Individuals experiencing a mental illness are often stigmatized. Children also stigmatize those who experience a mental illness. There is national interest in reducing the negative effects of stigma, especially in children. Unfortunately, children anti-stigma interventions are being used without being empirically tested for their effectiveness. A goal of the Opening Minds Anti-stigma initiative of the Mental Health Commission of Canada is to identify programs and resources that have been empirically tested and found to be effective in reducing stigma. This study was funded by the Opening Minds Initiative of the Mental Health Commission of Canada to: First, investigate the effectiveness of providing children ages 11-14 with mental illness education using a storybook in order to reduce their mental illness stigma; and, second, to examine children’s perceptions of the anti-stigma book used to provide the education. A quasi-experimental design was used to test the effectiveness of the mental illness educational storybook in reducing mental illness stigma. The Youth Opinion Survey for Stereotype and Social Distance measurement was used to obtain baseline information before the education was provided. A pre-test, post-test process was used. Several qualitative questions, embedded in the post-test questionnaire, were provided to the children participating with an opportunity to use their own words to describe what they thought about mental illness before and after the education, what they learned from the educational storybook and whether or not they liked the education they received. The results show that the exposure to an educational storybook about children mental illness stigma was effective in reducing the percentage of negative responses at post-test. The participants used less negative words to describe someone “with a mental illness”. An improvement in the overall scores at post-test was seen for both stereotype and social distance. After the study was completed, the feasibility of conducting a study of this type was evaluated. Recommendations for the possibility of using this method for future studies are included. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-07-03 11:39:54.603

This study examines the design, implementation and evaluation of a communication skills training programme for adherence counsellors in a paediatric HIV clinic. Effective communication is a pre-requisite skill for any counselling interaction. For both prevention and treatment, counselling is a critical component of the healthcare team response to the HIV epidemic. Given the shortages of healthcare workers in sub-Saharan Africa, task-shifting of the counselling role to less-trained cadres of workers is commonplace. In the multilingual, multicultural South African context, taskshifting coupled with the complexity of the message in paediatric HIV presents enormous challenges. In-service support for counsellors is lacking. Counsellor burn-out and fatigue is commonplace affecting the quality of counselling interactions. Measuring the quality of communication in a multilingual context poses ethical and methodological challenges and is a neglected area of research. Traditional communication and counselling assessments appear to be largely taxonomic; lack cultural and linguistic sensitivity; and fail to acknowledge communication as a dynamic, two-way process. Mindful of these issues, this study utilized a non-taxonomic approach. Verbal and non-verbal communication was analysed before and after the implementation of in-service training which was tailored to the specific research context. The training comprised a two day multidisciplinary team workshop followed by individual training. This consisted of video feedback and analysis of counsellors’ own sessions and was attended by four counsellors. Results were recorded over an eighteen month period. Twenty-two consultations between counsellors and caregivers were video-recorded, transcribed verbatim and analysed using a hybridized form of linguistic analysis. Findings that demonstrated consensus, substantiation and cross-consultation occurrence were triangulated with thematically analysed interview data, patient questionnaires and researcher reflections. These methods are more sensitive to process than checklist approaches and individualised, complex dynamics emerged. Communication barriers and facilitators were identified before training. Variations in communicative competence between counsellors appeared to be unrelated to prior training. After training, counsellors asked more open-ended questions, encouraged caregivers more, provided simpler explanations of treatment regimens and checked understanding more effectively. In response, caregivers initiated more questions. These findings suggest that communication training improves treatment literacy and results in interactions that are more patient-centered. Despite this evidence, the results suggest limitations to the impact of communication training given the lack of agency of women in South Africa. Interactions included frank and open discussion about cultural beliefs. However, this benefit may be lost due to poor healthcare team cohesion. In their roles as mothers and caregivers themselves, counsellors are effective patient advocates and bring their own lifeworld experience to the counselling interaction. These shared stories are testimonies to the resilience of women living in poverty. Whilst allowing for greater exploration of patients’ cultural beliefs and explanatory models, communication training has limited impact in assisting counsellors with dealing with issues such as disclosure, non-adherence and scepticism about biomedicine. Results indicate conflict between patient-centeredness and perceived desired medical outcomes. Caregivers and counsellors appeared to engage in ritualistic dialogue when discussing certain topics suggesting that a shared lifeworld between caregiver and counsellor is insufficient to overcome barriers from the meso (institutional) and macro (broader socio-political) context. An awareness of the impact of context is critical to our understanding of communication in a clinical setting. The results from this research have implications for the role of the counsellor within a multidisciplinary team and establish a need for communication specialists to work in a clinical setting within the HIV epidemic.

