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Readiness
Kinds of Readiness Selected AbstractsModerators and mediators of two brief interventions for alcohol in the emergency departmentADDICTION, Issue 3 2010Nancy P. Barnett ABSTRACT Objective To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department. Methods Patients (18,24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking. Results Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found. Conclusions Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects. [source] Comparison of three models of alcohol craving in young adults: a cross-validationADDICTION, Issue 4 2004Peter M. McEvoy ABSTRACT Aims The aim of study 1 was to develop a three-factor Approach and Avoidance of Alcohol Questionnaire (AAAQ), designed to assess mild and intense inclinations to drink, as well as inclinations to avoid drinking. The aims of study 2 were to cross-validate the AAAQ with an independent sample and to test the goodness-of-fit of three models of craving for alcohol: (a) the traditional unidimensional model; (b) a two-dimensional, approach,avoidance ambivalence model; and (c) an expanded two-dimensional neuroanatomical model that retains avoidance, while positing a threshold that partitions approach into two distinct levels and relates all three factors involved in craving to brain pathways associated with inhibitory processes, reward and obsessive,compulsive behaviour, respectively. Design, setting and participants The survey was administered to 589 Australian university students (69% women) in study 1 and to 523 American university students (64% women) in study 2. Measurements Inclinations to drink and to not drink (AAAQ), drinking behaviour (quantity and frequency), drinking problems (Young Adult Alcohol Problems Screening Test; YAAPST) and readiness for change (Stages of Change Readiness and Treatment Eagerness Scale; SOCRATES). Findings The expanded two-dimensional neuroanatomical model provided the best fit to the data. The AAAQ explained a substantial proportion of the variance in drinking frequency (41,53%), drinking quantity (49,60%) and drinking problems (43%). AAAQ profiles differed as a function of drinking-related risk, and the three AAAQ scales differentially predicted readiness for change. Conclusions Approach and avoidance inclinations toward alcohol are separable constructs, and their activation may not be invariably reciprocal. Craving can be defined as the relative activation of substance-related response inclinations along these two primary dimensions. There may be a threshold of intensity that separates mild from intense approach inclinations. [source] Acceptability of Emergency Department-based Screening and Brief Intervention for Alcohol ProblemsACADEMIC EMERGENCY MEDICINE, Issue 12 2000Daniel W. Hungerford DrPH Abstract. Objectives: To adapt screening and brief intervention for alcohol problems (SBI) to a high-volume emergency department (ED) setting and evaluate its acceptability to patients. Methods: Patients at a large public-hospital ED were screened with the Alcohol Use Disorders Identification Test (AUDIT). Screen-positive drinkers (AUDIT score , 6) were provided brief, on-site counseling and referral as needed. Three months later, project staff blinded to baseline measures reassessed alcohol intake, alcohol-related harm, alcohol dependence symptoms, and readiness to change. Results: Of 1,034 patients approached, 78.3% (810) consented to participate (95% CI = 75.5% to 81.2%), and 21.2% (172) screened positive (95% CI = 18.4% to 24.0%). Of 88 patients with complete intervention data, 94.3% (83) accepted an intervention (95% CI = 89.5% to 99.2%), with acceptance rates ranging from 93% to 100% across four alcohol-problem-severity levels (p = 0.7). A majority (59.0%) set goals to decrease or stop drinking (95% CI = 48.4% to 69.6%). The group recontacted (n= 23) experienced statistically significant decreases in alcohol intake, alcohol-related harm, and dependence symptoms, with measures decreasing for 68%, 52%, and 61% of the patients. Readiness to change also showed statistically significant improvement, with scores increasing for 43% of the patients. Moreover, two-thirds of the patients (15/23) reported at follow-up that SBI was a helpful part of their ED visit. Conclusions: High rates of consent and acceptance of counseling for alcohol problems by patients across a wide range of problem severity indicate that this protocol was acceptable to at-risk patients in a public-hospital ED. Improvements in alcohol-related outcome measures at follow-up were strong enough to warrant controlled studies of intervention efficacy. [source] Learning While Babbling: Prelinguistic Object-Directed Vocalizations Indicate a Readiness to LearnINFANCY, Issue 4 2010Michael H. Goldstein Two studies illustrate the functional significance of a new category of prelinguistic vocalizing,object-directed vocalizations (ODVs),and show that these sounds are connected to learning about words and objects. Experiment 1 tested 12-month-old infants' perceptual learning of objects that elicited ODVs. Fourteen infants' vocalizations were recorded as they explored novel objects. Infants learned visual features of objects that elicited the most ODVs but not of objects that elicited the fewest vocalizations. Experiment 2 assessed the role of ODVs in learning word,object associations. Forty infants aged 11.5 months played with a novel object and received a label either contingently on an ODV or on a look alone. Only infants who received labels in response to an ODV