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PubMed2005

The ABCs of engagement in out-of-school-time programs.

The rapid growth of out-of-school time programs over the past five years has resulted in a dramatic increase in opportunities for young people. However, many programs have been ill defined, without appropriate attention to the developmental needs of children and adolescents and without the necessary elements in place to fully capture the interests and talents of youth. In this chapter, the author shows how constructs drawn from research in education can be applied to research and practice in the out-of-school-time arena, in an effort to learn how the field can more fully engage young people in activities and programs. With more and more research indicating positive connections between participation in safe, supportive, and challenging activity settings and healthy psychological and social adjustment, attempts to encourage engagement rather than casual participation are warranted. Researchers and practitioners need to be mindful that engagement results not just from showing up, but from the interplay of the affective, behavioral, and cognitive experiences of youth in these settings. Suggestions for designing growth-enhancing contexts that increase the likelihood of engagement are offered, as are suggestions for future research in this area.

Adolescent↗
PubMed1980

Self-help groups: the members' perspectives.

The emergence of self-help groups as an important source of help-giving for persons with psychological problems has occurred without a systematic attempt to tap an important source of information about this phenomenon: the members themselves. Eighty members of nine self-help groups were surveyed. The results of this study suggest that self-help groups serve a different population than do professional therapists, that the help-giving processes are mainly supportive in nature, and that an optimistic attitude toward increased collaboration between professional care-givers and self-help groups is justified. Questions for further research are discussed.

Behavior Therapy↗
PubMed1990

Increasing group attendance on a psychiatric unit: an alternating treatments design comparison.

Compliance is a critical factor for success in the treatment of chronic psychiatric patients. Major reasons for therapeutic failure are that patients discontinue their medications, fail to keep therapist appointments, or do not participate in recommended psychosocial activities. An alternating treatments design was employed to assess the use of verbal instructions and feedback to promote group attendance on a psychiatric unit. Results showed these methods served to significantly increase group attendance but had no significant effect on patient satisfaction. These results are discussed with regard to cost-efficient methods for promoting treatment compliance with psychiatric inpatients.

Adult↗
PubMed1986

The treatment of emotional disorders in general practice: psychological methods versus medication.

This paper describes three recent trials in which psychological methods were evaluated in the treatment of emotional disorders in general practice. In the first trial, brief counselling by the general practitioner was found to be as effective as anxiolytic medication, was welcomed by patients and did not increase demands on doctors' time. In the second trial (still in progress), in which treatment is aimed at emotional disorders of poor prognosis, problem solving treatment by a psychiatrist is being compared with control treatment by the G.P. The third trial evaluated an anxiety management programme provided by clinical psychologists in health centres; substantial reductions in anxiety occurred rapidly and were maintained at follow-up.

Affective Symptoms↗
PubMed1995

A comparative study of cognitive behavior therapy versus general anesthesia for painful medical procedures in children.

A treatment outcome study was conducted to compare the efficacy of cognitive behavior therapy (CBT) versus general anesthesia in alleviating the distress of 18 pediatric cancer patients (ages: 3-12 years) undergoing bone marrow aspirations (BMAs). CBT and short-acting mask anesthesia were delivered within a repeated-measures counterbalance design. Results indicated that children exhibited more behavioral distress in the CBT condition for the 1st minute lying down on the treatment table. However, parents rated significantly more behavioral adjustment symptoms 24 h following the BMA when their children had received anesthesia. No differences were found in childrens' and parents' preference for CBT versus anesthesia.

Anesthesia, General↗
PubMed1978

Affect, accessibility of material in memory, and behavior: a cognitive loop?

Two studies investigated the effect of good mood on cognitive processes. In the first study, conducted in a shopping mall, a positive feeling state was induced by giving subjects a free gift, and good mood, thus induced, was found to improve subjects' evaluations of the performance and service records of products they owned. In the second study, in which affect was induced by having subjects win or lose a computer game in a laboratory setting, subjects who had won the game were found to be better able to recall positive material in memory. The results of the two studies are discussed in terms of the effect that feelings have on accessibility of cognitions. In addition, the nature of affect and the relationship between good mood and behavior (such as helping) are discussed in terms of this proposed cognitive process.

Affect↗
PubMed2002

Evaluating process in child and family interventions: aggression prevention as an example.