O objetivo deste trabalho é analisar os efeitos da intervenção farmacêutica para os pacientes idosos com diabetes mellitus tipo 2, em relação à compreensão do usuário sobre as instruções contidas na receita médica, o entendimento da doença existente e conhecimento sobre o uso de medicamentos, que inclui: a utilização correta, respeito aos horários de tomar a medicação e as posologias prescritas. Foram avaliados 129 pacientes idosos (com 60 anos ou mais) com diabetes no momento de retirar os medicamentos na unidade básica distrital de saúde (UBDS) do Distrito Oeste de Saúde de Ribeirão Preto. No momento em que o paciente retirou a medicação prescrita para o tratamento do diabetes na UBDS foi realizada uma entrevista para obter dados pessoais, informações sobre as medicações em uso e a doença, se necessita cuidador, identificar a escolaridade, avaliar as condições de armazenamento das medicações e aplicados os testes de medida de adesão ao tratamento (Morisky e Green ampliado) e de quantificação de conhecimento relativo ao tratamento medicamentoso (Med Take). Posteriormente, o paciente recebeu uma orientação farmacêutica em relação aos medicamentos prescritos para o diabetes, obedecendo um formulário padronizado que indicava os horários de tomadas das medicações, o medicamento, a quantidade e as interações com alimentos. Após quatro meses, o paciente foi novamente entrevistado, com outra aplicação dos testes de Morisky e Green ampliado e Med Take. O impacto da intervenção farmacêutica foi avaliado pela comparação do desempenho dos entrevistados nos dois momentos, bem como pela variação de alguns parâmetros clínicos, como peso, níveis pressóricos e hemoglobina glicada, através de teste não paramátrico de Mcnemar, Wilcoxon e o modelo de regressão linerar com efeitos mistos (efeitos aleatórios e fixos). O ajuste do modelo foi feito através do software SAS versão 9.0. Como resultado obtivemos uma melhora no segundo momento na aplicação do teste de Morisky e Green com valor p < 0,0001 . No Med Take obtivemos também melhora na pontuação, exceto na comparação do medicamento gliclazida nos parâmetros dose e interação com medicamento que não houve diferença com significância estatistica, provavelmente em decorrência do número reduzido de pacientes em uso dessa medicação, que foi de 10 (dez). Nos dados clínicos não houve diferença estatísticamente significante, que acreditamos ser pelo período reduzido (4 meses) de seguimento. Concluímos que a intervenção farmacêutica melhorou a adesão e o conhecimento do paciente sobre o uso do medicamento. / The objective of this work is to analyse the efffects of pharmaceutical intervention to elderly patients with diabetes mellitus type 2, about the understanding of the user on the instructions contained on the prescription, the understanding of the existant disease and the knowledge about use of drugs, wich includes: the proper utilization, respect for schedules, taking the prescribed medications and dosages. It was evaluated 129 elderly patients (60 years or older), with diabetes at the time of taking medicine in basic health unit (BHU) in the west health district of Ribeirao Preto. By the time the patient removed the prescribed medication for the treatment of diabetes in BHU was interviewed to obtain personal data, information about the medications in use and disease caregiver, the identification of the school level, evaluate the conditions of storage of medications and tests applied to measure adherence treatment (Morisky and Green expanded) and quantification of knowledge related to drug treatment (Med Take). Subsequently, the patient received an orientation in relation to the prescribed pharmaceutical drugs for diabetes, obeying a standardized form indicating the hours of taken medications, the drug, the quantity and the instructions with food. After four months the patient was again interwied with other application of Morisky and Green expanded test and Med Take. The impact of pharmaceutical intervention was evaluate by comparison of the performance of respondents in two periods, as well as variation of some clinical parameters such as weight, blood pressure and glycated hemoglobin, through the nonparametric Mcnemar, Wilcoscon and linear regression model with mixed efffects (fixed and random efffects). The model fitness was made through the SAS software version 9.0. As a result we obtained an improvement in the second stage in the application of Morisky and Green with p <0.0001. In the Med Take also got improvement in score, except in the comparison of the drug gliclazide dose parameters and interaction with drug no differences with statistical significance, probably due to the small number of patients using this medication, which was ten (10). Clinical data there was no statistically significant difference, which we believe is the shorter period (4 months) follow-up. We conclude that pharmaceutical intervention improved adherence and knowledge of the patient about the medication.

