SAFE START: AN EARLY CHILDHOOD MENTAL HEALTH PROGRAM IN A TERTIARY HEALTHCARE SETTING—A CRITICAL REVIEW

Early childhood mental health programs are vital for the current and future mental health and brain development of infants, toddlers, and preschoolers. Founded in 2014, Safe Start is the only early childhood mental health program in Beirut, Lebanon. It aims at being the prototype of such services at the national level. A retrospective analysis of the outcomes of the first year of operations has resulted in important findings about the age of the participants, their diagnoses, previous therapies that the participants have undergone, types of referrals recommended, and the number of participants who were lost to follow‐up. This first analysis pointed at the need for more in‐depth research to encompass the gaps and benefits of such services. It shows the pivotal importance of designing awareness strategies about the importance of early childhood mental health services and care; to move from a diagnostic seeking behavior to commitment to psychotherapy and follow‐up interventions.     

Using Curriculum-Based Measurement to Evaluate Intervention Efficacy

SUMMARY

The use of Curriculum-Based Measurement for evaluating treatment efficacy is described and discussed. The basic methods and applications of Curriculum-Based Measurement are described, followed by examples of its application in two intervention program evaluation projects. The first project involved one individual student experiencing academic difficulties. The second project focused on evaluating a reading instruction program for a group of students. In both examples, the use of Curriculum-Based Measurement contributed significantly to monitoring student progress in response to educational program variables and making treatment evaluation decisions.     

An investigation of psychosocial factors related to changes in physical activity and fitness among female adolescents

Research examined the effects of a supervised physical activity program on potential psychosocial mediators and determined whether changes in these psychosocial variables predicted changes in physical activity and fitness. Sedentary adolescent females were assigned to an intervention (n?=?79) or comparison (n?=?67) group. Cardiovascular fitness (cycle ergometer), physical activity (3-Day Physical Activity Recall), and psychosocial variables related to physical activity (i.e., self-efficacy, perceived barriers, social support, enjoyment) were assessed at three time points over the 9-month study. An intention-to-treat analysis showed that the intervention did not impact any of the psychosocial variables, with the exception of perceived barriers, which increased in the intervention group. Longitudinal analyses showed that improvements in fitness were associated with positive changes in global self-efficacy and exercise enjoyment. Psychosocial variables did not mediate the program's effects on fitness or activity. However, individual level changes in psychosocial variables were related to changes in cardiovascular fitness.     

Effects of different psychological interventions on neck,shoulder and low back pain in female hospital staff

Abstract

One hundred and eleven females volunteered to take part in this intervention study of musculoskeletal pain. They all completed a survey of pain among five hundred and eighty-six female hospital staff and presented mild to severe pain in the neck, shoulder and/or low back. They were randomly assigned to one of the following groups; Focus on job-stress and psychosocial coping (Cognitive), relaxation training (Relaxation), the combination of the two (Combined) or to a control group (Control). Musculoskeletal pain (intensity and duration) was assessed by self-report prior to interventions, immediately after interventions, and at a four months follow-up. Results from multivariate analyses of variance as well as covariance (pre-intervention levels of pain as covariate) showed that magnitude of pain reduction was dependent upon the interaction between area of the back and type of intervention. These trends were more significant for intensity than for duration scores. They were due to reductions of pain in (1) neck and shoulders for the Cognitive and Combined groups and (2) in the low back and shoulders for the Relaxation group. The four month follow-up assessment revealed a significant risk of relapse only for duration of low back pain among subjects in the Combined group. Results from the Cognitive approach to intervention may reflect a causal role for ability to cope with psychosocial job stress in the development of neck and shoulder pain in female hospital staff.     

Predicting intention and behaviour following participation in a theory-based intervention to improve gluten free diet adherence in coeliac disease

Objective: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease.

Design: Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74; three-month: n = 68; six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence).

Results: Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention; by the six-month follow-up change in perceived behavioural control was the stronger predictor.

Conclusions: Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control.     

Computer-assisted dieting: Effects of a randomised controlled intervention

In this pilot study, the effects of two computer-assisted dieting (CAD) interventions on weight loss and blood chemistry were examined among overweight and obese adults. Participants (91 community members, average age 42.6 years) were randomly assigned to CAD-only (a single-session introduction and provision of a dieting software, n = 30), CAD plus an additional four-session self-management group training (CAD+G, n = 31) and a waitlist control group whose members were randomised into the two interventions at the 3-month follow-up (n = 30). A three (group)-by-two (time) repeated measures ANOVA revealed no significant group by time interaction during the initial 3-month period. However, the two intervention groups combined showed a significant, though moderate weight loss relative to the control group. Further, although a general improvement was found with regard to the lipid panel results during the first 3 months of the trial, the treatment by time interaction was not significant. A comparison of the developments in the two intervention groups during the 3- to 6-month follow-up time period revealed a tendency towards greater weight regain in the CAD-only condition. The evidence suggests that CAD supports initial weight loss; however, additional self-management training might be necessary to support maintenance.     

