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System Interventions (system + intervention)
Selected AbstractsCluster Subtypes within the Preparation Stage of Change for Sun Protection BehaviorAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 1 2010Marimer Santiago-Rivas Objective: Numerous effective tailored interventions for smoking cessation and other behaviors have been developed based on the Transtheoretical Model. Recent studies have identified clusters within each stage of change. The goal of this study is to determine if replicable clusters exist within the Preparation stage of change for sun protection. Method: Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Two random samples of approximately 128 participants were selected from subjects in the Preparation stage (N = 258). Cluster analyses were performed using Ward's Method on the standardised scores from the three scales of Pros, Cons, and Self-Efficacy. Interpretability of the pattern, pseudo F test, and dendograms were used to determine the number of clusters. Results: A four-cluster solution replicated across subsamples. Differences between clusters on eight of the nine Processes of Change, and on behavioral measures, were found. Discussion: The cluster solutions were robust, easily interpretable, and demonstrated good initial external validity. They replicated patterns found for other behaviors that have demonstrated long-term predictability and can provide the basis for a tailored intervention. [source] Quality Improvement and Changes in Diabetic Patient Outcomes in an Academic Nurse Practitioner Primary Care PracticeJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2005FAANP, Thomas A. Mackey PhD Purpose To examine a set of system interventions in the management of patients with diabetes and the outcomes of their care. Data sources Preintervention and postintervention data collected from electronic medical records. Conclusions The sample size was smaller than expected, contributing to a lack of statistical significance from preintervention to postintervention in the patient outcome measures. The systems-level variables that were under the direct control of the clinic staff (e.g., pneumococcal vaccine given) showed great improvement. In the preintervention period, the percentage of "yes" responses to the system-level variables ranged from 8 to 24 and jumped to 16 to 95 after the intervention. Implications for practice Unequivocally, this project demonstrated that systems-level changes result in improved care being provided to patients; however, these had minimal impact on the patient outcome variables. Promoting change in patient behavior is difficult, which may have contributed to the lack of significance in this area, while the variables under the direct control of the clinic staff were more easily changed. [source] Improving the Quality of Workers' Compensation Health Care Delivery: The Washington State Occupational Health Services ProjectTHE MILBANK QUARTERLY, Issue 1 2001Thomas M. Wickizer Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the results, a new initiative was developed to incorporate several key delivery system components. The Washington State experience in developing a quality improvement initiative may have relevance for health care clinicians, administrators, policymakers, and researchers engaged in similar pursuits within the general medical care arena. [source] Gender and role-based perceptions of domestic abuse: does sexual orientation matter?,BEHAVIORAL SCIENCES & THE LAW, Issue 2 2003Eric P. Seelau Ph.D. Although it is estimated that domestic abuse is as common in gay male and lesbian intimate relationships as in heterosexual relationships, the legal system often fails to recognize or respond to same-gender cases. Empirical research examining the impact of sexual orientation on perceptions of abuse is virtually nonexistent. Undergraduates (N,=,252) read a summary of a domestic abuse incident in which victims and perpetrators varied by gender and, by implication, sexual orientation. Victim and respondent gender, rather than the couple's sexual orientation, primarily affected responses to domestic abuse. Domestic abuse perpetrated against women was perceived to be more serious and in need of intervention than abuse against men. Women were more likely than men to believe the victim and to recommend criminal justice system interventions. Because they are inconsistent with gender role stereotypes, domestic abuse cases involving male victims or female perpetrators may not receive equitable treatment within the criminal justice system. Copyright © 2003 John Wiley & Sons, Ltd. [source] Qualitative Data Collection and Analysis Methods: The INSTINCT TrialACADEMIC EMERGENCY MEDICINE, Issue 11 2007William J. Meurer MD Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source] Notes for a Cultural History of Family Therapy,FAMILY PROCESS, Issue 1 2002C. Christian Beels M.D. The official history of family therapy describes its beginnings as a daring technical and philosophical departure from traditional individual treatment in the 1960s, inspired especially by the "system thinking" of Gregory Bateson. This celebrated origin story needs to be supplemented with a longer and larger history of both practice and thought about the family, and that is the subject of this article. The longer history goes back to the founding of social work by Mary Richmond, of pragmatism by William James, and of the organic view of social systems intervention by John Dewey. Seen against this background, family therapy is, among other things, a consequence of the development of persistent elements of American professional culture, experience, and philosophy. The taking of this historical-anthropological view discloses also the origins of two other histories that have made their contribution to the development of family therapy: a science of observing communication processes that starts with Edward Sapir and leads to contemporary conversation analysis, and a history of mesmerism in the United States that culminates in Milton Erickson and his followers. [source] | |||||||||||||