O objetivo deste trabalho é analisar os efeitos da intervenção farmacêutica para os pacientes idosos com diabetes mellitus tipo 2, em relação à compreensão do usuário sobre as instruções contidas na receita médica, o entendimento da doença existente e conhecimento sobre o uso de medicamentos, que inclui: a utilização correta, respeito aos horários de tomar a medicação e as posologias prescritas. Foram avaliados 129 pacientes idosos (com 60 anos ou mais) com diabetes no momento de retirar os medicamentos na unidade básica distrital de saúde (UBDS) do Distrito Oeste de Saúde de Ribeirão Preto. No momento em que o paciente retirou a medicação prescrita para o tratamento do diabetes na UBDS foi realizada uma entrevista para obter dados pessoais, informações sobre as medicações em uso e a doença, se necessita cuidador, identificar a escolaridade, avaliar as condições de armazenamento das medicações e aplicados os testes de medida de adesão ao tratamento (Morisky e Green ampliado) e de quantificação de conhecimento relativo ao tratamento medicamentoso (Med Take). Posteriormente, o paciente recebeu uma orientação farmacêutica em relação aos medicamentos prescritos para o diabetes, obedecendo um formulário padronizado que indicava os horários de tomadas das medicações, o medicamento, a quantidade e as interações com alimentos. Após quatro meses, o paciente foi novamente entrevistado, com outra aplicação dos testes de Morisky e Green ampliado e Med Take. O impacto da intervenção farmacêutica foi avaliado pela comparação do desempenho dos entrevistados nos dois momentos, bem como pela variação de alguns parâmetros clínicos, como peso, níveis pressóricos e hemoglobina glicada, através de teste não paramátrico de Mcnemar, Wilcoxon e o modelo de regressão linerar com efeitos mistos (efeitos aleatórios e fixos). O ajuste do modelo foi feito através do software SAS versão 9.0. Como resultado obtivemos uma melhora no segundo momento na aplicação do teste de Morisky e Green com valor p < 0,0001 . No Med Take obtivemos também melhora na pontuação, exceto na comparação do medicamento gliclazida nos parâmetros dose e interação com medicamento que não houve diferença com significância estatistica, provavelmente em decorrência do número reduzido de pacientes em uso dessa medicação, que foi de 10 (dez). Nos dados clínicos não houve diferença estatísticamente significante, que acreditamos ser pelo período reduzido (4 meses) de seguimento. Concluímos que a intervenção farmacêutica melhorou a adesão e o conhecimento do paciente sobre o uso do medicamento. / The objective of this work is to analyse the efffects of pharmaceutical intervention to elderly patients with diabetes mellitus type 2, about the understanding of the user on the instructions contained on the prescription, the understanding of the existant disease and the knowledge about use of drugs, wich includes: the proper utilization, respect for schedules, taking the prescribed medications and dosages. It was evaluated 129 elderly patients (60 years or older), with diabetes at the time of taking medicine in basic health unit (BHU) in the west health district of Ribeirao Preto. By the time the patient removed the prescribed medication for the treatment of diabetes in BHU was interviewed to obtain personal data, information about the medications in use and disease caregiver, the identification of the school level, evaluate the conditions of storage of medications and tests applied to measure adherence treatment (Morisky and Green expanded) and quantification of knowledge related to drug treatment (Med Take). Subsequently, the patient received an orientation in relation to the prescribed pharmaceutical drugs for diabetes, obeying a standardized form indicating the hours of taken medications, the drug, the quantity and the instructions with food. After four months the patient was again interwied with other application of Morisky and Green expanded test and Med Take. The impact of pharmaceutical intervention was evaluate by comparison of the performance of respondents in two periods, as well as variation of some clinical parameters such as weight, blood pressure and glycated hemoglobin, through the nonparametric Mcnemar, Wilcoscon and linear regression model with mixed efffects (fixed and random efffects). The model fitness was made through the SAS software version 9.0. As a result we obtained an improvement in the second stage in the application of Morisky and Green with p <0.0001. In the Med Take also got improvement in score, except in the comparison of the drug gliclazide dose parameters and interaction with drug no differences with statistical significance, probably due to the small number of patients using this medication, which was ten (10). Clinical data there was no statistically significant difference, which we believe is the shorter period (4 months) follow-up. We conclude that pharmaceutical intervention improved adherence and knowledge of the patient about the medication.