learned the association. Taken together, the findings suggest that infants' ODVs signal a state of attention that facilitates learning. [source] Evaluation of NOC Measures in Home Care Nursing PracticeINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Gail M. Keenan PURPOSE To evaluate the reliability, validity, usefulness, and sensitivity of 89 NOC outcomes in two Visiting Nurse Associations in Michigan. METHODS Of a total 190 NOC outcomes 89 were assigned for testing. Interrater reliability and criterion validity were assessed a total of 50 times per outcome (on 50 different patients) across the study units. The total number of times the reliability and validity were assessed for each of the 89 measures studied ranged from 5,45. Three RN research assistants (RNRAs) oversaw and participated in data collection with the help of 15 clinicians. Convenience sampling was used to identify subjects. A roster of outcomes to be studied was maintained and matched with patient conditions whenever possible until the quota of outcomes assigned had been evaluated. Clinicians and RNRAs independently rated the outcomes and indicators applicable to the patient. NANDA diagnoses, NIC interventions, and medical diagnoses were recorded. FINDINGS A total of 258 patients (mean age 62) enrolled; 60% were women, 23% were from minority groups, and 78% had no college degree. Thirty-six of the 89 NOC measures were designated "clinically useful." The 10 outcomes with the highest interrater reliability were Caregiver Home Care Readiness; Caregiver Stressors; Caregiving Endurance Potential; Infection Status; Mobility Level; Safety Status: Physical Injury; Self-Care: Activities of Daily Living; Self-Care: Bathing; Self-Care: Hygiene; and Wound Healing: Secondary Intention. Criterion measurement and repeated ratings provided evidence to support the validity and sensitivity of the NOC outcomes. Evidence also suggested that NOC label level ratings could be a feasible, reliable, and valid method of evaluating nursing outcomes under actual use. For some measures, adjustments in the scales and anchors are needed to enhance reliability. For others, it may be unrealistic to reliably score in one encounter, thus scoring should be deferred until the clinician has adequate knowledge of the patient. CONCLUSIONS Continued study and refinement that are coordinated and integrated systematically strongly recommended. Comprehensive study in an automated system with a controlled format will increase the efficiency of future studies. [source] Recognizing Opportunities for Spiritual Enhancement in Young AdultsINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2001Roberta Cavendish PhD Purpose. To describe opportunities in the lives of young adults that strengthen or enhance spirituality. Methods. Descriptive, qualitative. Tape-recorded, semi-structured interviews were conducted with 13 well adults the ages 18 to 24. Interview transcripts, field notes, vignettes, and research committee minutes were analyzed to reduce coded data into conceptual categories and themes. Findings. Seven themes emerged from the participant's responses to probes: Beliefs, Connectedness, Inner Motivating Factors, Life Events, Divine Providence, Understanding the Mystery, and Walking Through. Conclusions. The accurate assessment of spiritual needs of young adults may be contingent on the assessment of their developmental needs. Knowing the opportunities that present in the lives of young adults to foster spiritual growth is important for nurses, who often are present when these opportunities occur. Practice Implications. Standardized language is limited for accurate nursing diagnosis of human responses in the spiritual domain. The findings support a new wellness nursing diagnosis, "Readiness for Enhanced Spirituality," to conceptualize a spirituality continuum and support wellness diagnoses. Search Terms: Nursing diagnosis, psychosocial development, religiosity, spirituality, transitions stage [source] Readiness for Cognitive Therapy in People with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 1 2006Paul Willner Aims, Cognitive therapies are increasingly being offered by clinical psychologists to people with intellectual disabilities. This paper reviews some of the factors that influence people's readiness to engage in cognitive therapy. Literature review, Limited verbal ability, psychological-mindedness (particularly in relation to the understanding of emotions and the mediating role of cognitions), and self-efficacy, are all likely to present significant barriers. There may also be motivational barriers to treatment, including the functionality of some psychological presentations, maladaptive beliefs promoting resistance to change, the intellectually challenging nature of cognitive therapy, and external factors such as inappropriate settings. Engagement with therapy can be promoted by involving carers to support the therapy, but carers may themselves display a range of limitations of ability and motivation similar to those displayed by clients, which need to be recognized, and where possible addressed, in order for their involvement to be effective. Recommendations, If barriers to treatment are recognized, significant steps can be taken to increase accessibility. In addition to simplifying the delivery of therapy, there is also scope to simplify the model; this point is illustrated by case examples, and some principles for formalizing modifications to standard procedures are suggested. As barriers to treatment can often be surmounted, a decision whether or not to offer