Human-centered participatory co-design with children and adults for a prototype lifestyle intervention and implementation strategy in a rural middle school
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SUBMITTER: Watkins J
PROVIDER: S-EPMC10949632 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:This study aimed to evaluate the effectiveness of an intervention to reduce bicycle injuries among rural middle school students in China. A one-year cluster-randomized controlled trial was conducted with seventh grade students from six middle schools in two towns in rural Chaoshan, China. The two towns were randomly assigned to either the intervention or control group. Road safety education materials, two lectures on road safety, and a series of health education activities were delivered to 1312 students in the intervention group over one year, and the content of the intervention included traffic safety knowledge, methods of preventing bicycle injury and management of bicycle injuries. Questionnaires weere administered to the two groups before and after the intervention to measure the incidence, cognitions, and behaviors related to bicycle injuries. The pre-intervention incidence of bicycle injuries exhibited no significant difference between the two groups, while the difference reached significance after the intervention (χ² = 13.409, p < 0.001). In the intervention group, the incidence decreased significantly after the intervention (χ² = 8.137, p = 0.004), while no significant change was observed in the control group. Publicity and education intervention measures have certain short-term effects on the prevention of bicycle injuries among rural middle school students; we should approach intervention measures according to the characteristics of traffic injuries in different areas.
| S-EPMC5551128 | biostudies-other
Project description:BackgroundParticipatory research offers a promising approach to addressing health inequities and improving the social determinants of health for diverse populations of adolescents. However, little research has systematically explored factors influencing the implementation of participatory health interventions targeting health disparities.ObjectiveThis study examined the utility of the Consolidated Framework for Implementation Research (CFIR) in identifying and comparing barriers and facilitators influencing implementation of participatory research trials by employing an adaptation of the CFIR to assess the implementation of a multi-component, urban public school-based participatory health intervention.MethodsWe collected qualitative data over a one-year period through weekly team meeting observational field notes and regular semi-structured interviews with five community-based participatory researchers, one school-based partner, and four school principals involved in implementing a participatory intervention in five schools. Adapted CFIR constructs guided our largely deductive approach to thematic data analysis. We ranked each of the three intervention components as high or low implementation to create an overall implementation effectiveness score for all five schools. Cross-case comparison of constructs across high and low implementation schools identified constructs that most strongly influenced implementation.ResultsTen of 30 assessed constructs consistently distinguished between high and low implementation schools in this participatory intervention, with five strongly distinguishing. Three additional constructs played influential, though non-distinguishing, roles within this participatory intervention implementation. Influential constructs spanned all five domains and fit within three broad themes: 1) leadership engagement, 2) alignment between the intervention and institutional goals, priorities, demographics, and existing systems, and 3) tensions between adaptability and complexity within participatory interventions. However, the dynamic and collaborative nature of participatory intervention implementation underscores the artificial distinction between inner and outer settings in participatory research and the individual behavior change focus does not consider how relationships between stakeholders at multiple levels of participatory interventions shape the implementation process.ConclusionsThe CFIR is a useful framework for the assessment of participatory research trial implementation. Our findings underscore how the framework can be readily adapted to further strengthen its fit as a tool to examine project implementation in this context.
