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Acceptability of Four Intervention Components Supporting Medication Adherence in Women with Breast Cancer: a Process Evaluation of a Fractional Factorial Pilot Optimization Trial. 支持乳腺癌妇女坚持用药的四项干预措施的可接受性:分数因子试点优化试验的过程评估。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1007/s11121-024-01711-9
Sophie M C Green, Nikki Rousseau, Louise H Hall, David P French, Christopher D Graham, Kelly E Lloyd, Michelle Collinson, Pei Loo Ow, Christopher Taylor, Daniel Howdon, Robbie Foy, Rebecca Walwyn, Jane Clark, Catherine Parbutt, Jo Waller, Jacqueline Buxton, Sally J L Moore, Galina Velikova, Amanda Farrin, Samuel G Smith

Adjuvant endocrine therapy (AET) reduces mortality in early-stage breast cancer, but adherence is low. We developed a multicomponent intervention to support AET adherence comprising: text messages, information leaflet, acceptance and commitment therapy (ACT), and side-effect website. Guided by the multiphase optimization strategy, the intervention components were tested in the ROSETA pilot optimization trial. Our mixed-methods process evaluation investigated component acceptability. The pilot optimization trial used a 24-1 fractional factorial design. Fifty-two women prescribed AET were randomized to one of eight experimental conditions, containing unique component combinations. An acceptability questionnaire was administered 4 months post-randomization, and semi-structured interviews with 20 participants further explored acceptability. Assessments were guided by four constructs of the theoretical framework of acceptability: affective attitude, burden, perceived effectiveness, and coherence. Quantitative and qualitative findings were triangulated to identify agreements/disagreements. There were high overall acceptability scores (median = 14-15/20, range = 11-20). There was agreement between the qualitative and quantitative findings when triangulated. Most participants "liked" or "strongly liked" all components and reported they required low effort to engage in. Between 50% (leaflet) and 65% (SMS) "agreed" or "strongly agreed," it was clear how each component would help adherence. Perceived effectiveness was mixed, with 35.0% (text messages) to 55.6% (ACT) of participants "agreeing" or "strongly agreeing" that each component would improve their adherence. Interview data provided suggestions for improvements. The four components were acceptable to women with breast cancer and will be refined. Mixed-methods and triangulation were useful methodological approaches and could be applied in other optimization trial process evaluations.

辅助内分泌疗法(AET)可降低早期乳腺癌患者的死亡率,但其依从性却很低。我们开发了一种支持坚持内分泌治疗的多成分干预措施,包括:短信、信息传单、接受与承诺疗法(ACT)和副作用网站。在多阶段优化策略的指导下,这些干预措施在 ROSETA 试点优化试验中进行了测试。我们的混合方法过程评估调查了各组成部分的可接受性。试点优化试验采用了 24-1 分因子设计。52名开具AET处方的妇女被随机分配到八个实验条件之一,其中包含独特的成分组合。随机化后 4 个月进行了可接受性问卷调查,并对 20 名参与者进行了半结构化访谈,进一步探讨了可接受性问题。评估以可接受性理论框架的四个结构为指导:情感态度、负担、感知有效性和连贯性。对定量和定性结果进行了三角测量,以确定一致/不一致之处。总体可接受性得分较高(中位数 = 14-15/20,范围 = 11-20)。对定性和定量结果进行三角分析后,发现两者之间存在一致性。大多数参与者 "喜欢 "或 "非常喜欢 "所有内容,并表示参与这些内容所需的努力较少。50%(传单)和 65%(短信)的参与者 "同意 "或 "非常同意 "每项内容对坚持治疗的帮助。对有效性的看法不一,35.0%(短信)到 55.6%(ACT)的参与者 "同意 "或 "非常同意 "每项内容都能提高他们的依从性。访谈数据提供了改进建议。患有乳腺癌的妇女可以接受这四个组成部分,并将对其进行改进。混合方法和三角测量是有用的方法论,可用于其他优化试验过程评估。
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引用次数: 0
Geographical Variation in the Associations Between School Characteristics and Homophobic Bullying: a Contextual Analysis. 学校特征与仇视同性恋者的欺凌行为之间的地域差异:背景分析》(Geographical Variation in the Associations between School Characteristics and Homophobic Bullying: a Contextual Analysis)。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-09-23 DOI: 10.1007/s11121-024-01732-4
Salvatore Ioverno, Amy McCurdy, Stephen T Russell

