第二受害者支持项目的比较研究

目的解读Scott第二受害者支持三级介入模式，为我国今后开发相关支持项目提供参考。方法利用文献分析法进行阐释和比较。结合第二受害者自然恢复历程变化解读该模式内在规律，将现有支持干预项目进行对比，辨别这类研究之间的联系和差异，深入了解该模式的影响。结果Scott第二受害者支持三级介入模式可加快第二受害者恢复历程，在实践中可较好地维护第二受害者支持项目运行。结论该模式理论符合第二受害者创伤恢复规律，对第二受害者支持项目的开发具有一定指导作用，值得借鉴。     

The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women's healthy eating

Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = 225) between the ages of 50–69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women.     

Predictors of pain and functioning in arthritis

The impact on pain and functioning of (i) four therapeutic behaviorsthat are often encouraged as part of a widely disseminated arthritispatient education program and (ii) three factoriaily derivedaspects of social support were examined. The data analyzed wereoriginally collected as part of an evaluation of the efficacyof an arthritis self-management intervention. However, for thissecondary analysis, variation in therapeutic behaviors and socialsupport independent of the intervention were of interest. Twoaspects of support (viz. loneliness and social contacts) werepredictive of subsequent pain while one therapeutic behavior(exercise) was predictive of subsequent functioning. Findingsfrom the present study together with those from the originalevaluation suggest that social support and health behavior doinfluence outcomes. However, natural variation in these predictorsappears to be more important than changes, if any, producedby the patient education intervention.     

Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. Conclusion: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.     

Cost effectiveness of brief interventions for reducing alcohol consumption

The direct costs and health effects of a primary-care-based brief intervention for hazardous alcohol consumption were examined. The total cost of the intervention was calculated from costs associated with: marketing the intervention programme; providing training and support in the use of the intervention materials; physician time required for providing brief advice for 'at-risk' drinkers. The effect of the intervention on health outcomes was expressed in terms of number of life years saved by preventing alcohol-related deaths. This was derived by combining estimates of the impact of the programme if it were implemented nationally with available evidence on the health effects of excess alcohol consumption. Results are based on international trial evidence showing the physical resources required by the intervention and its effectiveness combined with Australian price data. The costs associated with screening and brief advice using the current intervention programme range from Aus$19.14 to Aus$21.50. The marginal costs per additional life year saved were below Aus$1873. The robustness of the model used is supported by an extensive sensitivity analysis. In comparison with existing health promotion strategies the costs and effects of the current intervention are highly encouraging.     

Group cohesion and social support in exercise classes: results from a danish intervention study.

This study examines the formation of group cohesion and social support in exercise classes among former sedentary adults, participating in a Danish community-based intervention. Furthermore, the aim is to analyze the impact of this process on exercise activity among the participants. A multimethod approach was used, analyzing both survey data and 18 personal interviews collected among 87 participants who completed the intervention project. Analysis was performed according to the grounded theory method. The formation of group cohesion was conditioned by the social composition of the group, the teaching ability by the instructors, and the activity by itself. The cohesive group was characterized by an attitude of mutual support toward exercise activities. This mutual support facilitated development of self-efficacy beliefs among the participants improving their mastery expectation regarding exercise. Manipulating group dynamics may be a promising intervention tool in the promotion of leisure-time physical activity.     

Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial

STUDY OBJECTIVE: To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on maternal and child health outcomes. DESIGN: Randomised controlled trial with economic and process evaluations and follow up at 12 and 18 months. The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor (SHV), or a year of support from community groups providing drop in sessions, home visiting and/or telephone support (CGS). Each was compared with a control group that received standard health visitor services. SETTING: Two disadvantaged boroughs of London, United Kingdom. PARTICIPANTS: 731 women from culturally diverse backgrounds with infants. MAIN RESULTS: At 12 and 18 months, there was little impact for either intervention on the main outcomes: child injury (SHV: relative risk 0.99; 95% confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use (with fewer taking their children to the GP) and had less anxious experiences of motherhood than control women. User satisfaction with the SHV intervention was high. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. CONCLUSIONS: There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population. The SHV intervention was associated with improvement in some of the secondary outcomes.     

