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PubMed2026

Engagement and Retention in Precision Public Health: A Cascade Analysis of Two Cluster Randomized Trials.

INTRODUCTION: When research fails to reach and engage all populations who might benefit from study findings, it can compromise scientific validity and ultimately health equity. Few studies have systematically examined factors driving study engagement through longitudinal intervention research. This project examined sociodemographic, geographic, and structural influences on engagement and attrition across the participation "cascade" (outreach, enrollment, retention) for two large-scale multilevel precision medicine and precision prevention trials for smoking and lung cancer screening. METHODS: Modified Poisson regression models were used to determine the factors associated with study engagement based on sociodemographic and geographical factors at each step in the cascade of participation, from initial outreach through retention at 12 months post-enrollment. Secondary analyses examined the cascade among the subset of patients who had active electronic patient portals and were approached via the portal. RESULTS: A total of 24,366 patients were approached for participation. Race, Social Vulnerability Index (SVI), insurance status, and distance from the study site were significantly associated with engagement at various points in the cascade. Black patients were more likely than White patients to be reached (48.9% vs 47.1%; p = 0.022) and to complete eligibility screening (52.8% vs. 38.4%; p < 0.001), but less likely to consent to participate (56.7% vs 69.8%; p < 0.001) and complete genetic testing (58.5% vs. 69.8%; p = 0.003). Patterns of engagement through electronic patient portal versus non-electronic recruitment channels also differed by race- and place-based factors, with Black patients being less likely than White patients to respond in the portal (8.8% vs 15.5%; p < 0.001), and patients who reside farther from the study site being more likely to respond in the portal compared to those who live closer (14.9% vs 12.5%; p < 0.001). CONCLUSIONS: These findings highlight the need for tailored, stage-specific engagement strategies to ensure representative participation in genomic and behavioral intervention research to advance the integration of genomics into public health practice.

Journal Article↗
PubMed2005

Self-engagement, stressors, and health: a longitudinal study.

The authors examined whether engagement in a performance domain could buffer or exacerbate the consequences of different stressors. Soldiers completed measures of engagement in work, work demands (days training, work hours, and subjective work overload), and symptoms at two time periods. Engagement in work interacted with days training and work hours at Time 1 to predict health symptoms at Time 2 (after controlling Time 1 outcomes). Soldiers highly engaged in their jobs were less likely to report negative consequences under high levels of training/work hours in comparison to soldiers disengaged from their jobs. However, engagement in work interacted with work overload in the opposite manner, with high levels of engagement potentiating the relationship between overload and reports of health symptoms. Engagement in a domain appears to buffer individuals from stressors that do not undermine performance but may exacerbate the impact of stressors that compromise performing well in the domain.

Adult↗
PubMed2006

Rules of engagement promote polarity in RNA trafficking.

Many cell biological pathways exhibit overall polarity (net movement of molecules in one direction) even though individual molecular interactions in the pathway are freely reversible. The A2 RNA trafficking pathway exhibits polarity in moving specific RNA molecules from the nucleus to localization sites in the myelin compartment of oligodendrocytes or dendritic spines in neurons. The A2 pathway is mediated by a ubiquitously expressed trans-acting trafficking factor (hnRNP A2) that interacts with a specific 11 nucleotide cis-acting trafficking sequence termed the A2 response element (A2RE) found in several localized RNAs. Five different molecular partners for hnRNP A2 have been identified in the A2 pathway: hnRNP A2 itself, transportin, A2RE RNA, TOG (tumor overexpressed gene) and hnRNP E1, each playing a key role in one particular step of the A2 pathway. Sequential interactions of hnRNP A2 with different molecular partners at each step mediate directed movement of trafficking intermediates along the pathway. Specific "rules of engagement" (both and, either or, only if) govern sequential interactions of hnRNP A2 with each of its molecular partners. Rules of engagement are defined experimentally using three component binding assays to measure differential binding of hnRNP A2 to one partner in the presence of each of the other partners in the pathway. Here we describe rules of engagement for hnRNP A2 binding to each of its molecular partners and discuss how these rules of engagement promote polarity in the A2 RNA trafficking pathway. For molecules with multiple binding partners, specific rules of engagement govern different molecular interactions. Rules of engagement are ultimately determined by structural relationships between binding sites on individual molecules. In the A2 RNA trafficking pathway rules of engagement governing interactions of hnRNP A2 with different binding partners provide the basis for polarity of movement of intermediates along the pathway.

