<p dir="ltr">Researchers have developed Evidence-Based Practices (EBPs) to enhance student math outcomes within the Multi-Tiered Systems of Support (MTSS) framework. However, these EBPs often fail in real school settings due to poor implementation practices. Concerns about whether educators implement EBPs with sufficient fidelity persist. Implementation Fidelity (IF) measures how closely program delivery aligns with its intended design. This study investigated the effects and implications of an IF intervention package designed to equip general education majors with the necessary skills to implement a mathematics word problem-solving (WPS) intervention—the Conceptual Model-Based Problem-Solving (COMPS) intervention—with appropriate fidelity. Additionally, the study explored the real-world experiences encountered by education major college students when implementing the intervention in schools and examined practical factors influencing the implementation of mathematics EBPs in rural educational settings. The findings provide insights into effective strategies for improving IF in educational interventions and highlight the challenges and successes of implementation in real-world contexts.</p>

Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently. / Master of Science / Low health literacy – meaning a limited capacity to access and understand basic health information that is needed to make suitable health decisions – has been linked to a plethora of poor health behaviors and outcomes, including increased obesity risk for the children of low health literate parents. When sharing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended in which health care professionals ask patients to repeat instructions or explain key concepts using their own words and then re-instruct patients as needed until they master these concepts. No studies thus far have examined the degree to which TB/TTG strategies can be implemented with fidelity – meaning adherence to protocol and competence in delivery – in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of learning objectives in a program to improve health-related behaviors; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into an evidenced-based 5 A's approach for behavioral change. Research partners delivered all calls in Wave 1 of the pilot trial, while community staff delivered a majority of calls during Waves 2 and 3 with ongoing training and support from research staff. Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this difference was not significant (it may have been due to chance). Both research and community partners followed guided call scripts with high fidelity. The health literacy level of participants at the start of the program was associated with TB/TTG performance during calls, but this effect was limited to only a few calls. In all of these instances, participants with the higher level of health literacy (adequate) were found to have better TB/TTG performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls, while agreeing that calls helped improve their eating and physical activity habits and helped them learn class material better. Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently.

Residential facilities for adults with developmental disabilities offer essential accommodations and support services, with fostering communication for residents as an important aspect of care. Despite the importance of communication, previous research has identified concerns about staff performance (SP) in facilitating positive social interactions, such as engaging in consequent-mediating behavior for residents' mands. Previous research has primarily focused on improving SP through skills-based training. Yet, Skinner's theory of verbal behavior emphasizes the social and reciprocal nature of mands. Skinner suggests that the listener's behavior, engaging in consequence-mediating behavior, must be conditioned by the verbal community. However, empirical investigations into the reinforcing practices of staff in residential facilities, such as the shaping and sustaining of different types of resident mands, is limited. The current investigation sought to address this gap in research by evaluating if distinct mand topographies, disguised or specific mands, influenced the likelihood of staff engaging in consequence-mediated behavior across three staff-resident dyads. Results suggest a low probability of staff responding to, or reinforcing, mands, thus limiting conclusions on the effects of mand topographies on staff performance. Future directions and considerations regarding resident-staff interactions are discussed.

This study evaluated the predictive and concurrent validity of the Tiered Fidelity Inventory (TFI). Structural equation modeling was applied to test the associations between the TFI and student outcomes. First, a total of 1,691 schools with TFI Tier 1 in 2016-17 and school-wide discipline outcomes in 2015-16 and 2016-17 were targeted, finding a negative association between TFI Tier 1 and differences between African American and non-African American students in major office discipline referrals (ODR) per 100 students per day in elementary schools. A sensitivity test with schools with TFI Tier 1, 2, and 3 was conducted, showing a negative association between TFI Tier 1 and the square root of major ODR rates in elementary schools. Second, TFI Tier 1 was positively related to the proportions of students meeting or exceeding state-wide standards in reading from 1,361 schools with TFI Tier 1 and academic outcomes in 2014-15 and 2015-16. Also, the association between TFI Tier 1 and academic outcomes was found to be stronger when schools implemented SWPBIS for 6 or more years. A sensitivity test with schools with TFI Tier 1, 2, and 3 indicated positive associations between TFI Tier 1 and the proportions of students meeting or exceeding state-wide standards in both subjects. Third, TFI Tier2 was positively associated with the logit of proportions of students with CICO daily points from 570 schools with TFI Tier 2 in 2016-17 and CICO outcomes in 2015-16 and 2016-17. Fourth, correlations between the Evaluation subscale of TFI Tier 1 or 2 and relevant measures in 2016-17 were tested from 2,379 schools. TFI Tier 1 Evaluation was positively correlated with counts of TFI administrations, number of fidelity measures, and counts of viewing SWIS Reports. These correlations were significant except for ODRs by staff. Also, TFI Tier 2 Evaluation was significantly positively correlated with years of SWPBIS implementation, years of CICO-SWIS implementation, and counts of viewing CICO Reports except student period, and negatively with counts of viewing student single period. These findings were discussed by comparing them with previous research findings, suggesting implications for future research and practice, and addressing research limitations.