某部战士人际关系困扰与领悟社会支持和应对方式的相关性调查

目的了解某部战士人际关系困扰状况,为心理辅导和心理干预提供理论指导。方法采用人际关系综合诊断量表、应对方式和领悟社会支持量表对283名战士进行调查,通过相关分析和回归分析,探讨人际关系困扰与社会支持和应对方式的相关性。结果战士人际困扰总检出率为15.9%;领悟社会支持总分与异性交往呈显著负相关,自责、退避、幻想和合理化等消极的应对方式与人际因子正相关显著。logistic回归分析显示,解决问题、退避、合理化进入回归方程,对人际关系构成显著的回归效应(P<0.05)。结论战士群体人际关系状况需要关注,应对方式对人际因子状况有显著影响。     

Encouraging Schools to Promote Health: Impact of the Western Australian School Health Project (1992 — 1995)

The Western Australian School Health (WASH) Project, a school health promotion intervention operating over a four-year period (1992-1995), provided a comprehensive, year-long intervention to help successive groups of schools develop health promotion programs. The WASH Project worked with self-selected school communities and used community development strategies to support participating schools in identifying and responding to health concerns relevant to their students. This paper reports the school impact results of the WASH Project. School impact data involved 24 variables categorized into two areas: school organizational factors supportive of health promotion, and school health promotion factors. Two methods of analysis were used: logistic regression indicating the direction of change, and linear regression indicating the magnitude of change. Results demonstrated that schools successfully made organizational changes, such as the allocation of additional time, personnel, and monetary resources, to support health promotion.     

A Pilot Study on the Impact of a Home-based Parenting Intervention: Parents Plus

This article reports on a pilot study undertaken in order to explore the impact of a home-based parenting intervention (Parents Plus), on parents and families. Parents Plus is part of a Welsh Early Years strategy called Flying Start and aims to promote positive parent–child interactions. This article explores the medium-term to long-term impact of the intervention. One hundred and ninety-seven families who received the intervention between 2000 and 2007 were sent letters advising they would be telephoned to take part in a survey about their perceptions of Parents Plus, and were given the choice to opt out of the research. A total of 21 mothers participated in a short telephone survey, and six mothers participated in in-depth interviews that explored changes in family life in more detail. Interviews were transcribed and analysed using thematic content analysis. The results showed that the intervention had a dual impact: practical tips and techniques to help manage behaviour, and emotional support for mothers. The article presents in diagrammatic form mothers' reported changing experiences and attitudes towards their need for help and their esteem as parents through the intervention period.     

Effects of Integrating Pedometers,Parental Materials,and E-mail Support Within an Extracurricular School Sport Intervention

PurposeThe objective of this study was to evaluate the impact of a school-based intervention (Program X) incorporating pedometers and e-mail support on physical activity, sedentary behavior, and healthy eating in adolescents.MethodsA randomized control trial was used to evaluate the impact of the Program X intervention. Six schools (N = 124 participants; mean age 14.1 ± .8 years) were randomized to intervention or control conditions for the 6-month study period. Objectively recorded physical activity (mean steps/day), self-reported sedentary behavior, and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated-measures analysis of variance and χ² tests.ResultsParticipants in the intervention group increased their step counts by 956 ± 4107 steps/day (boys) and 999 ± 1999 (girls). Repeated-measures analysis of variance revealed significant group-by-time interactions for boys (F = 7.4, p = .01, d = .80) and girls (F = 29.6, p <.001, d = 1.27) for mean steps/day. The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys (χ² = 4.0, p = .043) and increased the number of fruit serves among girls (χ² = 4.8, p = .028). The intervention did not have a statistically significant effect on sedentary behavior.ConclusionA school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls.     