Homophobic bullying constitutes a serious threat to adolescent well-being and could be understood as an ecological phenomenon, influenced by diverse school, regional, and community contexts. This study examined geographic variations in the relationship between school characteristics and homophobic bullying. Data from 2244 California schools, including student surveys and administrative records, were combined and analyzed using geographically weighted regression (GWR). Results showed that the associations between school characteristics and general victimization were consistent across geographic areas. However, when it came to homophobic bullying, the relationships with school characteristics varied significantly based on location. Notably, regions with high intolerance, urbanity, large school size, and small student-teacher ratios appeared to offer protection against bullying. Additionally, student socioeconomic status influenced bullying in disadvantaged rural schools with limited Gay-Straight Alliance (GSA) presence. Ethnic diversity also played a role, with low diversity or dominance of two ethnic groups linked to higher bullying rates.

仇视同性恋的欺凌行为对青少年的幸福构成严重威胁,可以将其理解为一种生态现象,受到学校、地区和社区不同环境的影响。本研究考察了学校特征与仇视同性恋欺凌之间关系的地域差异。研究人员将来自加州 2244 所学校的数据(包括学生调查和行政记录)进行了合并,并使用地理加权回归法(GWR)进行了分析。结果显示,不同地理区域的学校特征与一般受害情况之间的关联是一致的。然而,就恐同欺凌而言,不同地区的学校特征与恐同欺凌之间的关系存在显著差异。值得注意的是,不容忍度高、城市化程度高、学校规模大、师生比例小的地区似乎能防止欺凌事件的发生。此外,学生的社会经济地位也会影响到条件较差的农村学校中的欺凌行为,因为这些学校中的同性恋-异性恋联盟(GSA)人数有限。种族多样性也发挥了作用,低多样性或两个种族群体占主导地位与较高的欺凌率有关。
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引用次数: 0
Effects of Resource Sharing Networks on Community Anti-Drug Coalitions' Outcomes: A Social Network Analysis. 资源共享网络对社区禁毒联盟成果的影响:社会网络分析
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-01 Epub Date: 2024-08-22 DOI: 10.1007/s11121-024-01719-1
Yvonne Gaddy, Eric C Jones, Rebecca Wells, Sarah M Chilenski, Louis D Brown

Substance use-related problems continue to be a national public health crisis despite years of prevention efforts. Community anti-drug coalitions are well positioned to address substance use at local levels. Coalitions often rely on their members to connect to resources they need to address community issues and plan for sustainability over time. Such capacity building occurs through voluntary cooperation among members, making it essential to understand the role network connections play. This study sought to determine whether structural characteristics of coalitions' resource sharing networks impact members' perceptions of community improvement and coalition sustainability. Surveys at two timepoints collected data from 68 coalitions in Pennsylvania and Missouri on members' connections or ties to share information, personnel, money, or other types of collaboration. Analyses examined how coalition-level measurements of sectoral diversity, density, and resource sharing centralization, respectively, were associated with members' perceptions of community improvement, sustainability planning, and coalition sustainability. Sectoral diversity and centralization were unrelated to study outcomes. Density was also unrelated with perceived community improvement and sustainability planning. However, two facets of cooperative density were positively associated with perceived coalition sustainability: the density of ties to share information and the density of multiple types of collaborative ties. This study suggests that both information and other collaborative ties foster perceived coalition sustainability, although not community improvement.