Animals↗
PubMed2005

Engagement of patients in religious and spiritual practices: confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life research.

BACKGROUND: Quality of life is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. In order to examine how patients with severe diseases view the impact of spirituality and religiosity on their health and how they cope with illness, we have developed the SpREUK questionnaire. We deliberately avoided the intermingling of attitudes, convictions and practices, and thus addressed the distinct forms and frequencies of spiritual/religious practices in an additional manual, the SpREUK-P questionnaire. METHODS: The SpREUK-P was designed to differentiate spiritual, religious, existentialistic and philosophical practices. It was tested in a sample of 354 German subjects (71% women; 49.0 +/- 12.5 years). Half of them were healthy controls, while among the patients cancer was diagnosed in 54%, multiple sclerosis in 22%, and other chronic diseases in 23%. Reliability and factor analysis of the inventory were performed according to the standard procedures. RESULTS: We confirmed the structure and consistency of the previously described 18-item SpREUK-P manual and improved the quality of the current construct by adding several new items. The new 25-item SpREUK-P 1.1 (Cronbach's alpha = 0.8517) has the following scales: (1) conventional religious practice (CRP), (2) existentialistic practice (ExP), (3) unconventional spiritual practice (USP), (4) nature/environment-oriented practice (NoP), and (5) humanistic practice (HuP). Among the tested individuals, the highest engagement scores were found for HuP and NoP, while the lowest were found for the USP. Women had significantly higher scores for ExP than male patients. With respect to age, the engagement in CRP increases with increasing age, while the engagement in a HuP decreased. Individuals with a Christian orientation and with a religious and spiritual attitude had the highest engagement scores for CRP, while the engagement in an USP was high with respect to a spiritual attitude. Variance analyses confirmed that the SpR attitude and religious affiliation are the main relevant covariates for CRP and ExP, while for the USP the SpR attitude and the educational level are of significance, but not religious affiliation. Patients with multiple sclerosis overall had the lowest engagement scores for all five forms of SpR practice, while it is remarkable that cancer patients had lower scores for HuP and USP than healthy subjects. CONCLUSION: The current re-evaluation of the SpREUK-P questionnaire (Version 1.1) indicates that it is a reliable, valid measure of five distinct forms of spiritual, religious and philosophical practice that may be especially useful for assessing the role of spirituality and religiosity in health related research. An advantage of our instruments is the clear-cut differentiation between convictions and attitudes on the one hand, and the expression of these attitudes in a concrete engagement on the other hand.

Adaptation, Psychological↗
PubMed2003

Predicting engagement with services for psychosis: insight, symptoms and recovery style.

BACKGROUND: Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement. AIMS: We examined whether insight, psychotic symptoms or individuals' recovery style ('integration' v. 'sealing-over') predicts service engagement. METHOD: Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement. RESULTS: Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms. CONCLUSIONS: Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

Acute Disease↗
PubMed2006

Factors related to frequency of engaging in outside activities among elderly persons living an independent life at home.

We examined by cross-sectional design the association between the frequency of outside activity and the demographic, health problem, lifestyle, psychosocial and environmental factors among 239 community-dwelling elderly Japanese people (105 men and 134 women) aged 65 years and older, who lived independently at home. The associations of the outside activities more than 6-7 days per week based on a categorical questionnaire choice with potential factors were expressed by odds ratio (OR) and 95% confidence interval (CI) calculated through logistic regression analysis by sex. The proportions of those engaging in outside activity more than 6-7 days per week were 38.1% and 21.6% among men and women, respectively. The associations of the factors belonging to various fields with the frequency of engaging in outside activities were clearly pronounced among men. Elderly men engaging in outside activities more often were scored less for depression and more socially active than men engaging in outside activities less often. Multiple regression analysis revealed meeting and talking often with friend (OR=4.18, 95% CI: 1.06-16.5), current alcohol consumption (3.01, 1.06-8.54), having any hobby (3.59, 0.94-13.7), and easy access to public transportation (3.43, 1.28-9.16) as significant or borderline significant factors related to engaging in outside activities more than 6-7 days per week. Women who were currently employed engaged in outside activities more frequently. The frequency of engaging in outside activities was associated with factors belonging to various fields among elderly people living independently, particularly among men, suggesting its usefulness as an indicator of comprehensive well-being.

Activities of Daily Living↗
PubMed2026

Uncertainty and information management for Lynch syndrome in a genomic screening cohort: Connections to clinical engagement.