Das Psychosoziale Coaching folgt einem Interventionsansatz, welcher in einer speziellen Risikogruppe, > 50-jährige Langzeitarbeitslose, Menschen mit psychischen Erkrankungen identifizieren und den Weg in das bestehende psychiatrische/psychotherapeutische Versorgungssystem bahnen soll. Ziel der Studie war es vor diesem Hintergrund, die Notwendigkeit und Wirkung eines solchen niedrigschwelligen Interventionsangebotes abzubilden. Es konnte gezeigt werden, dass bei der Risikogruppe älterer Langzeitarbeitsloser ein Bedarf an einer niedrigschwelligen psychiatrischen Intervention besteht. Durch den untersuchten Ansatz konnten psychisch kranke Langzeitarbeitslose in eine Behandlung gelotst werden und eine Steigerung des subjektiven Wohlbefindens und der subjektiven Leistungsfähigkeit erreicht werden. Eine mit allgemeinen Zahlen vergleichbar hohe Integrationsquote der Teilnehmer am Psychosozialen Coaching liefert zudem Hinweise auf einen positiven ökonomischen Effekt.

Encouraging good nutrition is particularly important in the early years of life for the development of appropriate food habits and healthy adults in later life. These are governed by many contending and conflicting influences. Objective: This research examines the food choice influences for mothers of young children in Skelmersdale, West Lancashire (UK). Participants were recruited from a large community food intervention (clients) and were compared with those not involved in the initiative (non-clients). This enabled the reflection of the broader socio-cultural experiences of food and the influence of 'structure' and 'agency' on food choices. The research adopted a phenomenological approach using ethnographic recording techniques (interview and observation). The research findings are presented as ethnographic fictions. These short fictional stories provide a 'thick' description of the participant's lifeworld. They locate these choices in the person and the place. A hierarchy of food choice influences emerged from the data, with three main findings. Most prominently, the influence of individual capacity on the food choices made. Secondly, the influence of place, town planning and the geography of an area on food choices. Thirdly, the influence of gender, relationships and social networks. Central to the thesis of this research is the use of ethnographic fiction to enable a better understanding of the complexity involved in food choice and community development approaches to nutritional change. The use of ethnographic fiction conveyed a better understanding of people and of the role and impact of an intervention upon the wider processes involved in food choice. Ethnographic fiction was used here for the first time in public health nutrition to explain the complex picture of food choice for mothers of young children in Skelmersdale, and to convey new insight on food choice and the complexity of food choice influence.

The transition from primary to secondary school is regarded as one of the most difficult in children’s educational careers and the negative academic, social and emotional effects of an unsuccessful transition have been widely documented, with many practitioners identifying the transition to secondary school as a key intervention point (Galton, Morrison and Pell, 2000, Turnbull, 2006). Shy and socially withdrawn children are particularly vulnerable at this time. Pyramid Clubs, a short-term selective and preventative therapeutic group intervention offer a promising model of support, but a robust evidence-base is currently lacking (Munoz, Mrazek, and Haggerty, 1999; Shepherd and Roker, 2005). This study evaluated the use of a Pyramid Club to provide a ‘bridge’ of support before, during and following nine children’s transition to secondary school. The study was conducted from a critical realist stance and quantitative and qualitative methodology were adopted within an embedded single-case study design. The study had two aims; to evaluate the effectiveness of the club; and to explore the process, in order to understand the club’s mechanism of effect. Pre-and post-intervention teacher report data were collected in conjunction with club leader, club member and parents’ perspectives, obtained though focus groups and individual interviews. The researcher also observed each club meeting. Data were analysed using descriptive statistics and thematic analysis. The findings indicate the club offers an effective method of support. The children enjoyed the club experience and a range of social-emotional gains were reported. The findings were used to propose a theoretical framework based on the concept of resilience, to explain how Pyramid Clubs can be successfully used to support vulnerable children’s transition to secondary school. Core elements, which were considered to be essential components of the intervention, were identified to aid future implementation and evaluation of Transition Pyramid Clubs.