尽管多年来一直在努力预防,但与药物使用相关的问题仍然是一个全国性的公共健康危机。社区禁毒联盟有能力在地方层面解决药物使用问题。联盟通常依靠其成员来联系解决社区问题所需的资源,并为长期的可持续发展进行规划。这种能力建设是通过成员之间的自愿合作来实现的,因此了解网络连接所发挥的作用至关重要。本研究试图确定联盟资源共享网络的结构特征是否会影响成员对社区改善和联盟可持续性的看法。在两个时间点进行的调查收集了宾夕法尼亚州和密苏里州 68 个联盟的数据,内容涉及成员在共享信息、人员、资金或其他类型合作方面的联系或纽带。分析研究了联盟层面的部门多样性、密度和资源共享集中化分别与成员对社区改善、可持续性规划和联盟可持续性的看法之间的关系。部门多样性和集中化与研究结果无关。密度也与感知到的社区改善和可持续发展规划无关。然而,合作密度的两个方面与联盟的可持续性呈正相关:信息共享联系的密度和多种类型合作联系的密度。这项研究表明,信息联系和其他合作联系都能促进联盟的可持续发展,但不能促进社区的改善。
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引用次数: 0
Family Check-Up Online: Effects of a Virtual Randomized Trial on Parent Stress, Parenting, and Child Outcomes in Early Adolescence. 在线家庭体检:虚拟随机试验对青春期早期父母压力、养育子女和儿童结果的影响。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-24 DOI: 10.1007/s11121-024-01725-3
Anne Marie Mauricio, Katherine A Hails, Allison S Caruthers, Arin M Connell, Elizabeth A Stormshak

We adapted the Family Check-Up Online (FCU-O) (1) to support families coping with pandemic-related stressors to prevent behavioral and emotional problems among middle school youth and (2) for smartphone delivery to increase access and reach during the COVID-19 pandemic. This study evaluated the direct and indirect effects of the adapted FCU-O at 4-months post-baseline. The FCU-O combines online parenting support with telephone coaching. Participants were primary caregivers of children ages 10 to 14 years. Eligibility included endorsing depression on the PHQ-2 or significant stress on a 4-item version of the Perceived Stress Scale. We randomly assigned participants to the adapted FCU-O (N = 74) or a waitlist control condition (N = 87). Participants predominantly self-identified as female (95%), 42.77 years old on average, and White (84.6%). Outcomes included caregiver reports of perceived stress and parenting, and youth conduct problems and depressive symptoms. Using a multilevel modeling approach, we tested intent-to-treat intervention effects at 4-months, with time points nested within participants. The FCU-O reduced caregiver stress and improved proactive parenting and limit setting but had no effects on youth outcomes. Effect sizes were small to moderate (Cohen's d ranged from .37 to .57). We examined indirect effects on youth outcomes at 4-months via changes in caregiver stress and parenting at 2-months. Mediation analyses suggested indirect effects on youth depressive symptoms via reductions in caregiver stress and increases in proactive parenting. Results indicate the FCU-O has potential as a public health intervention for families facing extreme stressors such as those during the COVID-19 pandemic. ClinicalTrials.gov Identifier: NCT05117099.

我们对在线家庭体检(FCU-O)进行了改编(1),以支持家庭应对与大流行相关的压力,预防中学生出现行为和情绪问题;(2)在 COVID-19 大流行期间使用智能手机提供服务,以增加访问量和覆盖面。本研究评估了改编后的 FCU-O 在基线后 4 个月的直接和间接效果。FCU-O结合了在线育儿支持和电话辅导。参与者为 10 至 14 岁儿童的主要照顾者。合格条件包括在 PHQ-2 中认可抑郁或在 4 个项目的感知压力量表中认可显著压力。我们将参与者随机分配到经过改编的 FCU-O(74 人)或候补对照组(87 人)。参与者主要自我认同为女性(95%)、平均年龄 42.77 岁、白人(84.6%)。研究结果包括照顾者对压力感知和养育子女情况的报告,以及青少年行为问题和抑郁症状。我们采用多层次建模方法,测试了 4 个月的干预效果,并将时间点嵌套在参与者中。FCU-O降低了照顾者的压力,改善了积极主动的养育方式和限制设置,但对青少年的结果没有影响。效果大小为小到中等(Cohen's d 从 0.37 到 0.57 不等)。我们通过 2 个月时照顾者压力和养育方式的变化,考察了 4 个月时对青少年结果的间接影响。中介分析表明,照顾者压力的减少和积极养育的增加对青少年抑郁症状有间接影响。研究结果表明,FCU-O 有可能成为一种公共卫生干预措施,适用于面临极端压力(如 COVID-19 大流行期间的压力)的家庭。ClinicalTrials.gov Identifier:NCT05117099。
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引用次数: 0
Parenting Profiles in Military Families: Intervention-Related Transitions and Relationships to Child Adjustment 军人家庭的养育概况:与干预有关的转变以及与儿童适应的关系
IF 3.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-16 DOI: 10.1007/s11121-024-01721-7
Sun-Kyung Lee, Abigail H. Gewirtz, Timothy F. Piehler

