The effectiveness of callback counselling for smoking cessation: a randomized trial

Aims. The development of acceptable, widely available and effective smoking cessation methods is central to public health strategy for tobacco control. We examined the effectiveness of a telephone callback counselling intervention, compared to the provision of self-help resources alone.

Methods. Participants were 998 smokers calling a state-wide "Quitline" service randomly allocated to either callback counselling or ordinary care. The callback condition consisted of a series of brief counselling calls at strategic times in addition to ordinary care. The number of calls varied according to caller needs, and most occurred generally just before the person's quit day and in the week or two after it. The service was delivered by trained telephone counsellors.

Results. At the 3-month follow-up, significantly more participants in the callback group (24%) reported that they were quit, compared to those in the usual care comparison group (13%). The difference in point prevalence of smoking declined to 6% by the 12-month follow-up. Using sustained abstinence there was a significant benefit of callback counselling at 12-month follow-up. Treating dropouts as smokers reduced the overall magnitude of the effects somewhat. The benefit of callbacks was to marginally increase quit attempts and to significantly reduce relapse.

Conclusion. Our findings are consistent with those of other studies demonstrating benefits of callback telephone counselling to facilitate cessation. Such counselling provides a flexible, relatively inexpensive and widely available form of cessation service. It appears to encourage a greater proportion of quit attempts and to reduce the rate of relapse among those quitting. Further research is required to determine ways to enhance effectiveness, particularly studies of how to reduce relapse.

Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression.

Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods.

Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold.

Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

Does interpersonal psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial

Background: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial.

Methods/design: The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate.  Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive  symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method.

Discussion: This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services.

Smoking cessation programs in pregnancy: systematically addressing development, implementation, women's concerns and effectiveness

Objectives:  To increase a review's relevance to practitioners and service users and identify the implications for systematic review methodology. Methods:  A systematic review of the effects of smoking cessation programmes implemented during pregnancy integrated process indicators and the views of maternity service users and health promotion specialists. Additional qualitative data were extracted systematically from included randomised control trials (RCTs) to determine whether the design of interventions and conclusions arising from their evaluation related to the views of service users. On completing the review we reflected on the types of observational and qualitative research it drew on, where this research was incorporated into the review, and its added value. Results:   Incorporating process indicators into the review revealed: 1) problems with implementation and transplantation of some interventions and 2) studies with more stringent quality criteria and process evaluations demonstrated greater impact (weighted mean difference in smoking). Pregnant smokers were rarely involved in the design or evaluation of the interventions. Prior observational and qualitative studies and small scale consultations influenced the criteria by which the effectiveness of the interventions were judged, and revealed to what extent these criteria are adopted in practice.
Conclusions:   Systematically abstracting data about the development and delivery of interventions revealed gaps that might be filled by the active involvement of service users.

Proposed multi-dimensional approach to evaluating service recovery

Purpose – The purpose of this paper is to extend thinking on service recovery processes and satisfaction with service recovery, using multi-dimensional consumer outcomes. The objective of the work was to propose that satisfaction with service recovery should be based on customers' expectations of the recovery encounter, which would be shaped by their expectations of “non-failed” encounters.

Design/methodology/approach – The paper adopts a theoretical approach. Using the existing service recovery literature as well as the traditional services literature, the conceptual framework and associated research propositions are developed.

Findings – The proposed framework suggests that service recovery is a service encounter it its own right. The effectiveness of recovery encounters will be based on how encounters operate relative to customer expectations and experiences with regard to the recovery activity.

Research limitations/implications – The research propositions and proposed framework need further empirical investigation.

Practical implications – The proposed framework suggests that managing service recovery should be undertaken in a similar fashion to managing any service, and thus managers need to understand customers' recovery expectations. Organisations also need to consider how a recovery action impacts on a range of customer outcomes, as focusing on one aspect will not capture consumers' full set of behaviours.

Originality/value – The proposed model identifies that service recovery should be evaluated with regard to consumers' recovery expectations and satisfaction is not based on expectations with regard to non-failed encounters.

Reducing consumer switching intentions following service failure : do empowerment and apology help?

This research explores the effectiveness of apology and empowerment as service recovery actions and their impact on consumers switching intentions within the hospitality industry. It also examines two different types of failure - process failure and outcome and whether consumer-switching intentions vary based on failure type. Results suggest that apology is effective in reducing switching intentions in both types of failure. Employee empowerment reduces switching intentions in outcome failure situations, but increases switching intentions in process settings. There is also an interaction effect of apology and empowerment in the outcome failure setting, but not in the process failure setting. Recommendations for managing service recovery are provided.

