Correcting an analysis of variance for clustering

Is radicalization a family issue? A systematic review of family-related risk and protective factors, consequences, and interventions against radicalization

BACKGROUND

Family-related risk and protective factors are crucial for different antisocial behaviors, but their role in radicalization requires synthesis. Radicalization is likely to have a negative impact on families, and well-designed and implemented family-focused intervention programs have the potential to decrease radicalization.

OBJECTIVES

Research questions were: (1) What are the family-related risk and protective factors for radicalization? (2) What is the impact of radicalization on families? (3) Are family-based interventions against radicalization effective?

SEARCH METHODS

Searches included 25 databases and hand searches of gray literature from April to July 2021. Leading researchers in the field were asked to provide published and unpublished studies on the topic. Reference lists of the included studies and previously published systematic reviews on risk and protective factors for radicalization were scanned.

SELECTION CRITERIA

Published and unpublished quantitative studies on family-related risk and protective factors for radicalization, the impact of radicalization on families, and family-focused interventions were eligible with no restrictions regarding the study year, location, or any demographic characteristic. Studies were included if they measured the relation between a family-related factor and radicalization or if they included a family-focused intervention against radicalization. For family-related risk and protective factors, radicalized individuals needed to be compared to general population. Studies were included if they defined radicalization as support or commission of violence to defend a cause, including support for radical groups.

DATA COLLECTION AND ANALYSIS

The systematic search identified 86,591 studies. After screening, 33 studies focused on family-related risk and protective factors were included, with 89 primary effect sizes and 48 variables grouped in 14 factors. For the factors that included two or more studies, meta-analyses with random effects were conducted. When possible, moderator analyses were performed together with sensitivity and publication bias analyses. No studies on the impact of radicalization on families or family-focused interventions were included.

RESULTS

The current systematic review based on studies with 148,081 adults and adolescents from diverse geographic locations showed that parental ethnic socialization (z = 0.27), having extremist family members (z = 0.26), and family conflict (z = 0.11) were related to more radicalization, whereas high family socioeconomic status (z = -0.03), bigger family size (z = -0.05), and high family commitment (z = -0.06) were related to less radicalization. Separate analyses described family-factors for behavioral versus cognitive radicalization, and different radical ideologies including Islamist, right-wing and left-wing. It was not possible to distinguish risk and protective factors from correlates and the level of overall bias was mostly high. No results regarding the impact of radicalization on families or family-focused interventions were included.

AUTHORS' CONCLUSIONS

Although causal relations between family-related risk and protective factors could not be established, it is reasonable to suggest that policies and practice should aim at decreasing family-related risks and increasing protective factors for radicalization. Tailored interventions including these factors should be urgently designed, implemented and evaluated. Studies focused on the impact of radicalization on families and family-focused interventions are urgently needed together with longitudinal studies on family-related risk and protective factors.

PROTOCOL: Is radicalization a family issue? A systematic review of family-related risk and protective factors, consequences, and interventions against radicalization

This systematic review aims to answer the following research questions: (1) What are the family-related risk and protective factors for radicalization? (2) What is the impact of radicalization on families? (3) To what extent are family-based interventions against radicalization effective? The review will answer these research questions by systematically gathering and synthesizing published and unpublished scientific literature on family-related risk and protective factors for radicalization, the impact of radicalization on family, and studies that evaluate the impact of family-based interventions on radicalization. This review will also explore what components of family-based interventions are most effective for countering radicalization. Thus, this systematic review will provide a global vision of scientific literature focused on family and radicalization including quantitative research.

Implementation of family psychosocial risk assessment in pediatric cancer with the Psychosocial Assessment Tool (PAT): study protocol for a cluster-randomized comparative effectiveness trial

Background

Childhood cancer affects and is affected by multiple levels of the social ecology, including social and relational determinants of health (e.g., economic stability, housing, childcare, healthcare access, child and family problems). The 2015 Standards of Psychosocial Care in Pediatric Cancer outline optimal psychosocial care sensitive to these ecological factors, starting with assessment of psychosocial healthcare needs to promote medical and psychosocial outcomes across all children with cancer. To address the first standard of family psychosocial assessment, the Psychosocial Assessment Tool (PAT) is a validated screener ready for broad implementation.

Method

The PAT will be implemented across a national sample of 18 pediatric cancer programs ranging in size (annual new patients) in a mixed methods, comparative effectiveness study, guided by the Interactive Systems Framework for Dissemination and Implementation, comparing two implementation strategies. It is hypothesized that implementation will be more successful at the patient/family, provider, and institutional level when training (strategy I) is combined with implementation expanded resources (strategy II). There are three aims: (1) Refine the two implementation strategies using semi-structured qualitative interviews with 19 stakeholders including parent advocates, providers, pediatric oncology organization representatives, healthcare industry leaders; (2) Compare the two theoretically based and empirically informed strategies to implement the PAT in English and Spanish using a cluster-randomized controlled trial across 18 sites. Stratified by size, sites will be randomized to cohort (3) and strategy (2). Outcomes include adoption and penetration of screening (patient/family), staff job satisfaction/burnout (provider), and cost-effective use of resources consistent with family risk (institution); (3) Based on the results of the trial and feedback from the first and second aim, we will develop and disseminate a web-based PAT Implementation Toolkit.

Discussion

Use of the PAT across children’s cancer programs nationally can achieve the assessment standard and inform equitable delivery of psychosocial care matched to family need for all patients.

Trial Registration

ClinicalTrials.gov, NCT04446728, registered 23 June 2020

Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan

Background: Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents our findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan.