Introdução: Intervenções educacionais que preparam as equipes de saúde para a promoção e apoio a práticas alimentares saudáveis na infância podem ser efetivas na melhoria dos desfechos relacionados à saúde, nutrição e desenvolvimento infantil. Objetivo: Avaliar se a utilização de um material de educação permanente, elaborado para apoiar o tutor da Estratégia Amamenta e Alimenta Brasil (EAAB), é efetivo em melhorar indicadores de implementação da EAAB e indicadores de alimentação infantil em crianças menores de um ano. Métodos: Estudo de intervenção do tipo antes e depois realizado no município de Embu das Artes, SP. A intervenção consistiu em disponibilizar o Manual como material de apoio às atividades educativas sobre aleitamento materno e alimentação complementar que poderia ser usado por tutores da EAAB. Os tutores realizaram atividades de treinamento com as equipes de saúde durante oito meses. A coleta de dados ocorreu nos momentos pré e pós intervenção e em ambos foram aplicados: teste de conhecimentos sobre aleitamento materno (AM) e alimentação complementar (AC) aos tutores e profissionais de saúde; questionário auto aplicado junto aos gerentes para caracterização das UBS quanto às ações de promoção do AM e AC e entrevistas junto às mães sobre as práticas de alimentação da criança. Análise de dados: a tese gerou 3 manuscritos: No primeiro com o objetivo de avaliar as práticas de alimentação complementar das crianças de 6 a 12 meses utilizou-se análise de regressão de Poisson com modelagem hierarquizada para determinar os fatores associados ao consumo de alimentos ultra processados. O segundo e o terceiro manuscritos avaliaram os efeitos da intervenção. O segundo teve como foco a aplicação do Manual e sua influência na implementação da EAAB, utilizando duas abordagens: na quantitativa foram analisados dimensões e indicadores do processo de implementação com base no modelo lógico da intervenção e na qualitativa foi avaliada a percepção dos tutores acerca do processo de utilização do Manual. O terceiro manuscrito avaliou a efetividade do Manual na melhoria dos indicadores de alimentação infantil e para tanto utilizou-se análise de regressão de Poisson multinível com modelagem hierarquizada. Resultados: Manuscrito 1. A prevalência de consumo de alimentos ultra processados foi de 43,1% entre os menores de um ano. Baixa escolaridade materna e falta de atendimento na primeira semana de vida da criança foram fatores associados ao consumo de alimentos ultra processados. Manuscrito 2. O Manual foi utilizado por 9 dos 13 tutores do município e a intervenção em algum grau foi realizada em 11 de 13 UBS. Em média foram realizadas 3,5 [0-5] atividades complementares por UBS. A média de acertos dos tutores no teste de conhecimentos inicial foi 31,43 ± 5,25 e final 34,86 ± 4,45; p= 0,021. Entre os trabalhadores a média no pré-teste foi 26,09 ± 4,45 e no pós-teste 30,28 ± 3,55; p= 0,002. Em média o número de critérios de certificação alcançados pelas UBS foi maior depois da intervenção (pré 3 [1-6] versus pós 5 [3-6]) e apresentou consistência com a percepção de mudanças dos gerentes assim como com o número de atividades conduzidas pelos tutores. A avaliação da intervenção sob a ótica dos tutores revelou contribuições do uso do Manual para sua atuação. Manuscrito 3. A intervenção foi efetiva para a redução da falta de diversidade alimentar mínima e da falta de adequação alimentar, indicador que avalia a frequência, consistência e diversidade da AC. Porém, não se verificou efeito sobre a interrupção do AME. Conclusões: A investigação das práticas de alimentação infantil na população estudada evidenciou um alto consumo de alimentos ultra processados, reforçando a necessidade de intervenções que promovam práticas alimentares saudáveis na infância. O uso do Manual de Apoio ao Tutor melhorou o conhecimento dos tutores e trabalhadores da atenção básica e promoveu mudanças no processo de trabalho das equipes, refletidas no alcance dos critérios de certificação na EAAB, evidenciando o potencial de uma intervenção educativa usando metodologia crítico-reflexiva. Além