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PubMed2006

Terms of engagement: aligning youth, adults, and organizations toward social change.

Youth engagement is widely accepted as an essential element of successful youth development activities at an organizational level. However, because the practical issue of how to engage youth in the work of organizations remains unsettled, this qualitative research study was conducted as an outgrowth of consultation by Youth Infusion (a youth organization that works to support youth as decision makers, advocates, and community change agents) requested by two youth-serving governmental agencies. Organizational structures, processes, and cultures that might support youth engagement were the focus of two research questions: (1) What accounts for differences in an organization's youth-adult engagement outcomes; and (2) What strategies can organizations adopt to maximize the likelihood of successful outcomes? Participatory action research drove the design and implementation of data collection and analysis. Five elements were related to successful youth engagement: (1) strong external advocacy coalitions; (2) alignment of management and staff; (3) clear, consensus-driven visions; (4) an openness to change; and (5) unified values. Organizations interested in advancing youth engagement in their daily operations should consider attending to these elements in their strategic planning.

Adolescent↗
PubMed2003

Testing the stress-buffering effects of self engagement among soldiers on a military operation.

The present research examined whether self engagement moderated the stressor-strain relationship in a sample of U.S. soldiers deployed on a peacekeeping mission to Bosnia. Given that individuals were nested within groups (Army companies), we examined the relationships of interest using multilevel random coefficient models. The results of these analyses revealed that self engagement interacted with three different stressors (lower amounts of sleep, work stress, family stress) in the prediction of psychological distress. In support of self engagement as a buffer against stress, when stressors were low (high amounts of sleep, low levels of work stress, and family stress), soldiers reported relatively low levels of psychological distress and physical symptoms, regardless of whether they were engaged in or disengaged from their job. However, when stressor levels were high, soldiers who were engaged in their job reported less elevation in reports of psychological distress than soldiers who were disengaged from their job. The results are discussed in terms of the potential mechanisms by which self engagement might protect individuals from stressful circumstances.

Adaptation, Psychological↗
PubMed1994

Group engagement: a conceptual analysis.

Group engagement is an approach which further advances the concept of group engagement but is empirically weak in identifying those behaviours that are related to learning. A definition of group engagement which emphasized age-appropriate, functional behaviours which fall within the set curriculum has finally been developed. This approach is the most conceptually sophisticated approach, is ideologically acceptable, and has some empirical validation. Future research should concentrate on articulating clear principles to guide operationalization and validation. The development of several different operationalizations of engagement for clearly specified different purposes is recommended. Group engagement measures should be subject to greater psychometric analysis. The use of disaggregation of group engagement to analyse the behaviour of individuals and component behaviours is recommended.

Adolescent↗
PubMed2000

The protective effect of social engagement on mortality in long-term care.

OBJECTIVES: To examine the effect of social engagement (SE) on mortality in long-term care. DESIGN: A retrospective cohort study. SETTING: A 725-bed long-term care facility. PARTICIPANTS: A total of 927 long-term care residents who had SE measurements and did not have a serious communication problem. MEASUREMENTS: Minimum Data Set information including psychosocial items comprising an internally reliable and valid SE scale, and mortality risk factor measurements. Mortality data during the 1,721-day follow-up period was obtained from facility records. RESULTS: Life table analyses indicate that higher levels of SE are associated with longer survival (P = .0001). Unadjusted proportional hazards analyses show that residents who did not engage socially were 2.3 times more likely to die during the follow-up period compared with residents who were the most socially engaged. Multivariate adjusted analyses showed the protective effect of SE on mortality remained even after simultaneously adjusting for mortality risk factors. Residents who did not engage socially were 1.4 times as likely to die during the follow-up period compared with residents who were the most socially engaged. CONCLUSIONS: Increased levels of SE were associated with longer survival independent of mortality risk factors. SE may be a modifiable risk factor for death among long-term care residents. More research is needed to understand psychological factors that may influence residents' desire and ability to engage socially.

Activities of Daily Living↗
PubMed2003

Relational factors and family treatment engagement among low-income, HIV-positive African American mothers.