OBJECTIVE: Lynch syndrome (LS) is a common hereditary cancer predisposition syndrome. This study explores how individuals learning about LS-related cancer risk through a population genomic screening program appraise, reappraise, and manage uncertainty and engage in medical management. METHODS: We recruited participants with an LS result from a population genomic screening study, purposively sampling based on the characteristics of sex, age, LS gene, and family history of cancer. Semi-structured interviews and chart reviews focused on participants' experiences of learning about the LS result and making management decisions. Thematic analysis and heatmapping were used to explore participant characteristics related to uncertainty management and clinical engagement. RESULTS: Seventeen participants completed interviews, describing uncertainty discrepancies or ambivalent appraisals. Most participants who appraised their LS risk as a threat had high clinical engagement. All participants who had lower clinical engagement received misinformation, had little support from clinicians, or had misunderstandings about LS. CONCLUSION: Accurate information from trusted sources is critical to support uncertainty management and subsequent engagement in clinical risk management choices. PRACTICE IMPLICATIONS: Ensuring primary care providers have the information and tools to provide patients with accurate information may support recommended clinical engagement, thereby improving health outcomes for this population.

Clinical Engagement↗
PubMed1992

Mycoplasma arthritidis mitogen. V beta engaged in mice, rats, and humans, and requirement of HLA-DR alpha for presentation.

OBJECTIVE: Mycoplasma arthritidis mitogen (MAM) is mitogenic for mouse, rat, and human T cells, and behaves as a superantigen in mice through its capacity to bind to the alpha chain of I-E molecules and engage entire sets of T cells expressing specific V beta. Here, we have attempted to fully characterize the V beta-engaging activities of MAM in mice, and define similar activities in rats and humans. METHODS: Multiprobe RNase-protection assays and mice transgenic for human DR alpha, DR beta, and DR alpha beta were utilized for this purpose. RESULTS: MAM-reactive V beta in the mouse included not only the previously reported V beta 6, V beta 8.1, V beta 8.2, and V beta 8.3, but also V beta 5.1. In the rat, engagement of V beta 5.1, V beta 6, V beta 8.1, and V beta 8.2, but not V beta 8.3, was documented, whereas in humans, the engaged V beta included primarily V beta 19.1 (alternatively termed V beta 17.1) and, to a lesser extent, V beta 3.1, V beta 11.1, V beta 12.1, and V beta 13.1. In DR transgenic E alpha- E beta- mice, presentation of MAM and engagement of specific V beta was effected by DR alpha. CONCLUSIONS: Homologous V beta are engaged by MAM in mice, rats, and humans, presumably through a binding site similar to that proposed previously for other superantigens. MAM presentation primarily via the nonpolymorphic DR alpha makes it unlikely that there is involvement of such a superantigen in the pathogenesis of autoimmune diseases known to be associated with certain DR haplotypes. The possibility cannot be excluded, however, that superantigen-activated T cells may lead to disease by cross-reactions with self-antigens presented by particular DR haplotypes.

Amino Acid Sequence↗
PubMed2004

The role of engagement with services in compulsory admission of African/Caribbean patients.

BACKGROUND: High rates of compulsory admission of African/Caribbean patients have been reported. Several factors have been associated with this finding. The roles of some factors related to engagement with services have not been empirically evaluated. AIMS: The aim of this study was to assess the role of engagement factors in compulsory admission of African/Caribbean patients. METHOD: A systematic case-note review was made of the admission process of 100 compulsorily and 100 voluntarily admitted patients; each group containing 50 randomly selected African/Caribbean and White British patients. Information about socio-demographic and engagement factors was collected and the findings compared. RESULTS: Compulsorily admitted African/Caribbean patients had more factors indicative of poor engagement with services than patients in the other groups. Prior to admission, they were less likely to keep their appointments, comply with their medication, contact their GPs and were more likely to present late. Furthermore, they had more history of multiple compulsory admissions. The compulsorily admitted patients, irrespective of ethnicity, also engaged poorly with services. CONCLUSIONS: Poor engagement with primary care and secondary mental health services of African/Caribbean patients appears to be contributing to their high rates of compulsory admission. This aspect of ethnic factors and compulsory admission requires further studies.

Adolescent↗
PubMed2007

Individual and environmental determinants of engagement in autism.