This article reports on 2 studies designed to develop and validate a set of measures for use in evaluating processes of child and family interventions. In Study 1 responses from 187 families attending an outpatient clinic for child behavior problems were factor analyzed to identify scales, consistent across sources: Alliance (Satisfactory Relationship with Interventionist and Program Satisfaction), Parenting Skill Attainment, Child Cooperation During Session, Child Prosocial Behavior, and Child Aggressive Behavior. Study 2 focused on patterns of scale scores among 78 families taking part in a 22-week preventive intervention designed to affect family relationships, parenting, and child antisocial and prosocial behaviors. The factor structure identified in Study 1 was replicated. Scale construct validity was demonstrated through across-source convergence, sensitivity to intervention change, and ability to discriminate individual differences. Path analysis validated the scales' utility in explaining key aspects of the intervention process. Implications for evaluating processes in family interventions are discussed.

Adolescent↗
PubMed2003

Changes in house design reduce exposure to malaria mosquitoes.

House design may affect an individual's exposure to malaria parasites, and hence to disease. We conducted a randomized-controlled study using experimental huts in rural Gambia, to determine whether installing a ceiling or closing the eaves could protect people from malaria mosquitoes. Five treatments were tested against a control hut: plywood ceiling; synthetic-netting ceiling; insecticide-treated synthetic-netting ceiling (deltamethrin 12.5 mg/m2); plastic insect-screen ceiling; or the eaves closed with mud. The acceptability of such interventions was investigated by discussions with local communities. House entry by Anopheles gambiae, the principal African malaria vector, was reduced by the presence of a ceiling: plywood (59% reduction), synthetic-netting (79%), insecticide-treated synthetic-netting (78%), plastic insect-screen (80%, P < 0.001 in all cases) and closed eaves (37%, ns). Similar reductions were also seen with Mansonia spp., vectors of lymphatic filariasis and numerous arboviruses. Netting and insect-screen ceilings probably work as decoy traps attracting mosquitoes into the roof space, but not the room. Ceilings are likely to be well accepted and may be of greatest benefit in areas of low to moderate transmission and when used in combination with other malaria control strategies.

Animals↗
PubMed1977

The evaluation of sexual health services in a medical setting.

An interdisciplinary Sexual Health Services unit has been established at the University of Minnesota Medical School that offers counseling and treatment programs for a wide variety of sex-related concerns and problems. The programs are based on the principles of responsibility for self, permission to be sexual, the use of reeducation, the facilitation of increased awareness in clients, and structured behavior change. The programs have been evaluated according to client satisfaction with the extent to which they have met pretreatment goals and according to results of pre/posttesting with objective instruments. One year follow-up results from 131 clients and immediate posttreatment results from 411 clients show positive change in a large majority of cases.

Behavior Therapy↗
PubMedDate not supplied

Association of point-of-purchase tobacco advertising and promotions with choice of usual brand among teenage smokers.

The objective is to determine the relationship between brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes and choice of usual brand among school students. A cross-sectional survey was designed that merged records of store tobacco advertising and promotions. The survey was administered to 3,890 U.S. high school smokers with a usual brand, matched to 196 convenience stores. Choice of Marlboro as a usual brand was associated with presence of a Marlboro gift with purchase (p <.001) and a greater brand share of interior (p = .05) and exterior (p = .05) advertising voice for Marlboro. Choice of Camel as a usual brand was associated with a greater share of interior advertising voice for Camel (p <.001) but was unrelated to a Camel gift with purchase promotions (p > .05) and negatively associated with a greater share of exterior advertising voice for Camel (p < .001). The results are consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but resultsfor Camel are mixed and inconclusive. Further research is required to confirm and extend these findings.

Adolescent↗
PubMed1988

A review of systems for the personal aspects of patient care.

Because patients are appropriate judges of the personal aspects of the care received from physicians, the authors conducted lengthy interviews with 50 randomly chosen medical inpatients. They were asked to describe, in an open-ended but semistructured fashion, their favorable and unfavorable impressions and reactions to the personal aspects of care rendered by their physicians. From the specific comments made by the patients in these interviews, we constructed a detailed taxonomy of desired physician attitudes and behaviors. The taxonomy can be used in a manner analogous to a Review of Systems for teaching students and practitioners the elements of personal care and also can be applied for research in patient-physician communication.

Adult↗
PubMed1982

Satisfaction with maternity care: a matter of communication and choice.

The purpose of this study was to determine the level of satisfaction with maternity care and whether satisfaction was related to the patterns of communication between caretakers and patient and to specific clinical procedures used during labor and delivery. Data, gathered in a statewide survey, indicated widespread satisfaction with prenatal labor and delivery care. Level of satisfaction was related to both the quality of communication and the fulfillment of preferences about the management of labor and delivery. There was a general consensus among respondents about the desirability of childbirth coaches, controlled breathing and relaxation techniques, and freedom to move around and the undesirability of medication rendering one unconscious for delivery. There was considerable variation in desire concerning medication during labor, use of a fetal monitor, presence of family members and choice atmosphere. The implications for alternatives in maternity care are discussed.