Parenting programs aim to improve parenting quality, which may, in turn, support various aspects of child development, including behavior and mental health. However, parenting interventions show considerable heterogeneity in response patterns across different families, demonstrating that they are not one-size-fits-all programs. This variability points to a need for greater understanding of which families benefit most from these interventions and how to improve response among those who do not. Following this literature gap, this study employed a person-centered approach to identify different parenting profiles associated with heterogeneity in treatment responses to a family-based prevention interventions adapted for military families. This study used data from a randomized controlled trial of the ADAPT intervention for 336 US military families in which at least one parent had deployed to war. Latent profile analyses revealed three unobserved parenting profiles among mothers and fathers, reflecting High positive, Moderate positive, and Coercive parenting styles. Latent transition analysis (LTA) suggested that the ADAPT program led to improvements in parenting, particularly among mothers who began the program with moderate or typical levels of parenting skills, and that these positive changes in parenting may help to decrease child externalizing problems. For fathers, the ADAPT program was most effective in preventing declines in positive parenting among those with initially typical levels of positive parenting. Overall, study findings demonstrate considerable heterogeneity in parenting behavior among a sample of military families that is associated with variability in parent responses to the evidence-based parenting program.

亲职教育项目旨在提高亲职教育的质量,进而促进儿童各方面的发展,包括行为和心理健康。然而,亲职教育干预措施在不同家庭中的反应模式存在很大差异,这表明它们并不是 "一刀切 "的计划。这种差异性表明,需要进一步了解哪些家庭从这些干预措施中受益最多,以及如何改善那些没有受益的家庭的反应。根据这一文献空白,本研究采用了一种以人为本的方法,来识别不同的养育特征,这些特征与针对军人家庭调整的基于家庭的预防干预措施的治疗反应的异质性有关。本研究使用了针对 336 个美国军人家庭的 ADAPT 干预随机对照试验的数据,在这些家庭中,父母至少有一方被派往战场。潜特征分析表明,在母亲和父亲中存在三种未观察到的养育特征,分别反映了高度积极、中度积极和强迫性养育风格。潜移默化分析(LTA)表明,ADAPT 计划改善了养育子女的方式,尤其是那些在计划开始时养育子女的技能处于中等或典型水平的母亲,这些积极的养育子女方式的改变可能有助于减少儿童的外部化问题。对于父亲来说,ADAPT 计划在防止那些最初具有典型积极养育水平的父亲的积极养育水平下降方面最为有效。总之,研究结果表明,在军人家庭样本中,养育行为存在相当大的异质性,这与家长对循证养育计划的反应存在差异有关。
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引用次数: 0
Testing an Organizational Implementation Process Model Related to Teachers’ Implementation-Related Attitudes and Behaviors: a Multilevel Mediation Analysis 测试与教师实施态度和行为相关的组织实施过程模型:多层次中介分析
IF 3.5 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-13 DOI: 10.1007/s11121-024-01722-6
Catherine M. Corbin, Yanchen Zhang, Mark G. Ehrhart, Jill Locke, Aaron R. Lyon

