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In the Great Recession, sovereign bailouts were deemed necessary to alleviate the stress of indebted countries. These bailouts contained some of the most contentious policies, including austerity, structural reforms, and privatizations that triggered sharp bursts of protest during the Great Recession. In this chapter, we examine the impact of those particular political events on protest within this period, aiming to assess their impact and explore the mechanisms through which they operate on protest behavior. We observe that bailouts had a strong effect on protest, but in a mostly regional pattern, as they were accompanied by massive and frequent demonstrations only in southern Europe but not in eastern Europe. We also try to see whether the effect of bailouts can be explained by a deterioration of economic sentiment, but we find that their effect on protest remains even when accounting for such a decline in prospects. The chapter then shows that bailouts, ceteris paribus, were also much more contested than non-supranational austerity packages. Overall, bailouts have a strong effect on protest, but the regional pattern suggests that this is stronger where possibilities of alternative institutional political representation were available, as in the case of Greece which is examined more closely.
The chapter establishes that economic and political grievances matter for economic protest in general and public economic protest in particular. In addition, it shows that, during the period covered, political grievances have been strongly influenced by economic grievances across Europe, but most clearly in southern Europe. While the rapid recovery of the countries of north-western Europe and the pain tolerance in the countries of central and eastern Europe probably served to limit the impact of the economic grievances on political dissatisfaction, the fact that the southern European countries not only were hard hit by the economic crisis, but also experienced a relative decline with regard to the other parts of Europe, most likely enhanced the impact of economic on political grievances in this part of Europe. Moreover, it is also above all in southern Europe that the effect of economic on political grievances was conditioned by state capacity and IMF interventions: while weak state capacity enhanced the effect of the former on the latter, IMF interventions attenuated it. Finally, a core finding of this chapter is that economic protest was most heavily influenced by the joint effect of economic and political grievances. Protest mobilization was particularly pronounced whenever dire economic conditions and dissatisfaction with the political system rose together and reinforced each other.
This chapter focuses on the intersection between Bahrain, Iran, and the British during the interwar years and the influence that contacts with Iran and Iranians had on the process of nation and state building in Bahrain. It analyzes the role of Iran and the role of the Iranian immigrant communities in the evolution of the Bahrain administration and the emergence of Arab nationalist sentiments in Bahrain. It depicts how different elements of the Iranian communities viewed Iran, the Al Khalifa ruling family, and the British. And it explores how the Al Khalifa and different segments of Bahraini society regarded Bahrain residents of Iranian origin and nationality. The analysis is preceded with a background on politics and society in Bahrain with special attention to the growth and characteristics of the Iranian immigrant communities.
Sexual assault, including unwanted sexual contact, coercion, and rape, is a social phenomenon that has been approached in a variety of ways in different global contexts. Attempts to address risk and protective factors for perpetrators and victims are limited by the difficulty of collecting empirical data on experiences that can be traumatic, stigmatizing, complicated, and private. This chapter explores current and historic definitions of sexual assault as well as how these definitions influence estimates of sexual assault prevalence and subsequent psychological and public health responses. We describe best practices in sexual assault measurement, explore the need for culturally acceptable interventions that acknowledge intersections of identity, critique current victim response services, and finally provide recommendations for future directions in sexual assault prevention and response.
Chapter 1 examines Lebanon’s post-independence tourism promotion and maps its relations to a wider discursive field that constituted the coastal capital Beirut as a Mediterranean site of modern leisure and tourism. It reveals how the geographic turn to the Lebanese coast is linked to a rising global economy of mass tourism on the Mediterranean and to Cold War US development funds and modernization imperatives. However, the lens of global modernity becomes complicated once Lebanon’s colonial history, its creation as a nation-state and ensuing national identity politics are brought to the fore. Thus the chapter interrogates the hegemony of a Mediterranean geography of belonging, especially in light of its antagonistic relation to contemporary politics of pan-Arab nationalism in the region. It sheds light on the visual communication strategy of the National Council for Tourism Development and the role of the graphic design department headed by artist Mouna Bassili Sehnaoui (b. 1945). The analysis reveals how Lebanon’s visual culture of tourism contributed to the formation of a Lebanese subjectivity premised on separatism from the Arab context, arguing that cosmopolitan Beirut, ‘the Paris of the East’, emerged in and through the material folds of 1960s tourism promotions, associated practices and aesthetics.
The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal.
To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP.
A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers.
The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors.
Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.