cognitive therapy should be derived from a comprehensive formulation, and should never be based solely on a client's performance on tests of cognitive ability. [source] Directed Thinking and Readiness to Change Self-Beneficial Behaviors: Are You Ready for Some Studying?JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 10 2007Heather A. Labansat Previous research has suggested that intentions to engage in studying and other self-beneficial activities might be promoted more by thinking about actions one could take than by thinking about reasons for doing so. The present experiments assessed whether the relative efficacy of actions vs. reasons might depend on individuals' readiness to change. Consistent with previous findings on the processes of change most relevant in different stages, the benefits of self-generated actions were more pronounced for participants who were in the later stages of change. This "matching-to-stage" relationship occurred in 2 experiments that differed in stage measurement, how thinking was directed, and which outcomes were measured. The results have both practical and theoretical implications for attempts to change self-beneficial behaviors. [source] Brief Motivational Interviewing for DWI Recidivists Who Abuse Alcohol and Are Not Participating in DWI Intervention: A Randomized Controlled TrialALCOHOLISM, Issue 2 2010Thomas G. Brown Background:, Driving while impaired (DWI) recidivists with unresolved alcohol use problems pose an ongoing risk for traffic safety. Following conviction, many do not participate in mandated alcohol evaluation and intervention programs, or continue to drink problematically after being relicensed. This study investigated if, in DWI recidivists with alcohol problems and not currently involved in DWI intervention, Brief Motivational Interviewing (BMI) produced greater reductions in risky drinking at 6- and 12-month follow-up compared to an information-advice control condition. Additional analyses explored whether BMI was associated with greater readiness to change, subsequent substance abuse treatment service utilization, and satisfaction compared to the control condition. Methods:, Male and female recidivists with drinking problems and not currently engaged in DWI intervention were recruited, evaluated, and then randomly assigned to receive 1 of 2 manualized interventions: 30-minute BMI session or information-advice. Participants, interviewers, researchers, and statisticians were blind to assignment. Outcomes were changed in: percent of risky drinking days (i.e., ,3 standard drinks/d for males; ,2 for females) in the previous 6 months derived from the Timeline Followback, biomarkers of alcohol abuse (GGT, AST, ALT, MCV) by blood assay, and alcohol abuse-related behaviors using the MMPI-Mac scale. Data from the Readiness to Change Questionnaire, a substance abuse service utilization questionnaire, and the Client Satisfaction Scale were also collected. Results:, Analyses revealed significant declines in risky drinking with both interventions. BMI (n = 92) resulted in a 25% reduction in risky drinking days at 12-month follow-up, which compared to the control intervention (n = 92) represented a significant decline from 6-month levels. Exposure to BMI also produced significantly greater improvement at 6-month follow-up in a biomarker of alcohol abuse and a behavioral measure related to recidivism risk. Exploration of readiness to change, substance abuse service utilization, and satisfaction with intervention indicated a perception of BMI being more useful in coping with problems. Conclusions:, Brief MI approaches warrant further implementation and effectiveness research as an opportunistic DWI intervention strategy to reduce risks associated with alcohol use outside of clinical and DWI relicensing settings. [source] Predicting Treatment Seekers' Readiness to Change Their Drinking Behavior in the COMBINE StudyALCOHOLISM, Issue 5 2009Carlo C. DiClemente Background:, Initial motivation and readiness to change (RTC) are complex constructs and have been important but inconsistent predictors of treatment attendance and drinking outcomes in studies of alcoholism treatment. Motivation can be described in multiple ways as simply the accumulation of consequences that push change, a shift in intentions, or engagement in various tasks that are part of a larger process of change. Method:, Using baseline data from participants in the COMBINE Study, this study reevaluated the psychometric properties of a 24-item measure of motivation derived from the University of Rhode Island Change Assessment Scale that yielded 4 subscales representing attitudes and experiences related to tasks of stages of Precontemplation, Contemplation, Action, and Maintenance Striving as well as a second-order factor score representing a multidimensional view of RTC drinking. A variety of hypothesized predictors of readiness and the stage subscales were examined using multiple regression analyses to better understand the nature of this measure of motivation. Results:, Findings supported the basic subscale structure and the overall motivational readiness score derived from this measure. RTC drinking behavior was predicted by baseline measures of perceived stress, drinking severity, psychiatric comorbidity, self-efficacy, craving, and positive treatment outcome expectancies. However, absolute values were small, indicating that readiness for change is not explained simply by demographic, drinking severity, treatment, change process, or contextual variables. Conclusion:, This measure demonstrated good