| S-EPMC8414723 | biostudies-literature
Project description:BackgroundSedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use, limited social connections, and high stress contribute to the growing prevalence of chronic diseases. Lifestyle medicine, emphasizing therapeutic lifestyle changes for prevention and treatment, has demonstrated effectiveness but remains underutilized in clinical settings. The Complete Lifestyle Medicine Intervention Program-Ontario (CLIP-ON) was developed to educate the rural population of Northern Ontario in lifestyle medicine to improve health outcomes and engagement.ObjectiveThis study evaluates the implementation and effectiveness of the CLIP-ON program for patients with chronic diseases in the Parry Sound area, focusing on lifestyle behaviors, health outcomes, enrollment, retention rates, and interdisciplinary team engagement.MethodsThis observational cohort study guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) includes pre- and postintervention assessments from participants and health care providers. A hybrid type II mixed methods design evaluates the intervention's effectiveness and implementation process in real-world settings through quantitative and qualitative data collection. CLIP-ON is tailored to the residents of the Parry Sound catchment area in Northern Ontario. Participants (≥18 years old) with chronic conditions such as prediabetes, type II diabetes, systemic hypertension, cardiovascular vascular disease, dyslipidemia, or high BMI (≥25) will be recruited through self-referral or provider referral. Approximately 10 participants per cohort will be enrolled in the CLIP-ON program, consisting of 22 weeks of weekly group sessions and monthly individual consultations with physicians, health coaches, kinesiologists, and registered dieticians either in person or through a web-based platform. CLIP-ON will cover the 6 pillars of lifestyle medicine through 14 group sessions followed by an 8-week supervised exercise program. Anthropometric and cardiometabolic variables will be measured before and after the program. Participants will be surveyed on lifestyle habits, wellness, perceived barriers, and program satisfaction at 3 and 6 months. Focus groups and dropout interviews with participants (n=10 per cohort) and providers (n=6 per cohort) will guide program adaptations. Quantitative and qualitative data collected at baseline and follow-up will assess the program's implementation and identify barriers and opportunities for improvement.ResultsThis study was approved by the Laurentian University Research Ethics Board (6021397) on July 6, 2023. The first cohort was enrolled in late 2023 and is still under evaluation. The second cohort began in mid-2024, and data collection is currently underway. A mixed methods analysis will be used at enrollment, program completion (22 weeks), and follow-up (6 months after program completion). Focus groups assessing the program's effectiveness and implementation will take place after the 22-week intervention. Data will be analyzed in early 2025.ConclusionsThis protocol provides insights into the implementation of this lifestyle medicine program and its impact on participants' health. The findings will guide future advancements and establish a scalable model for other communities.Trial registrationClinicalTrials.gov NCT06192251; https://clinicaltrials.gov/study/NCT06192251.International registered report identifier (irrid)DERR1-10.2196/59179.
| S-EPMC11733517 | biostudies-literature
Project description:BackgroundEvidence-based HIV interventions often fail to reach anticipated impact due to insufficient utilization in real-world health systems. Human-centered design (HCD) represents a novel approach in tailoring innovations to fit end-users, narrowing the gap between efficacious interventions and impact at scale.MethodsWe combined a narrative literature review of HCD in HIV programs with our experience using HCD to redesign an intervention promoting patient-centered care (PCC) practices among health care workers (HCW) in Zambia. We summarize the use and results of HCD in the global HIV response and share case study insights to advance conceptualization of HCD applications.ResultsThe literature review identified 13 articles (representing 7 studies) on the use of HCD in HIV. All studies featured HCD hallmarks including empathy development, user-driven inquiry, ideation, and iterative refinement. HCD was applied to mHealth design, a management intervention and pre-exposure prophylaxis delivery. Our HCD application addressed a behavioral service delivery target: changing HCW patient-centered beliefs, attitudes, and practices. Through in-depth developer-user interaction, our HCD approach revealed specific HCW support for and resistance to PCC, suggesting intervention revisions to improve feasibility and acceptability and PCC considerations that could inform implementation in transferable settings.ConclusionsAs both a research and implementation tool, HCD has potential to improve effective implementation of the HIV response, particularly for product development; new intervention introduction; and complex system interventions. Further research on HCD application strengths and limitations is needed. Those promoting PCC may improve implementation success by seeking out resonance and anticipating the challenges our HCD process identified.
| S-EPMC6880397 | biostudies-literature
Project description:BackgroundIndividual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector.MethodsAs part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked.ResultsA series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls.ConclusionFindings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed.Trial registrationClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.
