversal learning in the beagle dog as a measure of executive function and inhibitory control in aging

Several studies converge on the idea that executive processes age earlier than other cognitive processes. As part of a larger effort to investigate age-related changes in executive processes in the dog, inhibitory control was measured in young, middle-aged, old, and senior dogs using size discrimination learning and reversal procedures. Compared to young and middle-aged dogs, old and senior dogs were impaired on both the initial learning of the size task and the reversal of original reward contingencies. Impaired performance in the two aged groups was characterized as a delay in learning the correct stimulus-reward contingencies and, among the senior dogs in particular, an increase in perseverative responding. These separate patterns of reversal impairments in the old and senior dogs may reflect different rates of aging in subregions of the frontal cortex.