Academic literature on the topic 'E-intervention'

One way internet users determine the quality of a website is to look for so called 'credibility factors'. These factors can either be positive: the presence of a date, reference list, independent site certification; or negative: the presence of advertisements or broken links. This thesis investigates what role such factors play in the effectiveness of two e-health interventions. An e-health intervention is a health related website designed to change a person’s behaviour. Until now research into credibility has been largely theoretical. Studies have relied on subjective outcome measures such as Likert scales, website content recall, expressions of preference and self reported behaviour. This thesis describes two studies, the second of which investigates, for the first time, whether surface credibility manipulations change objective behavioural outcomes. Surface credibility is how much a perceiver believes a website on simple inspection. Based on a comprehensive literature review of credibility research, the following credibility factors were explored: presence of advertising, recognisable logos, contact details, physical address, references, third party certification, currency information, privacy statement, HTTPS encryption, top level domain and presence of a broken link. The first study involved the assembly of an exercise promotion website. Participants were randomised to receive the site modified to contain either factors heightening credibility or those lowering credibility. Participants using the high credibility version spent twice as long browsing the site as those using the low credibility version. There was no effect on attitude to exercise or self reported physical activity. The second study used the same methodology but with a website targeting an objectively measurable health behaviour (registration as an organ donor). In this study 889 university students were exposed to a website promoting organ donation. Information on the site was assembled based on theoretical domain interviewing and current research into organ donation interventions. 336 (37.79%) participants registered through the study website. The study detected no significant difference in registration rates between high and low credibility versions of the site. Of the 17 comments left on the low credibility site, only 3 were credibility related criticisms. It is the finding of this thesis that university students are willing to submit personal information and place trust in a website contravening many current credibility guidelines. Future studies into credibility are needed to explore why this is the case. One possibility is that the website was trusted simply because it was part of a research study. Another possibility is that the high quality of the textual content compensated for the lack of credibility of the site itself. It is the recommendation of this thesis that future studies focus on objective behavioural outcome measures and control for other forms of credibility such as participation in a research study.

<p> <i><b>Introduction:</b></i> Preconception interventions targeting substance use as well as effective contraception are important to improve the health of both the mother and her offspring, or to reduce unintended pregnancies. Computer-delivered interventions have been shown to be effective in the reducing the risk of alcohol-exposed pregnancies. However, little is known about the effect of specific computer-delivered intervention components and if/how they contribute to the desired intervention outcome. This study experimentally evaluated the contribution of two common intervention factors (empathy and video) of a motivational e-intervention for marijuana and contraception use. </p><p> <i><b>Methods:</b></i> One hundred sixty-six females who reported using marijuana in the last 6 months and having intercourse without reliable contraception in the last 12 months were recruited from a large urban university. Participants were randomly assigned to one of four intervention conditions: empathy, video, both empathy and video, or neither. The main and interaction effects of empathy and video on pre-post intervention change of intent to use marijuana in the next 30 days and intent to contact a physician about making an appointment to discuss contraception methods in the next 30 days was evaluated. </p><p> <i><b>Results:</b></i> The main effect of empathy and the main effect of video on mean change of intention to use marijuana in the next 30 days was not statistically significant, (<i>F</i>(1,162) = .063, <i> p</i> = .802, partial &eta;² = .000, and _F(1,162) = .198, <i>p</i> = .657, partial &eta;² = .001), respectively. The main effect of empathy and the main effect of video on mean change of intention to contact a physician to schedule an appointment to discuss contraception in the next 30 days were also not statistically significant, (<i>F</i>(1,162) = .004, <i>p</i> = .987, partial &eta;² = .00 and <i>F</i>(1,162) = .540, _p = .464, partial &eta;² = .003), respectively. The interaction between empathy and video for both the pre-post intervention change of intention to use marijuana in the next 30 days and for pre to post intervention change of intention to contact a physician to schedule an appointment to discuss LARC in the next 30 days was not significant. </p><p> <i><b>Conclusion:</b></i> Continued research is needed to evaluate the contributions of empathy and video in computer-delivered intervention in order to identify and optimize the factors that contribute to the videos effect. Examining the effectiveness of specific components will contribute to a greater understanding of how behavioral health interventions can employ technology in ways that are increasingly evidence-based and optimally effective. </p><p>