Conducting classroom-based educational research trials is important for establishing the efficacy and effectiveness of specific instructional interventions. Such endeavours, however, are challenging to implement. This was made evident during a recent independent evaluation of the efficacy of the MiniLit program, wherein various difficulties emerged relating to the dosage and fidelity of instruction, and the measures and analyses employed by the research team. As such, this served as an object lesson in what can, and frequently does, go wrong in even the best planned intervention research enterprises conducted in schools. The present article is intended to capture the authors’ experiences in implementing research trials in school contexts, with specific examples drawn from the independent evaluation of MiniLit. In particular, this study has reinforced the need to select assessment measures carefully, according to how well they represent targeted skills in the specific population of interest. In addition, it has highlighted the importance of planning program efficacy trials such that participants can receive enough exposure of the intervention to progress to a realistic extent.
The Handbook of Behavior Change is the first wide-ranging compendium of theory- and evidence-based research and practice on behavior change. It provides scientists, students, and practitioners with the current evidence on behavior change and expert advice on how to develop, evaluate, and implement behavior change interventions. The handbook also sets an agenda for future research on behavior change theory and practice across multiple behaviors, contexts, and populations. This chapter outlines emerging issues and future research directions arising from the handbook. The chapter stresses the importance of theory development, including the need for greater emphasis on ecological and social theories; clearer descriptions and operationalizations of behavior change theories; and increased application of interdisciplinary approaches. Future research on intervention development should conduct more comprehensive intervention fidelity assessments; adopt novel means to improve the translation, feasibility, and optimization of interventions; ensure consideration of ethical issues in behavior change research; routinely evaluate mechanisms of action in behavior change interventions; and apply complex systems approaches to behavior change. “Best-practice” guidance on behavior change should consider emerging methods and approaches to behavior change; implement trials to evaluate the long-term maintenance of behavior change; and develop core curricula on behavior change to educate the next generation of scientists and practitioners.
This chapter describes key methods to promote intervention engagement in order to maximize uptake, prevent early dropout, and support sustained behavior change. The importance of reviewing or conducting qualitative and mixed methods research on target users’ attitudes, capabilities, and lifestyle is highlighted so that interventions can be designed to meet users’ needs. Tailoring interventions is useful to provide appropriate advice and support for the needs of the target population – especially among those who find it difficult to engage due to personal circumstances or lack of resources. Interventions should then be optimized by collecting data on how people engage with them and iteratively modifying them to improve engagement. Qualitative studies are needed to explore target users’ views of intervention elements. Quantitative usage and outcome data are valuable to analyze usage patterns and identify predictors of dropout or effective behavior change. To maintain longer-term engagement with behavior change, it can be useful to harness social support and establish environment-prompted habits that require less deliberative effort to sustain. The chapter provides examples and tools that can be used to design and optimize interventions, drawing on the “person-based approach” that has been used to develop many interventions that have proved engaging and effective.
Robust development of behavior change interventions is based on a sound understanding of the target group, the target behaviors that need to change, the context in which change will occur, the hypothesized mechanisms of change, and the behavior change techniques. Intervention development frameworks advocate a systematic approach to behavior change intervention development. Key tasks include (1) identify and analyze the problem addressed in behavioral terms; (2) identify intervention mechanisms, content, and delivery mode(s) and design a logic model or program theory; (3) develop materials or prototypes (e.g., interface); and (4) test the intervention iteratively through empirical optimization. The tasks apply to both developing new interventions and optimizing existing interventions. The tasks may differ somewhat for digital behavior change interventions (e.g., iterative testing and refinement of early prototypes during development). Depending on time and resources, the tasks can be completed relatively quickly or take considerable time. The current chapter presents key challenges in intervention development and describes potential solutions. Fidelity, feasibility, and acceptability should be considered during all development tasks. The chapter also provides recommendations for advancing the methodology of intervention development and the use of intervention development frameworks and approaches in practice and policy settings.
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.
Rigorous evaluation of interventions is vital to advance the science of behavior change and identify effective interventions. Although randomized controlled trials (RCTs) are often considered the “gold standard”, other designs are also useful. Considerations when choosing intervention design are the research questions, the stage of evaluation, and different evaluation perspectives. Approaches to explore the utility of an intervention, include a focus on (1) efficacy; (2) “real-world” effectiveness; (3) how an intervention works to produce change; or (4) how the intervention interacts with context. Many evaluation designs are available: experimental, quasi-experimental, and nonexperimental. Each has strengths and limitations and choice of design should be driven by the research question. Choosing relevant outcomes is an important step in planning an evaluation. A typical approach is to identify one primary outcome and a narrow range of secondary outcomes. However, focus on one primary outcome means other important changes may be missed. A well-developed program theory helps identify a relevant outcomes. High-quality evaluation requires (1) involvement of relevant stakeholders; (2) evaluating and updating program theory; (3) consideration of the wider context; (4) addressing implementation issues; and (5) appropriate economics input. Addressing these can increase the quality, usefulness, and impact of behavior change interventions.