disso, a intervenção mostrou-se efetiva para melhorar as práticas de alimentação complementar na população estudada. / Introduction - Educational interventions that prepare healthcare teams to promote infant feeding practices can be effective in improving outcomes related to health, nutrition and child development. Objective - To evaluate whether a continuing education tool (the Manual to Support Estratégia Amamenta e Alimenta Brasil (EAAB) Tutors) can improve EAAB implementation indicators and feeding practices in infants under one year of age. Methods - A before and after study was conducted at 13 primary healthcare units (PHU) in Embu das Artes, São Paulo. The intervention consisted in providing the Manual to support educational activities on breastfeeding and complementary feeding that could be used by tutors of EAAB. Tutors performed comprehensive training activities with healthcare teams over eight months. In both cross-sectional studies (pre and post intervention) a questionnaire was applied to the managers from the 13 PHU to characterize the healthcare service and actions to promote breastfeeding and complementary feeding; knowledge tests were also applied to tutors and health workers indicators of breastfeeding and complementary feeding practices were assessed by interviewing 1,159 mothers. Analysis: the thesis resulted in three manuscripts - The first one aimed to evaluate the complementary feeding practices of children from 6 to 12 months with a focus on the consumption of ultraprocessed foods (UPF) and multiple hierarchical models were performed. The second and third manuscripts evaluated the effects of the intervention. The second evaluated the application of the Manual and its influence on the implementation of EAAB, with two approaches: in the quantitative, the dimensions and indicators of the implementation process were analyzed based on the logical model of the intervention; in the qualitative approach the perception of the tutors about the process of manuals\' use was evaluated. The third manuscript evaluated the effectiveness of the Manual in improving indicators of infant feeding practices. Multivariate analysis was performed using Poisson multilevel regression Results: Manuscript 1: The prevalence of UPF consumption was 43.1% among children. Lower maternal education and lack of early assistance at the PHU were factors associated with higher UPF consumption. Manuscript 2: The Manual was used by 9 of 13 tutors and the intervention was performed in 11 of 13 PHU. In average, 3.5 [0-5] comprehensive training activities (CAs) were performed by PHU. The mean scores of tutors in the initial knowledge test were 31.43 ± 5.25 and final 34.86 ± 4.45; p = 0.021. Among health workers, the mean in the pre-test was 26.09 ± 4.45 and in the post-test 30.28 ± 3.55; p = 0.002. In average, the number of certification criteria fulfilled by the PHS was higher after intervention (before 3 [1-6]; after 5 [3-6]) and was consistent with the changes perceived by managers as well as with the number of CAs carried out by tutors. Tutors\' perception revealed contributions of the Manual for their action. Manuscript 3: The intervention was effective in reducing the lack of minimum food diversity and the lack of food adequacy, an indicator that evaluates the frequency, consistency and diversity of complementary feeding. However, there was no effect on interruption of exclusive breastfeeding. Conclusions: The investigation of infant feeding practices in the study population evidenced a high ultra-processed foods consumption, reinforcing the need of interventions to promote healthy eating practices in childhood. The use of the Manual to Support EAAB Tutors improved the knowledge of tutors and primary healthcare workers and promoted improvements in the work process of healthcare teams, reflected in the achievement of the EAAB certification criteria, evidencing the potential of an educational intervention using problem-based learning methodology. In addition, the intervention proved to be effective in improving complementary feeding practices in the study population.