Volume 1 of this thesis focuses on interventions used to combat public stigma towards people with intellectual disabilities (ID) in African countries. It is presented in three parts. Part one presents a systematic review of the types of interventions conducted in African countries to combat public stigma towards people with ID. It also critically appraises the quality of evidence reported by these initiatives. The paper concludes by identifying which interventions are likely to thrive in African settings and discussing the factors that contribute to their successful implementation. However, it points out that there remains insufficient evidence to adequately judge the efficacies of such interventions and calls for more rigorous evaluations in African settings. Part two is a joint empirical study that investigates the efficacy of a brief digital intervention as a tool to combat public stigma towards people with ID in two countries: Nigeria and Kenya. The empirical paper within this volume looks at the Nigerian intervention. The intervention focuses on an integrated approach combining education and indirect contact through film. The paper outlines the impact of the integrated approach used, the study limitations and the implications for further research. Part three is a critical appraisal of the work undergone in the empirical paper. Focus is given to the need for more global research within the programme and the significant relevance of this type of work.

Schizophrenia is a severe and chronic disorder in many cases. The illness can impact on the whole family. Family interventions are a psychosocial treatment for schizophrenia. A robust evidence base has developed supporting the use of family interventions, as reduced relapse and other clinical benefits can be produced. The majority of service users in forensic services suffer from schizophrenia. Yet little is known about the need, acceptability or feasibility of family intervention in forensic services. The over-arching goal of this programme of research was to review the literature for family intervention and conduct a comprehensive needs assessment, with a final aim to resolve the barriers of implementation of family intervention within forensic services. Meta-analysis indicated that the efficacy of family interventions resulted in positive outcomes in reduced relapse and psychotic symptoms, and improved knowledge and relationships. Family interventions were found to be applicable to the psychological needs of forensic service users. Problems were identified with staff training and supervision on forensic wards, with few wards providing family intervention as part of treatment for schizophrenia. Relatives of forensic service users expressed a need for family intervention. Staff highlighted that the barriers to family intervention were associated with insufficient time, poor support, lack of training, deficient information sharing, and geographic limitations between family homes and the forensic units. Staff offered solutions to implementing family intervention that related to revised policy and improved supervision. Relatives and staff held positive attitudes toward family intervention with open-minded attitudes towards the use of a web camera to facilitate family intervention in forensic services (e-FFI). The fourteen week web based family intervention (e-FFI) feasibility study generated reduced levels of stress, stigma and expressed emotion with improvements in the family’s knowledge of schizophrenia, personal health and an acceptance of forensic services. E-FFI was administered with ease achieving positive feedback from the family and the forensic service.

This thesis focuses on using an e-intervention to challenge the stigma of intellectual disability in Kenya. Part one of the thesis is a systematic literature review examining the attitudes towards people with intellectual disabilities in Africa. The search strategies used to identify the relevant literature are specified. The 22 papers are presented according to the differences in attitudes among various groups including the general public, teachers and families. The findings are then summarised and methodological issues and implications discussed. Part two is an empirical study using a randomised control trial to assess (1) attitudes towards intellectual disability in Kenya. Attitudes were assessed at baseline, immediately post-intervention and at one month follow-up and (2) the feasibility of a digital intervention in a Kenyan context. The measures used were the Attitudes Toward Intellectual Disabilities questionnaire short version (ATTID-SF) reflecting affective, cognitive and behavioural dimensions and the supernatural beliefs subscale of the Intellectual Disabilities Literacy Scale (IDLS). The prevalent attitudes towards intellectual disabilities are described and the effects and feasibility of the intervention discussed. This paper forms part of a joint research study conducted with Deborah Odukoya (2017; Clinical Psychology Doctorate Trainee, University College London) who will report attitudes towards intellectual disabilities in Nigeria. While both projects were conceptualised and planned in parallel, an entirely separate intervention that was appropriate to the respective cultural context was produced by each of us, and data collection and analyses were conducted entirely separately. Part 3 is a critical appraisal detailing personal reflections and considers methodological issues which arose during the study.

This paper determines the effects of police interventions on darknet markets. Darknet markets have been rapidly growing and the amount of drugs being sold on them keeps rising. This paper finds no significant changes in prices of drug listings before and after drug busts, and no significant changes in price per unit of drugs across the entire market. The results are similar to prior research done on normal drug markets that determined that police interventions have no significant effect on changing drug prices. With the rapid growth of drugs being sold on darknet markets, it is critical for law enforcement to understand how the markets react to police interventions.