Engagement is a core component of effective educational programs for children with autism. Analysis of 711 naturalistic goal-directed classroom behaviors of four school-age children with autism and four comparable children with Down syndrome (DS) was conducted. The definition of engagement was expanded to include child compliance and congruence. A main finding was both child and environmental factors influenced type of engagement. Children with DS produced 20% more goal-directed behaviors that were both congruent and compliant compared to children with autism. Large group instruction was associated with less congruent engagement but more compliant engagement for children with autism. These findings suggest specific types of engagement which may lead to advances in developing evidence-based practices for specific developmental disorders.

Attention↗
PubMed2001

Calculations show substantial serial engagement of T cell receptors.

The serial engagement model provides an attractive and plausible explanation for how a typical antigen presenting cell, exhibiting a low density of peptides recognized by a T cell, can initiate T cell responses. If a single peptide displayed by a major histocompatibility complex (MHC) can bind, sequentially, to different T cell receptors (TCR), then a few peptides can activate many receptors. To date, arguments supporting and questioning the prevalence of serial engagement have centered on the down-regulation of TCR after contact of T cells with antigen presenting cells. Recently, the existence of serial engagement has been challenged by the demonstration that engagement of TCR can down-regulate nonengaged bystander TCR. Here we show that for binding and dissociation rates that characterize interactions between T cell receptors and peptide-MHC, substantial serial engagement occurs. The result is independent of mechanisms and measurements of receptor down-regulation. The conclusion that single peptide-MHC engage many TCR, before diffusing out of the contact region between the antigen-presenting cell and the T cell, is based on a general first passage time calculation for a particle alternating between states in which different diffusion coefficients govern its transport.

Antigen-Presenting Cells↗
PubMed2003

The risk of smoking in relation to engagement with a school-based smoking intervention.

Health promotion interventions cannot work if people do not engage with them. The aim of this study was to examine whether disengagement from an adolescent smoking prevention and cessation intervention was an independent risk factor for regular smoking 1 and 2 years later. The data were taken from a cluster randomised controlled trial, in the West Midlands, UK, based on the transtheoretical or stages of change model. In this trial, 8,352 13-14-year old school pupils enrolled, and the data in this report were based on the 7,413 and 6,782 pupils present at 1 and 2 years follow-ups, respectively. The intervention group undertook three sessions using an interactive computer programme. At the end of the programme, pupils recorded their responses to it. Pupils were classed as engaged if they thought the intervention was both useful and interesting; all others were classed as disengaged. Random effects logistic regression related the number of times engaged to regular smoking at 1 and 2 years follow-up, adjusted for school absences and 11 potential confounders. The majority of pupils were engaged by the intervention. For participants using the intervention three times but not engaging once, the odds ratios (95% confidence intervals) for smoking at 1 and 2 years relative to the controls were 1.83 (1.41-2.39) and 1.70 (1.38-2.11). For those engaging three times, they were 0.79 (0.60-1.03) and 0.96 (0.75-1.21). There was no interaction with baseline intention to smoke, classified by stage of change, but there was a borderline significant interaction with baseline smoking status, with disengagement acting as a stronger risk factor among baseline never-smokers. We conclude that disengagement from interventions is a risk factor for smoking independently of experimentation with cigarettes. The best explanation is that disengagement from school, an established risk factor for smoking, generalises to disengagement from didactic school-based health promotion programmes.

Adolescent↗
PubMed1999

Client engagement in drug treatment.

Client engagement in drug abuse treatment is associated with favorable treatment outcomes, but it is not completely understood why some clients are more likely to engage in treatment. This study examines a wide array of client characteristics and treatment experiences potentially associated with engagement. Findings from the Los Angeles Target Cities Project, funded by the Center for Substance Abuse Treatment, indicate that the predictors of treatment engagement are generally confined to current treatment experiences. For both women and men, the perceived utility of treatment, ancillary services, and the client-counselor relationship are the strongest predictors of client engagement in treatment. Client characteristics are generally not strong predictors of treatment engagement. Concerning the client-counselor relationship, the findings suggest that women may respond more favorably to an empathic counseling style, whereas men may respond to a more utilitarian style. The findings contradict popular stereotypes about the treatment-"receptive" client, identify possible directions for treatment improvement, and highlight the need for more research examining the treatment experience of the client. Other research, clinical, and policy implications are discussed.

Adult↗
PubMed2002

Higher education and civic engagement.

