Subjecteducation of healthcare executives
health management education
health administration education
health management & policy
global health systems
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/4596
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Examining the relationship between choice, therapeutic alliance and outcomes in mental health servicesStanhope, V; Barrenger, SL; Salzer, MS; Marcus, SC (2013-01-01)Background: Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. Method: The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. Results: Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. Implications: The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer. © 2013 by the authors; licensee MDPI, Basel, Switzerland.
Exploiting social influence to magnify population-level behaviour change in maternal and child health: Study protocol for a randomised controlled trial of network targeting algorithms in rural HondurasShakya, HB; Stafford, D; Hughes, DA; Keegan, T; Negron, R; Broome, J; McKnight, M; Nicoll, L; Nelson, J; Iriarte, E; Ordonez, M; Airoldi, E; Fowler, JH; Christakis, NA; Airoldi, Edoardo|0000-0002-3512-0542 (2017-03-01)© 2017 Published by the BMJ Publishing Group Limited. Introduction: Despite global progress on many measures of child health, rates of neonatal mortality remain high in the developing world. Evidence suggests that substantial improvements can be achieved with simple, low-cost interventions within family and community settings, particularly those designed to change knowledge and behaviour at the community level. Using social network analysis to identify structurally influential community members and then targeting them for intervention shows promise for the implementation of sustainable community-wide behaviour change. Methods and analysis: We will use a detailed understanding of social network structure and function to identify novel ways of targeting influential individuals to foster cascades of behavioural change at a population level. Our work will involve experimental and observational analyses. We will map face-to-face social networks of 30 000 people in 176 villages in Western Honduras, and then conduct a randomised controlled trial of a friendship-based network-targeting algorithm with a set of well-established care interventions. We will also test whether the proportion of the population targeted affects the degree to which the intervention spreads throughout the network. We will test scalable methods of network targeting that would not, in the future, require the actual mapping of social networks but would still offer the prospect of rapidly identifying influential targets for public health interventions. Ethics and dissemination: The Yale IRB and the Honduran Ministry of Health approved all data collection procedures (Protocol number 1506016012) and all participants will provide informed consent before enrolment. We will publish our findings in peer-reviewed journals as well as engage non-governmental organisations and other actors through venues for exchanging practical methods for behavioural health interventions, such as global health conferences. We will also develop a 'toolkit' for practitioners to use in network-based intervention efforts, including public release of our network mapping software.
Characteristics and Predictors of Ecstasy (MDMA) Use During CollegeBrown, Ronald T.; Hanlon, Alexandra L.; Hiller, Matthew L.; Kendrick, Zebulon V.; Segal, Jay S. (Temple University. Libraries, 2008)This cross-sectional investigation examined characteristics of ecstasy use during college and associations between ecstasy use during college and demographic factors, family functioning, mental health, and stage of change for ecstasy use. In addition a multivariate model was developed to predict characteristics of ecstasy use during college. An electronic survey was sent to all undergraduate students enrolled at a large urban university in the mid-Atlantic region of the United States during the spring of 2007. Demographic factors and characteristics of ecstasy use were examined using standardized measures employed in national drug use surveys and by the World Health Organization. Measures associated specifically with ecstasy use during college were developed for this investigation. Family functioning was measured with the Parent Adolescent Communication Scale. Mental health was measured with the K6 screening instrument for nonspecific psychological distress. Stage of change was measured with a five-stage algorithm. The final sample for analysis consisted of 194 participants who reported ecstasy use during college and 2849 participants who reported no ecstasy use during college. Data were described using conventional descriptive statistics, chi-square statistics and non-parametric statistics. A logistic regression model was used to identify variables associated with ecstasy use during college. Based on the results, the following generalized conclusions were drawn: ecstasy continues to be used by college students at large urban universities in the mid-Atlantic region of the United States; because the majority of college students reported using ecstasy for the first time during college and also reported using ecstasy for up to two years, it appears that the college environment is a contextual factor for ecstasy use; lower family communication is associated with ecstasy use during college; psychological distress is associated with ecstasy use during college; being white (versus non-white), male (versus female) and having low or moderate (versus high) family communication each is independently associated with ecstasy use during college; differences in stage of change for ecstasy use among ecstasy users and the demographic profile of ecstasy users compared to non-ecstasy users suggest that prevention, education and intervention efforts should be designed to match the unique factors associated with ecstasy use during college.