Methods: We used a cross-sectional post-intervention design with regression-adjusted difference-in-differences (DiD) analysis, and included 2 groups of health workers (treatment and control). The treatment group were those who have received training in IMCI recently (in the last 12 months), and the control group were those who have never received training in IMCI. The assessment method was direct observation of health workers during patient-provider interaction. We used data, collected over a period of 3 years (2015–2017) from primary healthcare facilities, and investigated training effects on quality of care. The outcome variables were 4 indices of quality care related to history taking, information sharing, counseling/medical advice, and physical examination. Each index was formed as a composite score, composed of several inter-related tasks of quality of care carried out by health workers during patient-provider interaction for under-5 children.

Results: Data were collected from 733 primary healthcare facilities with 5818 patients. Quality of care was assessed at the level of patient-provider interaction. Findings from the regression-adjusted DiD multivariate analysis showed significant effects of IMCI training on 2 indices of quality care in 2016, and on 4 indices of quality care in 2017. In 2016 two indices of quality care showed improvement. There was an increase of 8.1% in counseling/medical advice index, and 8.7% in physical examination index. In 2017, there was an increase of 5.7% in history taking index, 8.0% in information sharing index, 10.9% in counseling/medical advice index, and 17.2% in physical examination index.

Conclusion: Conducting regular IMCI training courses for health workers can improve quality of care for under-5 children in primary healthcare facilities in Afghanistan. Findings from our study have the potential to influence policy and strategic decisions on IMCI programs in developing countries.

Challenges to patient centredness - a comparison of patient and doctor experiences from primary care

Background

We designed this observational study to investigate the level of patients’ and doctors’ ratings of patient-centred aspects of the primary care consultation.

Methods

Questionnaire study with patients and doctors. Consecutive patients in a primary care setting and 16 doctors responding post visit. Results are presented as proportions with 95% confidence intervals.

Results

411 questionnaires, 223 from patients and 188 from doctors, covered 251 consultations. Both patients and doctors gave the highest possible estimations on the aspects of patient-centred communication and satisfaction less frequently when the patient had other reasons for visit than purely somatic. Unlike the doctors’ estimations, the frequency of highest possible estimations in patient responses dropped if the patients had two to six reasons for visit rather than one. Among the six patient-centred aspects, both patients and doctors gave the highest possible estimation least frequently on the aspect of shared decision-making.

Conclusion

The results suggest that the nature of the reason, as well as the number of reasons for visit, interferes with the doctors’ level of patient-centred communication. Our results furthermore confirm the findings of previous studies that doctors insufficiently involve patients in their care.

Electronic supplementary material

The online version of this article (10.1186/s12875-019-0959-y) contains supplementary material, which is available to authorized users.

Reference values of within-district intraclass correlations of academic achievement by district characteristics: results from a meta-analysis of district-specific values

BACKGROUND

Randomized experiments are often considered the strongest designs to study the impact of educational interventions. Perhaps the most prevalent class of designs used in large-scale education experiments is the cluster randomized design in which entire schools are assigned to treatments. In cluster randomized trials that assign schools to treatments within a set of school districts, the statistical power of the test for treatment effects depends on the within-district school-level intraclass correlation (ICC). Hedges and Hedberg (2014) recently computed within-district ICC values in 11 states using three-level models (students in schools in districts) that pooled results across all the districts within each state. Although values from these analyses are useful when working with a representative sample of districts, they may be misleading for other samples of districts because the magnitude of ICCs appears to be related to district size. To plan studies with small or nonrepresentative samples of districts, better information are needed about the relation of within-district school-level ICCs to district size.

OBJECTIVE

Our objective is to explore the relation between district size and within-district ICCs to provide reference values for math and reading achievement for Grades 3-8 by district size, poverty level, and urbanicity level. These values are not derived from pooling across all districts within a state as in previous work but are based on the direct calculation of within-district school-level ICCs for each school district.

RESEARCH DESIGN

We use mixed models to estimate over 7,000 district-specific ICCs for math and reading achievement in 11 states and for Grades 3-8. We then perform a random effects meta-analysis on the estimated within-district ICCs. Our analysis is performed by grade and subject for different strata designated by district size (number of schools), urbanicity, and poverty rates.

I-CAN SLEEP: rationale and design of a non-inferiority RCT of Mindfulness-based Stress Reduction and Cognitive Behavioral Therapy for the treatment of Insomnia in CANcer survivors

Individuals with cancer are disproportionately affected by sleep disturbances, relative to the general population. These problems can be a consequence of the psychological, behavioral and physical effects of a cancer diagnosis and treatment. Sleep disturbances often persist for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future psychopathology, health problems and poorer quality of life. It is important to develop and evaluate treatments that comprehensively address the common symptom profiles experienced by cancer survivors.

METHODS

This study is a randomized controlled non-inferiority trial comparing Cognitive Behavior Therapy for Insomnia (CBT-I; a known efficacious treatment) to Mindfulness-Based Stress Reduction (MBSR; a treatment with demonstrated potential). This design can efficiently compare these two treatments directly and determine whether MBSR performs to the same standard as CBT-I for the treatment of insomnia with additional benefits of reducing cancer-related distress. Participants are randomly assigned to an 8-week CBT-I or MBSR group. Sleep indices are measured using subjective (sleep diaries) and objective (actigraphy) assessment tools. The primary outcome is insomnia severity. Secondary outcomes include sleep quality, symptoms of stress, mood disturbance, mindfulness, and dysfunctional beliefs and attitudes toward sleep. Assessments are completed at three time periods: pre-treatment, post-treatment and at 3month follow up.

CONCLUSIONS

Considering the high prevalence of distress and sleep disturbances in the cancer population, should MBSR produce sleep effects comparable to CBT-I, it may be more comprehensive - making it the treatment of choice for addressing cancer-related psychological sequelae.