Youth En Route (YER) is a transition program for youth and young adults with multiple disabilities. It offers a multifaceted approach that includes self-discovery, skill development, and community experience. Underlying the service delivery model is a philosophy of self-determination. This program evaluation measured the self-determination skills, sense of personal control over life choices, and community participation of 34 youth prior to and one year following their involvement with YER. Youth reported statistically and clinically significant improvement from pretest to posttest with respect to both self-determination and sense of personal control. Moreover, youth reported spending significantly more time at posttest than at pretest engaged in volunteer/work activities and community leisure activities. On average, youth reported high satisfaction with YER services. Practical and research implications are discussed.
This article demonstrates a novel application of propensity score matching techniques: to estimate nonexperimental impacts on program participants within the context of an experimental research design. The author examines the relationship between program participation, defined as qualifying for an earnings supplement by working full-time, and marital union formation among low-income mothers in two Canadian provinces. The author finds that receipt of an earnings supplement substantially increased union formation in one province but not the other. A subgroup analysis based on propensities of program participation revealed that the positive effect on unions was concentrated among relatively disadvantaged participants. The techniques demonstrated in the article are broadly applicable to studies in which take-up is less than 100% among those randomly assigned to a program group.
Trials in which intact communities are the units of randomization are increasingly being used to evaluate interventions which are more naturally administered at the community level, or when there is a substantial risk of treatment contamination. In this article we focus on the planning of community intervention trials in which k communities (for example, medical practices, worksites, or villages) are to be randomly allocated to each of an intervention and a control group, and fixed cohorts of m individuals enrolled in each community prior to randomization. Formulas to determine k or m may be obtained by adjusting standard sample size formulas to account for the intracluster correlation coefficient rho. In the presence of individual-level attrition however, observed cohort sizes are likely to vary. We show that conventional approaches of accounting for potential attrition, such as dividing standard sample size formulas by the anticipated follow-up rate pi or using the average anticipated cohort size m pi, may, respectively, overestimate or underestimate the required sample size when cluster follow-up rates are highly variable, and m or rho are large. We present new sample size estimation formulas for the comparison of two means or two proportions, which appropriately account for variation among cluster follow-up rates. These formulas are derived by specifying a model for the binary missingness indicators under the population-averaged approach, assuming an exchangeable intracluster correlation coefficient, denoted by tau. To aid in the planning of future trials, we recommend that estimates for tau be reported in published community intervention trials.
It has been highlighted that youth empowerment and participation are important principles for school health promotion. Despite this fact, children and youth are rarely given instruments to participate or to influence their situations and the environments in their schools. Photovoice is a method to increased empowerment and participation. Originally it was created as a community action research method based on Freire's critical pedagogy and feminist theory. The purpose of this study was to explore challenges and opportunities for applying photovoice in a school setting to support genuine participation. Together with teachers and students in an upper secondary school in Östersund's municipality in the north of Sweden, the photovoice method was field tested and modified to a classroom situation. The teachers and the students were interviewed about their experiences with the method. The results were interpreted by content analysis and showed that the teachers' capability to be facilitators and the students' possibility to make a difference for the school or the municipality were the most important factors to succeed with photovoice. The conclusions were that photovoice challenges schools and society to have a better structure for genuine participation if youth participation is seen as valuable.
Canada's approach to shared decision making (SDM) is as disparate as its healthcare system; a conglomerate of 14 public plans at various administrative levels. SDM initiatives are taking place in different pockets of the country and are in different stages of development. The most advanced provincial initiative is occurring in Saskatchewan, where in 2010 the provincial government prepare to introduce patient decision aids into certain surgical specialties. With regard to decision support tools for patients, perhaps the most active entity is the Patient Decision Aids Research Group in Ottawa, Ontario. This group maintains a public inventory of decision aids ranked according to International Patient Decision Aid Standards and has developed the generic Ottawa Personal Decision Guide, as well as a toolkit for integrating decision aids in clinical practice. All of these tools are publicly available free of charge. Professional interest in SDM in Canada is not yet widespread, but Canada's principal health research funding agency is sponsoring several important SDM projects. Researchers from institutions across the country are promoting SDM through continuing professional development programs and other interventions in fields as varied as primary care, dietary medicine and workplace rehabilitation. Still, the future of SDM in Canada remains uncertain. Canada's provincially based structure obliges promoters to work with each province separately, and the recent growth of private healthcare risks dissipating efforts to implement SDM.
Public priorities for improvement often differ from those of clinicians and managers. Public involvement has been proposed as a way to bridge the gap between professional and public clinical care priorities but has not been studied in the context of quality-indicator choice. Our objective is to assess the feasibility and impact of public involvement on quality-indicator choice and agreement with public priorities.