In the U.S., work-related death is an all too familiar occurrence on farms. Tractor overturns continue to be the most frequent cause of these fatalities. Efforts to alter farming’s ranking as one of the most deadly occupations in the country must provide proven strategies for the elimination of these preventable deaths. In the past, efforts to decrease the rate of overturn fatalities and injuries have largely focused onincreasing the proportion of tractors with a rollover protective structure (ROPS). These devices, in combination with seatbelts, are 99% effective in protecting the tractor operator from death or injury. Unfortunately, only 59% of U.S. tractors are currently equipped with ROPS. Due to the relative lack of political willpower to legislate ROPS installation and the less than encouraging response to education and awareness programs to date, it appeared necessary to explore alternative intervention strategies. The over-arching purpose of this thesis project has been to assess the utility of social marketing as a framework for developing effective health and safety interventions in the farm community. However, our specific objectives included; a more thorough understanding of the perceived barriers and motivators that influence farmer’s safety decisions, the design and evaluation of social marketing incentives developed to encourage safe behaviors and the evaluation of a social marketing campaign designed to positively impact farmer’s intentions and readiness to retrofit unsafe tractors. The research was by and large conducted in New York State and supported by grants from the National Institutes of Occupational Safety and Health (NIOSH). Previous research conducted in the New York farm community had indicated that small crop and livestock farmers would be an ideal intervention target for a social marketing tractor overturn intervention as their farms accounted for close to 85% of New York farms which lack or have only one ROPS protected tractor. A qualitative assessment of perceived barriers and motivators regarding retrofitting behaviors was performed with representatives of the small crop and livestock community. Grounded theory analysis of these in-depth interviews revealed several key categories which include: 1) risk becomes “normal”, 2) risk becomes part of a “farming identity”, and 3) risk becomes “cost-effective”. This information was used to design potential intervention incentives, such as toll-free assistance finding and purchasing ROPS, financial rebates, and campaign messages designed to address farmer’s stated concerns. Subsequent research included testing and revising messages and evaluating the effect of the different campaign incentives in a prospective quasirandomized controlled trial conducted in different regions of New York and Pennsylvania. The results indicate that social marketing offers a promising framework for the development of injury or fatality prevention programs in farm communities. Farmers in the social marketing region demonstrated the most significant changes in both behavioral intention and readiness to retrofit compared to farmers from other regions. Data also indicated that social norms strongly influence farmer’s decisions to work safely, as demonstrated by the strong correlations between behavioral intention measures and measures of social norms. As well as providing an assessment of the utility of social marketing as an intervention framework, the thesis provides a cogent example of how behavioral theories can be used in the design and evaluation of intervention programs. Both stages of change theory and the theory of planned behavior proved to be valuable for measuring dispositional and behavioral changes and for finetuning future interventions.

abstract: This action research dissertation study was undertaken to establish the foundation of a comprehensive evaluation component for the Turn-It-Around (TIA) workshop intervention program at Arizona State University (ASU), and was delivered in the form of a program development consultation. The study's intent was to enhance the ASU Counseling Service's departmental capacity to evaluate one of its important clinical services. The outcomes of this study included multiple assessments of TIA's evaluability and the fidelity of its implementation to its program design. The study products include a well-articulated program theory comprised of program goals, learning objectives, a detailed description of program activities, a logic model, and theoretical construct checklist documents articulating the behavioral science theory underlying the TIA intervention. In addition, instruments tailored to the Turn-It-Around intervention that are suitable for assessing program outcomes were developed and are implementation ready. TIA's clinical stakeholders were interviewed following the generation and delivery of the products and instruments mentioned above to determine whether they found the study's processes and products to be worthwhile and useful. In general, the clinicians reported that they were very satisfied with the benefits and outcomes of the program development consultation. As an action research dissertation, this study generated useful and usable collateral materials in the form of reports, documents, and models. These products are now at the disposal of TIA's institutional stakeholders for use in day-to-day business activities such as training new facilitators and liaisons, and giving presentations that describe the usefulness of TIA as an intervention. Beyond the documents generated to form a program evaluation infrastructure for Turn-It-Around, the processes involved in crafting the documents served to engage relevant stakeholders in a cycle of action research that enriched and solidified their understandings of TIA and furnished them with insight into their counterparts' thinking about the intervention and its potential to benefit the college students they are responsible for helping. Consistent with the intent of action research, the processes involved in accomplishing the objectives of this study surfaced new topics and questions that will be useful in subsequent cycles of program improvement. &#8195; / Dissertation/Thesis / Ed.D. Educational Leadership and Policy Studies 2012