Clinically derived hypotheses regarding treatment engagement of families of low-income, HIV-positive, African American mothers are tested using univariate and multivariate logistic regression models. Predictors are baseline family relational factors (family support, mother's desire for involvement with family, and family hassles) and mother's history of substance dependence. The study examines a subsample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy (SET). SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS. Participants in the subsample were randomly assigned to SET and attended at least two therapy sessions. Findings reveal that family relational factors predicted family treatment engagement (family support, p < .004; mother's desire for involvement with family, p < .008; family hassles, p < .027). Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother's own treatment engagement (p < .016). History of substance dependence was neither associated with family treatment engagement nor family support. Post hoc analyses revealed that family hassles (p < .003) and mother's desire for involvement with family (p < .018) were differentially related to family treatment engagement in low- versus high-support families. Implications for clinical practice and future research are discussed.

Adult↗
PubMed2005

How dentists cope with their job demands and stay engaged: the moderating role of job resources.

This study focuses on job demands, job resources, and work engagement among 1,919 Finnish dentists employed in the public sector. Based on the Job Demands - Resources model, it was first predicted that the inverse relationship between job demands (e.g. workload, physical environment) and work engagement would be weaker when dentists had many resources (e.g. variability in the required professional skills, peer contacts). Second, using the Conservation of Resources theory it was hypothesized that job resources are most beneficial in maintaining work engagement under conditions of high job demands. The data were based on a postal questionnaire with a response rate of 71%. The dentists were split into two random groups in order to cross-validate the results. A set of hierarchical regression analyses resulted in 17 out of 40 significant interactions (40%). Four out of 20 possible interaction effects could be cross-validated showing, for example, that variability in professional skills mitigated the negative effect of qualitative workload on work engagement and, in addition, boosted work engagement when the qualitative workload was high. The main conclusion is that job resources are useful in coping with the high demands in dentistry and help dentists to stay engaged.

Adaptation, Psychological↗
PubMed2004

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

OBJECTIVE: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. METHOD: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). RESULTS: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. CONCLUSIONS: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

Age Factors↗
PubMedDate not supplied

Using choice-making opportunities to increase activity engagement in individuals with dementia.

Structured choice-making procedures, referred to as preference assessments, have been frequently used to identify reinforcers for individuals with developmental disabilities; however, few studies have examined the use of preference assessments with older adults with dementia. This study evaluated the utility of 4 versions of a 2-choice preference assessment for identifying items and activities associated with high levels of engagement in clients at an adult day care program. The same 8 items were presented in 4 formats (ie, verbal, pictorial, textual, tangible), and items from each assessment were ranked with respect to the subsequent level of participant engagement with each item. Correlations were computed between the preference hierarchy and subsequent engagement levels for each format. The format with the highest correlation coefficient was subsequently used in interventions in which frequent structured choice opportunities were presented throughout the day to increase engagement. For 3 of 4 participants, the vocal modality was optimal, while the tangible modality was optimal for the fourth. Moderate to substantial increases in engagement were observed for all participants when structured choices were offered. Implications for activity engagement in adult day care programs are discussed.

Aged, 80 and over↗
PubMed2005

Processes of disengagement and engagement in assertive outreach patients: qualitative study.

BACKGROUND: Assertive outreach has been established to care for'difficult to engage' patients, yet little is known about how patients experience their disengagement with mainstream services and later engagement with outreach teams. AIMS: To explore the views of disengagement and engagement held by patients of assertive outreach teams. METHOD: In-depth interviews were conducted with 40 purposefully selected patients and analysed using components of both thematic analysis and grounded theory. RESULTS: Patients reported a desire to be independent, a poor therapeutic relationship and a loss of control due to medication effects as most important for disengagement. Time and commitment of staff, social support and engagement without a focus on medication, and a partnership model of the therapeutic relationship were most relevant for engagement. CONCLUSIONS: The findings underline the importance of a comprehensive care model, committed staff with sufficient time, and a focus on relationship issues in dealing with 'difficult to engage' patients.

Adult↗
PubMed2004

Engaging in activities involving information technology: dimensions, modes, and flow.