This chapter presents a generic, ten-task plan for collaboratively developing, testing, refining, and implementing behavior change interventions. Even carefully designed, expensive interventions can prove ineffective if designers make incorrect assumptions about (1) how a behavior pattern is generated and regulated; (2) how participants or organizations are likely to respond; or (3) how novel personal, interpersonal, or organizational practices can be sustained in situ or over time. Interventionists can be misdirected by assuming that recipients are motivated to change or that motivation is sufficient to evoke change, or that they are choosing reflectively to repeat behavior patterns or that they make choices in an influence-free environment or have just a few everyday life goals. Reliance on any of these assumptions, or the application of simple rules such as educate them, promise rewards, or threaten them, can undermine intervention design from the outset. Interventionists can be effective when they cocreate bespoke, tailored, mechanism-based, interventions that are engaging, rewarding, and sustainable in context. Detailed analyses of mechanism and change processes combined with evidence-based, context-tailored collaborative design is a prerequisite. Success needs to be demonstrable in less expensive efficacy evaluations before investing in large-scale effectiveness trials that provide the evidence base for scaled-up implementation.
The critical processes driving successful research translation remain understudied. We describe a mixed-method case study protocol for analyzing translational research that has led to the successful development and implementation of innovative health interventions. An overarching goal of these case studies is to describe systematically the chain of events between basic, fundamental scientific discoveries and the adoption of evidence-based health applications, including description of varied, long-term impacts. The case study approach isolates many of the key factors that enable the successful translation of research into practice and provides compelling evidence connecting the intervention to measurable changes in health and medical practice, public health outcomes, and other broader societal impacts. The goal of disseminating this protocol is to systematize a rigorous approach, which can enhance reproducibility, promote the development of a large collection of comparable studies, and enable cross-case analyses. This approach, an application of the “science of translational science,” will lead to a better understanding of key research process markers, timelines, and potential points of leverage for intervention that may help facilitate decisions, processes, and policies to speed the sustainable translational process. Case studies are effective communication vehicles to demonstrate both accountability and the impacts of the public’s investment in research.
Children adopted internationally experience adverse conditions prior to adoption, placing them at risk for problematic social–emotional development. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help internationally adoptive parents behave in ways that promote young children's social–emotional competence. Participants included 131 parent–child dyads randomly assigned to receive either ABC (n = 65) or a control intervention (n = 66). In addition, 48 low-risk biologically related parent–child dyads were included as a comparison group. At follow-up assessments conducted when children were 24 to 36 months old, internationally adopted children who received the ABC intervention had higher levels of parent-reported social–emotional competence than children who received a control intervention. In addition, observational assessments conducted when children were 48 and 60 months of age showed that internationally adopted children who received ABC demonstrated higher social–emotional competence than children who received a control intervention. Adopted children who received the control intervention, but not the ABC intervention, displayed more difficulties with social–emotional competence than low-risk children. Finally, postintervention parent sensitivity mediated the effect of ABC on observed child social–emotional competence in parent interactions, controlling for preintervention parent sensitivity. These results demonstrate the efficacy of a parenting-focused intervention in enhancing social–emotional competence among children adopted internationally.
Dysregulation in children's physiological stress systems is a key process linking early adversity to poor health and psychopathology. Thus, interventions that improve children's stress physiology may help prevent deleterious health outcomes. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal caregiving support by enhancing maltreating mothers’ capacity to reminisce with their young children. This study evaluated associations between maltreatment, intimate partner violence, and the RET intervention with changes in children's diurnal cortisol regulation across the 1 year following the intervention, and the extent to which improvements in maternal elaborative reminiscing differed between intervention groups and mediated change in children's physiological functioning. Participants were 237 children (aged 36 to 86 months) and their mothers. Results indicated that the RET intervention was associated with significant positive change in elaborative reminiscing, which was sustained over time. Mothers’ elaboration immediately after the intervention served as a mediator of RET's effects on improvements in children's diurnal cortisol regulation (steeper diurnal slopes) from baseline to 1 year following intervention. This suggests RET is effective in facilitating physiological regulation among maltreated children.
Attachment and Biobehavioral Catch-up (ABC) demonstrates efficacy in improving parent and child outcomes, with preliminary evidence for effectiveness in community settings. The objective of this study was to assess the effectiveness of a community-based ABC implementation in improving parent outcomes as well as to examine potential mediators and moderators of intervention effectiveness. Two hundred parents and their 5- to 21-month-old infants recruited from an urban community were randomly assigned to receive ABC or be placed on a waitlist. The majority of participants had a minority racial or ethnic background. Before intervention, parents completed questionnaires about sociodemographic risk and adverse childhood experiences. At both baseline and follow-up, parents reported depression symptoms and were video-recorded interacting with their infant, which was coded for sensitivity. The ABC intervention predicted significant increases in parental sensitivity and, among parents who completed the intervention, significant decreases in depression symptoms. Changes in parental depression symptoms did not significantly mediate the intervention effects on sensitivity. Risk variables did not moderate the intervention effects. The results indicate that ABC shows promise for improving parent outcomes in community settings, supporting dissemination.