This paper focuses on the relationship between social engagement, particularly civic engagement, and education. It is well known that more highly educated people are more likely to engage in voluntary work in formalized settings. It has been difficult to disentangle the effect of higher education from that of family origin and occupational socialization. This paper examines the effects of tertiary education on the social and civic engagement of young people, using the British Household Panel Study. The social and civic activity of young people is observed in their late teens, before entering the labour market or tertiary education, and compared with that of the same young people in their early 20s, after completing tertiary education courses or gaining labour market experience. It was found that the social and civic engagement of young people who would enter higher education was higher in their late teens than that of their peers who did not enter. However, higher education had a small additional effect on civic engagement, for both young and mature students. The children of professionals were the social grouping most likely to be involved in civic activities. The relationship of higher education, professional occupations and family socialization is discussed.

Adolescent↗
PubMed2006

Predictors of engagement in vocational counseling for methadone treatment patients.

Employment enhances the outcomes of substance dependency treatment. Unfortunately, although unemployed methadone treatment patients frequently state they are interested in a job, many fail to participate in vocational services when available. Unless patients become engaged, vocational services do not have an opportunity to be effective. This is the first study to explore a broad array of factors that may be associated with differential engagement in vocational services among methadone patients. The study was conducted in two methadone programs in New York City during 2001-2004. Unemployed methadone patients (n = 211) were voluntarily randomly assigned to either of two vocational counseling programs (standard vs. experimental) and followed for 6 months. The sample was 59% male, 75% minority group, aged 45 years on average, and in methadone treatment for 5 years on average. Being engaged in the vocational counseling programs was defined as five or more sessions with the counselor in the first 6 months after study entry. In multivariate analysis, the factors associated with higher engagement in vocational counseling were being non-Hispanic, having more education, a drug injection history, a crack use history, having chronic emotional/mental problems, better work attitudes, and assignment to the experimental vocational program. The results indicate that it is often the most "needy" unemployed methadone patients who become more engaged in vocational counseling. A vocational counseling model which emphasizes assertive outreach and attends to nonvocational clinical issues as well is more likely to engage patients.

Adult↗
PubMed2006

A measure of engagement for children with intellectual disabilities in early childhood settings: a preliminary study.

BACKGROUND: The purpose of this study was to develop a measure of engagement that could be used in practice with children with disabilities, including children with severe intellectual disabilities. METHOD: The Individual Child Engagement Record (ICER) was designed to observe and record the engagement of individual children in order to identify optimal programs for them. Using the measure, 5 children with mild to severe disabilities were observed in an inclusive childcare setting across 4 types of ongoing activities: routine, one-to-one instruction, planned, and child-initiated. RESULTS: Generally, the children were better engaged in routine activities. The lowest level of engagement was found for planned activities. There were, however, differences across children with regard to the relative value of the different types of activities in promoting engagement. CONCLUSIONS: The measure allowed for the identification of activities that would provide better learning opportunities for children with significant disabilities.

Child↗
PubMed2002

Low level social engagement as a precursor of mortality among people in later life.

OBJECTIVE: to examine if a low level of social engagement is a precursor for mortality. METHODS: a case-control design, controlling for physical health, age and sex examining social engagement and morale. We took measures on 3 occasions, 4 years apart. RESULTS: a low level of social engagement was an important precursor of 8-year mortality. There were intermediate significant differences for social engagement, physical health and morale. CONCLUSIONS: levels of social engagement either have a direct effect on mortality, or represent hidden health problems, acting as a marker for later ill health. Social engagement may also have a role in intermediate declines in physical health and morale.

Aged↗
PubMed2001

Predictors of engagement in adolescent drug abuse treatment.

OBJECTIVES: To identify key demographic, parent, and adolescent characteristics that influence engagement in outpatient drug abuse treatment. METHOD: Youths aged 12 to 17 years (N = 224; 81% male and 72% African American) referred for drug treatment and their parents participated in this study. Marijuana was the primary substance of abuse. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning. RESULTS: A discriminant function analysis revealed that engagement in treatment was related to, in order of weighting, more positive parental expectations for their adolescent's educational achievement (standardized discriminant function coefficient [SDF] = 0.68), higher parental reports of youth externalizing symptoms (SDF = 0.59), and higher levels of family conflict perceived by the youth (SDF = 0.36). Family income, gender, juvenile justice status, minority group status, family structure, parental age and psychopathology, and treatment characteristics did not distinguish treatment-engaged from unengaged adolescents. CONCLUSIONS: The results suggest that both parent and youth perceptions are pivotal to whether or not adolescents are engaged in psychotherapy. These findings lead the authors to recommend adolescent engagement interventions focusing on both the youth and his or her parents and suggest a content focus for adolescent engagement interventions.

Adolescent↗