Effectiveness of online word of mouth on exposure to an Internet-delivered intervention

The use of online word of mouth (WOM) seems a promising strategy to motivate young people to visit Internet-delivered interventions. An Internet-delivered intervention aimed at changing implicit attitudes related to alcohol was used in two experiments to test effectiveness of e-mail invitations on a first visit to the intervention. The results of the first experiment (N = 196) showed that an invitation by e-mail from a friend was more effective to attract young adults (aged 18–24 years) to the intervention website than an invitation from an institution. A 2 × 2 design was used in the second experiment (N = 236) to test manipulations of argument strength and the use of peripheral cues in invitations. Results showed that weak arguments were more effective to attract young adults to the intervention website when an incentive was withheld. These results need to be taken into account when using online WOM as a strategy to improve exposure to Internet-delivered interventions.     

Young men’s minimisation of their body dissatisfaction

Abstract

Objective: To examine men’s body dissatisfaction qualitatively.

Design: Forty-two British men aged 18–45 years took part in a two-session group intervention across 12 groups. The intervention was designed to improve body dissatisfaction by engaging them in a critique of the appearance ideal through written and behavioural exercises.

Main outcome measures/results: Analysis of the topics discussed during the intervention generated two core themes. Theme 1 showed that, in general, men minimised the existence of their own body dissatisfaction while (somewhat surprisingly) outlining the ubiquity and potency of the appearance ideal for men in general. Theme 2 involved men reporting the problematic impact of body dissatisfaction in their lives (despite earlier minimisation), such as social avoidance, strict eating and supplement regimes, or difficulty in situations where the body was exposed.

Conclusion: The results stress the need to acknowledge that men experience a range of impacts of body dissatisfaction beyond clinical presentations (such as disordered eating) that influence their everyday lives, while also recognising that they tend to minimise this dissatisfaction in conversation. These findings have important implications for advocacy and interventions to improve men’s body dissatisfaction.     

Developing ways to encourage early detection and presentation of oral cancer: What do high-risk individuals think?

The aim of this pilot research was to improve understanding of individuals at risk of oral cancer, to determine their attitudes towards and responses to early detection interventions. In-depth interviews with the target group (n?=?25) were used to determine their views, attitudes and requirements for an intervention to encourage early detection of oral cancer. This data was used in combination with theory-based constructs to develop written material that aimed to increase awareness of oral cancer, encourage mouth self-examination (MSE) and early presentation. A second pilot study used a think-aloud protocol to assess the target groups’ (n?=?14) reactions to the written information. In both studies the tape-recorded responses were analysed using framework analysis. The target group had limited knowledge about oral cancer, particularly the signs and symptoms. Participants saw benefits in performing MSE but noted the main barriers were not knowing what signs to look for or where to look. The written information was generally well-received but required some modifications. In particular, the target group required further persuasion that their lifestyle contributed to an increased risk of oral cancer. The results of these pilot studies have informed the development of a theory-based intervention for the early detection of oral cancer.     

Path analysis of exercise treatment-induced changes in psychological factors leading to weight loss

Physical activity may affect weight loss largely through psychological pathways associated with eating changes, especially in obese individuals whose caloric expenditure through exercise is typically small. Direct testing of this is, however, lacking. Previously sedentary adults (N?=?114; 77% female; M _age?=?43.3 years), with a minimum body mass index (BMI) of 35?kg/m² (M _BMI?=?42.0?kg/m²), participated in a 24-week treatment of cognitive-behavioural exercise support and nutrition information. A path model based on tenets of social cognitive and self-efficacy theory was constructed. It was expected that improvements in self-efficacy, physical self-concept, body satisfaction and mood associated with the exercise treatment would predict changes in self-regulation and increased physical activity. It was also hypothesised that improvements in self-efficacy and self-regulation for appropriate eating would transfer from these relationships and predict weight loss. After three theoretically viable paths were added based on modification indices, structural equation modelling indicated a good fit with the data, χ ²(16)?=?20.53, p?=?0.20; RMSEA?=?0.05; SRMR?=?0.06; CFI?=?0.97; TLI?=?0.95. Associations of psychological effects linked to exercise programme participation with predictors of appropriate eating and weight loss were found, and may inform theory, research and treatments.