psychometric properties and results supported the independence as well as convergent and divergent validity of the measured constructs. Predictors of overall readiness and subscale scores indicate that a variety of personal and contextual factors contribute to treatment seekers' motivation to change in an understandable but complex manner. [source] Automating Standard Alcohol Use Assessment Instruments Via Interactive Voice Response TechnologyALCOHOLISM, Issue 2 2002James C. Mundt Background: Interactive voice response (IVR) technology integrates touch-tone telephones with computer-automated data processing. IVR offers a convenient, efficient method for remote collection of self-report data. Methods: Twenty-six subjects recruited from an outpatient alcohol treatment center completed IVR and paper/pencil versions of a demographic and drinking history questionnaire, Stages of Change Readiness and Treatment Eagerness Scale, Drinker Inventory of Consequences, Obsessive-Compulsive Drinking Scale, Alcohol Dependence Scale, and two numerical rating scales of craving and desire to drink during the prior week. Administration of the instruments in both formats was repeated 1 week later. The order of administration method was counterbalanced between subjects and reversed across data collection sessions. Scale and subscale scores from both methods were correlated within sessions. Test-retest correlations were also calculated for each method. A criterion of ,= 0.01 was used to control type I statistical error. Results: Intermethod correlations within each session were significant for all of the instruments administered. Test-retest correlations for both methods were also significant, except for the numerical ratings. Scores on the Alcohol Dependence Scale obtained via IVR were significantly lower than those collected by paper/pencil. Other differences between the data collection methods or across the sessions were inconsistent. The average IVR call length was 34 min and 23 sec. Paper/pencil forms required an average of 18 min and 38 sec to complete and an additional 10 min and 17 sec for data entry. Conclusions: IVR technology provides a convenient alternative to collecting self-report measures of treatment outcomes. Both paper/pencil and IVR assessments provide highly convergent data and demonstrate good test-retest reliability. Alcohol Dependence Scale score differences between methods highlight special considerations for IVR adaptation of existing paper/pencil instruments. Benefits of IVR include procedural standardization, automatic data scoring, direct electronic storage, and remote accessibility from multiple locations. [source] Validating the Readiness for Interprofessional Learning Scale (RIPLS) in the postgraduate context: are health care professionals ready for IPL?MEDICAL EDUCATION, Issue 5 2006Ross Reid Aims, This paper describes the process of validating the Readiness for Interprofessional Learning Scale (RIPLS) for use with postgraduate health care professionals. Context, The RIPLS questionnaire has proved useful in the undergraduate context, enabling tutors to assess the readiness of students to engage in interprofessional learning (IPL). With the drive in the National Health Service (NHS) to deliver health care in interprofessional teams, it seems logical to ask whether postgraduate education should, or could, be delivered successfully in interprofessional contexts. As a preliminary to undertaking an extended IPL project, the researchers tested the validity of the RIPLS tool in the postgraduate health care context. Method, A modified version of the RIPLS questionnaire was administered to all general practitioners, nurses, pharmacists and allied health professionals in the Dundee Local Health Care Cooperative (LHCC) (n = 799). A total of 546 staff responded (68%). Results, Three factors, comprising 23 statements, emerged from the statistical analysis of the survey data, namely, teamwork and collaboration, sense of professional identity and patient-centredness. The internal consistency measure was 0.76. Analysis of variance suggested some key differences between the different professions in respect of the factors. Conclusions, The RIPLS questionnaire was validated for use in the postgraduate context, thus providing researchers with a tool for assessing health professionals' attitudes towards interprofessional learning at practice level, community health partnership level or at a national level of education and training. Significant differences between professional groups should be taken into account in designing any interprofessional learning programme. [source] PIE à la Mode: Mainstreaming Evaluation and Accountability in Each Program in Every County of a Statewide School Readiness InitiativeNEW DIRECTIONS FOR EVALUATION, Issue 99 2003Abraham Wandersman This chapter describes the framework and implementation of a program accountability system in a statewide initiative (South Carolina First Steps to School Readiness), which was developed (1) to enable practitioners to provide evaluation information required by legislative mandate and (2) to develop the capacity of practitioners to systematically plan their program, implement with quality, and self-evaluate. The components of this program are reflected in its name: Planning, Implementation, and Evaluation (PIE). The chapter describes PIE in relation to program theory, usage, and efforts to mainstream. [source] College Fitness Center Emergency ReadinessPREVENTIVE CARDIOLOGY, Issue 3 2007Andrew Milsten MD No abstract is available for this article. [source] Integrating