The purpose of this thesis is to apply an evidence-based perspective to educational interventions and techniques, and more specifically, to examine areas in which techniques ostensibly derived from an understanding of the psychological literature are applied to children’s learning. Broadly, the thesis moves from a review of ‘alternative’ techniques in education, toward empirical studies in areas where techniques informed by psychological science may, or may not, inform educational practice, toward a final empirical study examining the outcomes of the educational process. In an introductory review (Chapter One), I assess the evidence base of five ‘alternative’—but still commonly-used—educational techniques, providing a sketch of the sometimes seductive claims made by their proponents, and the reasons teachers may decide to use them in their classrooms. Chapter Two describes a study of one such ‘alternative’ technique: coloured filters for alleviating reading difficulties. I followed-up a sample of eighteen children who had used these filters—plastic overlays or tinted spectacle lenses—while reading for one year, and showed that, similar to the analysis at initial diagnosis, the lenses did not appear to improve reading on either a rate-of-reading test or a reading comprehension measure. In Chapter Three, I describe an investigation of a second technique: brief relaxation and exercise periods designed to improve children’s attention and concentration in the classroom. In two experiments, one involving two hundred and twelve children and the second involving two hundred and seventy children, I found inconclusive results: small detrimental effects of exercise on attention, but small positive effects on memory. Chapter Four addresses a technique related to those in the previous chapter: wakeful resting. Shown to be effective for learning in amnesic patients and older individuals, and theoretically important for our understanding of memory consolidation and forgetting, this technique had not yet been applied to children learning in the classroom. Here, I provide evidence from two experiments—one large-scale, in which the technique was carried out by two hundred and eighty-four children in the classroom, and one small-scale, where the measures were administered to fourteen children in a controlled setting—that both show the technique does not appear to improve memory in young children. In Chapter Five, I describe a simultaneous study of two educational techniques, one popular but poorly-evidenced, and one unpopular but with a strong evidential basis: mind-mapping and retrieval practice, respectively. In two samples of one hundred and nine and two hundred and nine children, I showed that retrieval practice, with or without mind mapping, improved fact learning in primary school children. In Chapter Six, I focus on the effects of education, examined in a large, longitudinal, publicly available birth cohort dataset (n > 18,000). Using structural equation modeling, I show that reading and mathematics skills measured in childhood predict socio-economic status in mid-life, even after controlling for socio-economic status of origin, general intelligence, motivation, and educational duration. Finally, in Chapter Seven, I summarize the findings of the thesis, give recommendations for future research, and discuss potential contributions to education from three other fields of psychology: neuroscience, social psychology, and differential psychology.

The health implications of poor dietary habits among adolescents are increasingly evident with the high prevalence of obesity and diet-related ill health in this population. Of particular concern is the high amount of sugar present in the adolescent diet. Nutrition education is an efficacious strategy to change sugary drink consumption particularly when including experiential strategies but sugar consumption within a more comprehensive diet has not been addressed. Food models have been incorporated as a teaching aid that support experiential activities and there is some evidence that they can be effective. However, there is a lack of evidence on the use of these strategies with adolescents and specifically for reducing sugar consumption across the diet. This study aimed to assess the impact of a two 45-minute interactive nutrition session intervention using food models on adolescent's sugar literacy (knowledge and awareness of added sugar, confidence in label reading to assess sugar content in food, and intention to limit consumption of added sugar). An experimental design with randomization into intervention and control condition and pre and post measures was used to test the efficacy of the intervention. Two hundred and three students ages 14 to 19 from 6 schools on Vancouver Island, BC, Canada participated in the study. The intervention group received two 45-minute interactive nutrition sessions using food models to learn about added sugar content in foods and beverages, recommendations for added sugar in the diet and food group servings in a healthy diet. A questionnaire to evaluate sugar literacy, including student knowledge, self-efficacy and intention to consume less added sugar, was completed at baseline and after the intervention. Adolescents’ knowledge of added sugar in foods and beverages and of the number of servings of food groups in a healthy diet was limited at baseline but improved significantly in the intervention condition [F(1, 201)=104.84, p<.001] compared to the controls. Intention to consume less added sugar increased significantly after the intervention [F(1, 201)=4.93, p=.03] as did label reading confidence [F(1, 201)=14.94, p<.001]. It appears that a brief nutrition education intervention using food models as an experiential learning strategy was efficacious for changing student’s knowledge about sugar guidelines and sugar in food, label reading confidence and intention to change sugar consumption. Further studies are needed to analyze the impact of a sugar literacy intervention using food models on actual sugar consumption in adolescents. / Graduate / 2020-04-26