The effectiveness of school-based universal prevention programs is frequently diminished due to low-quality implementation. Organizational factors support high-quality implementation because of their broad influence across implementers. Conceptually, implementation leadership (i.e., behaviors that prioritize, reward, and support evidence-based practice [EBP] implementation) works to embed a favorable implementation climate (i.e., implementers’ collective perceptions that their organization prioritizes, rewards, and support EBP implementation) leading to improved implementation citizenship behavior and attitudes toward EBP. This organizational implementation process model has some empirical support but has not been tested in a multilevel framework or related to hypothesized attitudinal and behavioral outcomes. The sample included 319 teachers across 39 US public elementary schools; all were implementing Schoolwide Positive Behavior Interventions and Supports. Multilevel mediation (level 1 = teacher, level 2 = school) was used to test the indirect association of implementation leadership on implementation-related attitudes and behaviors via implementation climate across two time points (fall and spring). At the school level, the organizational implementation process model was validated related to implementation citizenship behavior, but not attitudes toward EBP. At the teacher level, the process model was validated related to both outcomes, and there was a significant direct effect of implementation leadership on attitudes toward EBP. Developing strong leaders for implementation seems key to achieving high-quality EBP implementation. Implications for schools, principal training, and research are discussed.

由于实施质量不高,校本普及预防计划的效果经常被削弱。组织因素因其对实施者的广泛影响而支持高质量的实施。从概念上讲,实施领导力(即优先考虑、奖励和支持循证实践(EBP)实施的行为)可以营造良好的实施氛围(即实施者集体认为其组织优先考虑、奖励和支持 EBP 实施),从而改善实施公民行为和对 EBP 的态度。这一组织实施过程模型有一定的实证支持,但尚未在多层次框架内进行测试,也未与假设的态度和行为结果相关联。样本包括 39 所美国公立小学的 319 名教师;所有教师都在实施全校范围的积极行为干预和支持。采用多层次调解(第 1 层 = 教师,第 2 层 = 学校)的方法,通过两个时间点(秋季和春季)的实施氛围,检验实施领导对实施相关态度和行为的间接影响。在学校层面,组织实施过程模型与实施公民行为相关,但与对 EBP 的态度无关。在教师层面,过程模型与这两种结果都有关系,而且实施领导对 EBP 的态度有显著的直接影响。培养强有力的实施领导者似乎是实现高质量 EBP 实施的关键。本文讨论了对学校、校长培训和研究的启示。
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引用次数: 0
Pivoting Training and Coaching for an Early Numeracy Intervention During COVID-19. 在 COVID-19 期间,为早期算术干预开展枢轴培训和辅导。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-30 DOI: 10.1007/s11121-024-01713-7
David Fainstein, Ben Clarke, Derek Kosty, Lauren M Cycyk, Jessica Turtura, Christian T Doabler

Early numeracy skills are vital for kindergarten students because they provide the foundation for acquiring mathematics skills in both kindergarten and subsequent years. Teacher support to intervene with kindergarteners at risk for poor mathematics learning outcomes is a promising approach to addressing this achievement gap. The current study replicates previous work on an established early numeracy intervention, ROOTS. In this instance, ROOTS uses remote professional development as a novel format for interventionist training support during the COVID-19 pandemic. Findings indicate that interventionists receiving remote support for implementing ROOTS found training and coaching acceptable and feasible. Remote training and coaching supported strong levels of implementation fidelity. Furthermore, children who received the ROOTS intervention outperformed their control group peers on post-test measures of mathematics achievement within a randomized controlled trial research design. Outcomes and implications for using remote professional development as a format for supporting educators in their use of early numeracy intervention programs are discussed within a pandemic-response context.

