Browsing by Subject "interventions"
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Item Open Access Assessing Cardiovascular Disease Burden in Rural Uganda and Informing Future Interventions(2018-01-07) Benson, KathrynThis senior thesis seeks to investigate cardiovascular disease (CVD) risk in a rural region in Uganda and to use insights from field experience and the literature to explore possible interventions. The thesis research involved a total of 232 participants, including village residents (142), market workers (50), religious leaders (20), and village health workers (VHTs) (20). The village sample data are part of a larger longitudinal study, conducted under the Community Health Collaboration project of the Student Research Training Program (SRT) at Duke University. Recruitment for the other three cohorts of market workers, religious leaders, and VHTs began with this current study, conducted in the summer of 2016. The current study continued the biometric assessments of CVD risk within the village cohort and extended the testing to market workers. A total of 192 individuals participated in these three biometric assessments of their body mass index (BMI), systolic and diastolic blood pressure, and fasting blood glucose. In addition, the research team conducted surveys using an interview format with all four cohorts. The survey assessed demographic information, lifestyle factors, CVD perceptions, and CVD knowledge, and religious influences on CVD. Overall, the biometric findings show substantial CVD risk in the village sample and the persistence of risk for individuals over time, as evidenced by the results from longitudinal, linear mixed-effect models. Beyond this high, persistent CVD risk for villagers, the market workers had even higher CVD risk as evidenced by elevated BMI and fasting blood glucose. The elevated CVD risk for market workers is possibly due to differences in lifestyle factors including diet and exercise that are associated with urbanization. The survey results show near unanimous agreement among participants that CVD is a problem in their community. Despite the overall concern, the findings expose inaccuracies in knowledge about CVD across all cohorts. Regarding the role of religion, more than 90% of participants across all cohorts believe that religion can alleviate CVD symptoms. Further questioning about religion and CVD reflected a broad array of direct and indirect interpretations of the role of religion. Exploratory regression analyses, which link survey data to CVD risk indicators, yielded results that have implications for tailoring CVD interventions to rural Uganda. To further connect the findings to intervention strategies, the discussion summarizes the method and results of a literature review on possible CVD interventions. The literature review advances three principal categories of intervention: education, policy, and programming. For each of these categories, the study findings together with the literature review provide the basis for recommending three integrative strategy for CVD intervention: VHT CVD education programs, policy reform to address CVD medication stock-outs, and religiously-based CVD programs. The strategies have promise for reducing CVD risk and improving the lives of individuals in rural Uganda.Item Open Access Flipping the Narrative: Highlighting the Positive Aspects of Healthy Aging(2023) Taylor, MorganPsychological research on aging typically characterizes it as a period of decline. Numerous studies have reported age-related deficits in episodic memory, sensory perception, and fluid intelligence. These reports only add to society’s negative views of aging, which inevitably have a detrimental impact on older adults’ cognition, health, and general well-being. However, there are several other domains of cognition that remain stable or improve during healthy aging. For example, emotional functioning increases with age: older adults can better regulate their emotions and resist their desires compared to younger adults. Older adults are also more skilled at solving interpersonal problems and display intact implicit and procedural memory. This dissertation highlights two other areas that show improvement with age (i.e., decision making and knowledge) and considers how we can use these positive aspects to offset the negative aspects of aging. Chapter 2 investigates heuristic decision making. While some work suggests that older adults are more reliant on these shortcuts, there is little evidence to support this claim. To clarify this issue, participants from across the adult lifespan solved decision scenarios that tapped each of the following classic heuristics: anchoring, availability, recognition, representativeness, and sunk cost fallacy. Chapter 3 further explores knowledge. While the literature confirms that knowledge increases across the lifespan, it is unclear 1) if people are generally aware of this increase and 2) whether they hold expectations about the scope of younger vs. older adults' knowledge. To address these questions, younger and older participants predicted the knowledge of hypothetical younger and older adults. Chapter 4 focuses on application. While many studies have demonstrated that negative aging stereotypes negatively impact older adults’ memory performance, research on positive aging stereotypes’ influence is still inconclusive. In order to address this gap, older participants demonstrated their memory performance before and after viewing a neutral intervention or positive stereotype intervention about their knowledge advantage. Altogether, I find that older adults continue to use cognitively efficient decision strategies; they are not more reliant on classic heuristics and use them to the same degree as younger adults. Furthermore, I demonstrate that adults of all ages recognize that older individuals have a knowledge advantage over younger individuals, regardless of the difficulty of the information. Critically, if older adults are reminded of this advantage, they remember more words during a memory test. Taken together, this body of work sheds light on the cognitive improvements that accompany healthy aging and considers ways to leverage these positive aspects, with the goal of offsetting age-related deficits and promoting positive self-perceptions of aging.