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O estudo caracterizou o perfil biodemográfico e clínico dos pacientes internados na clínica médica do Hospital Universitário da USP e os fármacos prescritos, avaliou as prescrições médicas em relação à ocorrência ou não de interações medicamentosas potenciais (IMP) e os fatores relacionados a elas para elaboração de instrumento educativo para auxiliar a atuação da equipe multidisciplinar na detecção de eventos adversos evitáveis potenciais de relevância clínica. Foram extraídos dos prontuários médicos os dados referentes à internação, identificação e estado clínico dos pacientes internados na clínica médica, entre março e agosto de 2006. Coletou-se ainda o diagnóstico principal no resumo de alta e o tempo de internação. Os fármacos prescritos foram coletados das prescrições médicas para análise da ocorrência de interações medicamentosas potenciais e classificação, empregando-se o banco de monografias Micromedex&#174; DrugReax&#174;. Empregou-se estatística descritiva e regressão logística multivariada na análise dos dados. Analisaram-se 5.666 prescrições médicas, a média de idade foi de 56,7±19,8 anos e o tempo médio de internação 10,7±9,4 dias. Os diagnósticos mais freqüentes foram broncopneumonia (138; 21,3%) e infarto agudo do miocárdio (57; 8,8%). Os grupos anatômicos mais freqüentemente prescritos, segundo o Anatomical Therapeutical Chemical, foram C (21,2%), A (17,5%), N (15,6%), B (15,0%) e J (13,6%). O número médio de fármacos por prescrição foi 5,7±2,9. Para a análise de IMP foram consideradas somente as prescrições com dois ou mais fármacos prescritos (5.336), das quais 3.097 (58,0%) apresentavam IMP. O número médio de fármacos entre essas prescrições foi 6,2±2,3. Observou-se associação significativa com as IMP identificadas no estudo: idade (p<0,001), tempo de internação (p<0,001), doenças cardiovasculares (p=0,0059) e número de fármacos (p<0,001). Tanto hipertensão arterial sistêmica quanto diabetes mellitus foram fatores de risco para ocorrência de IMP, com chances 4,93 e 2,79 vezes maiores de prescrição com IMP, respectivamente. Das 9.951 IMP observadas, 2.637 (26,5%) eram graves e bem documentadas. Observou-se associação entre o número de IMP graves e os pacientes com idade igual ou maior que 60 anos (p= 0,0007, chance 1,29 vezes maior). Diante do volume de informação sobre medicamentos e necessidade de consulta rápida para auxílio na tomada de decisões, os instrumentos educativos são de fundamental importância na garantia da qualidade e segurança da farmacoterapia. / The study characterized the demographic and clinical profile of patients admitted to the internal medicine unit of the USP University Hospital and the drugs prescribed, the prescriptions evaluated in relation to the occurrence of potential drug interactions (PDI) and factors related to them for developing educational tool to assist the performance of the multidisciplinary team in the detection of preventable adverse drug events of clinical relevance. Data were extracted from medical records regarding the identification and clinical status of patients from March to August 2006. It was still collected the main diagnosis in the discharge summary and the time of admission. The drugs prescribed were obtained from medical prescriptions for analysis of the occurrence of potential drug interactions and classification, using the database monographs Micromedex&#174; DrugReax&#174;. Descriptive statistics and logistic regression were used in data analysis. From 5.666 prescriptions evaluated, the average age was 56.7 ± 19.8 years and mean length of stay was 10.7 ± 9.4 days. The most common diagnoses were pneumonia (138, 21.3%) and heart infarct (57, 8.8%). The anatomical groups most frequently prescribed were C (21.2%), A (17.5%), N (15.6%), B (15.0%) and J (13.6%) according Anatomical Therapeutical Chemical. The average number of drugs per prescription was 5.7 ± 2.9. For the analysis of PDI were considered only the prescriptions with two or more drugs (5.336), and 3.097 (58.0%) presented PDI. The average number of drugs per prescription was 6.2 ± 2.3. There was a significant association the PDI identified in the study with: age (p <0.001), length of stay (p <0.001), cardiovascular diseases (p = 0.0059) and number of drugs prescribed (p <0.001). Both hypertension and diabetes mellitus were risk factors for the occurrence of PDI, with odds ratios 4.93 and 2.79, respectively. The frequency of major and well-documented drug interactions was 26.5%. From 9.951 PDI observed in 2.637 (26.5%) were considered major and well documented. There was association between the number of major PDI and elderly patients (p=0.0007, with odds ratio 1.29). Taking in consideration the excessive data available about drugs and the necessity of concise information to help clinical decisions, educational tools are essential to assure the quality and safety of pharmacotherapy.