早期计算技能对幼儿园学生至关重要,因为它们为学生在幼儿园及以后学习数学技能奠定了基础。对数学学习成绩较差的幼儿园学生进行教师支持干预,是解决这一成绩差距的有效方法。目前的研究重复了之前对成熟的早期算术干预--ROOTS--所做的工作。在这次研究中,ROOTS 采用了远程专业发展这种新颖的形式,在 COVID-19 大流行期间为干预者提供培训支持。研究结果表明,接受远程支持以实施 ROOTS 的干预者认为培训和辅导是可以接受和可行的。远程培训和指导支持了很高的实施忠诚度。此外,在随机对照试验研究设计中,接受 ROOTS 干预的儿童在数学成绩的后测指标上优于对照组儿童。在大流行病应对的背景下,讨论了将远程专业发展作为支持教育工作者使用早期算术干预计划的一种形式的成果和意义。
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引用次数: 0
Developmental Losses of Preschool Children Three Years into the COVID-19 Pandemic. COVID-19 大流行三年后学龄前儿童的发育损失。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-08 DOI: 10.1007/s11121-024-01716-4
Alejandro Vásquez-Echeverría, Meliza Gónzalez, Tianna Loose, Matilda Ciganda, Belén Díaz, Maite Liz, Clementina Tomás-Llerena, Sylvana M Côté

The COVID-19 pandemic and resulting mitigation measures have led to increased vulnerabilities in early child development. However, research is scarce and there are no studies on the persistence of these losses three years into the pandemic among young children. To fill in this gap, we examined census-like evaluations of school readiness carried out among preschoolers in Uruguay. The assessments were carried out among 5 cohorts of 5-year-olds: who were assessed prior to the pandemic (2018, 2019); during the pandemic (2020, 2021); and after the health emergency declaration ended in Uruguay (2022). A total of 180,984 teacher evaluations were included covering cognitive, motor and socio-emotional development, as well as attitudes toward learning. Overall, we found that scores in most spheres of child development decreased from before to during the pandemic in 2020 and 2021. In 2022, scores returned to pre-pandemic levels. Our findings suggest the recovery of developmental losses among cohorts of children in kindergarten took more than two years in a country that experienced a mild-to-moderate impact of the COVID-19 pandemic.

COVID-19 大流行及由此产生的缓解措施导致儿童早期发展的脆弱性增加。然而,这方面的研究却很少,而且也没有关于大流行三年后这些损失在幼儿中的持续性的研究。为了填补这一空白,我们对乌拉圭学龄前儿童的入学准备情况进行了普查式评估。评估在 5 批 5 岁儿童中进行:他们在大流行之前(2018 年、2019 年)、大流行期间(2020 年、2021 年)和乌拉圭卫生紧急状态宣布结束之后(2022 年)接受评估。我们共纳入了 180984 份教师评价,内容涵盖认知、运动和社会情感发展以及学习态度。总体而言,我们发现在 2020 年和 2021 年的大流行期间,大多数儿童发展领域的得分都比流行前有所下降。2022 年,得分恢复到大流行前的水平。我们的研究结果表明,在一个受到 COVID-19 大流行轻度至中度影响的国家,幼儿园儿童群体的发展损失恢复需要两年多的时间。
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引用次数: 0
Correction: Considerations for Subgroup Analyses in Cluster-Randomized Trials Based on Aggregated Individual-Level Predictors. 更正:基于综合个体水平预测因素的分组随机试验中的亚组分析注意事项。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1007/s11121-024-01647-0
Brian D Williamson, R Yates Coley, Clarissa Hsu, Courtney E McCracken, Andrea J Cook
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引用次数: 0
Correction: A Mixed-Methods Approach for Evaluating Implementation Processes and Program Costs for a Hypertension Management Program Implemented in a Federally Qualified Health Center. 更正:采用混合方法评估在联邦合格医疗中心实施的高血压管理计划的实施过程和计划成本。
IF 3 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1007/s11121-024-01670-1
Aisha Tucker-Brown, Michelle Spafford, John Wittenborn, David Rein, Ashley Marshall, Kincaid Lowe Beasley, Marla Vaughan, Natalie Nelson, Michelle Dougherty, Roy Ahn
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引用次数: 0
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