Expanding the evidence within evidence-based healthcare:thinking about the context, acceptability and feasibility of interventions

Evidence-based medicine is crucial to contemporary healthcare. It is dependent on systematic review methodology modelled on an arguably inadequate hierarchy of evidence. There has been a significant increase in medical and health research using qualitative and mixed method designs. The perspective taken in this article is that we need to broaden our evidence base if we are to fully take account of issues of context, acceptability and feasibility in the development and implementation of healthcare interventions. One way of doing this is to use a range of methods that better fit the different aspects of intervention development and implementation. Methods for the systematic review of evidence, other than randomised-controlled trials, are available and there is a readiness to incorporate these other types of evidence into good-practice guidance, but we need a clear methodology to translate these advances in research into the world of policy.

'Why don't you try it again?' A comparison of parent led, home based interventions aimed at increasing children's consumption of a disliked vegetable

Previous research suggests that the use of modelling and non-food rewards may be effective at increasing tasting, and consequential liking and acceptance, of a previously disliked food. Although successful school-based interventions have been developed, there is a lack of research into home-based interventions using these methods. This study aimed to develop and investigate the efficacy of a parent led home-based intervention for increasing children's acceptance of a disliked vegetable. A total of 115 children aged 2-4 years were allocated to one of four intervention groups or to a no-treatment control. The four intervention conditions were: repeated exposure; modelling and repeated exposure; rewards and repeated exposure; or modelling, rewards and repeated exposure. Children in all of the intervention conditions were exposed by a parent to daily offerings of a disliked vegetable for 14 days. Liking and consumption of the vegetable were measured pre and post-intervention. Significant increases in post-intervention consumption were seen in the modelling, rewards and repeated exposure condition and the rewards and repeated exposure condition, compared to the control group. Significant post-intervention differences in liking were also found between the experimental groups. Liking was highest (>60%) in the modelling, rewards and repeated exposure group and the rewards and repeated exposure group, intermediate (>26%) in the modelling and repeated exposure and repeated exposure groups, and lowest in the control group (10%). Parent led interventions based around modelling and offering incentives may present cost efficient ways to increase children's vegetable consumption.

Management interventions and prosocial behaviours:understanding the mediating mechanisms

Previous research suggests that the attitudes and behaviours of front-line employees (FLEs) significantly influence customers’ evaluations of service quality and customer satisfaction. Therefore, it becomes important to identify the variables that influence FLEs job attitudes and Prosocial ServiceBehaviours (PSBs). The conceptual framework developed from extant literature is presented, which proposes that management interventions (internal communication, training and development and empowerment) have a direct effect on PSBs. In addition, these relationships are mediated by role stress and job attitudes. Implications for service management and future research directions are discussed.

Successful development and testing of a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS)

Objectives: To develop a tool for the accurate reporting and aggregation of findings from each of the multiple methods used in a complex evaluation in an unbiased way. Study Design and Setting: We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) within a gastroenterology study [Evaluating New Innovations in (the delivery and organisation of) Gastrointestinal (GI) endoscopy services by the NHS Modernisation Agency (ENIGMA)]. We subsequently tested it on a different gastroenterology trial [Multi-Institutional Nurse Endoscopy Trial (MINuET)]. We created three layers to define the effects, methods, and findings from ENIGMA. We assigned numbers to each effect in layer 1 and letters to each method in layer 2. We used an alphanumeric code based on layers 1 and 2 to every finding in layer 3 to link the aims, methods, and findings. We illustrated analogous findings by assigning more than one alphanumeric code to a finding. We also showed that more than one effect or method could report the same finding. We presented contradictory findings by listing them in adjacent rows of the MATRICS. Results: MATRICS was useful for the effective synthesis and presentation of findings of the multiple methods from ENIGMA. We subsequently successfully tested it by applying it to the MINuET trial. Conclusion: MATRICS is effective for synthesizing the findings of complex, multiple-method studies.

Psychotherapy and social change:utilizing principles of cognitive-behavioral therapy to help develop new prejudice-reduction interventions

We propose that key concepts from clinical psychotherapy can inform science-based initiatives aimed at building tolerance and community cohesion. Commonalities in social and clinical psychology are identified regarding (1) distorted thinking (intergroup bias and cognitive bias), (2) stress and coping (at intergroup level and intrapersonal level), and (3) anxiety (intergroup anxiety and pathological anxiety). On this basis we introduce a new cognitive-behavioral model of social change. Mental imagery is the conceptual point of synthesis, and anxiety is at the core, through which new treatment-based approaches to reducing prejudice can be developed. More generally, we argue that this integration is illustrative of broader potential for cross-disciplinary integration in the social and clinical sciences, and has the potential to open up new possibilities and opportunities for both disciplines.