Internet-based self-management interventions have the potential to reduce the current disparity in access to psychological support for people with tinnitus. One example is the Tinnitus E-Programme, which was developed in the United Kingdom to support self-management in people with tinnitus. Although freely available online, there was little understanding of how the intervention is used, its active ingredients, how it works, the circumstances in which it works best, and whom it works best for. This PhD aimed to address these issues by evaluating and optimising the Tinnitus E-Programme. A systematic review of self-help interventions for tinnitus was conducted, which concluded that there was a need for further evaluations of unguided self-help interventions in UK populations. A mixed methods study explored past, current, and new users’ (n=40) views and usage of the Tinnitus E-Programme (1.0), demonstrating that it was acceptable to people with tinnitus. However, its implementation was limited by instances of poor usability, user engagement, and adherence to behavioural goals. Consistent with a person-based approach, the findings from this mixed methods study were used alongside evidence-based (i.e. systematic and literature reviews) and theory-based (i.e. behavioural analysis and logic modelling) approaches to develop the Tinnitus E-Programme 2.0. Think aloud interviews with 19 people with tinnitus evaluated this new version of the intervention and findings revealed that the Tinnitus E-Programme 2.0 was acceptable to its target users. The two primary research studies highlighted how users’ pre-existing beliefs regarding tinnitus and self-management, their perceptions of relevance, and the nature of tinnitus can influence users’ engagement with the Tinnitus E-Programme 1.0 and 2.0. Several cognitive factors (e.g. illness beliefs), behavioural factors (e.g. practicing relaxation), and behavioural determinants (e.g. motivation to practice relaxation) were identified by users to explain how changes in intervention outcomes may occur. Further development and implementation work is needed that introduces and evaluates additional intervention content and design features, and explores how the intervention can fit into current clinical service models for tinnitus. Future evaluation work should test the hypothesised mechanisms of impact and contextual factors proposed in this work, and assess the acceptability and feasibility of procedures for subsequent randomised controlled trials that will assess the efficacy of the intervention.

Background: Preterm infants are at high risk for neurodevelopmental disorders, even in the absence of overt brain lesions. NICU stressful environment, inadequate nutritional support and paucity of parental contact seem to negatively impact early brain development. In this context, mother milk feeding, could play a beneficial role although it is known to be challenging. Recent studies have shown how early interventions can reduce stress exposure with a positive effect on mother-infant relationship and subsequent neurodevelopment in preterm infants. Aims: To determine the effectiveness, in preterm infants, of an Early Intervention program on: i) visual function at term equivalent age (TEA) as an early emerging cognitive function; ii) infant’s feeding behavior and in particular on mother milk assumption at discharge; iii) epigenetic changes in DNA methylation status at TEA; iv) brain growth and maturation assessed by advanced Magnetic Resonance Imaging (MRI) at TEA. Methods: We conducted a parallel-group, randomized controlled trial (Trial Registration Number: NCT02983513). We included preterm infants born between 25+0 and 29+6 weeks of gestational age (GA) without severe morbidities and their families. Infants were recruited and randomized to either receiving Early intervention (EI) or Standard Care (SC). EI program included PremieStart, based on parental involvement, together with a multisensory stimulation (both tactile – through infant massage - and visual stimulation). SC, delivered according to NICU protocols, included Kangaroo Mother Care and minimal handling. Infants with major neonatal morbidities (i.e. surgical NEC; severe brain injuries as GMH-IVH>2°, cPVL) were excluded. The following evaluation were performed: i) Visual ability were assessed at TEA according to the protocol developed by Ricci et al. ii) Infants’ human milk intake at discharge was calculated from the infants’ computerized medical chart, as well as time of acquisition of full-oral feeding iii) As a proxy of DNA methylation we explored LINE-1 methylation status. The analyses were conducted using two blood samples: a cord blood sample, collected at birth, and a peripheral blood sample, harvested at TEA. iv) To calculate brain growth automated segmentation was conducted on each neonatal Axial T2 2 mm scan, in conjunction with the T1 scan. Volumetric measures of the structures were extracted from each segmentation. Results: Seventy preterm (EI n=34, SC n=36) infants were enrolled. According to the protocol 3 infants allocated to EI did not receive treatment. All babies in the SC group received allocated treatment as part of routine clinical practice. Main results include: i) Visual abilities: in total, 59% of infants in the EI group achieved the highest score possible in all 9 items of the visual assessment compared to 17% in the SC group (p=0.001). All infants in both groups showed complete maturation in four items, but EI infants showed more mature findings also in the other 5 items (ocular motility both spontaneous and with target, tracking arc, visual acuity and attention at distance). ii) Infant’s feeding behavior: a significantly higher rate of infants fed with any human milk was observed in the EI group (75.9%) compared to SC group (32.1%) (p=0.001) and EI infants were four times more likely to be fed exclusively with human milk at NICU discharge. Full oral feeding was achieved almost one week before in EI infants (mean postmenstrual age 36.8±1.6 vs 37.9±2.4 weeks in EI vs SC, p=0.04). iii) Epigenetic changes: LINE-1 methylation status increased from preterm birth to TEA for both group but was more pronounced in the EI group (p=0.0077) especially when looking at single CpG sites. iv) Brain growth: no differences were observed between the two groups in terms of regional brain volumes for the 48 areas analyzed. Conclusions: The present work provides further insights in the field of EI. Combining parental involvement and multisensory stimulation, our EI strategy showed an overall beneficial effect for preterm infants. This study, despite far to be conclusive, concur with recent evidence that the quality of early experiences influences neurodevelopment in preterm infants.

