Self-help parenting interventions for childhood behaviour disorders: a review of the evidence.

The use of self-help interventions for parents of children with behaviour problems is becoming more prevalent. This review critically evaluated the evidence supporting the efficacy of such programmes for children with behaviour problems. Using a systematic literature search, two modes of delivery were evaluated, namely bibliotherapy and multimedia. Programmes that included minimal therapist support were also included. Overall, there is good evidence supporting the efficacy of self-help programmes in improving child behaviour, over the short and longer term. Self-help programmes led to outcomes similar to those achieved with more intensive therapist input. Including minimal levels of therapist support in addition to self-help materials enhances child and parent outcomes. Parents view self-help favourably but significantly less so than programmes including some form of therapist input. The future directions for self-help parent programmes include the need for longer-term follow-ups, the identification of moderators of outcome and economic evaluations of self-help programmes.

Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation.

OBJECTIVE: Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention. METHOD: Interested dental hygienists (N = 1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated. RESULTS: Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median. CONCLUSION: Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.

Self-directed learning and portfolio development for nurses: developing workbooks as a facilitative tool.

Workbooks are often used for discipline-specific learning in academic institutions but there is growing recognition of their potential usefulness in the clinical setting to promote learning and professional development. The purpose of this paper is to share some tips/guidelines for those clinical staff interested in developing self-directed learning programs using a workbook approach. Combined with skilled facilitation, custom designed workbooks based on adult learning theories can enhance skills and encourage portfolio development in the clinical setting. This cost and time effective approach utilises existing resources to cater to diverse needs and topics, building sustainable collaborations. This paper will argue that the proposed program has the potential to contribute to healthcare improvement by promoting skill development amongst staff and contributing to evidence-based practice.

Doing more with less: using silent in-services for staff development.

A unit's greatest asset is nurses who are up-to-date in their practice. Time and money constraints demand innovative and creative educational methods. Silent inservices teach and empower while encompassing multiple learning styles in a cost-efficient manner.

Using self-directed learning modules. A literature review.

The impetus for cost containment may necessitate using teaching strategies different from traditional classroom models used in staff development. Educators can design self-directed learning modules to educate staff to work more effectively with special populations, such as children and elderly patients. Encompassing more than 40 years of literature, this review identifies the best modular designs, the cost benefits, and various studies about the effectiveness of self-directed learning modules.

The cost-effectiveness of alternative methods of nutrition education for hypercholesterolemic children.

OBJECTIVES: This study compared the cost-effectiveness, from the family's perspective, of a parent-child auto-tutorial nutrition education program with that of counseling by a dietitian after identification of hypercholesterolemic children in pediatric offices. METHODS: Personnel, parent time, equipment, and laboratory costs associated with the interventions were analyzed. Reductions in dietary fat as a percentage of total calories were analyzed by means of 24-hour dietary recalls and in plasma low-density lipoprotein cholesterol at 3 and 12 months postintervention. RESULTS: Average costs totaled $208.08 for the parent-child auto-tutorial program and $213.28 for counseling. While the parent-child program was somewhat less cost-effective in terms of dietary change, it was more cost-effective in terms of lipid reduction at 3 months, although this advantage disappeared by 12 months. CONCLUSIONS: Modest reductions in fat in the diet and in plasma lipid levels were achieved at costs that also appear modest in comparison with treatment of elevated cholesterol in adulthood. Follow-up interventions may be needed to sustain effects, while longitudinal studies are needed to assess the long-term cost benefit.

Off to a successful start! The use of self-study for hospital-wide nursing orientation.

Introducing speaker after speaker and providing lecture after lecture is a standard method for delivering nursing orientation in many hospitals. However, this is not always the most effective method of orientation for new nurses. In this article, the author outlines the process used to convert a traditional, lecture-style orientation to one alternative method, self-study, and shows how the change decreases the time orientees spend in nursing orientation and lowers the cost per person.

Effective development and utilization of self-learning modules.

This article provides guidelines to assist the nurse educator in designing self-learning modules for appropriate topics and learners, in creating the module, and in developing tools to evaluate the effectiveness of the module. By following the guidelines presented, the nurse educator can create cost-effective learning opportunities for professional nurses. Utilization of self-learning modules encourages nurses to be self-directed and allows the nurse educator to be the resource rather than the source of learning.

