Evaluation & the Health Professions最新文献

This invited commentary reflects on Wandersman and Scheier's (2024) call for a more evidence-based model of training and technical assistance (i.e. TTA or implementation support). Their clarion call prompts us to consider what steps need to be taken to refine and scale a solution that genuinely enhances the effectiveness of TTA through a re-imagined model of implementation support. We highlight eight priorities to re-imagine a more effective and efficient model of TTA that reflects best practice and simultaneously contributes to continuous, collective evidence-building. The eight priorities include: (1) an ecosystem of TTA connecting TTA research and practice; (2) TTA capacity building; (3) health equity, and equitable partnerships; (4) trust and relationships; (5) TTA evaluation; (6) continuous quality improvement; (7) implementation support mechanisms; and (8) cost-effective solutions. We advocate for an international, cross-disciplinary, applied agenda aimed at establishing a robust empirical foundation for TTA to foster a culture of continuous quality improvement and knowledge generation across government agencies and philanthropies that fund TTA Centers. We describe a potential scenario for how funders can initiate and support evidence-based TTA.

Single-Case Experimental Designs (SCEDs), or N-of-1 trials, are commonly used to estimate intervention effects in many disciplines including in the treatment of youth mental health problems. SCEDs consist of repeated measurements of an outcome over time for a single case (e.g., student or patient) throughout one or more baseline phases and throughout one or more intervention phases. The manipulation of the baseline and intervention phase make the SCED a type of interrupted time series design, which is considered one of the most effective experimental designs for causal inference. An important step towards understanding why interventions are effective at producing a change in the outcome is through the investigation of mediating mechanisms. Hypotheses of mediating mechanisms involve an intervention variable which is hypothesized to affect an outcome through its effect on a mediating variable. Little work has attempted to combine mediation analysis and ABAB reversal designs. Therefore, the goals of this paper are to define, estimate, and interpret mediation effects for ABAB reversal designs. An empirical example is used to demonstrate how to estimate and interpret the mediation effects. R code is provided for researchers interested in estimating mediation effects in single-case reversal designs.

This study investigates the current landscape of behavioral addiction treatment in Türkiye hospitals, considering both inpatient and outpatient approaches. The analysis involved examining the websites of 1393 hospitals across Türkiye based on various criteria. The review of the websites was conducted between June and September 2023. The findings reveal that out of these hospitals, comprising 822 public and 571 private institutions, only 51 provide treatment for behavioral addictions. Behavioral addiction treatments are available in 23 of the 81 provinces in Türkiye, and 24 out of the 51 hospitals offering treatment for behavioral addictions are located in İstanbul (47.1%), while three (5.9%) are located in Ankara. Among these 51 hospitals, 22 are public, and 29 are private. The primary focus of treatment revolves around internet and gambling addiction. Upon analyzing the patient groups served, it was observed that 49% (n = 25) of the hospitals specialize in treating adult patients, while 29.4% (n = 15) cater to pediatric patients. While the websites of 11 hospitals contain information about the behavioral addiction treatments offered, they lack any information on the patient groups to which they cater. The predominant treatment modalities include psychotherapy (25.49%), followed by psychopharmacotherapy (19.61%) and cognitive-behavioral therapy (17.65%). In conclusion, the treatment of behavioral addictions, such as those related to the internet, gaming, and shopping, are offered in hospitals across various regions and age groups. Considering that only 3.7% of hospitals in Türkiye treat behavioral addictions, this type of treatment is not widespread.

Transitioning to motherhood comes with new and intensive tasks that may cause parental stress, low parental self-efficacy, and internalizing problems. This can in turn negatively affect the mother-child relationship. Mindful with your Baby/Toddler (MwyB/T) is a mindfulness-based intervention for parents of young children experiencing parental stress and internalizing problems. Previous evaluative studies showed promising results, but methodology of these studies was limited. The current study used a single case design, including a baseline, intervention, posttest, and follow-up phase, to evaluate the effectiveness of MwyB/T. Ten participants were included and completed daily administered personalized items and validated questionnaires measuring mindfulness, mindful parenting, parental self-efficacy, internalizing problems, and parental stress, for 10 participants. Personalized items were first coded into themes and then assessed using visual analysis and descriptive effect size measures. Reliable change indices were computed for the questionnaires. All mothers improved on personalized items, with most improving on most (or all) of their items. On the questionnaires the majority of mothers improved. Results indicate that MwyB/T could benefit mothers with various intervention goals. More research is needed on the role of personalized items, both as a research measure and an as a possible additional element of interventions.

Program evaluation is essential for medical schools to demonstrate social accountability and identify areas for improvement in medical education (MEd). Although stakeholder engagement is crucial in program evaluation, no previous review has specifically examined the stakeholders involved in MEd program evaluation. This scoping review addresses this gap by identifying the stakeholders, their roles, and their levels of engagement in evaluating MEd programs, along with the facilitators and barriers to their participation. Through a systematic search across four databases, we identified 53 relevant studies out of 7206 screened. Our findings reveal seven primary stakeholder groups, with students and program directors being the most frequent participants. However, a significant gap exists in the representation of community members and patients, indicating a need for greater inclusion of these key stakeholders. Additionally, we found that stakeholders are primarily engaged as passive participants providing feedback rather than actively shaping the evaluation process. Facilitators and barriers to participation were identified from the participants' perspective, highlighting the need for further research to understand the viewpoints of active stakeholders, such as faculty and administrators. Future studies should also explore the impact of different evaluation approaches on stakeholder engagement to develop more inclusive and effective MEd program evaluations.