Service migration in autonomic service oriented grids

The introduction of Web services into grids helped to address their two main obstacles to be embraced by business and industry, heterogeneity and useability. However, many problems are still open, e.g., grid reconfiguration, reliability and computing optimization. We argue here that a mechanism that could help solving these problems is Web Service migration, a part of automatic and transparent brokerage. Web service migration presents a number of new requirements not addressed in traditional process migration, being the outcome of Web services specific configuration of hosts and application servers, and availability of Web services / resources state. In this paper we report on our study into the development of a Web service migration facility focused on providing migration of services in a Service Oriented Grid environment. We present a novel approach to Web service migration, embodied in a System Management Broker, which is transparent, interoperable and flexible. We take the requirements of Web services into consideration when discovering suitable destination hosts and match services to suitable grid resources which are able to fulfil the needs of the service. We discuss a number of experiments conducted with different types of grid and Web service applications to highlight the feasibility and effectiveness of our migration facility and demonstrate how our facility significantly improves Service Oriented Grids.

Our health in our hands : building effective community partnerships for rural health service provision

This paper reports findings from a study in two small Tasmanian rural communities that examined the process of developing and sustaining partnerships between health services and their communities. It identifies a generic framework for partnership development that appears to be common to partnerships, regardless of their purpose or of partners involved. The framework comprises ten predictors or indicators of effectiveness, and a sequential nine-stage partnership development process. Integral to the framework are social capital, and the leadership practices of health service and community leaders. The influence of context on the partnership development process is also examined, with reference to historical precedent, age or maturity of the partnership, and community readiness.

Values underlying the National Service Framework for coronary heart disease in England : a discourse analysis

OBJECTIVES: The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is known about coronary heart disease and partly on its underlying 'values'. This paper seeks to identify those values.

METHODS:An analysis of the discourses within the text of the NSF based on critical discourse analysis.

RESULTS: Three different discourses can be identified: the managerial, the clinical and the political. The managerial discourse is dominant. Each discourse has its own values. The main 'aspirational' values within the NSF are efficiency, effectiveness, autonomy (choice), universalism and equity. Some aspirational values--particularly equity--appear to be largely rhetorical and lead to few recommendations or prescriptions. Some values that might have been expected to underlie the framework, such as compassion and democracy, are largely absent.

CONCLUSIONS: Discourse analysis provides a more systematic and transparent method of describing the values behind health care policy than the methods that have been used previously.

New educational service products : tertiary EC/EB education - the Asia-Pacific region

Electronic Commerce (EC) / Electronic Business (EB) has been (and is expected to continue to be) a dynamic, rapidly evolving area of technology, requiring skilled people with up-to-date knowledge and skills. The global community has required (and still requires) tertiary academic programs to prepare and train these people quickly. In the late nineties, following a tidal wave of tertiary EC program development in the United States, new tertiary programs began to appear in the Asia-Pacific (AP) region to satisfy this need, over a very short period of time. This research project aims to examine whether the development and effectiveness of tertiary EC/EB educational programs can be enhanced through employing a particular marketing paradigm. Four regions - Australia, New Zealand, Hong Kong SAR and the Republic of Singapore — were selected from the AP region, for this study. Based on a review of marketing literature, an inductive approach is adopted to build a model for new educational service product offerings. I also provide a description and comprehensive analysis of EC/EB education, and explore the model empirically, examining how it applies to the way EC education programs have been developed, to date. Essentially, this project consists of two major activities: theory building and theory testing – and is divided into three parts. Part 1: Preliminary study – literature review for theory building. This section of the thesis provides a literature review of the domains of curriculum development, EC/EB program development and management, EC/EB component models and new service product development. Part 2 : Understanding the marketplace – quantitative analysis. This section comprises five major surveys which provide an understanding of EC/EB education. Part 3 : In-depth analysis – qualitative research for theory testing. This section discusses the results of the multiple case studies of EC/EB degree programs undertaken over a five year period. The results of this project highlight both theoretical and practical aspects of the topic. In terms of the theoretical aspect, I provide a contribution to existing theory concerning the planning and development of new tertiary education programs. Research into academic course development in the past has tended to assume that all program development is pedagogically based and influenced. There is an assumption that people only develop academic programs and academic courses for pedagogic reasons. What this research project has done is to suggest that there are, in fact, many possible reasons for developing new programs and that, although these reasons might be pedagogic in nature, they can also be industry-focased, and market-oriented in the following ways: -the university is shaping the way it is perceived by the public – that is, the market; -the university is highlighting where its expertise lies. This led me to a form of new service product development consistent with the new image of the university. There is a clear need for diverse models for program development which accommodate the dynamic roles of modern universities. My research project develops such a model based on conditions in the Asia-Pacific region, and discusses findings arising from the overall project, which can be used to improve new educational program offerings in future, in both the Asia-Pacific and, I suggest, in other regions. This potential use of my findings highlights the practical contribution made by the research Project.