Empathetic communication enhances the nurse-patient relationship and improves patient outcomes and needs to be taught and evaluated during simulated clinical experiences. Experience in healthcare education has shown students' empathy levels decrease over time. The purpose of this quasi-experimental pretest posttest, study was to compare nursing students' empathy levels, self-confidence, and satisfaction with simulation between the use of the high-fidelity manikin simulator (HFMS) and a standardized patient (SP) used during their simulated clinical experience. Kolb's experiential learning theory was used to guide the study through the four phases specific to simulation and learning. Convenience sampling was used to recruit 135 nursing students in the pre-simulation survey; 123 participants completed the post-simulation survey with 64 in the control group (HFMS) and 59 in the experimental group (SP). Data were analyzed using an independent t-test to determine if there were any mean differences between the HFMS and SP groups in terms of empathy, satisfaction, and self-confidence. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student and the NLN's Satisfaction and Self-Confidence Scales. Results revealed there were no significant difference in students' empathy levels, self-confidence, and satisfaction. Positive social change through prioritizing nursing students' empathetic communication in patient care may be enhanced in the simulated clinical environment with various approaches. Recommendations for future research are to determine what interventions best develop nursing students' empathy, satisfaction, and self-confidence in patient care .

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BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.

Over the history of interaction design, concepts and methods of prototyping have been significantly developed to address new challenges faced by the field and the ever-going advancement of new technologies. Some of the important developments are related to the notions of mixed-fidelity prototyping, experience prototyping, and prototypes as filters. Building upon these developments, this study explores a multiple-fidelity prototyping approach, that is, using progressively higher fidelity prototypes in iteration. The study focused particularly on the design of user engagement. It documented, and contributed to, an actual design process of Xplore, an augmented reality game-based learning application. Three participatory design-style workshops employing low-, mixed-, and high-fidelity prototypes were conducted respectively. Thematic analyses of participants’ interactions revealed sets of themes in the workshops, which reflected the changing focus and scope of the design space. The implications of the results obtained in the study highlighted the role of prototypes of each fidelity level in engaging users in a design process, as well as the potential benefits of combining multiple fidelity prototypes when designing for user engagement.

This study developed a summative scale that could be administered in a short time period to determine the Quality of Use (QOU) of an intervention used by teachers. The scale can be completed in less than an hour using easily attainable information. The QOU scale was applied to an elementary reading program to determine if the program results were dependent upon the quality of the fidelity of teacher use. The study focused on use of the Linguistic Pattern Series (LPS) portion of the Integrated Skills Method (ISM) Reading Program by 20 special education teachers in 13 elementary schools in San Antonio, Texas. Progress is measured by the use of the Decoding Skills Test (DST) (ISM Teaching Systems, Inc., 2004-b). To determine each teacher's QOU, a summative scale was developed composed of five items (Initial Placement, Frequency of Direct Instruction, Materials – LPS, Materials – Literature/Test Prep, and Scheduling) that possessed low-moderate cohesiveness of Alpha=.71. Results of the study showed a correlation between QOU summary scores and residualized DST Raw Score Grade Equivalent (RSGE) gains. The QOU could predict .771^2 = 50 percent of score variance. This is a strong prediction for a non-student external measure in education.

Tystnad kan användas som ett kognitivt verktyg för att påverka en filmupplevelse och för att förhöja vissa audiovisuella aspekter. Denna studie undersöker hur tystnad som berättargrepp inom genren sci-fi kan användas genom två koncept för ljudinspelning: fidelity, som är en trogen ljudinspelning av vad som visas i bild, och intelligibility, som adderar ljud för narrativ information. Koncepten lät oss som ljuddesigners analysera och kontrollera tystnadsögonblicken i varje scenario. Point of audition användes som ett adderat designverktyg för att fokusera tystnadsögonblicken i narrativet. Genom diskussion i fokusgrupper kunde vi utvärdera hur tystnaden upplevdes i varje separat klipp. Studien visade att tystnad som berättargrepp föredrogs vid en kombination av de två koncepten. / Silence can be used as a cognitive tool to influence a film experience and to elevate certain audiovisual aspects. This study examines how silence as a narrative technique in the sci-fi genre can be used through two concepts for sound recording: fidelity, which is a faithful sound recording of what is shown on screen, and intelligibility, which adds sound for narrative information. The concepts allowed us as sound designers to analyze and control the moments of silence in each scenario. Point of audition was used as an added design tool to focus the moments of silence in the narrative. Through discussions in focus groups, we were able to evaluate how the silence was experienced in each separate clip. The study showed that silence as a narrative approach was preferred in a combination of the two concepts.