Effectiveness of the interventions in preventing the progression of pre-frailty and frailty in older adults:a systematic review protocol

REVIEW QUESTION / OBJECTIVE : The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? INCLUSION CRITERIA : Types of participants This review will consider studies that include older adults (female and male) aged 65 years and over, explicitly identified as pre-frail or frail by the researchers or associated medical professionals according to a pre-specified scale or index, and who have received health care and support services in any type of setting (primary care, nursing homes, hospitals). This review will exclude studies that: - Include participants who have been selected because they have one specific illness - Consider people with a terminal diagnosis only. - Types of intervention(s)/phenomena of interest: The clinical/medical component of the review will consider studies that evaluate any type of interventions to prevent the progression of pre-frailty and frailty in older adults. These interventions will include, but will not be limited to, physical activity, multifactorial intervention, psychosocial intervention, health and social care provision, and cognitive, nutrition or medication/medical maintenance and adherence focused interventions. The economic component of the review will consider studies that have performed any type of health economic analysis of ...

The future of engineering - Do primary school engineering education interventions leave a lasting impression?

This positional paper proposes a conceptual framework and methodological approach for use in a PhD study investigating the longer term educational and social impact of 'active' engineering focused interventions for children age 8-10 in the UK. The study will critically analyse how a child's participation in an engineering education activity contributes to the Engineering Capital that the child possesses; focusing on how the child's awareness and perceptions about engineering are affected. To achieve this aim it is proposed that Grounded Theory methodology be used to enable an in-depth analysis of participation from the perspective of the child participant. The study proposed will be longitudinal, taking place over three formative years for the education and career aspirations of the child, from age 8-10 to 11-13. Although the research is in its infancy, this paper will provide the opportunity to develop theory in an underdeveloped area of engineering education research.

Bank financing of Hungarian SMEs: Getting over to credit crisis by state interventions

In this article we aimed to present and analyse the 21st century history of bank financing in the Hungarian small and medium enterprise (SME) sector in the period ranging from 2000 to 2012. The credit products offered by banks and credit unions are the most fundamental means of external financing capable of fulfilling the financing needs of a wide array of SMEs. The conditions of accessing credits and their prices exert a decisive influence on the profitability and business opportunities of SMEs. As a result of economic slowdown SMEs had to face higher interest rates, decreasing credit limits, and bank financing options that became increasingly slowly accessible alongside stricter conditions. Due to this process SMEs business performance had been falling continuously which has a destructive contribution to the national economy. In the first chapter of the article we present the dynamic development of credit financing in the Hungarian SME sector, along with the causes that triggered it, then we will continue with the negative tendencies dating from the onset of the 2008 debt crisis. In the second chapter we discuss the vicious circle, due to which the business performance of the SMEs, as well as the conditions of access to credits and their prices, have entered into a negative spiral. In the third and final chapter we make suggestions regarding the direction and means of necessary government intervention, in order to stop and reverse the negative tendencies observed in SME credit financing.

Effects of nursing interventions for fever in acutely ill adults

Fever has both beneficial and detrimental effects. There is evidence that antipyretics and physical cooling methods, when used in combination, are more effective than antipyretics alone. This randomized controlled study examined 45 acutely ill adults with fever ${\ge}102.5\sp\circ\rm F$ where three nursing interventions were used. Group I received acetaminophen 650 mgs., Group II received acetaminophen 650 mgs. and tepid sponging, and Group III received acetaminophen 650 mgs. and hypothermia blanket. The purpose of this study was to evaluate which nursing intervention reduced temperature most effectively with respect to eight biobehavioral variables. Research hypotheses were tested statistically using the chi-square test and repeated measures analysis of variance. The study found statistically significant results for fever reduction overall, but no difference for the groups. Therefore, we suggest that acetaminophen alone be used in the treatment of fever in order to decrease cost, nursing time, and increase patient comfort. ^

Exploring the role of therapy process and outcome in interventions that target adolescent identity and intimacy

This study examined the feasibility of using a session impact measure with a sample of 24 at risk high school students participating in an intervention targeting identity and intimacy. Three therapists led 3 intervention groups with the same format. The study investigated the impact of therapy process, including Group, Facilitator, Skills, and Exploration impacts as measured by the Session Evaluation Form (SEF). The study also investigated the differential impact of session process on intervention outcome as measured by the CPSS, EPSI, RAVS, EIPQ and Youth Report Form. Analyses were conducted using descriptive statistics, frequencies, one-way analysis of variance (ANOVA), and Chi square tests. The results supported the utility of the SEF and they tentatively supported the impact of the therapist on participants' perceptions of therapeutic processes and on intervention outcome. In particular, Group 1 performed better than Group 3. This study found that the SEF is a useful session impact measure. ^

A qualitative study of an interagency relationship: Education interventions for foster children