Are drinkers interested in inexpensive approaches to reduce their alcohol use?

This study examined whether adult drinkers would be willing to receive self-help and other minimal contact aids designed to help them drink more moderately. A total of 316 adults eighteen years of age and older residing in two adjacent communities in northwest Arkansas participated in a mail survey. Drinkers most frequently requested newspaper articles on how to drink more moderately (20.7%), followed by television and radio programs (15.5%). Over one-fourth (26.2%) of adult alcohol users reported an interest in receiving one or more of the aids to limit drinking. Heavier drinkers were more likely than lighter drinkers to be interested in television and radio programs, contests and cash awards, and newspaper articles aimed at helping them to drink more moderately (p's less than or equal to .01). Drinkers who were interested in receiving one or more self-help alcohol aids reported higher levels of alcohol consumption, and greater motivation to limit their alcohol use (p's less than or equal to .01). These data suggest that a considerable number of alcohol users would like to receive inexpensive aids to help them to drink more moderately.

Developing self-learning packages.

In the current health care economy, staff development educators are searching for viable, cost-effective methods of delivering instruction. Self-learning packages are one such method. A step-by-step method for developing self-learning packages is presented along with a comparative analysis of costs with the use of self-learning packages versus a traditional classroom program.

A method of self-directed learning in continuing medical education with implications for recertification.

A method of self-directed learning for physicians that can be used to satisfy a portion of specialty board recertification requirements integrates contract learning (self-formulated learning plans), information brokering (linking physicians with consultants and community resources), and collegial networking (discussion groups). The method encourages physicians to focus on educational objectives, supplies learning resources, and promotes interactions with colleagues in study groups. Fifty-nine (53%) of the 102 learning goals update physicians' knowledge. Print sources and discussions with experts were the commonest resources used. Forty-five (49%) of 91 participants completed their learning plans. Forty-nine (74%) completed projects were judged successful in achieving their goals. Twenty-five (45%) of 56 physicians responding to a questionnaire stated that the method was superior to traditional continuing medical education. Fifty-two percent of the participants found the method as effective as traditional continuing medical education. Proof of accomplishment allows the method to be used as part of a specialty board recertification process.

The use of learning resource centers in the teaching of pulmonary medicine.

Learning resource centers (LRC) are areas designed for individual study which contain a variety of self-instructional materials. To evaluate the use of LRC in teaching pulmonary medicine, a survey was conducted of medical school pulmonary sections; responses were obtained from 30 sections with an NHLBI pulmonary Academic Award (PAA groups), and 21 sections without PAA (non-PAA group). LRC were established in 77 percent of the PAA group but only 14 percent of the non-PAA group. A higher percentage of pulmonary fellows than students used the resource center and student use was higher when the LRC was formally integrated into the curriculum. Textbooks and journals were more heavily used than materials utilizing audiovisual educational techniques. The results of this study suggest that pulmonary LRC use is modest, LRC cost is high, and LRC educational value may not be superior to general medical libraries.

The marketing of instructional materials to health practitioners.

With the increasing costs of education, for both practitioners and academic health centers, the time for a different format for continuing education has arrived. An educational resource department is the logical center to the development and management of a project as described in this paper. The educational resource department, the academic health center, and the practitioners can all benefit from turning attention outside academic walls.

Critical care nursing orientation: a comparison of teaching methods.

In summary we have shown in this small group of 32 nurses that the PIM approach is as effective a method for critical care orientation as traditional classroom teaching. The savings in instructors' and orientees' time via PIMs result in dollar savings; but more importantly, the PIM was found by our orientees to be more satisfying. PIMs encouraged flexibility and individualized attention, and by self-pacing allowed several nurses to begin practice in the critical care setting earlier than usual. In light of the high cost of orientation, one finding that warrants further exploration is the orientee's uncertainty of remaining in critical care nursing. It is possible that as the orientee becomes socialized into the critical care setting, her values, attitudes, and commitment to remain may change over time. Future follow-up will help us to examine changing attitudes as these nurses become acclimated to the critical care setting. Head nurses and staff development instructors play a major role in preventing frustration and turnover and in creating a positive climate for growth.