A key informant needs assessment of an adult population: Application to consultation and prevention programs

Sixty-three key informants first identified the four most important problems confronting adults between the ages of 30 and 40 years and then responded to a series of open-ended questions in relation to the two most important problems identified. Respondents then rated a list of life events and problem areas as to their seriousness and prevalence and identified those they viewed as most important. Respondent-generated problems, in order of importance, were financial, employment, parenting, health/mental health, and marital. As examples of the qualitative outcomes of the open-ended questions, responses are summarized in this article for two problems: financial and parenting. The two most important problems identified from the rating scales were financial troubles and divorce, followed by a number of items pertaining to mental health, child-rearing, and marital problems. The discussion focuses on considerations of reliability and validity and on implications of the findings for the design of services.     

Burnout prevention: A review of intervention programs

Objective

To evaluate the effectiveness of intervention programs at the workplace or elsewhere aimed at preventing burnout, a leading cause of work related mental health impairment.

Methods

A systematic search of burnout intervention studies was conducted in the databases Medline, PsycINFO and PSYNDEX from 1995 to 2007. Data was also extracted from papers found through a hand search.

Results

A total of 25 primary intervention studies were reviewed. Seventeen (68%) were person-directed interventions, 2 (8%) were organization-directed and 6 (24%) were a combination of both interventions types. Eighty percent of all programs led to a reduction in burnout. Person-directed interventions reduced burnout in the short term (6 months or less), while a combination of both person- and organization-directed interventions had longer lasting positive effects (12 months and over). In all cases, positive intervention effects diminished in the course of time.

Conclusion

Intervention programs against burnout are beneficial and can be enhanced with refresher courses. Better implemented programs including both person- and organization-directed measures should be offered and evaluated.

Practice implications

A combination of both intervention types should be further investigated, optimized and practiced. Institutions should recognize the need for and make burnout intervention programs available to employees.     

Program maturity and cost analysis in the evaluation of primary prevention programs.

Primary prevention has been growing as a major initiative in mental health, and to avoid overpromising its benefits, primary prevention programs must be evaluated in a systematic and effective fashion. Information on the developmental maturity and the direct costs of a program is very useful in assessing its merit, even if definitive findings on incidence reduction are not available for many years. This paper outlines the steps by which information on a program's developmental maturity and direct costs can be obtained, and discusses the implications of these steps for primary prevention policy.     

A participatory process for developing quality assurance tools for health education programs

There is a constant need to find methods and tools for achieving high quality in health education and health promotion programs. The aim of this initiative was to develop standards and criteria for quality assessment of health education programs. Health educators participated in a process to develop these standards and criteria. A consensus was reached regarding the list of standards by participation of the health educators in two workshops. This list consisted of the three main stages of health education programs: planning, implementation and evaluation. Operational criteria for each standard were developed in order to be able to measure the standards. Four different subjects were chosen for the development of the criteria: menopause, smoking cessation, cardiac rehabilitation and prenatal care. A consensus regarding these criteria was reached by discussions in workshops. The tools developed were tested by interviewing health educators who were planning and running these programs. The tools built were found acceptable by the health educators as they provided information on the quality of the programs.     

Effectiveness of workplace diabetes prevention programs: A systematic review of the evidence

Purpose

The primary purpose is to review diabetes workplace interventions and the degree to which they improve diabetes-related outcomes in employees diagnosed with or at risk for T2DM.

Acceptability of programs for the prevention of eating disorders

Researchers can overcome difficulties with recruitment and implementation encountered by previous eating disorder prevention efforts by understanding targeted groups' opinions about such programs. Treatment acceptability methodology provides a framework to examine the social validity of interventions. Using this methodology, the acceptability of programs was examined with an often-targeted group. The study also assessed opinions of this group about the importance of prevention and methods of implementation. Male and female undergraduates (N = 347) rated the acceptability of sample programs. Results indicated that programs focused on information about eating disorders and their consequences were rated most acceptable. Participants felt programs should be offered to adolescents, within the school system, but ratings of the importance of eating disorder prevention were somewhat disappointing.     

Domains of consultation research in primary care

The consultation is increasingly viewed as a crucial aspect of general practice medicine, but a variety of methods of conceptualising, describing and modifying its structure and content have been described. This article describes the historical background to the current interest in the consultation, and describes four qualitatively distinct approaches (or 'domains') to understanding the consultation: the psychodynamic; clinical-observational; social-psychological; and sociological. Four key dimensions along which the domains can be differentiated are described. These concern whether the critique of medical practice inherent in the domain is internal or external to the discipline of general practice; whether the focus of the domain is on the consultation participants' identities or activities; whether the key research methodology is quantitative or qualitative in character; and the degree to which the objective of research within the domain is to describe current practice or prescribe ways of conducting the consultation. Methods of encouraging work across domains are discussed.     

Measuring consultation skills in primary care in England: evaluation and development of content of the MAAS scale.