The Interagency Agreement between the Broward County School System and District 10 Department of Children and Families (DCF) was implemented to improve the organization's relationship and in turn improve education interventions for foster children. The purpose of this study was to examine and describe key decision-makers' perspectives of this interagency relationship after implementing mutual policy. ^ The research questions which drove this study were: (a) from the perspectives of the participants, what was the relationship between the decision-makers of the Department of Children and Families and the Broward County School System, after the implementation of a unification plan that was influenced by the court system? and, (b) how was the relationship between the school system and DCF reflected in the Interagency Agreement? ^ Data were obtained through a case study that included interviews, document analysis and field observations. Participants were key decision-makers in their respective institutional settings and were chosen using criterion sampling. The researcher analyzed and interpreted data from the District 10 DCF commissioned assessment of foster care, the State of Florida Management Plans (education section), the Interagency Agreement, and participant interviews. ^ This study focused on the following five contextual areas regarding the Interagency Agreement: interagency cooperation, interagency coordination, interagency collaboration, traditional organizational linkages, and organizational climate. The results of this study suggest that the organizations' improved relationship improved the educational system for foster children. ^ This researcher recommends that the Interagency Agreement shares the leadership structure with an active parent organization of 15 foster parents who would be divided into three subcommittees. These subcommittees would perform specific tasks such as involving other foster parents, and writing mini proposals to address the social and tutoring needs of foster children. A Wraparound process including community organizations (clubs, businessmen and concerned community groups, Big Brothers/Big Sisters, Boys and Girls Clubs) is also recommended in order to engage foster children in activities to build their social skills, friendships and self-esteem. This researcher also recommends that the Broward County School System consider a role that would provide for the development of curriculum for inservice for teachers. This would empower teachers and allow them to better address the academic and social needs of the foster children. ^

Hidden Communication Deficits in Children with Autism and Early Behavioral Interventions

Taking a behavioral systems approach to autism, early hidden communicative deficits are introduced as precursors of autistic development. This paper argues that early identification of communication (language and cognition) impairments followed by intensive behavioral interventions, as early as infancy, may have the most preventive effect on the development of autism.

Two Decades Out of the Whirlpool: Past (and Possible Future) United States Interventions in Latin America [Student's Paper Series]

This paper examines the history of U.S. interventions in Latin America and attempts to explain their frequency by highlighting two factors – besides security and economic interests – that have made American interventions in Latin America so common. First, immense differences in size and influence between the United States and the States of Latin America have made interventions appear to be a low risk solution to crises that threaten American interests in the region. Second, when U.S government concerns and aspirations for Latin America converge with the general fears and aspirations of American foreign policy, interventions become much more likely. Such a convergence pushes Latin American issues high up the U.S. foreign policy agenda because of the region’s proximity to the United States and the perception that costs of intervening are low. The leads proponents of intervention to begin asking questions like “if we cannot stop communism/revolutions/drug-trafficking in Latin America, where can we stop it?” This article traces how these factors influenced the decision to intervene in Latin America during the era of Dollar Diplomacy and during the Cold War. It concludes with three possible scenarios that could lead to a reemergence of an American interventionist policy in Latin America. It makes the argument that even though the United Sates has not intervened in Latin America during the twenty-two years, it is far from clear that American interventions in Latin America will be consigned to the past.

The possible selves method in evaluating youth development interventions: The use of Integrated Qualitative /Quantitative Data Analytic Strategies (IQ -DAS)

This study investigated the feasibility of using qualitative methods to provide empirical documentation of the long-term qualitative change in the life course trajectories of “at risk” youth in a school based positive youth development program (the Changing Lives Program—CLP). This work draws from life course theory for a developmental framework and from recent advances in the use of qualitative methods in general and a grounded theory approach in particular. Grounded theory provided a methodological framework for conceptualizing the use of qualitative methods for assessing qualitative life change. The study investigated the feasibility of using the Possible Selves Questionnaire-Qualitative Extension (PSQ-QE) for evaluating the impact of the program on qualitative change in participants' life trajectory relative to a non-intervention control group. Integrated Qualitative/Quantitative Data Analytic Strategies (IQ-DAS) that we have been developing a part of our program of research provided the data analytic framework for the study. ^ Change was evaluated in 85 at risk high school students in CLP high school counseling groups over three assessment periods (pre, post, and follow-up), and a non-intervention control group of 23 students over two assessment periods (pre and post). Intervention gains and maintenance and the extent to which these patterns of change were moderated by gender and ethnicity were evaluated using a mixed design Repeated Measures Multivariate Analysis of Variance (RMANOVA) in which Time (pre, post) was the within (repeated) factor and Condition, Gender, and Ethnicity the between group factors. The trends for the direction of qualitative change were positive from pre to post and maintained at the year-end follow-up. More important, the 3-way interaction for Time x Gender x Ethnicity was significant, Roy's Θ =. 205, F(2, 37) = 3.80, p <.032, indicating that the overall pattern of positive change was significantly moderated by gender and ethnicity. Thus, the findings also provided preliminary evidence for a positive impact of the youth development program on long-term change in life course trajectory, and were suggestive with respect to the issue of amenability to treatment, i.e., the identification of subgroups of individuals in a target population who are likely to be the most amenable or responsive to a treatment. ^