To evaluate the effect of school-based nutrition interventions (SBNI) involving schoolchildren and adolescents in sub-Saharan Africa (SSA) on child nutrition status and nutrition-related knowledge, attitudes and behaviour.
A systematic review on published school nutrition intervention studies of randomised controlled trials, controlled clinical trials, controlled before-and-after studies or quasi-experimental designs with control. Nine electronic bibliographic databases were searched. To be included, interventions had to involve changes to the school’s physical and social environments, to the school’s nutrition policies, to teaching curriculum to incorporate nutrition education and/or to partnership with parents/community.
Schools in SSA.
School-aged children and adolescents, aged 5–19 years.
Fourteen studies met our inclusion criteria. While there are few existing studies of SBNI in SSA, the evidence shows that food supplementation/fortification is very effective in reducing micronutrient deficiencies and can improve nutrition status. Secondly, school nutrition education can improve nutrition knowledge, but this may not necessarily translate into healthy nutrition behaviour, indicating that nutrition knowledge may have little impact without a facilitating environment. Results regarding anthropometry were inconclusive; however, there is evidence for the effectiveness of SBNI in improving cognitive abilities.
There is enough evidence to warrant further trials of SBNI in SSA. Future research should consider investigating the impact of SBNI on anthropometry and nutrition behaviour, focusing on the role of programme intensity and/or duration. To address the high incidence of micronutrient deficiencies in low- and middle-income countries, food supplementation strategies currently available to schoolchildren should be expanded.
Children of adolescent mothers are a high-risk group for negative child development. Previous findings suggest that early interventions may enhance child development by improving mother–child interaction. The purpose of the current study was to evaluate a mother–child intervention (STEEP-b) program in high-risk adolescent mother–infant dyads (N = 56) within a randomized controlled trial (RCT). Mother–child interaction was assessed at baseline (T1), postintervention (T2), and follow-up (T3). The primary outcome was the change in maternal sensitivity and child responsiveness from T1 to T2 that was measured by blinded ratings of videotaped mother–child-interaction with the Emotional Availability Scales. A modified intention-to-treat analysis was performed to examine the data. No intervention effect was found for maternal sensitivity, 95% CI [-0.59–0.60], p = .99, and child responsiveness, 95% CI [-0.51–0.62], p = .84. Maternal sensitivity and child responsiveness did not change over time in both groups (all ps > .05). A statistically nonsignificant, but potentially clinically meaningful difference emerged between rates of serious adverse events, SC: 4 (14.8%), STEEP-b: 1 (3.4%), possibly driven by different intensity of surveillance of dyads in the treatment groups. The current findings question the effectiveness of STEEP-b for high-risk adolescent mothers and do not justify the broad implementation of this approach.
Pharmacological intervention is an important component of patient care. However, drugs are often inappropriately used. It is necessary for countries to implement strategies to improve the rational use of drugs, including independent information for healthcare professionals and the public, which must be supported by well-trained staff. The primary objectives of the EDU.RE.DRUG (Effectiveness of informative and/or educational interventions aimed at improving the appropriate use of drugs designed for general practitioners and their patients) study are the retrospective evaluation of rates of appropriate prescribing indicators (APIs) and the assessment of the effectiveness of informative and/or educational interventions addressed to general practitioners (GPs) and their patients, aimed at improving prescribing quality and promoting proper drug use.
Methods and analysis:
This is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to GPs and their patients in two Italian regions (Campania and Lombardy). The study data are retrieved from administrative databases (Demographic, Pharmacy-refill, and Hospitalization databases) containing healthcare information of all beneficiaries of the National Health Service in the Local Health Units (LHUs) involved. According to LHU, the GPs/patients will be assigned to one of the following four intervention arms: (1) intervention on GPs and patients; (2) intervention on GPs; (3) intervention on patients; and (4) no intervention (control). The intervention designed for GPs consists of reports regarding the status of their patients according to the APIs determined at baseline and in two on-line Continuous Medical Education (CME) courses. The intervention designed for patients consists in flyers and posters distributed in GPs ambulatories and community pharmacies, focusing on correct drug use.
A set of indicators (such as potential drug–drug interactions, unnecessary duplicate prescriptions, and inappropriate prescriptions in the elderly), adapted to the Italian setting, has been defined to determine inappropriate prescription at baseline and after the intervention phase. The primary outcome was a composite API.
Ethics and dissemination:
The study was approved by the Ethics Committee of the University of Milan on 7th June 2017 (code 15/17). The investigators will communicate trial results to stakeholders, collaborators, and participants via appropriate presentations and publications.
Registration details: NCT04030468. EudraCT number 2017-002622-21