Quality as the criterion for delivered information systems effectiveness

One of the major challenges of MIS activities is the difficulty in measuring the effectiveness of delivered systems. The principal purpose of my research is to explore this field in order to develop an instrument by which to measure such effectiveness. Conceptualisation of Information System (IS) Effectiveness has been substantially framed by DeLone and McLean's (1992) Success; Model. But with the innovation in Information Technology (IT) over the past decade, and the constant pressure in IT to improve performance, there is merit in undertaking a fresh appraisal of the issue. This study built on the model of IS Success developed by DeLone and MeLean, but was broadened to include related research from the domains of IS, Management and Marketing. This analysis found that an effective IS function is built on three pillars: the systems implemented; the information held and delivered by these systems; and, the service provided in support of the IS function. A common foundation for these pillars is the concept of stakeholder needs. In seeking to appreciate the effectiveness: of delivered IS applications in relation to the job performance of stakeholders, this research developed an understanding of what quality means in an IT context I argue that quality is a more useful criterion for effectiveness than the more customary measures of use and user satisfaction. Respecification of the IS Success Model was then proposed. The second phase of the research was to test this model empirically through judgment panels, focus groups and interviews. Results consistently supported the structure and components of the respecified model. Quality was determined as a multi-dimensional construct, with the key dimensions for the quality of delivered IS differing from those used in the research from other disciplines. Empirical work indicated that end-user stakeholders derived their evaluations of quality by internally evaluating perceived performance of delivered IS in relation to their expectations for such performance. A short trial explored whether, when overt measurement of expectations was concurrent with the measurement of perceptions, a more revealing appraisal of delivered IS quality was provided than when perceptions alone were measured. Results revealed a difference between the two measures. Using the New IS Success Model as the foundation, and drawing upon the related theoretical and empirical research, an instrument was developed to measure the quality/effectiveness of delivered IS applications. Four trials of this instrument, QUALIT, are documented. Analysis of results from preliminary trials indicates promise in terms of business value: the instrument is simple to administer and has the capacity to pinpoint areas of weakness. The research related to the respecification of the New IS Success Model and the associated empirical studies, including the development of QTJALIT, have both contributed to the development of theory about IS Effectiveness. More precisely, my research has reviewed the components of an information system, the dimensions comprising these components and the indicators of each, and based upon these findings, formulated an instrument by which to measure the effectiveness of a delivered IS.

Diabetes service provision : a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews.

Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly.

Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

Violent offender rehabilitation and the therapeutic community model of treatment : towards integrated service provision?

Rehabilitation programs for violent offenders are at an early stage in their development, and there is currently only a very limited empirical base from which to draw any conclusions about treatment effectiveness (Jolliffe and Farrington, 2007). Therapeutic communities for offender populations have a much longer history, although the effects of applying this model of treatment to violent offenders have not been systematically investigated. This paper reviews the content and evidence supporting both violent offender treatment programs and therapeutic community models, concluding that approaches to treatment which combine features of both may prove to be most successful, and warrant further development and evaluation.

The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use

Objective The Clinical Global Impression Scale (CGI) is established as a core metric in psychiatric research. This study aims to test the validity of CGI as a clinical outcome measure suitable for routine use in a private inpatient setting.

Methods The CGI was added to a standard battery of routine outcome measures in a private psychiatric hospital. Data were collected on consecutive admissions over a period of 24 months, which included clinical diagnosis, demographics, service utilization and four routine measures (CGI, HoNOS, MHQ-14 and DASS-21) at both admission and discharge. Descriptive and comparative data analyses were performed.

Results Of 786 admissions in total, there were 624 and 614 CGI-S ratings completed at the point of admission and discharge, respectively, and 610 completed CGI-I ratings. The admission and discharge CGI-S scores were correlated (r = 0.40), and the indirect improvement measures obtained from their differences were highly correlated with the direct CGI-I scores (r = 0.71). The CGI results reflected similar trends seen in the other three outcome measures.

Conclusions The CGI is a valid clinical outcome measure suitable for routine use in an inpatient setting. It offers a number of advantages, including its established utility in psychiatric research, sensitivity to change, quick and simple administration, utility across diagnostic groupings, and reliability in the hands of skilled clinicians.