We will conduct a cluster randomised controlled trial comparing quality-indicator prioritisation with and without public involvement. In preparation for the trial, we developed a 'menu' of quality indicators, based on a systematic review of existing validated indicator sets. Participants (public representatives, clinicians, and managers) will be recruited from six participating sites. In intervention sites, public representatives will be involved through direct participation (public representatives, clinicians, and managers will deliberate together to agree on quality-indicator choice and use) and consultation (individual public recommendations for improvement will be collected and presented to decision makers). In control sites, only clinicians and managers will take part in the prioritisation process. Data on quality-indicator choice and intended use will be collected. Our primary outcome will compare quality-indicator choice and agreement with public priorities between intervention and control groups. A process evaluation based on direct observation, videorecording, and participants' assessment will be conducted to help explain the study's results. The marginal cost of public involvement will also be assessed.
We identified 801 quality indicators that met our inclusion criteria. An expert panel agreed on a final set of 37 items containing validated quality indicators relevant for chronic disease prevention and management in primary care. We pilot tested our public-involvement intervention with 27 participants (11 public representatives and 16 clinicians and managers) and our study instruments with an additional 21 participants, which demonstrated the feasibility of the intervention and generated important insights and adaptations to engage public representatives more effectively. To our knowledge, this study is the first trial of public involvement in quality-indicator prioritisation, and its results could foster more effective upstream engagement of patients and the public in clinical practice improvement.
NTR2496 (Netherlands National Trial Register, http://www.trialregister.nl).
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Citizen participation in neighbourhood development is one way to promote public health and contribute to the well-being of individuals. However, some people participate while others do not. This study examines the individual characteristics of people who during the past 2 years have participated in a neighbourhood development process compared with potential and non-participants. Socio-demographic factors, perceptions and behaviour were analysed in a cross-sectional study. A questionnaire was answered by 1160 randomly chosen citizens over the age of 18 who lived in three Swedish cities. The most important single factor related to participation in neighbourhood development was prior experience of participation, such as attempting to influence city policies by contacting politicians, submitting a citizen proposal, etc. Furthermore, having frequent political discussions with neighbours was another behavioural factor that was found associated to people's participation in neighbourhood development. Among socio-demographic factors, only ethnicity was found significant after controlling for other factors; i.e. people born outside the Nordic countries were less likely to participate.
In the past 50 years, individual patient involvement at the clinical consultation level has received considerable attention. More recently, patients and the public have increasingly been involved in collective decisions concerning the improvement of health care and policymaking. However, rigorous evaluation guiding the development and implementation of effective public involvement interventions is lacking. This article describes those key ingredients likely to affect public members' ability to deliberate productively with professionals and influence collective health care choices.
We conducted a trial process evaluation of public involvement in setting priorities for health care improvement. In all, 172 participants (including 83 patients and public members and 89 professionals) from 6 Health and Social Services Centers in Canada participated in the trial. We video-recorded 14 one-day meetings, and 2 nonparticipant observers took structured notes. Using qualitative analysis, we show how public members influenced health care improvement priorities.
Legitimacy, credibility, and power explain the variations in the public members' influence. Their credibility was supported by their personal experience as patients and caregivers, the provision of a structured preparation meeting, and access to population-based data from their community. Legitimacy was fostered by the recruitment of a balanced group of participants and by the public members' opportunities to draw from one another's experience. The combination of small-group deliberations, wider public consultation, and a moderation style focused on effective group process helped level out the power differences between professionals and the public. The engagement of key stakeholders in the intervention design and implementation helped build policy support for public involvement.
A number of interacting active ingredients structure and foster the public's legitimacy, credibility, and power. By paying greater attention to them, policymakers could develop and implement more effective public involvement interventions.
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Drawing on the theory of planned behavior (TPB), this field study (N = 282) investigates the impact of two focal personality traits, extraversion and conscientiousness, on employees' attitudes and intentions to actively participate in their local union. Consistent with the TPB, subjective norms, perceived behavioral control, and attitudes toward participation each explained unique variance in union participation intentions. Furthermore, results revealed that extraversion was positively related, and conscientiousness was negatively related to participation intentions, with attitudes toward participation mediating these effects. A significant interaction between extraversion and conscientiousness was also observed, such that introverted workers higher in conscientiousness were less inclined to express positive attitudes toward union participation. Overall, these results provide support for the utility of the TPB in predicting union participation intentions and highlight the vital role that personality traits may play in determining union participation attitudes and intentions.