BACKGROUND: Consultation skills are essential for general practice. Tools for measuring consultation skills in everyday practice are not well developed AIM: To examine and develop the content validity of the MAAS History-taking and Advice Checklist GP (MAAS-GP) tool which is used in The Netherlands for testing consultation skills, with simulated patients in United Kingdom general practice from the perspectives of both general practitioners and patients. DESIGN OF STUDY: Qualitative research using semi-structured interviews. SETTING: Alternate patients attending seven general practices in the north west of England. METHOD: Thematic analysis of the contents of patient and GP interviews, and of focus groups, mapping key themes to the MAAS-GP. RESULTS: There was strong agreement between patients and GPs on issues mapping to 46 out of 68 items of the MAAS-GP. Eight further MAAS-GP items were linked to issues only raised by patients and four to issues raised only by GPs. The remaining 10 items could not be related to issues raised by either. All of the issues raised by GPs could be mapped but 27 patient items could not. These were included in a revised checklist, the Liverpool MAAS (LIV-MAAS). CONCLUSION: the revised tool seems to have content validity in measuring consultation skills. Measurement of its relability is now required.     

A model for the development of genetics education programs for health professionals.

PURPOSE: The need for education programs to facilitate the integration of genetics into health practice is well recognized. The inclusion of education as an aspect of genetics policy and the establishment of national bodies for genetics education extend program development beyond ad hoc programs conducted by individual practitioners. A framework for the development of an effective program is required that has a strong theoretic basis and incorporates rigorous evaluation. METHODS: Relevant aspects of three theories that can inform genetics education programs are described: program logic modeling, adult learning theory, and evaluation theory. These are drawn on to develop a framework for the development and implementation of genetics education programs for health professionals and concurrent evaluation. RESULTS: The utility of the framework is demonstrated in the development and implementation of "The Genetics File" program, a multifaceted program for general practitioners, comprising an enduring print resource and interactive workshop. The evaluation strategy developed is also documented. CONCLUSIONS: Program logic, adult learning theory, and evaluation theory together provide a useful and relevant theoretic framework for the development of genetics education programs for health professionals.     

Enhanced treatment for depression in primary care: long-term outcomes of a psycho-educational prevention program alone and enriched with psychiatric consultation or cognitive behavioral therapy

BACKGROUND: The long-term outcome of major depression is often unfavorable, and because most cases of depression are managed by general practitioners (GPs), this places stress on the need to improve treatment in primary care. This study evaluated the long-term effects of enhancing the GP's usual care (UC) with three experimental interventions. METHOD: A randomized controlled trial was conducted from 1998 to 2003. The main inclusion criterion was receiving GP treatment for a depressive episode. We compared: (1) UC (n=72) with UC enhanced with: (2) a psycho-educational prevention (PEP) program (n=112); (3) psychiatrist-enhanced PEP (n=37); and (4) brief cognitive behavioral therapy followed by PEP (CBT-enhanced PEP) (n=44). We assessed depression status quarterly during a 3-year follow-up. RESULTS: Pooled across groups, depressive disorder-free and symptom-free times during follow-up were 83% and 17% respectively. Almost 64% of the patients had a relapse or recurrence, the median time to recurrence was 96 weeks, and the mean Beck Depression Inventory (BDI) score over 12 follow-up assessments was 9.6. Unexpectedly, PEP patients had no better outcomes than UC patients. However, psychiatrist-enhanced PEP and CBT-enhanced PEP patients reported lower BDI severity during follow-up than UC patients [mean difference 2.07 (95% confidence interval (CI) 1.13-3.00) and 1.62 (95% CI 0.70-2.55) respectively] and PEP patients [2.37 (95% CI 1.35-3.39) and 1.93 (95% CI 0.92-2.94) respectively]. CONCLUSIONS: The PEP program had no extra benefit compared to UC and may even worsen outcome in severely depressed patients. Enhancing treatment of depression in primary care with psychiatric consultation or brief CBT seems to improve the long-term outcome, but findings need replication as the interventions were combined with the ineffective PEP program.     

Evaluation of large-scale combination HIV prevention programs: essential issues

HIV prevention research has shifted to the evaluation of combination prevention programs whereby biomedical, behavioral, and structural interventions are implemented concurrently to maximize synergies among interventions. However, these kinds of combination prevention packages, particularly when implemented at scale, pose significant evaluation challenges, including how best to determine impact and how and whether to measure the effectiveness of component strategies. In addition, methodological challenges unique to HIV infection such as the absence of a reliable incidence assay, the lack of naive control groups, and no suitable surrogates further complicate rigorous evaluation. In this commentary, we discuss the key considerations for planning impact evaluations of combination HIV prevention programs in light of these challenges, including defining the evaluable package, determining which component programs require independent assessment of impact, choosing study designs with valid counterfactuals, selecting appropriate outcomes of interest, and the importance of mid-course program corrections.