O estudo caracterizou o perfil biodemográfico e clínico dos pacientes internados na clínica médica do Hospital Universitário da USP e os fármacos prescritos, avaliou as prescrições médicas em relação à ocorrência ou não de interações medicamentosas potenciais (IMP) e os fatores relacionados a elas para elaboração de instrumento educativo para auxiliar a atuação da equipe multidisciplinar na detecção de eventos adversos evitáveis potenciais de relevância clínica. Foram extraídos dos prontuários médicos os dados referentes à internação, identificação e estado clínico dos pacientes internados na clínica médica, entre março e agosto de 2006. Coletou-se ainda o diagnóstico principal no resumo de alta e o tempo de internação. Os fármacos prescritos foram coletados das prescrições médicas para análise da ocorrência de interações medicamentosas potenciais e classificação, empregando-se o banco de monografias Micromedex&#174; DrugReax&#174;. Empregou-se estatística descritiva e regressão logística multivariada na análise dos dados. Analisaram-se 5.666 prescrições médicas, a média de idade foi de 56,7±19,8 anos e o tempo médio de internação 10,7±9,4 dias. Os diagnósticos mais freqüentes foram broncopneumonia (138; 21,3%) e infarto agudo do miocárdio (57; 8,8%). Os grupos anatômicos mais freqüentemente prescritos, segundo o Anatomical Therapeutical Chemical, foram C (21,2%), A (17,5%), N (15,6%), B (15,0%) e J (13,6%). O número médio de fármacos por prescrição foi 5,7±2,9. Para a análise de IMP foram consideradas somente as prescrições com dois ou mais fármacos prescritos (5.336), das quais 3.097 (58,0%) apresentavam IMP. O número médio de fármacos entre essas prescrições foi 6,2±2,3. Observou-se associação significativa com as IMP identificadas no estudo: idade (p<0,001), tempo de internação (p<0,001), doenças cardiovasculares (p=0,0059) e número de fármacos (p<0,001). Tanto hipertensão arterial sistêmica quanto diabetes mellitus foram fatores de risco para ocorrência de IMP, com chances 4,93 e 2,79 vezes maiores de prescrição com IMP, respectivamente. Das 9.951 IMP observadas, 2.637 (26,5%) eram graves e bem documentadas. Observou-se associação entre o número de IMP graves e os pacientes com idade igual ou maior que 60 anos (p= 0,0007, chance 1,29 vezes maior). Diante do volume de informação sobre medicamentos e necessidade de consulta rápida para auxílio na tomada de decisões, os instrumentos educativos são de fundamental importância na garantia da qualidade e segurança da farmacoterapia. / The study characterized the demographic and clinical profile of patients admitted to the internal medicine unit of the USP University Hospital and the drugs prescribed, the prescriptions evaluated in relation to the occurrence of potential drug interactions (PDI) and factors related to them for developing educational tool to assist the performance of the multidisciplinary team in the detection of preventable adverse drug events of clinical relevance. Data were extracted from medical records regarding the identification and clinical status of patients from March to August 2006. It was still collected the main diagnosis in the discharge summary and the time of admission. The drugs prescribed were obtained from medical prescriptions for analysis of the occurrence of potential drug interactions and classification, using the database monographs Micromedex&#174; DrugReax&#174;. Descriptive statistics and logistic regression were used in data analysis. From 5.666 prescriptions evaluated, the