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BackgroundThe Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) is an important tool for assessing teacher skill and aspects of the fidelity of mindfulness-based interventions, but prior research on and implementation of the MBI:TAC has used video recordings, which can be difficult to obtain, share for assessments, and which increase privacy concerns for participants. Audio-only recordings might be a useful alternative, but their reliability is unknown.ObjectiveTo assess evaluator perception of the rating process and inter-rater reliability of MBI:TAC ratings using audio-only recordings.MethodsWe prepared audio-only files from video recordings of 21 previously rated Mindfulness-Based Stress Reduction teachers. Each audio recording was rated by 3 trained MBI:TAC assessors drawn from a pool of 12 who had previously participated in rating the video recordings. Teachers were rated by evaluators who had not viewed the video recording and did not know the teacher. We then conducted semi-structured interviews with evaluators.ResultsOn the 6 MBI:TAC domains, the intraclass correlation coefficients (ICCs) for audio recordings ranged from .53 to .69 using an average across 3 evaluators. Using a single rating resulted in lower ICCs (.27-.38). Bland-Altman plots showed audio ratings had little consistent bias compared to video recordings and agreed more closely for teachers with higher ratings. Qualitative analysis identified 3 themes: video recordings were particularly helpful when rating less skillful teachers, video recordings tended to provide a more complete picture for rating, and audio rating had some positive features.ConclusionsInter-rater reliability of the MBI:TAC using audio-only recordings was adequate for many research and clinical purposes, and reliability is improved when using an average across several evaluators. Ratings using audio-only recordings may be more challenging when rating less experienced teachers.

Bien que les effets des programmes d'entraînement aux habiletés parentales (PEHP) soient probants et permettent de réduire les risques de maltraitance à l’enfance, les parents qui y participent n’en bénéficient pas tous également. Pour optimiser les interventions, les auteurs s’accordent sur l’importance d’identifier quels sont les mécanismes responsables du changement thérapeutique afin de mettre en place les stratégies qui les déclenchent. Ce mémoire explore la relation entre la fidélité d’implantation du PEHP "Ces années incroyables" et l’activation de certains mécanismes responsables du changement thérapeutique. Les analyses réalisées avaient pour objectif de déterminer si trois composantes de la fidélité, l’adhérence, le dosage et la qualité, sont associées à deux mécanismes de changement, l’alliance thérapeutique et l’engagement. Des analyses de corrélations de Pearson ont permis d’identifier et de retenir quatre indicateurs de la fidélité, les vignettes vues par rencontre, les jeux de rôle faits par rencontre, la durée des rencontres et la satisfaction des parents qui corrélaient avec au moins un des mécanismes de changement à l’étude. Par la suite, des analyses de régression linéaire multiple avec entrée forcée, incluant ces quatre indicateurs, ont été réalisées. Les résultats de celles-ci ont montré que les indicateurs de fidélité expliquaient en partie la variance de l’alliance thérapeutique rapportée par les parents. Ce portrait ne permet malheureusement pas de prendre position sur l’importance de la fidélité d’implantation dans l’activation de l’alliance thérapeutique ou de l’engagement chez les parents. Des études ultérieures sont donc nécessaires pour mieux comprendre les mécanismes enjeux dans le changement thérapeutique des PEHP.

Motivational interviewing (MI) is a method of eliciting individuals’ inner motivation to change their behavior. MI is typically delivered within health care settings as well as in occupational and educational settings and in multiple populations. MI builds on practice skills that are relational and technical, aiming to evoke and reinforce client utterances in the direction of behavior change, termed change talk, and to reduce client utterances in the direction of maintaining current behaviors, termed sustain talk. Meta-analyses show that MI training leads to increased practice of relational and technical skills, and practice of relational and technical skills are related to change talk. Technical skills increase the proportion of change talk in relation to sustain talk. Sustain talk has a negative effect on behavioral outcomes, but change talk has a positive effect on behavioral outcomes. Meta-analyses also show positive effects of MI over six months in reducing or eliminating binge drinking, alcohol consumption, problematic substance use, and smoking, and increasing physical activity in chronic illness patients. Studies have shown positive effects of MI on behavior change in a range of behaviors and populations. A step-by-step guide to MI outlines typical intervention content, target populations and behaviors, practitioner training and skills required, and evaluation of fidelity and effectiveness.

Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%).ResultsHome visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition.DiscussionThere are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.

Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%).ResultsHome visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants' growth (weight/height Z score) tended to be significantly better compared to the control condition.DiscussionThere are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean-American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.

The thesis presents three papers discussing some of the methodological issues regarding studies investigating complex community-based cardiovascular health interventions. All three studies involved the Cardiovascular Health Awareness Program (CHAP), a standardised blood pressure and risk factor assessment and educational sessions held in pharmacies or other locally accessible areas in small to mid-sized communities in Ontario, Canada. The first paper reviews the literature and proposes a guide on how to develop a theoretical framework for complex community-based interventions using CHAP as an example. The paper describes a stepwise process of developing a theoretical framework including challenges encountered and strategies employed to overcome them. The second paper presents how recently published randomized controlled trials evaluating complex community-based cardiovascular health interventions monitored and reported implementation fidelity based on a structured review of the published articles and a survey of their primary authors. The results showed that fidelity reporting of included studies was better than those described in previous reviews. Fidelity was verified through self-reports by implementers and supervision by researchers. Strategies described to standardize intervention delivery were through training of implementers and use of implementation guides. The authors’ survey results were consistent with the review results though there were some gaps which could be improved to strengthen fidelity reporting. A data analysis issue with studies investigating complex community-based interventions is that outcomes can be affected by factors from multiple levels. The third paper explores the association of individual, partnership, and community-related factors with CHAP participants’ use of health-related community resources and cardiovascular risk behaviours. This was a cross-sectional analysis of an on-going cohort study. The results sho, Doctor of Philosophy (PhD)

Intervention fidelity examines the degree to which an intervention is delivered as planned. Generic fidelity measures incorporate the active ingredients of more than one intervention and characteristics common to all interventions. Three studies were conducted to define the active ingredients of intervention for children with physical disabilities and generate a generic fidelity measure. These studies involved: (1) describing generic fidelity measures; (2) generating essential attributes of paediatric rehabilitation; and (3) differentiating between two interventions to consistently rate the behaviours of the therapist, child and parent. (1) In a narrative review of generic fidelity measures, five measures were identified within the psychotherapy literature. These measures presented a variety of approaches to examine fidelity, described psychometric property standards, and highlighted 37 non-specific intervention items that were relevant to paediatric rehabilitation. (2) A consensus process with eight experts and interviews with seventeen clinicians working with children with physical disabilities generated 35 attributes that highlighted the general observed therapist and client behaviours essential within a successful intervention session. (3) The Paediatric Rehabilitation Observational measure of Fidelity (PROF) was developed (30 items) to evaluate specific and non-specific behaviours within two occupational therapy and physiotherapy interventions for children with cerebral palsy. Six trained raters examined 25 intervention videos for psychometric testing. Results indicated that the PROF demonstrated good to excellent Inter-rater reliability and early construct validity. These studies present an important starting point to observe and measure the active ingredients within paediatric rehabilitation, incorporating its dynamic nature involving the child and parent within the therapy process., Doctor of Philosophy (PhD)