Designs in Partially Controlled Studies: Messages from a Review

The ability to evaluate effects of factors on outcomes is increasingly important for a class of studies that control some but not all of the factors. Although important advances have been made in methods of analysis for such partially controlled studies,work on designs for such studies has been relatively limited. To help understand why, we review main designs that have been used for such partially controlled studies. Based on the review, we give two complementary reasons that explain the limited work on such designs, and suggest a new direction in this area.

Learning to drive: learners' self-reported cognitive failure level predicts driving instructor's observation rating of driving performance

OBJECTIVES Evidence increases that cognitive failure may be used to screen for drivers at risk. Until now, most studies have relied on driving learners. This exploratory pilot study examines self-report of cognitive failure in driving beginners and error during real driving as observed by driving instructors. METHODS Forty-two driving learners of 14 driving instructors filled out a work-related cognitive failure questionnaire. Driving instructors observed driving errors during the next driving lesson. In multiple linear regression analysis, driving errors were regressed on cognitive failure with the number of driving lessons as an estimator of driving experience controlled. RESULTS Higher cognitive failure predicted more driving errors (p < .01) when age, gender and driving experience were controlled in analysis. CONCLUSIONS Cognitive failure was significantly associated with observed driving errors. Systematic research on cognitive failure in driving beginners is recommended.

Use of audiovisual messages from land user to land user for sharing knowledge about SLM: experiences from a pilot project in Kenya and Tajikistan

The global World Overview of Conservation Approaches and Technologies (WOCAT) initiative has developed standardised tools and methods to compile and evaluate knowledge available about SLM. This knowledge is now combined and enriched with audiovisual information in order to give a voice to land users, reach a broad range of stakeholders, and assist in scaling up SLM to reverse trends of degradation, desertification, and drought. Five video products, adapted to the needs of different target groups, are created and embedded in already existing platforms for knowledge sharing of SLM such as the WOCAT database and Google Earth application. A pilot project was carried out in Kenya and Tajikistan to verify ideas and tools while at the same time assessing the usefulness of the suggested products on the ground. Video has the potential to bridge the gap between different actor groups and enable communication and sharing on different levels and scales: locally, regionally, and globally. Furthermore, it is an innovative tool to link local and scientific knowledge, raise awareness, and support advocacy for SLM. Keywords: Sustainable Land Management (SLM), knowledge sharing, audiovisual messages, video, World Overview of Conservation Approaches and Technologies (WOCAT)

Persuasive email messages for patient communication.

To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.

DOES THE MESSAGE MATTER? ENHANCING PATIENT ADHERENCE THROUGH PERSUASIVE MESSAGES

To improve health and reduce costs, we need to encourage patients to make better healthcare decisions. Many informatics interventions are aimed at improving health outcomes by influencing patient behavior. However, we know little about how the content of a message in these interventions can influence a health-related decision. In this research we formulate a conceptual model to help explain and guide the design of “persuasive messages”, those which can change and influence patient behavior. We apply the conceptual model to design persuasive appointment reminder messages using humancentered design principles. Finally, we empirically test our hypotheses in a randomized controlled trial in order to determine the effectiveness of persuasive appointment reminders to reduce the number of missed appointments in a sample of 1016 subjects in a community health center. The results of the study confirm that reminder messages are effective in reducing missed appointment compared with no reminders (p=0.028). Further, reminder messages that incorporate heuristic cues such as authority, commitment, liking, and scarcity are more effective than reminder messages without such cues (p=0.006). However, the addition of systematic arguments or reasons for attending appointments have no effect on appointment adherence (p=0.646). The results of this research suggest that the content of reminder messages may be an important factor in helping to reduce missed appointments.

