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Using Multivariate Statistics

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

Background: The Internet is increasingly used as a medium for the delivery of interventions designed to promote health behavior change. However, reviews of these interventions to date have not systematically identified intervention characteristics and linked these to effectiveness. Objectives: The present review sought to capitalize on recently published coding frames for assessing use of theory and behavior change techniques to investigate which characteristics of Internet-based interventions best promote health behavior change. In addition, we wanted to develop a novel coding scheme for assessing mode of delivery in Internet-based interventions and also to link different modes to effect sizes. Methods: We conducted a computerized search of the databases indexed by ISI Web of Knowledge (including BIOSIS Previews and Medline) between 2000 and 2008. Studies were included if (1) the primary components of the intervention were delivered via the Internet, (2) participants were randomly assigned to conditions, and (3) a measure of behavior related to health was taken after the intervention. Results: We found 85 studies that satisfied the inclusion criteria, providing a total sample size of 43,236 participants. On average, interventions had a statistically small but significant effect on health-related behavior (d+ = 0.16, 95% CI 0.09-0.23). More extensive use of theory was associated with increases in effect size (P = .049), and, in particular, interventions based on the theory of planned behavior tended to have substantial effects on behavior (d+ = 0.36, 95% CI 0.15-0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001). Finally, the effectiveness of Internet-based interventions was enhanced by the use of additional methods of communicating with participants, especially the use of short message service (SMS), or text, messages. Conclusions: The review provides a framework for the development of a science of Internet-based interventions, and our findings provide a rationale for investing in more intensive theory-based interventions that incorporate multiple behavior change techniques and modes of delivery. [J Med Internet Res 2010;12(1):e4]

Using the Internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy

Background Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease.

Aim To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes.

Design of study A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention.

Method After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis.

Results Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA1c were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing.

Conclusion Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.

Motivational interviewing: a systematic review and meta-analysis

Evaluating Model Fit

Objective: Following in the footsteps of several prior attempts, this review seeks a meaningful and data-based answer to the common question of how people fare, on average, after being treated for alcoholism (broadly defined as alcohol use disorders). Method: Findings from seven large multisite studies were combined to derive estimates of the average effectiveness of alcoholism treatment. To provide common outcome measures, conversion equations were used to compute variables not reported in the original studies. Results: During the year after treatment, 1 in 4 clients remained continuously abstinent on average, and an additional 1 in 10 used alcohol moderately and without problems. During this period, mortality averaged less than 2%. The remaining clients, as a group, showed substantial improvement, abstaining on 3 days out of 4 and reducing their overall alcohol consumption by 87%, on average. Alcohol-related problems also decreased by 60%. Conclusions: About one third of clients remain asymptomatic duri...

How effective is alcoholism treatment in the United States

https://faculty.washington.edu/claytonn/publications/Walters_Neighbors_2005.pdf

Feedback interventions for college alcohol misuse: What, why and for whom?

Objective: Alcohol consumption has been a growing concern at U.S. colleges, particularly among first-year students, who are at increased risk for problems. This study tested the efficacy of the “electronic Check-Up to Go” (e-CHUG), a commercially-available internet program, at reducing drinking among a group of at-risk college freshman. Method: The design was a randomized controlled trial: 106 freshmen students who reported heavy episodic drinking were randomly assigned to receive feedback or to assessment only. Assessment measures were completed at baseline, 8 weeks, and 16 weeks. Results: At 8 weeks, the feedback group showed a significant decrease in drinks per week and peak BAC over control. By 16 weeks, the control group also declined to a point where there were no differences between groups. Changes in normative drinking estimates mediated the effect of the intervention. An additional 245 abstainers and light drinkers who were also randomized to condition did not show any intervention effect. Conclusions: This study provides preliminary support for the efficacy of this intervention at reducing short-term drinking among at-risk students.

A controlled trial of web-based feedback for heavy drinking college students.

A review of computer and Internet-based interventions for smoking behavior

The Therapeutic Education System, which combines skills-oriented counseling and contingency management in an Internet-delivered behavioral intervention, produced high rates of abstinence from drugs and heavy drinking among patients with a good prognosis (those who entered the study with positive urine drug or breath alcohol screen) but doubled the likelihood of abstinence among patients with an otherwise poor prognosis.

/pdf/internet-delivered-treatment-for-substance-abuse-a-multisite-59v8oj38vu.pdf

Scott T. Walters

Papers

How effective is alcoholism treatment in the United States

Feedback interventions for college alcohol misuse: What, why and for whom?

A controlled trial of web-based feedback for heavy drinking college students.

A review of computer and Internet-based interventions for smoking behavior

Internet-delivered treatment for substance abuse: A multisite randomized controlled trial