Evaluation of a community-based intervention to increase breastfeeding prevalence

BACKGROUND: The aim of the study was to determine whether peer counselling in the antenatal and post-natal period would increase the prevalence and duration of breastfeeding among low-income women in Glasgow. METHODS: The study was designed as a quasi-experimental evaluation of a community-based breastfeeding promotion programme. The intervention comprised peer counselling of pregnant women, support of breastfeeding mothers and local awareness-raising activities. The study subjects were all women attending the antenatal booking clinic resident in either the intervention or control area. Data were collected by means of four self-completion questionnaires, two administered antenatally and two post-natally. The proportions intending to breastfeed or breastfeeding in the intervention and control groups were compared at each assessment and over time. RESULTS: Of the 995 women enrolled in the study, data were available for analysis on 919 (92 per cent) to 6 weeks postnatally. At booking, 18 per cent of the intervention group and 21 per cent of the control group stated an intention to breastfeed. At delivery, the proportions initiating breastfeeding were 23 per cent of the intervention subjects and 20 per cent of the controls, and by 6 weeks post-natally, the proportion providing any breast milk had declined to 10 per cent of the intervention group and 8 per cent of the control group. Using multivariate analysis to adjust for factors (such as socio-economic status) known to influence breastfeeding, the breastfeeding prevalence was significantly higher in the intervention group relative to the controls at delivery [odds ratio (OR) 2.0; 95 per cent confidence interval (CI) 1.2-3.1, p = 0.006]. By 6 weeks post-natally the difference between the two groups was not statistically significant (OR 1.8; 95 per cent CI 1.0-3.4, p=0.07). CONCLUSIONS: As the impact of the intervention was not sustained even for the modest duration of 6 weeks postnatally, it would be premature to justify widespread use of peer support programmes to increase the prevalence of breastfeeding in socially disadvantaged communities.     

HPV持续阳性患者病耻感与社会支持的相关性研究

目的 探讨人乳头瘤状病毒（human papillomavirus,HPV）持续阳性患者病耻感与社会支持的相关性，为进一步制定干预方案提供参考依据。方法 选取河南省某所三级甲等医院妇科门诊患者203例，使用一般资料调查表、社会影响量表（SIS）、社会支持评定量表(SSRS)进行调查。采用单因素方差分析、t检验对不同人口学特征及SSRS得分对患者SIS得分进行比较，采用Pearson相关性分析病耻感与社会支持的关系。结果 患者病耻感得分处于中等水平（49.39±10.55）；SIS总得分与SSRS总得分（41.87±8.57）及各维度得分呈负相关；多重线性回归分析显示婚姻状况、家庭人均收入、职业状况、社会支持等是患者病耻感的影响因素，可解释总体变异度50.4%，其中社会支持独立影响患者病耻感水平总体变异37.2%。结论 本研究中患者病耻感水平处于中等且与社会支持呈负相关，医护人员可通过提高患者的社会支持水平来降低患者的病耻感程度。     

Evaluating a Psychoeducational,Therapeutic Group for Parents of Children with Autism Spectrum Disorder

The current study aimed to review and evaluate a three-session psychoeducational and psychotherapeutic group programme for parents of children with autism spectrum disorder (ASD). The group programme was facilitated through an ASD diagnostic and intervention service within a Northern Ireland Health and Social Care Trust over a 12-month period, throughout which time 83 parents attended a three-session course covering various aspects of ASD-specific material. Knowledge of ASD, understanding of behavioural management techniques and parental self-efficacy were measured through pre-course and post-course questionnaires, completed by the parents. Participants also completed a questionnaire regarding their experience following course attendance. The data were analysed using a mixed-methods approach. Results from pre-course and post-course analysis showed that parental understanding of the social deficits and the cognitive and behavioural difficulties associated with ASD significantly increased following course attendance. Course attendance also significantly increased parental understanding of the strategies used to support a child with ASD and parental self-efficacy. Client experience questionnaires were analysed using thematic analysis, with themes centring on the importance of peer and professional support, timeliness of intervention and relevance of information covered within the course. The parents' evaluation of the course was rated predominantly as a positive experience. The importance of parents receiving involvement through an intervention programme is explored and the results are discussed in relation to potential impact on service provision, identifying future need and areas for further research.     

Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare

This study compares two approaches to the estimation of social welfare intervention costs: one “top-down” and the other “bottom-up” for a group of social welfare clients with severe problem behavior participating in a randomized trial. Intervention costs ranging over a two-year period were compared by intervention category (foster care placement, institutional placement, mentorship services, individual support services and structured support services), estimation method (price, micro costing, average cost) and treatment group (intervention, control). Analyses are based upon 2007 costs for 156 individuals receiving 404 interventions. Overall, both approaches were found to produce reliable estimates of intervention costs at the group level but not at the individual level. As choice of approach can greatly impact the estimate of mean difference, adjustment based on estimation approach should be incorporated into sensitivity analyses. Analysts must take care in assessing the purpose and perspective of the analysis when choosing a costing approach for use within economic evaluation.     

‘Yarn about it’: Aboriginal Australian women’s perceptions of the impact of routine enquiry for intimate partner violence

Aboriginal women globally are disproportionately affected by intimate partner violence (IPV) and face additional barriers to help-seeking. It is crucial that interventions for IPV are made safe for Indigenous women, given inflated rates of statutory intervention and widespread institutional racism. As part of a larger study of antenatal IPV screening, we interviewed 12 Aboriginal Australian women about the perceived impact of an antenatal IPV routine enquiry intervention. Seven women reported positive impact, and five women reported the absence of positive impact. Qualitative comparative analysis was used to map pathways to perceived impact. Cultural safety – the practice of countering tendencies in health care that undermine safety – was a key condition for positive impact. Others included: (i) continuity of care; (ii) asking about abuse without judgement and with care; and (iii) support and validation. Absence of these factors also typified pathways for nil positive impact. Naming the abuse, a sense of connection, unburdening, taking steps to safety and enabling informed care were all reported benefits. Two women reported explicitly negative impacts: one noted a sense of intrusion, and the other, disengagement from the health service. Interventions for IPV have the potential to benefit Indigenous women where cultural safety is prioritised.     

Supporting self‐management by Community Matrons through a group intervention; an action research study

The aim of this study was to examine the feasibility and impact of a group intervention by Community Matrons to support those living with multiple long‐terms conditions. Little evidence exists as to how the role of the Community Matron (CM) should be delivered to effectively enhance disease self‐management and levels of self‐efficacy for the service users. This qualitative participatory action research study explored the use of group work as a method of intervention by CMs. A purposive sample of 29 participants was recruited. Each patient group had 8–10 participants, led by a CM working in both the researcher and practitioner role, operating over 12‐month period. Data were collected by participant observation, researcher reflexive account and interviews. Grounded theory method was used to systematically analyse the data. Three main data categories emerged: (i) comparison by patients that leads to re‐motivation of the self; (ii) learning, leading to enhanced self‐management techniques, through storytelling and understanding of each other's experiences; and (iii) ownership that resulted in the self‐awareness, cognisance and insight into the role of the support group they were based in and how it benefited them. The core category of ‘Taking back the self – understanding the whole,’ conveyed the impact that this care delivery method had upon readjusting the balance of power between health professional and service users and its consequence in refreshing and improving their self‐management and the patients’ self‐efficacy. It was concluded that CM intervention using a model of group learning can lead to more effective and efficient support, through improving self‐efficacy and patients’ related self‐management ability.     