average age was 56.7 ± 19.8 years and mean length of stay was 10.7 ± 9.4 days. The most common diagnoses were pneumonia (138, 21.3%) and heart infarct (57, 8.8%). The anatomical groups most frequently prescribed were C (21.2%), A (17.5%), N (15.6%), B (15.0%) and J (13.6%) according Anatomical Therapeutical Chemical. The average number of drugs per prescription was 5.7 ± 2.9. For the analysis of PDI were considered only the prescriptions with two or more drugs (5.336), and 3.097 (58.0%) presented PDI. The average number of drugs per prescription was 6.2 ± 2.3. There was a significant association the PDI identified in the study with: age (p <0.001), length of stay (p <0.001), cardiovascular diseases (p = 0.0059) and number of drugs prescribed (p <0.001). Both hypertension and diabetes mellitus were risk factors for the occurrence of PDI, with odds ratios 4.93 and 2.79, respectively. The frequency of major and well-documented drug interactions was 26.5%. From 9.951 PDI observed in 2.637 (26.5%) were considered major and well documented. There was association between the number of major PDI and elderly patients (p=0.0007, with odds ratio 1.29). Taking in consideration the excessive data available about drugs and the necessity of concise information to help clinical decisions, educational tools are essential to assure the quality and safety of pharmacotherapy.

Educational Intervention to Impact Parental Decisions to Consent to Human Papillomavirus Vaccine by Tawa B. Ibikunle-Salami MSN, Indiana Wesleyan University, 2010 BSN, Indiana Wesleyan University, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University September 2015 Human Papillomavirus (HPV) is a global health issue that is transmitted sexually and affects both genders. Evidence shows that approximately 79 million people are affected in the United States with 14 million newly affected yearly. The Centers for Disease Control and Prevention indicates that teens and young adults under age 25 are at particular risk, so it is important to begin the vaccination series between 9 and 17 years of age. Parental voluntary acceptance of HPV vaccine for their minor children was noted as a problem in a clinic in Northwest Indiana, and 8% clinic HPV series completion rate is significantly lower than the targeted federal goal of 80% by 2020. A literature review indicated that an educational intervention provided by healthcare professionals could serve as one of the strongest predictors of HPV vaccine acceptance. The purpose of this project was to develop an evidence-based parental educational process to support providers' influence on parents of children ages 9 to 17 to provide consent for the HPV vaccine. The project goals focused on parental knowledge, beliefs, and attitudes. The clinic providers will utilize assessment tools validated by experts and evidence-based educational materials to promote HPV and HPV vaccine awareness. The theoretical foundations of the project were the theory of reasoned action and Pathman's pipeline that target the parents directly through individual educational sessions to achieve knowledge gain and behavioral change. Implementation of educational materials by clinic providers may improve parental knowledge of HPV and the HPV vaccine acceptance. Social change may result from the integration of the project into clinical practice to increase the HPV vaccine acceptance rates, which will ultimately reduce the effects of HPV and its sequelae leading to long-term wellness promotion.