technology readiness into technology acceptance: The TRAM modelPSYCHOLOGY & MARKETING, Issue 7 2007Chien-Hsin Lin Based on previous theoretical streams, the present study integrates technology readiness (TR) into the technology acceptance model (TAM) in the context of consumer adoption of e-service systems, and theorizes that the impact of TR on use intention is completely mediated by both perceptions of usefulness and ease of use. TAM was originally developed to predict people's technology-adopting behavior at work environments, but this research stemmed from a questioning of its applicability in marketing (i.e., non-work) settings. The differences between the two settings are exhibited by consumers' self-determining selection behavior and their high involvement in the e-service creation and delivery process. This paper first reviews the TAM and the construct of technology readiness, and then proposes and empirically tests an integrated Technology Readiness and Acceptance Model (TRAM) to augment TAM by taking technology readiness construct into the realm of consumers' adoption of innovations. The results indicate that TRAM substantially broadens the applicability and the explanatory power of either of the prior models and may be a better way to gauge technology adoption in situations where adoption is not mandated by organizational objectives. Further, theoretical and practical implications and future research directions are discussed. © 2007 Wiley Periodicals, Inc. [source] In Response to the Published Article "Application of the Community Readiness Model for Childhood Obesity Prevention (Findholt, 2007)"PUBLIC HEALTH NURSING, Issue 5 2008B.S.N., Kala Mayer R.N. No abstract is available for this article. [source] Three-month Follow-up of Brief Computerized and Therapist Interventions for Alcohol and Violence Among TeensACADEMIC EMERGENCY MEDICINE, Issue 11 2009Rebecca M. Cunningham MD Abstract Objectives:, Alcohol use and violent behaviors are well documented among adolescents and have enormous effects on morbidity and mortality. The authors hypothesized that universal computer screening of teens in an inner-city emergency department (ED), followed by a brief intervention (BI), would be 1) feasible (as measured by participation and completion of BI during the ED visit) and well received by teens (as measured by posttest process measures of intervention acceptability) and 2) effective at changing known precursors to behavior change such as attitudes, self-efficacy, and readiness to change alcohol use and violence. Methods:, Adolescent patients (ages 14,18 years) at an urban ED were approached to complete a computerized survey. The survey was conducted daily from 12 noon to 11 pm from September 2006 through November 2008. Adolescents reporting both alcohol use and violence in the past year were randomized to a control group or a 35-minute BI delivered by a computer or therapist as part of the SafERteens study. Validated measures were administered, including demographics, alcohol use, attitudes toward alcohol and violence, self-efficacy for alcohol and violence, readiness to change alcohol and violence, and process questions, including likeability of intervention. Results:, A total of 2,423 adolescents were screened. Thirteen percent of those approached refused. The population was 45% male, 58% African American, and 6.2% Hispanic. Of those screened, 637 adolescents (26%) screened positive; 533 were randomized to participate, and 515 completed the BI prior to discharge. The BIs were well received by the adolescents overall; 97% of those randomized to a BI self-reported that they found one intervention section "very helpful." At posttest, significant reductions in positive attitudes for alcohol use and violence and significant increases in self-efficacy related to alcohol/violence were found for both therapist and computer interventions. At 3-month follow-up there was 81% retention, and generalized estimating equations (GEE) analysis showed that participants in both interventions had significant reductions in positive attitudes for alcohol use (therapist p = 0.002, computer p = 0.0001) and violence (therapist p = 0.012, computer p = 0.007) and significant increases in self-efficacy related to violence (therapist p = 0.0.04, computer p = 0.002); alcohol self-efficacy improved in the therapist BI condition only (therapist p = 0.050, computer p = 0.083). Readiness to change was not significantly improved. Conclusions:, This initial evaluation of the SafERteens study shows that universal computerized screening and BI for multiple risk behaviors among adolescents is feasible, well received, and effective at altering attitudes and self-efficacy. Future evaluations of the SafERteens study will evaluate the interventions' effects on behavioral change (alcohol use and violence) over the year following the ED visit. [source] Ready or Not ,? Teen Sexuality and the Troubling Discourse of ReadinessANTHROPOLOGY & EDUCATION QUARTERLY, Issue 4 2006Catherine Ashcraft In this article, I explore how talk about being "ready" or "not ready" for sex shapes teen and adult understandings of sexuality. I argue that this "discourse of readiness" poses serious threats to teens' identity development, sexual decision making, and educators efforts to help them through these processes. To illustrate, I draw from my nine-month ethnography, examining how participants used readiness discourses to make sense of their sexualities. I suggest implications for educators, policy makers, and researchers in anthropology and education. [source] Beyond