Food allergy, an immune-mediated adverse hypersensitivity reaction to ingested food, is an emerging global health problem that not only causes the disease to susceptible individuals but also causes psychological impacts and financial damage to their families. Food allergy incidence is significantly increased in the past decade and currently estimated at 6-8% in 1 year old children, and 2-4% in older children and adults. Food allergy is the leading cause of anaphylaxis in children and severe cases may lead to fatal anaphylaxis reactions. Although continuous efforts have been made to better understand the nature of allergens, predisposing environmental factors, and the host's immune response mechanisms, there is no cure available for food allergy today. In this study, we have investigated three food allergy reducing strategies by supplementing probiotics, low doses of allergens and omega-3 poly unsaturated fatty acids (ω-3 PUFAs) in cow's milk protein sensitized Balb/c mice. Lactobacillus rhamnosus GG (LGG) supplementation had tendency to promote Th1 response while VSL#3 provided more potent allergy reducing effects via inducing intestinal secretory IgA (sIgA). Low doses of allergen administration offered suppression of allergen-specific immune responses via Treg-mediated active suppression, indicated by suppressing both allergen-specific Th1 response [reduced BLG-specific serum IgG2a and elevated IL-12(p40)], and Th2 response [lower BLG-specific serum IgE and IgG]. Interestingly, mice received both VSL#3 and low doses of allergen exhibited both allergen-specific active suppression effects and higher sIgA production. We then investigated the effects of different levels of ω-3 and ω-6 PUFAs in the energy and fat rich Western-style diet on food allergy development. Observation of elevated BLG-specific serum immunoglobulins in all experimental mice indicated that both ω-3 and ω-6 PUFAs failed to prevent the development of allergen-specific immune response. However, ω-3 PUFAs alleviated anaphylactic reactions and the severity of allergic reaction as indicated by the unchanged rectal temperature, lower hypersensitivity scores, and Th1-favoured immune responses in BLG-sensitized O3H mice. In general, this study revealed the promising strategies for treatments and prevention against food allergy in the near future.<br>Les allergies alimentaires, réactions dues à une hypersensibilité du système immunitaire après ingestion d'un certain type d'aliments, constituent un problème de santé publique croissant qui, en plus de dégrader la santé des individus susceptibles, engendre un impact psychologique et financier pour les familles touchées. L'incidence des allergies alimentaires a significativement augmenté ces dernières années et le taux est actuellement estimé être de 6-8% chez les jeunes enfants d'1 an et de 2-4% chez les autres enfants et les adultes. Les allergies alimentaires représentent la première cause d'anaphylaxie chez l'enfant et plusieurs cas d'allergies peuvent causer une réaction anaphylactique fatale. Bien que des efforts continus aient été faits pour tenter de mieux comprendre la nature des allergènes, les facteurs environnementaux prédisposant aux allergies et les mécanismes de la réponse immunitaire, aucun traitement contre les allergies alimentaires n'est disponible à l'heure actuelle. Dans cette étude, nous avons testé trois différentes stratégies visant à réduire l'allergie alimentaire, à savoir l'utilisation de probiotiques, de faibles doses d'allergènes et d'acides gras polyinsaturés oméga-3 chez des souris Balb/c sensibilisées aux protéines de lait de vache. L'administration de Lactobacillus rhamnosus GG (LGG) a montré une tendance à promouvoir une activation des cellules Th1 alors que VSL#3 a engendré une plus forte réduction de l'allergie via l'induction de la sécrétion intestinale d'IgA (sIgA). L'administration de faibles doses d'allergènes a provoqué une suppression de la réponse immunitaire dirigée contre les allergènes via l'activation des cellules Treg, ceci étant suggéré par la suppression des réponses immunitaires Th1 spécifique [diminution des IgG2a BLG-spécifiques et augmentation des IL-12(p40)] et Th2 spécifique [diminution des IgE et IgG BLG-spécifiques]. De plus, les souris ayant reçu à la fois VSL#3 et des faibles doses d'allergènes ont montré une suppression des effets de la réponse allergénique et une production plus élevée de sIgA. Nous avons ensuite étudié les effets de différents niveaux d'oméga-3 et d'oméga-6 dans un régime alimentaire de type occidental riche en énergie et en matières grasses sur le développement des allergies alimentaires. L'observation d'une élévation des immunoglobulines BLG-spécifiques chez toutes les souris expérimentales ont indiqué que les oméga-3 et -6 n'ont pas réussi à empêcher le développement de la réponse immunitaire dirigée contre les allergènes. Cependant, les oméga-3 ont diminué les réactions anaphylactiques et le degré de sévérité de la réaction allergique, ceci étant suggéré par un score d'hypersensibilité plus faible, une absence de changement de la température rectale et une réponse immunitaire favorisée par les cellules Th1. Pour conclure, cette étude a révélé des stratégies prometteuses pour le traitement et la prévention des allergies alimentaires dans les années à venir.

