https://faculty.weber.edu/eamsel/Research%20Groups/Dual%20PRocess%20Research/New%20Papers/Steinberg%20(2008).pdf

A Social Neuroscience Perspective on Adolescent Risk-Taking.

Qualitative Interviewing: The Art of Hearing Data

Background
People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects.

Objectives
To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions.

Search methods
We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles.

Selection criteria
Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings.

Data collection and analysis
Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis.

Main results
For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 83 interventions reported in 70 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.

Authors' conclusions
For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.

Interventions for enhancing medication adherence.

Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs—exploratory sequential, explanatory sequential, and convergent—and through four advanced frameworks—multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods.

/pdf/achieving-integration-in-mixed-methods-designs-principles-36zfo3ajv4.pdf

Achieving Integration in Mixed Methods Designs—Principles and Practices

Statistical Methods for Health Care Research

Background: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder.

Methods: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow-up interview approximately 4 weeks after the birth.

Results: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self-efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth.

Conclusions: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum. (BIRTH 30:1 March 2003)

Prevalence and predictors of women's experience of psychological trauma during childbirth.

Communication about sexual issues: mothers, fathers, and friends.

Motivational interviewing (MI), initially developed for addiction counseling, has increasingly been applied in public health, medical, and health promotion settings. This article provides an overview of MI, outlining its philosophic orientation and essential strategies. Major outcome studies are reviewed, nuances associated with the use of MI in health promotion and chronic disease prevention are described, and future directions are offered.

Motivational interviewing in health promotion: it sounds like something is changing.

African-Americans (AAs) are significantly less likely to be physically active than other Americans, and, like all Americans, they consume fewer than the recommended five fruit and vegetable (F & V) servings per day. This study, titled Healthy Body/Healthy Spirit, has two primary aims: (1) to test the effectiveness of a culturally tailored self-help dietary (focusing on F & V intake) and physical activity (PA) intervention compared to standard health education materials, and (2) to test the effectiveness of using Motivational Interviewing (MI), delivered by telephone, to modify PA and dietary habits. The study is a randomized effectiveness trial with three experimental conditions. Group 1 (comparison) will receive standard (existing commercial) nutrition and PA intervention materials, Group 2 (TX1) will receive a culturally tailored self-help nutrition and PA intervention of similar intensity as Group 1, and Group 3 (TX2) will receive the same intervention as Group 2, plus four telephone counseling calls based on MI. Participants will be AA adults recruited through local black churches. Despite the extensive use of MI to modify addictive behaviors, this represents one of the first controlled field trials to employ MI to address diet and PA. Secondly, this is one of the first studies to test the effectiveness of a self

/pdf/healthy-body-healthy-spirit-a-church-based-nutrition-and-1glylz6rmg.pdf

Colleen DiIorio

Papers

Prevalence and predictors of women's experience of psychological trauma during childbirth.

Communication about sexual issues: mothers, fathers, and friends.

Motivational interviewing in health promotion: it sounds like something is changing.

Healthy Body/Healthy Spirit: a church-based nutrition and physical activity intervention

The association of stigma with self-management and perceptions of health care among adults with epilepsy.