Stages of Change: Multi-Determinant Continuum Models of Action Readiness and Menu-Based InterventionsAPPLIED PSYCHOLOGY, Issue 1 2008Charles Abraham The merits of modelling action readiness as a series of stages is discussed, focusing on the Health Action Process Approach (HAPA) which postulates a motivational stage (for non-intenders) and a volitional stage (for intenders). The HAPA helpfully clarifies that the relationship between self-efficacy and action may be different for inexperienced intenders and experienced actors. This model also usefully distinguishes between different types of planning undertaken by intenders and it is suggested that further specification of planning tasks could explain why some intenders act while others do not. Despite the advantages of the HAPA, it is argued that the distinction between intenders and non-intenders is fuzzy and unstable and that demarcation of the stage boundary is arbitrary. A multi-determinant, multi-goal continuum approach is recommended. Such modelling recognises graded discontinuities throughout the development of action readiness from attitude formation to behaviour change maintenance. It is argued that menu-based interventions designed to deliver different messages and materials to people with different action-readiness deficits may be more cost effective than stage-tailored interventions. On discute de l'intérêt qu'il y a de modéliser la préparation à l'action en une série de stades à partir de l'Approche des Processus d'Action en faveur de la Santé (HAPA) qui pose l'existence d'une phase motivationnelle (pour ceux qui n'ont pas l'intention d'agir) et d'une phase volitionnelle (pour ceux qui l'ont). L'HAPA met utilement en évidence que la relation entre l'auto-efficience et l'action peut différer selon que l'on a affaire à un acteur expérimenté ou à une personne sans expérience qui pense agir. Ce modèle fait aussi une distinction utile entre les différentes sortes de planification qui s'offrent à ceux qui ont l'intention d'agir et laisse entendre qu'un approfondissement de la planification des tâches pourrait expliquer pourquoi certains passent à l'action et d'autres pas. En dépit de l'intérêt de l'HAPA, on peut penser que la distinction entre l'intention et l'absence d'intention est floue et instable et que le découpage en stades est arbitraire. On recommande une approche retenant un continuum à déterminants et à buts multiples. Cette modélisation reconnaît l'existence de discontinuités échelonnées tout au long du développement de la préparation à l'action depuis la formation de l'attitude jusqu'au changement effectif du comportement. On défend l'idée que les interventions à la carte conçues pour procurer différents messages et fournitures aux gens qui présentent différentes carences de préparation à l'action peuvent être plus rentables que les interventions basées sur les stades. [source] Biological Sensitivity to Context: The Interactive Effects of Stress Reactivity and Family Adversity on Socioemotional Behavior and School ReadinessCHILD DEVELOPMENT, Issue 1 2010Jelena Obradovi This study examined the direct and interactive effects of stress reactivity and family adversity on socioemotional and cognitive development in three hundred and thirty-eight 5- to 6-year-old children. Neurobiological stress reactivity was measured as respiratory sinus arrhythmia and salivary cortisol responses to social, cognitive, sensory, and emotional challenges. Adaptation was assessed using child, parent, and teacher reports of externalizing symptoms, prosocial behaviors, school engagement, and academic competence. Results revealed significant interactions between reactivity and adversity. High stress reactivity was associated with more maladaptive outcomes in the context of high adversity but with better adaption in the context of low adversity. The findings corroborate a reconceptualization of stress reactivity as biological sensitivity to context by showing that high reactivity can both hinder and promote adaptive functioning. [source] Industry responses to EU WEEE and ROHS Directives: perspectives from ChinaCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 5 2006Jieqiong Yu Abstract The electrical and electronics (EE) industry has come under increasing pressure to adopt extended producer responsibility (EPR) policies through the introduction of the European Union's Directives on Waste Electrical and Electronic Equipment (WEEE) and the Restriction of Use of Certain Hazardous Substances (ROHS). Based on the findings of 50 questionnaires and in-depth interviews with China's EE manufacturers, this paper investigates the perception of and readiness of companies for implementation of WEEE and ROHS in China. It identifies key difficulties encountered by manufacturers in fulfilling the requirements and evaluates the effectiveness of these two directives in promoting environmental reform. The findings indicate that the extent of companies' responses largely depends on their market structure and client requirements. Supply chain management, raw material testing and cost implications appear to be key challenges in addressing issues surrounding the directives. There is little evidence to suggest that these directives have effectively driven China's EE manufacturers towards systematic eco-design. