Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost.
Several classic studies have concluded that the accuracy of identifying uncontrollable situations depends heavily on depressive mood. Nondepressed participants tend to exhibit an optimistic illusion of control, whereas depressed participants tend to better detect a lack of control. Recently, we suggested that the different activity levels (measured as the probability of responding during a contingency learning task) exhibited by depressed and nondepressed individuals is partly responsible for this effect. The two studies presented in this paper provide further support for this mediational hypothesis, in which mood is the distal cause of the illusion of control operating through activity level, the proximal cause. In Study 1, the probability of responding, P®, was found to be a mediator variable between the depressive symptoms and the judgments of control. In Study 2, we intervened directly on the mediator variable: The P® for both depressed and nondepressed participants was manipulated through instructions. Our results confirm that P® manipulation produced differences in the participants' perceptions of uncontrollability. Importantly, the intervention on the mediator variable cancelled the effect of the distal cause; the participants' judgments of control were no longer mood dependent when the P® was manipulated. This result supports the hypothesis that the so-called depressive realism effect is actually mediated by the probability of responding.
BACKGROUND: While homelessness among youth is a serious problem, there is little information about evidence-based interventions for homeless youth. In cooperation with professionals and youths, Wolf (2012) developed Houvast (Dutch for ‘grip’): a strengths based method grounded in scientific and practice evidence. The main aim of Houvast is to improve the quality of life of homeless youths by focusing on their strengths, thus stimulating their capacity for autonomy and self-reliance.Method/Design: The effectiveness and fidelity of Houvast will be tested in ten Dutch services for homeless youth which are randomly allocated to an intervention group (n = 5), or a control group which provides care as usual (n = 5). Measurements of both objective and subjective quality of life and secondary outcomes (mental and physical health, substance use, coping, resilience, psychological needs, care needs, working relationship with the professional and attainment of personal goals) will be conducted among homeless youths (n = 251). Youths in both groups will be interviewed by means of a structured interview at baseline, at time of ending care or after having received care for six months (T1) and at nine months after baseline (T2). Model fidelity will be tested around T1. DISCUSSION: This study is unique as it includes a large number of homeless youths who are followed for a period of nine months, and because it focuses on a strengths based approach. If the Houvast method proves to be effective in improving quality of life it will be the first evidence-based intervention for homeless youth.Trail registration: Netherlands Trail Register (NTR): NTR3254.
BACKGROUND: Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.Objectives: The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users' manual for the measures. METHODS: A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings. DISCUSSION: The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices.
Community-led total sanitation (CLTS) is a participatory approach to addressing open defecation that has demonstrated success in previous studies, yet there is no research on how implementation arrangements and context change effectiveness. We used a quasi-experimental study design to compare two interventions in Ethiopia: conventional CLTS in which health workers and local leaders provided facilitation; and an alternative approach in which teachers provided facilitation. In 2012, Plan International Ethiopia trained teachers from 111 villages, and health workers and leaders from 54 villages in CLTS facilitation. The trained facilitators then implemented CLTS in their respective villages for a year. Latrine ownership, use, and quality were measured with household surveys. Differences between interventions were explored using surveys and interviews. The decrease in open defecation associated with teacher-facilitated CLTS was 8.2 percentage points smaller than for conventional CLTS (p=0.048). Teachers had competing responsibilities and initially lacked support from local leaders, which may have lessened their success. Teachers may be more appropriate for a supporting rather than leading role in sanitation promotion, as they did demonstrate ability and engagement. Open defecation decreased by 15.3 percentage points overall, but did not change where baseline open defecation was below 30%. Ownership of a latrine with stable flooring increased by 8.7 percentage points overall. Improved latrine ownership did not change during the intervention. CLTS is most appropriate where open defecation is high, as there were no significant changes in sanitation practices or latrine upgrades where baseline open defecation was low.
Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can reduce the rate of delirium in the elderly, but in spite of promising findings in animal experiments, no intervention reduces postoperative cognitive dysfunction in humans.
Vitamin A supplementation (VAS) programs targeted at children aged 6-59 months are implemented in many countries. By improving immune function, vitamin A (VA) reduces mortality associated with measles, diarrhea, and other illnesses. There is currently a debate regarding the relevance of VAS, but amidst the debate, researchers acknowledge that the majority of nationally-representative data on VA status is outdated. To address this data gap and contribute to the debate, we examined data from 82 countries implementing VAS programs, identified other VA programs, and assessed the recentness of national VA deficiency (VAD) data. We found that two-thirds of the countries explored either have no VAD data or data that were >10 years old (i.e., measured before 2006), which included twenty countries with VAS coverage ≥70%. Fifty-one VAS programs were implemented in parallel with at least one other VA intervention, and of these, 27 countries either had no VAD data or data collected in 2005 or earlier. To fill these gaps in VAD data, countries implementing VAS and other VA interventions should measure VA status in children at least every 10 years. At the same time, the coverage of VA interventions can also be measured. We identified three countries that have scaled down VAS, but given the lack of VA deficiency data, this would be a premature undertaking in most countries without appropriate status assessment. While the global debate about VAS is important, more attention should be directed towards individual countries where programmatic decisions are made.
Studies of criteria-based assessment tools have demonstrated the feasibility of objectively evaluating eHealth interventions independent of empirical testing. However, current tools have not included some quality constructs associated with intervention outcome, such as persuasive design, behavior change, or therapeutic alliance. In addition, the generalizability of such tools has not been explicitly examined.
Sedentary behaviour - i.e., low energy-expending waking behaviour while seated or lying down - is a health risk factor, even when controlling for physical activity. This review sought to describe the behaviour change strategies used within interventions that have sought to reduce sedentary behaviour in adults. Studies were identified through existing literature reviews, a systematic database search, and hand-searches of eligible papers. Interventions were categorized as ‘very promising’, ‘quite promising’, or ‘non-promising’ according to observed behaviour changes. Intervention functions and behaviour change techniques were compared across promising and non-promising interventions. Twenty-six eligible studies reported 38 interventions, of which 20 (53%) were worksite-based. Fifteen interventions (39%) were very promising, 8 quite promising (21%), and 15 non-promising (39%). Very or quite promising interventions tended to have targeted sedentary behaviour instead of physical activity. Interventions based on environmental restructuring, persuasion, or education, were most promising. Self-monitoring, problem solving, and restructuring the social or physical environment were particularly promising behaviour change techniques. Future sedentary reduction interventions might most fruitfully incorporate environmental modification and self-regulatory skills training. The evidence base is however weakened by low-quality evaluation methods; more RCTs, employing no-treatment control groups, and collecting objective data, are needed. Supplemental_PRISMA_checklist.pdf Supplemental References.pdf Supplemental Table_1.pdf Supplemental Table_2.pdf Supplemental Table_3.pdf Supplemental Table_4.pdf Supplemental Table_5.pdf.
Cognitive Behaviour Therapy (CBT) is the front-line psychological intervention for step 3 within UK psychological therapy services. Counselling is recommended only when other interventions have failed and its effectiveness has been questioned.