| S-EPMC6543642 | biostudies-literature
Project description:This study augmented the Prototype Willingness Model (PWM) to assess reactive and deliberative decision-making underpinning bystander intervention in gender-based violence contexts. There were 2079 participants (50% male, 49% female, and 1% unreported), aged 11-15 years old (M = 12.32, SD = 0.91), attending 19 secondary schools across Scotland. Participants self-reported the augmented PWM variables, then their intervention behaviour approximately 1 month later. Path analyses mostly supported the predicted relationships between positive and negative bidimensional attitudes, subjective norms, prototype perceptions, perceived behavioural control, and self-efficacy on intentions and willingness. Willingness predicted positive (speaking with a teacher) and negative (doing nothing) intervention in less serious violence. Self-efficacy predicted negative intervention in more serious violence. Subjective norms positively moderated the attitudes-intentions relationship. Overall, the results suggested that reactive (willingness) more so than deliberative (intention) decision-making account for intervention when young people witness gender-based violence. Additionally, the findings highlight the complexity of bystander intervention decision-making, where adding control perceptions, bidimensional attitudes, and moderators have independent contributions. Furthermore, self-comparison to the typical bystander who positively intervenes (prototype perceptions) was the strongest predictor of intentions and willingness, highlighting in a novel way the importance of image and group membership on decision-making.
| S-EPMC9790461 | biostudies-literature
Project description:BackgroundParents play a critical role in their children's health. We explored the association of children's perception of their parents' health behaviors and education level with the health behaviors of middle-school students participating in a school-based wellness program.MethodsStudents completed a baseline survey on their dietary, physical activity, and sedentary behaviors, and their parents' health behaviors and education. Descriptive statistics and generalized linear regression with random intercept analyzed which child-reported parent behaviors, parent education levels, and demographic factors were associated with healthy child behaviors.ResultsAmong 4607 students, for all behaviors assessed, children who perceived their parent exhibiting a healthy behavior were more likely to display the same healthy behavior. Healthier diet, more physical activity, and less sedentary habits were reported by students who reported their parents had college or higher education, compared to students who reported their parents had some college or less education.ConclusionsThese results encourage increased parental involvement in childhood wellness programs. Additionally, these data suggest interventions which target parents with lower educational attainment may also benefit their children's health behaviors. As we continue to understand how adolescent behavior is shaped, we can increase the effectiveness of targeted health education for parents and children.
| S-EPMC11562258 | biostudies-literature
Project description:Despite research supporting the efficacy of Automated Writing Evaluation (AWE) in improving writing outcomes, inconsistent implementation by teachers raises concerns about the efficacy of these systems in practice. However, little is known about what factors influence teachers' implementation and perceptions of AWE. This study examined the relationship between teachers' implementation and perceptions of the MI Write AWE system, seeking to identify actionable factors that could enhance AWE implementation and acceptance in the future. A mixed-methods design was utilized, combining quantitative analysis of usage logs and survey data with qualitative insights from focus groups and interviews with 19 teachers who participated in a randomized controlled trial (RCT) testing the efficacy of MI Write on students' writing outcomes. Quantitative data were subjected to descriptive and non-parametric statistical analyses, while qualitative data underwent a deductive coding process, offering an integrated view of MI Write's use and educators' perceptions. Teachers implemented MI Write variably and not to the extent expected of them within the RCT, but they did report generally positive attitudes towards MI Write. Findings indicated that positive perceptions of system usability and usefulness may be insufficient to promote effective implementation. Instead, ecological factors such as curricular alignment and the challenge of incorporating AWE into existing workload, administrative support, and broader social and educational policy appeared as factors influencing implementation. Findings emphasize that teachers' implementation and perceptions of AWE are dependent on a range of contextual elements beyond mere system functionality, suggesting that successful adoption requires addressing broader ecological considerations.