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] Contribution of Dermatologic Surgery in WarDERMATOLOGIC SURGERY, Issue 1 2010MAJOR J. SCOTT HENNING DO BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source] Clinician attitudes towards early psychosis intervention: the first 4 yearsACTA PSYCHIATRICA SCANDINAVICA, Issue 2002J. Gorrell Objectives, A questionnaire was administered with an aim to assess the attitudes of mental health clinicians towards the adoption of an early intervention approach and to monitor attitudinal change during the introduction of this approach. Method, The perceptions of Early Psychosis Intervention (PEPI) questionnaire was developed and then completed by clinicians at three time points over 4 years during the introduction of a best practice early intervention approach (n=143, 178, 102, respectively). Results, Indicate that at all three time points clinicians generally agreed with the potential advantages of early intervention but were unsure about their own readiness to implement such intervention. Responses to an open-ended question regarding concerns about the new approach indicated a positive shift up the developmental process of change, from initial concerns about personal skills, resources and workload, to a gradually more specific focus on particular aspects of clinical interventions and on the impact of the new approach. Conclusions, Our services have introduced early psychosis intervention. Clinicians have moved up the developmental process of change. The questionnaire has provided a means for clinicians to influence the change process. [source] Using Evidence to Improve Reproductive Health Quality along the Thailand-Burma BorderDISASTERS, Issue 3 2004Tara M. Sullivan The Mae Tao Clinic, located on the Thailand-Burma border, has provided health services for illegal migrant workers in Thailand and internally displaced people from Burma since 1989. In 2001, the clinic launched a project with the primary aim of improving reproductive health services and the secondary aim of building clinic capacity in monitoring and evaluation (M&E). This paper first presents the project's methods and key results. The team used observation of antenatal care and family-planning sessions and client exit interviews at baseline and follow-up, approximately 13 months apart, to assess performance on six elements of quality of care. Findings indicated that improving programme readiness contributed to some improvement in the quality of services, though inconsistencies in findings across the methods require further research. The paper then identifies lessons learned from introducing M&E in a resource-constrained setting. One key lesson was that a participatory approach to M&E increased people's feelings of ownership of the project and motivated staff to collect and use data for programme decision-making to improve quality. [source] Smoking Stage of Change and Interest in an Emergency Department,based InterventionACADEMIC EMERGENCY MEDICINE, Issue 3 2005Edwin D. Boudreaux PhD Abstract Objectives: To examine factors associated with motivation to quit smoking and interest in an emergency department (ED)-based intervention. Methods: Consecutive ED patients 18 years of age and older were interviewed. Severely ill and cognitively disabled patients were excluded. Smoking history, stage of change, self-efficacy, presence of a smoking-related illness, interest in an ED-based smoking intervention, and screening/counseling by the patient's ED provider were assessed. Results: A total of 1,461 of 2,314 patients (64%) were interviewed. A total of 581 (40%) currently smoked, with 21% in precontemplation (no intention to quit), 43% in contemplation (intention to quit but not within the next 30 days), and 36% in preparation (intention to quit within the next 30 days). Approximately 50% indicated a willingness to remain 15 extra minutes in the ED to receive counseling. Only 8% received counseling by their ED provider. A regression analysis showed that greater readiness to change was associated with multiple lifetime quit attempts, presence of a quit attempt in the past 30 days, and higher self-efficacy. Interest in an ED-based intervention was more likely among patients who reported higher self-efficacy. Conclusions: Approximately 50% of smokers reported at least moderate interest in an ED-based intervention and a willingness to stay 15 extra minutes, but only 8% reported receiving counseling during their ED visit. Considering time and resource constraints, counseling/referral may be best suited for patients characterized by a strong desire to quit, multiple previous quit attempts, high self-efficacy, a smoking-related ED visit, and strong interest in ED-based counseling. [source] Moderators and mediators of two brief interventions for alcohol in the emergency departmentADDICTION, Issue 3 2010Nancy P. Barnett ABSTRACT Objective To evaluate moderators and mediators of brief alcohol interventions conducted in the emergency department. Methods Patients (18,24 years; n = 172) in an emergency department received a motivational interview with personalized feedback (MI) or feedback only (FO), with 1- and 3-month booster sessions and 6- and 12-month follow-ups. Gender, alcohol status/severity group [ALC+ only, Alcohol Use Disorders Identification Test (AUDIT+) only, ALC+/AUDIT+], attribution of alcohol in the medical event, aversiveness of the event, perceived seriousness of the event and baseline readiness to change alcohol use were evaluated as moderators of intervention efficacy. Readiness to change also was evaluated as a mediator of intervention efficacy, as were perceived risks/benefits of alcohol use, self-efficacy and alcohol treatment seeking. Results Alcohol status, attribution and readiness moderated intervention effects such that patients who had not been drinking prior