Implicit memory for the content but not the speaker of sleep-played messages

We presented 28 sentences uttered by 28 unfamiliar speakers to sleeping participants to investigate whether humans can encode new verbal messages, learn voices of unfamiliar speakers, and form associations between speakers and messages during EEG-defined deep sleep. After waking, participants performed three tests which assessed the unconscious recognition of sleep-played speakers, messages, and speaker-message associations. Recognition performance in all tests was at chance level. However, response latencies revealed implicit memory for sleep-played messages but neither for speakers nor for speaker-message combinations. Only participants with excellent implicit memory for sleep-played messages also displayed implicit memory for speakers but not speaker-message associations. Hence, deep sleep allows for the semantic encoding of novel verbal messages.

Conceptualizing Success in Therapeutic Wilderness Experiences: The Creation and Maintenance of Instructor-Participant Relationships

Researchers have noted that relationships created between instructors and clients in therapeutic wilderness experiences are unique (Russell, 2003; Russell & Phillips-Miller, 2001; Sklar, Anderson, & Autry, 2007; Taniguchi et al., 2009), but little research has been done to explore these relationships. The present study is an investigation of how instructors build and maintain relationships with participants, conceptualize these relationships, and define success in these tasks. Nine instructors from a wilderness program for at-risk youth participated in interviews. Data were analyzed using a line-by-line coding technique. Results of this study add to existing research on wilderness therapy and therapeutic wilderness experiences, provide models of successful instructing, and guide programs and instructors in the services they provide to their participants.

Increasing awareness of colorectal cancer screening through targeted exam room based video messages

Colorectal cancer (CRC) is the third largest cause of cancer death in the United States. While the disease burden is high, there are proven methods to screen for CRC and detect it at a stage that is amenable to cure. Patients with low health literacy have difficulty navigating the health care system and are at increased risk to not receive preventive care services such as colorectal cancer screening (CRCS). To address this need, an exam-room based video was developed to be played for patients in the privacy of the exam room, while they are waiting to be seen by their medical provider. In roughly 2 minutes, the video informs the patient about CRC and CRCS and how they can successfully complete CRCS. One of the key barriers to completing CRCS is the need to increase patients' knowledge and improve attitudes surrounding CRCS. This study examines the impact of the video on patients' knowledge and attitudes about CRC and CRCS in a medically underserved patient population in Houston, Texas. ^ Sixty-one patients presenting for routine medical care were enrolled in the study. Depending on their randomization, the patients either received routine information about CRC and CRCS or they watched the video. We found that the patients who did watch the video did have improvements in their knowledge and improved attitudes about CRC and CRCS. Future studies will be needed to examine whether the video improves the patients' completion of CRCS.^

Point of decision signs and stair use in a university worksite setting: General versus specific messages

Point-of-decision signs to promote stair use have been found to be effective in various environments. However, these signs have been more consistently successful in public access settings that use escalators, such as shopping centers and transportation stations, compared to worksite settings, which are more likely to contain elevators that are not directly adjacent to the stairs. Therefore, this study tested the effectiveness of two point-of-decision sign prompts to increase stair use in a university worksite setting. Also, this study investigated the importance of the message content of the signs. One sign displayed a general health promotion message, while the other sign presented more specific information. Overall, this project examined whether the presence of the point-of-decision signs increases stair use. In addition, this research determined whether the general or specific sign promotes greater stair use. ^ Inconspicuous observers measured stair use both before the signs were present and while they were posted. The study setting was the University of Texas School of Nursing, and the target population was anyone who entered the building, including employees, students, and visitors. The study was conducted over six weeks and included two weeks of baseline measurement, two weeks with the general sign posted, and two weeks with the specific sign posted. Each sign was displayed on a stand in the decision point area near the stairs and the elevator. Logistic regression was used to analyze the data. ^ After adjustment for covariates, the odds of stair use were significantly greater during the intervention period than the baseline period. Furthermore, the specific sign period showed significantly greater odds of stair use than the general sign period. These results indicate that a point-of-decision sign intervention can be effective at promoting stair use in a university worksite setting and that a sign with a specific health information message may be more effective at promoting stair use than a sign with a general health promotion message. These findings can be considered when planning future worksite and university based stair promotion interventions.^