| S-EPMC11656462 | biostudies-literature
Project description:Successful implementation reflects the interplay between intervention, implementation strategy, and context. Hybrid effectiveness-implementation studies allow investigators to assess the effects of both intervention and implementation strategy, though the role of context as a third independent variable (IV) is incompletely specified. Our objective is to expand the hybrid typology to include mixtures of all three types of IVs: intervention, implementation strategy, and context. We propose to use I to represent the IV of intervention, IS to represent implementation strategy, and C to represent context. Primary IVs are written first and in upper case. Secondary IVs are written after a forward slash and in lower case; co-primary IVs are written after a dash and in upper case. The expanded framework specifies nine two-variable hybrid types: I/is, I-IS, IS/i, IS/c, IS-C, C/is, C/i, I-C, and I/c. We describe four in detail: I/is, IS/c, IS-C, and C/is. We also specify seven three-variable hybrid types. We argue that many studies already meet our definitions of two- or three-variable hybrids. Our proposal builds from the typology proposed by Curran et al. (1), but offers a more complete specification of hybrid study types. We need studies that measure the implementation-related effects of variations in contextual determinants, both to advance the science and to optimize intervention delivery in the real world. Prototypical implementation studies that evaluate the effectiveness of an implementation strategy, in isolation from its context, risk perpetuating the gap between evidence and practice, as they will not generate context-specific knowledge around implementation, scale-up, and de-implementation.
| S-EPMC6857476 | biostudies-literature
Project description:BackgroundStudents who are targets of bullying and who witness bullying are at high risk for negative mental health outcomes. Bystander training is essential to reduce bullying and the negative associated consequences for targets and bystanders. Resources necessary for program delivery, however, pose significant barriers for schools, particularly those in rural, low-income communities. Technology-based programs can reduce health disparities for students in these communities through cost-effective, easy-to-disseminate programming.ObjectiveThe aim of this study is to conduct usability testing of a bystander bullying web app prototype, STAC-T (technology-based STAC, which stands for the 4 bystander strategies Stealing the Show, Turning it Over, Accompanying Others, and Coaching Compassion) as an initial step in the development of a full-scale STAC-T intervention. Objectives include assessing usability and acceptability of the STAC-T prototype, understanding school needs and barriers to program implementation, and assessing differences in usability between school personnel and students.MethodsA sample of 16 participants, including school personnel and students recruited from 3 middle schools in rural, low-income communities, completed usability testing followed by a qualitative interview. Descriptive statistics, 2-tailed independent sample t tests, and consensual qualitative research were used to assess usability and program satisfaction and to extract themes related to acceptability, feasibility, needs, barriers, and feedback for intervention development.ResultsUsability testing indicated that the app was easy to use, acceptable, and feasible. Both school personnel (mean rating 89.6, SD 5.1) and students (mean rating 91.8, SD 7.0) rated the app well above the standard cutoff score for above-average usability (ie, 68), and both school personnel (mean rating 5.83, SD 0.41) and students (mean rating 6.10, SD 0.57) gave the app high user-friendliness ratings (0-7 scale, with 7 as high user-friendliness). The overall ratings also suggested that school personnel and students were satisfied with the program. Of the 6 school personnel who said they would recommend the program, 1 (17%), 4 (66%), and 1 (17%) rated the program as 3, 4, and 5 stars, respectively; 80% (8/10) of students said they would recommend the program; and 60% (6/10) and 40% (4/10) rated the program as 4 stars and 5 stars, respectively. Qualitative data revealed that school personnel and students found the STAC-T app to be useful, user-friendly, and relevant, while providing feedback related to the importance of digital learning activities that engage the user. Data from school personnel also indicated positive perceptions regarding program feasibility and probability of program adoption, with the most significant barrier being cost, suggesting the importance of considering the financial resources available to schools in rural, low-income communities when setting the price point for the full-scale STAC-T intervention.ConclusionsThis study provides support for the full-scale development of the STAC-T app and provides key information for revision to enhance used engagement.Trial registrationClinicalTrials.gov NCT04681495; https://clinicaltrials.gov/ct2/show/NCT04681495.
| S-EPMC8579223 | biostudies-literature