社会经济特征、社会支持对城市社区老年人死亡态度的影响研究Symbol`@@

目的 分析城市社区老年人死亡态度的现状及其与社会经济特征、社会支持的关系，为社区老年人死亡教育干预工作提供依据。方法 采用两阶段随机抽样抽取成都市990名老年人进行调查，应用结构方程模型探讨社会经济特征、社会支持对社区老年人死亡态度的影响及作用路径。结果 67.58%的老年人对死亡持接受态度；在老年男女性的路径中，老年男性的家庭人均月收入（P=0.007,β=0.119）和原职业(PSymbol|@@0.001,β=0.180)对死亡态度有直接作用，而文化程度（P<0.001,β=0.127）对死亡态度产生间接作用；老年女性的原职业对死亡态度同时有直接效应（P=0.018,β=0.101）和间接效应（P=0.001,β=0.007），其中家庭人均月收入（P=0.001,β=0.039）和文化程度(PSymbol|@@0.001,β=0.094)对死亡态度仅有间接作用。社会支持对不同性别老年人的死亡态度均有直接影响和中介作用。结论 城市社区大部分老年人的死亡态度较积极；社会经济特征、社会支持与其死亡态度相关且存在性别差异，提示社区死亡教育干预应重点关注社会经济特征、社会支持因素对老年人死亡态度的影响。     

Health‐care professionals’ assessment of a person‐centred intervention to empower self‐management and health across chronic illness: Qualitative findings from a process evaluation study

BackgroundPerson‐centred care (PCC) empowers patients to manage their chronic illness and promote their health in accordance with their own beliefs, values and preferences. Drawing on health‐care professional''s (HCP’s) experiences implementing an empowerment‐focused, person‐centred intervention called the Bodyknowledging Program (BKP), we undertook a process evaluation that aimed to assess the impact on patient health and well‐being.MethodsWe used individual in‐depth interviews and semi‐structured focus groups comprising n = 8 interprofessional HCP who facilitated intervention sessions with n = 58 patients situated in Norwegian specialist care sites. Content analysis was used to analyse the data and summarize major themes.ResultsHealth‐care professional interviews revealed four main ways in which the intervention operated in support of health‐related patient outcomes: (i) addressing the whole person; (ii) hope and affirmation; (iii) expanding recovery; and (iv) social support and revitalized relationships. The intervention provided new tools for patients to understand the social, emotional and physical impact of their illness. Health‐care professional reported new insights to facilitate patient engagement and to promote patients’ health.ConclusionsThe Bodyknowledging Program facilitated patient engagement through the promotion of patient‐centred care while developing the patients’ ability to exploit their own resources for effectively managing their health within illness. The process evaluation supported the underlying theoretical basis of the intervention and was suggestive of its potential transferability elsewhere.     

The utility of volunteer home-visiting support to prevent maternal depression in the first year of life

Background   Maternal depression can be detrimental to infant development. Structured home visiting initiated either in pregnancy or soon after the birth by a professional has led to better outcomes for mothers and their children but some vulnerable families may respond more favourably to a local volunteer. The value of volunteer support provided in the UK by Home-Start for maternal well-being is noted in qualitative studies, but there is no evidence of its impact from trials. The support is not structured and both the frequency and content of visits may vary.
Methods   A cluster randomized study allocated Home-Start local schemes to intervention or control conditions. Mothers in all areas were screened at routine health checks in late pregnancy. In intervention areas names of those scoring 9+ on the Social Disadvantage Screening Index were passed to Home-Start to be offered a volunteer. Not all those offered the support accepted the offer. In control areas no support was offered. Research assessments were conducted at 2 and 12 months. The outcomes were major or minor depression occurring between 2 and 12 months (Structured Clinical Interview for Diagnostic and Statistical Manual – Third Edition – Revised) and depression symptoms at 12 months (Edinburgh Postnatal Depression Scale). Three groups were compared: supported, case-matched controls and those offered but not receiving support.
Results   Almost one-third experienced depression during the time period. Volunteer support had no identifiable impact on the emergence of maternal depression from 2 to 12 months or on depression symptoms when infants were 12 months. The major predictor of both was depression identified at 2 months.
Conclusions   It was not found that informal support initiated following screening for disadvantage in pregnancy reduced the likelihood of depression for mothers with infants.