A quasi-experimental investigation of message appeal variations on organ donor registration rates.

OBJECTIVE: Approximately 6,000 Americans die every year awaiting an organ transplant. Health promotion interventions may alleviate the shortage of viable organs by increasing the number of registered organ donors. This study is the first to evaluate the differential effectiveness of various organ donor messages in naturalistic settings. DESIGN: A 4 (Appeal)x4 (Exemplar)x4 (Location) counterbalanced quasi-experimental design was implemented. MAIN OUTCOME MEASURE: The behavioral outcome measure was the number of individuals who registered to be organ donors at computer kiosks. RESULTS: A number of significant main effects and interactions emerged. Most notably, of the 4 different appeals (counterargument, emotional, motivating action, dissonance), counterargument was by far the most efficacious, especially in academic-type settings (library, university, community college); the emotional appeal was most successful in hospitals. CONCLUSIONS: The findings from this study have implications for both organ donor investigations and health campaign research in general. Statistical interactions highlight the importance of evaluating multiple exemplars in multiple locations for each type of appeal when conducting health campaign research.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Comparing computer‐based training and lecture formats to teach visual analysis of baseline‐treatment graphs

Accurate analysis of data is vital to the validation of interventions. As such, there has been a recent increase in studies evaluating visual analysis training procedures. However, past investigations have not evaluated direct and indirect visual analysis training methods with matched instructional content that was systematically designed. Furthermore, training has rarely included assessment of generalization and maintenance of visual analysis skills. The purpose of the current dissertation study was to compare the effectiveness and efficiency of (a) computer‐based training, (b) lecture formats with and (c) without the opportunity to pause, and (d) a no‐training group to teach visual analysis of AB graphs to university students. To make these formats directly comparable, the instructional content was equated by ensuring information and examples were identical across the three training procedures. Eighty‐three students were randomly assigned to one of the four groups. Results showed that all three training formats produced increases in accurate responding compared to the no‐training group. Visual analysis skills generalized to novel graphs and maintained approximately 2 weeks following all trainings. These results suggest that structured approaches that are carefully designed to train visual analysis are effective and lead to gains that generalize and maintain in the absence of training.     

The danger of conflating level-specific effects of control variables when primary interest lies in level-2 effects

In the multilevel modelling literature, methodologists widely acknowledge that a level-1 variable can have distinct within-cluster and between-cluster effects, and that failing to disaggregate these can yield a slope estimate that is an uninterpretable, conflated blend of the two. Methodologists have stated, however, that including conflated slopes of level-1 variables in a model is not problematic if substantive interest lies only in effects of level-2 predictors. Researchers commonly follow this advice and use methods that do not disaggregate effects of level-1 control variables (e.g., grand mean centering) when examining effects of level-2 predictors. The primary purpose of this paper is to show that this is a dangerous practice. When level-specific effects of level-1 variables differ, failing to disaggregate them can severely bias estimation of level-2 predictor slopes. We show mathematically why this is the case and highlight factors that can exacerbate such bias. We corroborate these findings with simulations and present an empirical example, showing how such distortions can severely alter substantive conclusions. We ultimately recommend that simply including the cluster mean of the level-1 variable as a control will alleviate the problem.     

Assessment to identify learner-specific prompt and prompt-fading procedures for children with autism spectrum disorder

Few studies have evaluated the use of assessment to identify the most efficient instructional practices for individuals with autism spectrum disorder. This is problematic as these individuals often have difficulty acquiring skills, and the procedures that may be efficient with one individual may not be for others. The experimenters conducted instructional assessments to identify the most efficient prompt type (model, partial physical, full physical) and prompt-fading procedure (progressive delay, most-to-least, least-to-most) for teaching auditory–visual conditional discriminations for individuals with autism spectrum disorder. Each assessment was conducted at least twice, and a final generality test combined the most and the least efficient prompt type and prompt-fading procedure for teaching novel auditory–visual conditional discriminations. The results demonstrated learner-specific outcomes for the prompt type assessment, whereas the least-to-most prompt fading procedure was most efficient for all participants.     

Back to sleep: Teaching adults to arrange safe infant sleep environments

There are over 3,000 sleep related infant deaths each year in the United States. Attempts to teach medical personnel and parents safe infant sleep practices in the infant sleep training literature have demonstrated mixed results. Thus, strategies to teach arrangements of safe infant sleep environments warrant further investigation. Behavioral skills training (BST) is an evidence-based teaching strategy shown to successfully teach various safety skills to children and adults. The current study evaluated the effectiveness of behavioral skills training to teach safe infant sleep practices to typically developing adults. Specifically, differential responding was assessed across multiple environmental arrangements typical of contexts parents may be exposed to when putting an infant to sleep. BST significantly improved appropriate arrangement of a safe sleep environment for infants for all 8 participants.