Substantial resources are being directed towards use of the Internet in K-12 Education with over $2.25 billion annually distributed to K-12 schools from the Federal government alone (Maiden & Beckham, 1999). In 1998, 90% of schools had Internet access while only 2% of funds spent on software in K-12 schools were directed towards Web-based courseware (Jerald & Orlofsky, 1999). The Web-based instructional module Healthy Hearts was developed as a self-contained instructional unit delivered over the Internet, popularly referred to as â e-Learningâ , for fifth grade students to use as part of the classroom curriculum. Healthy Hearts teaches children about risk factors associated with heart disease, including physical activity, tobacco, and nutrition. After piloting and formatively evaluating Healthy Hearts in two fifth grade classrooms, Elliott (1997) made recommendations for future modification and implementation. No research regarding effects the Web-based instructional unit Healthy Hearts has on fifth grade children exists. The purpose of this study is to evaluate the impact Healthy Hearts has on fifth grade childrenâ s physical activity knowledge, attitudes, and behavior. Participants included 233 fifth grade boys and girls and 11 teachers who implemented Healthy Hearts during Spring 2001. A repeated measures experimental-control design was employed to measure Healthy Hearts effects on physical activity knowledge, attitudes, and behavior. The questionnaire used for this study included three attitude items adapted from Sport, Play, and Active Recreation for Kids (SPARK) (Sallis, Alcaraz, McKenzie, & Hovell, 1999a), six criterion referenced knowledge items developed from Healthy Hearts objectives, and a Weekly Activity Checklist to assess physical activity behavior, which was developed and validated for SPARK (Sallis et. al., 1993a). Classroom teachers administered the baseline test before students began using the module. For five weeks following the baseline test, the group 1 engaged in Healthy Hearts lessons by going to a computer lab for 45 minutes twice a week while group 2 participated in regularly scheduled classroom activities. After group 1 finished Healthy Hearts, both groups completed test 1 and then teachers from group 2 implemented Healthy Hearts with their classes. When group 2 finished using Healthy Hearts, both groups completed test 2. Dependent variables were physical activity knowledge, attitude, and behavior with group as independent variables. Other independent variables included school socioeconomic status, time allocated to Healthy Hearts, non-Healthy Hearts instruction time for related objectives, and speed of Internet connection. Repeated measures ANOVA revealed significant effects of Healthy Hearts on physical activity knowledge and attitude, however Healthy Hearts had no significant effects on behavior. Results of this study indicate Healthy Hearts could be an effective means of using the Internet to deliver health and physical activity instruction to fifth grade children, and suggest a need for further design, development, and evaluation of Healthy Hearts.<br>Ph. D.