Surveys involving health care providers continue to be characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey participation. An important approach is to employ monetary incentives to improve survey response. Using a systematic review and analyses of 100 randomized comparisons (published in 48 papers) between monetary incentives and a non-incentive condition, this paper seeks to advance the understanding of best practices for using monetary incentives in clinician surveys. These analyses show even small incentives (≤$2) to be effective in improving clinician response relative to non-incentive subgroups, with diminished returns associated with serial incremental increases above that amount up to amounts greater than $25, at which point there is an appreciable improvement, supporting the use of higher incentives in this population. Cash and direct cash equivalents (e.g., cash cards and checks) produced greater odds of survey participation compared to vouchers, lotteries and charitable contributions, with lotteries and charities being the least effective forms of monetary incentive. Survey mode, timing and ethical considerations are also addressed. Noting the challenges associated with surveying clinicians, researchers must make every effort to improve access to this difficult-to-reach population by implementing appropriate incentive-based strategies designed to improve participation rates.

Although the prevalence of symptoms of post-traumatic stress disorder (PTSD) in infants and young children is similar as in older age groups, and PTSD intervention is as important in this age group, research on PTSD-treatment in infants is very scarce. Eye Movement Desensitization and Reprocessing (EMDR) Storytelling is a trauma-focused treatment that is being used by clinicians for infants with PTSD-symptoms. The aim was to assess the feasibility, acceptability and initial indications of effectiveness of EMDR Storytelling for infants aged 3-24 months with PTSD-symptoms after medical procedures. We included 6 infants and administered personalized items to assess PTSD-symptoms during the baseline, intervention and follow-up phase on a day-to-day basis. Furthermore, we measured PTSD-classification and symptoms at three and four measurement points, respectively. The data was analysed visually and quantitatively. EMDR Storytelling was shown to be feasible and acceptable for all participating families. Parent- and therapist-report showed that four out of the six infants included in the current study showed a clear reduction over time in PTSD-classification, -symptoms, and daily measured PTSD-symptoms. The results concerning the other two infants were mixed. Attention should be paid to cognitive (language) as well as interactional (infant-parent) mechanisms potentially underlying the benefits of EMDR Storytelling.

This study aimed to examine the factorial structure of the Jefferson Scale of Empathy-Medical student version (JSE-S) and assess items' discriminatory ability at higher and lower empathy levels in medical student populations from different countries and languages. JSE-S datasets were retrieved from previous studies of 4113 first- and/or second-year medical students from Switzerland, Portugal, Italy, Brazil, France, Spain, New Zealand, UK, Ireland, Mexico, and Peru. Parallel principal component analyses and item response theory were applied. Excluding item 18, the Compassionate Care subscale emerged in five samples (Switzerland, Portugal, Italy, France and UK/Ireland), Perspective Taking in three (Switzerland, Portugal and UK/Ireland) and Walking in Patient's Shoes in five (Switzerland, Portugal, Spain, UK/Ireland and Mexico/Peru). All subscales had items providing overlapping information. The JSE-S subscales had reliable high test performance at low empathy levels, while when the JSE-S increased, the standard error also increased. There was no consistent support across countries for the JSE-S three-factorial structure. Items provided redundant information and discriminatory power decreased when aiming to differentiate students at high empathy levels. A JSE-S revision to improve cross-cultural comparability, results' generalizability and validity should focus on suppressing or reformulating items that cannot differentiate medical students' empathy.

This study evaluated the effect of preoperative ocular fixation training on patients undergoing pterygium surgery. Before pterygium excision, patients were trained to perform eye position fixation training, which is beneficial for surgeons performing microsurgery. The study analysed the effectiveness of preoperative eye position fixation training in patients with pterygium by randomised controlled experimental design. The number of occurrences of self-turning, operation time, self-rating depression scale scores and self-rating anxiety scale scores of the experimental group (EG) were lower than those of the control group (CG). The recurrence rate and the incidence of conjunctival tear and conjunctival suture loosening in the EG were significantly lower than those in the CG. The use of eye fixation training prior to pterygium surgery can facilitate the activities of the surgeon, reduce the operation time, reduce the occurrence of complications and reduce the recurrence rate after the operation. Eye fixation training is worthy of application in patients with pterygium.

Indigenous governance of health care has increasingly been advocated among Indigenous peoples in many countries. However, there is limited research that has empirically examined its benefits. In 2020/21, we conducted a survey of 2113 Indigenous Wayuu individuals in Colombia who received services from the Indigenous Wayuu led health care insurance organization Anas Wayuu and its network of service providers, and Wayuu individuals who received services from non-Indigenous health insurance organizations. We compared their health care utilization and perception of quality of care. A main finding of the study was that Anas Wayuu enrollees were more than twice as likely to access health care than enrollees from non-Indigenous health insurance organizations, even when controlling for the demographic and health characteristics. The study provided compelling evidence suggesting that Anas Wayuu, being an Indigenous led health organization improves access to, and quality of care, among Indigenous health service recipients.