Item Open Access Improving the Doctor-Patient Relation in China Through a Three-Level Framework(2017-05-11) Bai, YifangThis thesis discusses the controversial doctor-patient relation problem in contemporary China. The key issue it aims to address is how to improve the doctor-patient relation with efforts from multiple levels. This thesis reviews literature on China’s healthcare service as a way to identify the causes of the doctor-patient tension. It then recommends possible interventions drawing on international experiences. The recommendations follow a three-level—macro-, meso- and micro-level—framework. What this thesis found is that the tension between doctors and patients is not only the fault of the frontline health workers. As a result, interventions for its improvement cannot target exclusively doctor’s behavior. Meanwhile, since the doctor-patient relations problem is not unique to China, we should also learn from the successful lessons in the global society. It is not our goal to resolve the problem in China’s healthcare system. With the discussion in this thesis, we hope to show that there is the potential to alleviate doctor-patient tension in China with joint efforts in the society.Item Open Access Informing the Cultural Translation of a Weight loss Intervention for Overweight/Obese Adults in Beijing(2011) Sun, JianiObjectives: To inform the cultural translation of a US behavioral intervention (iOTA) for the Chinese population.
Methods: We conducted a systematic literature review, counseling Chinese collaborators' experiences, and conducted key informant interviews. 38 overweight/obese participants (BMI≥24) were recruited in Peking University Health Science Center and Peking University Third Hospital for the key informant interview. Only 20 (52.6%) participants (12 female, 8 male) who came to the face-to-face interview and complete the 20-minute survey were selected for data analysis. The interviews contained questions about weight loss history, weight related concerns and barriers during weight loss process, general lifestyles, and also inquiries of comments and acceptance for each iOTA goal and intervention approach.
Results: Physical activity and dieting are the primary options for weight loss. Health and lack of perseverance are the biggest weight loss concern and barrier. After tailoring by literature review, all of the tailored iOTA goal and intervention approaches had more than 80% acceptance except "Red meat no more than 1 time per week" with only 60% acceptance. 20% people found difficulty attending all of the 4 group sessions.
Conclusion: iOTA principle is largely accepted by Chinese population with proper cultural modification focusing on health concerns, perseverance, special eating habit, and social stress.
Keywords: Weight-loss, interventions, iOTA, cultural translation, key informant interview
Item Open Access Invited Commentary: Cassel's "The Contribution of the Social Environment to Host Resistance"-A Modern Classic.(Am J Epidemiol, 2017-06-01) James, Sherman AJohn Cassel's 1976 paper "The Contribution of the Social Environment to Host Resistance" (Am J Epidemiol. 1976;104(2):107-123) is widely regarded as a classic in epidemiology. He makes the compelling argument that the quality of a person's social relationships, that is, the degree to which her relationships are more stressful than supportive (or vice versa) influences her susceptibility to disease independent of genetic endowment, diet, physical activity, etc. Cassel's provocative thesis was anchored in a cogent synthesis of findings from animal experiments and observational studies on diverse human populations. Beginning in the late 1970s, the paper stimulated an explosion of epidemiologic research on social support and human health. Beyond advancing epidemiologic theory, Cassel showed how findings from various epidemiologic study designs could be marshalled to build a persuasive causal argument that impaired social bonds increase the risk of premature disease and death. The paper also foreshadowed core ideas of later theoretical constructs, such as weathering and allostatic load, regarding the power of chronic environmental stressors to accelerate biological aging across multiple organ systems. Cassel's assessment of the research and practice implications of his conclusions has remarkable contemporary resonance for the field of epidemiology.Item Open Access Pre-Learning Interventions Modulate Learning from Error(2023) Sinclair, Alyssa HannahLearning from error is an adaptive process that allows us to correct mistakes, update knowledge, and make better choices. Yet, humans do not always learn from error— motivation, emotion, prior beliefs, and individual differences can all influence learning and memory. In this dissertation, I synthesize diverse evidence from across domains to argue that lingering cognitive and neural states create a context of learning that governs how and what we learn. Here, I report three novel pre-learning interventions that effectively modulate learning from error in humans. First, I show that an imagination exercise enhances subsequent learning from feedback about health risks. Second, I demonstrate that changing beliefs about the value of errors enhances subsequent knowledge updating, especially for individuals with high anxiety. Third, I report that induced motivational states impact both reinforcement learning and subsequent memory. Taken together, these studies demonstrate that pre-learning interventions can have lingering benefits, enhancing subsequent learning from error. These findings offer inspiration for real-world interventions that could improve education, enhance belief updating, drive behavior change, motivate action, or foster curiosity.