Adolescent↗
PubMed1982

Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior.

Three interactional analysis (IA) systems (Bales', Roters modified Bales and Stiles' "Verbal response modes") were used to characterize behavioral elements of provider-patient dialogues of 101 new-patient visits in a general medical clinic. In a previous article, the explanatory power of these IA systems was compared. In this article, specific provider and patient behaviors within segments of the encounter (introduction-history, physical examination and conclusion), which were shown to be related to encounter outcomes of knowledge, compliance and satisfaction, were examined. Review of interactional behaviors entering regression analysis with a significant F-to-enter (p less than or equal to 0.05) and supplementary contextual analyses suggested the importance of several categories of physician and patient behavior. Behaviors manifesting tension bear important and complex relationships to encounter outcomes. For example, patient and physician expressions of tension generally bear strong negative relationships to patient satisfaction, while patient expressions interpreted as tension release are positively related to both satisfaction and compliance. The timing of other behaviors appears to be critical to subsequent outcomes. If patient requests for medication occur early in the encounter, this behavior is positively related to subsequent patient satisfaction. However, if they occur in the concluding segment, a negative relationship results. Finally, several relationships taken together indicate that physician teaching in the concluding segment may be important. While useful observations may emerge from application of currently available IA techniques, the resulting information is best characterized as hypothesis-generating. These IA systems have many limitations, and research is needed to derived more clinically oriented systems that may permit more consistent demonstrations of critical process-outcome relationships.

Behavior↗
PubMed1986

Medical Communication Behavior System. An interactional analysis system for medical interactions.

The study assessed the psychometric properties of the Medical Communication Behavior System. This observation system records time spent by the physicians and patients on specific behaviors in the categories of informational, relational, and negative situation behaviors by using hand-held electronic devices. The study included observations of 101 genetic counseling sessions and also assessed the outcome measures of patient knowledge and satisfaction. In addition, 41 of the sessions were rated using the Roter Interactional Analysis System, and 20 additional control subjects completed the post-counseling information without being observed to examine the effects of recording the session. Results showed good interobserver reliability, and evidence of concurrent, construct, and predictive validity. No differences were found between the observed and unobserved groups of any of the outcome measures.

Behavior↗
PubMed1989

Communication of information about therapeutic alternatives: end-stage renal disease model.

We analyzed data from questionnaires obtained from 59 patients with end-stage renal disease and nine nephrologists and transplant surgeons to determine outcome of transplantation and dialysis (probability estimates) and the relative advantages of these two treatments (attitudinal responses). Data from national and local studies were available for comparison with the probability estimates. Results indicate that although personal experience with transplantation can bias a patient's estimate of treatment outcome, neither physicians nor patients had a bias toward optimism. Attitudinal responses were similar for patients and physicians, suggesting that physicians communicate personal views more easily than information. Results suggest that shortcomings in information processing need not make informed consent procedures invalid.

Adolescent↗
PubMed2006

A closer look at the managed care backlash.

BACKGROUND: Much anecdotal evidence exists regarding the managed care backlash of the late 1990s, but limited empirical evidence is available. OBJECTIVES: Using a unique series of employer surveys, we examined trends in enrollment rates in health maintenance organizations (HMOs) and other plan types between 1997 and 2003. RESEARCH DESIGN: We present enrollment rates in employer-sponsored health plans by plan type. These plan-level enrollment rates are disaggregated by whether or not enrollees had a choice of plan types and by firm size and year. SUBJECTS: Employees who were enrolled in employer-sponsored health insurance in private sector establishments. RESULTS AND CONCLUSIONS: Although we found evidence of a decline in the popularity of HMOs, it occurred later than indicated in earlier studies. In our data, HMO enrollment rates fell from roughly 32% to 26% between 1997 and 2003, with most of the decline occurring after 2001. Earlier studies reported that the decline in HMO enrollment rates occurred between 1996 and 1998, and between 2000 and 2001. In addition, an interesting story emerged when we examined trends by firm size. We found evidence of a decline in the HMO enrollment rate for large employers starting in 1998. However, this was offset by an increase in the HMO enrollment rate in small employers, which explains the stability in our figures before 2002. Our data also indicated that when workers were given a choice between an HMO and other plan types, workers increasingly opted for the non-HMO plan during this time period.

Choice Behavior↗