to their medical event, those who had low or medium attribution for alcohol in the event and those who had low or medium readiness to change showed lower alcohol use 12 months after receiving MI compared to FO. In the AUDIT+ only group those who received MI showed lower rates of alcohol-related injury at follow-up than those who received FO. Patients who had been drinking prior to their precipitating event did not show different outcomes in the two interventions, regardless of AUDIT status. Gender did not moderate intervention efficacy and no significant mediation was found. Conclusions Findings may help practitioners target patients for whom brief interventions will be most effective. More research is needed to understand how brief interventions transmit their effects. [source] PHILOSOPHY AS TRANSLATION: DEMOCRACY AND EDUCATION FROM DEWEY TO CAVELLEDUCATIONAL THEORY, Issue 3 2007Naoko Saito In this essay Naoko Saito aims to find an alternative idea and language for "mutual national understanding," one that is more attuned to the sensibility of our times. She argues for Stanley Cavell's idea of philosophy as translation as such an alternative. Based upon Cavell's rereading of Thoreau's Walden, Saito represents Thoreau as a cross-cultural figure who transcends cultural and national boundaries. On the strength of this, she proposes a Cavellian education for global citizenship, that is, a perfectionist education for imperfect understanding in acknowledgment of alterity. Our founding of democracy must depend upon a readiness to "deconfound" the culture we have come from, the better to find new foundations together. The "native" is always in transition, by and through language, in processes of translation. [source] Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidenceADDICTION, Issue 5 2009Timothy R. Apodaca ABSTRACT Aims Motivational interviewing (MI) is an efficacious treatment for substance use disorders. However, little is known about how MI exerts its therapeutic effects. This review is a first attempt to summarize and evaluate the evidence for purported within-session mechanisms of change. The primary question of interest was: which MI constructs and variables appear to be the most promising candidates for mechanisms of change? Methods Literature searches were conducted to identify studies delivering MI in an individual format for the treatment of substance use disorders. Our search identified a total of 152 studies for review; 19 studies met inclusion criteria by providing data on at least one link in the causal chain model under examination. Effect size estimates were calculated for every possible step in the causal model where sufficient data were provided by study authors. Results Four constructs of therapist behavior were evaluated: MI-Spirit, MI-Consistent behaviors, MI-Inconsistent behaviors and therapist use of specific techniques. Five constructs of client behavior were evaluated: change talk/intention, readiness to change, involvement/engagement, resistance and the client's experience of discrepancy. The absence of experimental and full mediation studies of mechanisms of change was notable. Effect sizes were generally mixed. Conclusions The most consistent evidence was found for three constructs: client change talk/intention (related to better outcomes); client experience of discrepancy (related to better outcomes); and therapist MI-Inconsistent behavior (related to worse outcomes). Regarding therapist use of specific techniques, use of a decisional balance exercise showed the strongest association to better outcomes. [source] Assessing motivation to quit smoking in people with mental illness: a reviewADDICTION, Issue 5 2009Ranita Siru ABSTRACT Background People with mental health (MH) disorders smoke at higher rates, are more nicotine-dependent and suffer greater morbidity and mortality from smoking-related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit. Objectives To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer-reviewed data on motivation to quit smoking in MH populations. Methods A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. ,2 analyses were used to compare motivation between MH and general populations, between in-patients and out-patients and between people with depression and people with psychotic disorders. Results Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in-patient populations. Conclusions People with MH disorders are motivated to quit smoking, although more research is needed looking at in-patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed. [source] The impact of a social network intervention on retention in Belgian therapeutic communities: a quasi-experimental studyADDICTION, Issue 7 2006Veerle Soyez ABSTRACT Background Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention. Aims The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention. Design, setting and participants Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake (n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session). Findings Hierarchical regression analyses showed that client-perceived social support (F1,198 = 10.9, P = 0.001) and treatment motivation and readiness (F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable ,significant others' participation in network intervention' (network involvement) in the model, the fit clearly improved (F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased (F1,197 = 2.9; P = 0.091). Conclusions Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals. [source] | ||||||||||||||||||||||||||||||||||||||||||||||