Type 2 diabetes is a common chronic disease, which has a negative health impact and results in enormous economic burden. The prevalence of type 2 diabetes is increasing dramatically and it affects older people disproportionately. The healthcare system in China is faced with an overwhelming burden due to a large ageing population, high prevalence of diabetes and limited healthcare resources. Self-management has been widely accepted as the cornerstone of the clinical management of type 2 diabetes. Since self-management usually involves complex behaviour change and can be emotionally challenging, effective education is essential to facilitate this transition. However, there has been no existing program of type 2 diabetes self-management for older patients in China until now. Furthermore, the generalisation of any health education programs is often hampered due to limited healthcare resources in China. The primary purpose of this study was to develop a socially and culturally suitable self-management program, which addressed self-efficacy and social support to facilitate behaviour change and subsequent health improvement, for older people with type 2 diabetes living in the community in China. The secondary purpose was to test a feasible delivery model of the program through involvement of peer leaders and existing community networks. This study was conducted in three phases. Phase one gathered information about barriers related to self-management behaviours and help needed to address them, from the perspective of older people with type 2 diabetes and community health professionals, through focus group discussion. Data from Phase One, together with guidelines of the selected theoretical frame work, results from an extensive literature review, and experiences of previous relevant studies provided the basis for development of a peer-led type 2 diabetes self-management program (Phase Two). Phase Three involved a pre-test, post-test non-equivalent control group design to test the effectiveness of the self-management program on older people with type 2 diabetes in the community. The impact of the program on peer leaders was examined using a one group pre-test, post-test design. In addition, evaluation of the program from peer leaders’ and older people’s perceptions was conducted through a post-test questionnaire. Older people with type 2 diabetes and health professionals expressed broadly the same concerns, which were: social support; confidence to practice self-management behaviours; self-management behaviours; barriers to self-management behaviours; and advice for ongoing health education. However, their points of view were not always identical and different emphases were identified. The peer-led program produced significant improvement in social support, self-efficacy, self-management behaviours and depressive status in the experimental group, as compared to the non-equivalent control group. However, there was no significant effect on quality of life nor health care utilisation. Therefore, the effectiveness of the program among older people with type 2 diabetes was partially confirmed. In addition, the participants were supportive, giving positive feedback about the program. Suggestions for future improvement were provided as well. After receiving specific peer leader training and assisting in most of the delivery process of the program, the peer leaders improved, significantly, in overall self-management behaviours and in specific areas of social support and self-efficacy, though they did not improve in depressive status, quality of life and health care utlisation. In addition, these peer leaders enjoyed being peer leaders, and gave very positive feedback about the whole program. In conclusion, this study has implications for understanding and facilitating self-management behaviours for older people with type 2 diabetes in China. The peer-led self-management program was effective in improving levels of self-efficacy, social support, self-management behaviours and depressive status among older people with type 2 diabetes living in the community in China. The delivery process involving peer leaders was deemed feasible to implement within the health care system in China. The program is suitable to be used by community health professionals in their practice in China. The study also has potential wider benefit to nursing practice and global health practice.

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The aim of this study was to develop, implement and evaluate the effectiveness of a behavior based, theory driven multi-component nutrition education Intervention promoting healthy eating among two (17 to 19 year old) Lebanese adolescent samples from contrasting socioeconomic statuses. The effects of the intervention were examined in a quasi-experimental control design trial among two hundred and nine adolescent males and females from Beirut, Lebanon: one hundred and ten belonged to a high socioeconomic status (HSES) population and ninety nine belonged to a low socioeconomic status (LSES) population of adolescents. There were four study groups: two intervention and two control. The intervention groups received twelve nutrition lessons, one hour each, involving class based teaching, print materials and activities delivered by a dietitian. Intervention Mapping protocol was applied and constructs from the Social Cognitive Theory were used for the development of the intervention. At baseline and after the intervention, food frequency questionnaires (FFQ) were administered and three 24-Hour Dietary Recalls were used to examine dietary practices and nutrient intakes while semistructured interviews were conducted to gain insight to underlying determinants of food choice. Quantitative data were analyzed using Mann Whitney U Test and Chi-Square analysis. Post intervention, adolescents in both the HSES and LSES intervention groups showed a significant improvement (p<0.05) in some dietary practices and nutrient intakes; however, the impact was higher in the HSES group. In both intervention groups, positive changes were observed in some personal determinants of food choice but none were noted for external factors. These results propose that the developed nutrition education intervention is a promising instrument to promote healthy eating among similar groups of Lebanese adolescents; however, further research is needed for interventions that specifically target LSES groups.