An engagement mode involves a subject (e.g., a user of information technology, or IT) who is engaged in an activity with an object in a certain manner (the mode). The purpose of this study is to develop a general model of engagement modes that may be used for understanding how IT-related activities are shaped by properties of the user and the IT object. A questionnaire involving items on IT engagement and the experience of flow was administered to 300 participants. The results supported an engagement mode (EM) model involving 5 different engagement modes (enjoying/acceptance, ambition/curiosity, avoidance/hesitation, frustration/ anxiety, and efficiency/productivity) characterized on 3 dimensions (evaluation of object, locus of control between subject and object, and intrinsic or extrinsic focus of motivation). The flow experience follows from a balance between enjoying/ acceptance and efficiency/productivity propelled by ambition/curiosity. The EM model could provide a platform for considering how IT users, IT applications, and IT environments should work together to yield both enjoyment and efficiency. Actual or potential applications of this research include designing IT training programs on different levels of specificity.

Adult↗
PubMedDate not supplied

Creating a safe passage: the meaning of engagement for nurses caring for children and their families.

The purpose of this study was to uncover the meaning of engagement for nurses who care for children and their families. This study employed a hermeneutic-phenomenological methodology as specified by van Manen (1984, 1990) and Ray (1991). A convenience sample consisted of eight nurses who worked in a pediatric ambulatory care setting. Data were generated from audiotaped interviews and journaling. The first level of reflection revealed the themes and metathemes of the meaning of engagement: Making Connection: Becoming Aware of the Person; Perceiving the Other: Developing and Nurturing the Relationship; A Sense of Investment: Unfolding From Commitment; and Remaining Distant: Choosing Not To Engage. In the second level of reflection selected literature further illuminated the meaning of engagement. Through deeper reflection, the metaphor Creating a Safe Passage surfaced to capture the meaning of engagement. This research supports the transformation of health care delivery toward a greater emphasis on the caring relationship. Findings illuminate specific characteristics of an engaged relationship. Implications for sensitizing health care professionals in practice, education, and research are described.

Adult↗
PubMed2004

Haemophilus influenzae type b-outer membrane protein complex glycoconjugate vaccine induces cytokine production by engaging human toll-like receptor 2 (TLR2) and requires the presence of TLR2 for optimal immunogenicity.

Conjugate vaccines consisting of the capsular polysaccharide (PS) of Haemophilus influenzae type b (Hib) covalently linked to carrier proteins, unlike pure PS, are immunogenic in infants and have significantly reduced Hib infections in the United States, but require multiple doses to induce protective anti-PS Ab titers. Hib-meningococcal outer membrane protein complex (OMPC) conjugate vaccine, however, elicits protective anti-PS Ab titers after one dose. We found that OMPC and Hib-OMPC engaged human Toll-like receptor 2 (TLR2) expressed in human embryonic kidney (HEK) cells, inducing IL-8 production, and engaged mouse TLR2 on bone marrow-derived dendritic cells, inducing TNF release. Hib conjugated to the carrier proteins CRM(197) and tetanus toxoid did not engage TLR2 on HEK or dendritic cells. Engagement of TLR2 by Hib-OMPC was MyD88 dependent, as Hib-OMPC-induced TNF production was ablated in MyD88 knockout (KO) mice. Hib-OMPC was significantly less immunogenic in TLR2 KO mice, inducing lower Hib PS IgG and IgM titers compared with those in wild-type mice. Splenocytes from OMPC-immunized TLR2 KO mice also produced significantly less IL-6 and TNF-alpha than those from wild-type mice. Hib-OMPC is unique among glycoconjugate vaccines by engaging TLR2, and the ability of Hib-OMPC to elicit protective levels of Abs after one dose may be related to TLR2-mediated induction and regulation of cytokines produced by T cells and macrophages in addition to the peptide/MHC II-dependent recruitment of T cell help commonly afforded by carrier proteins. TLR2 engagement by an adjuvant or carrier protein may be a useful strategy for augmentation of the anti-PS Ab response induced by glycoconjugate vaccines.

Adaptor Proteins, Signal Transducing↗
PubMed2006

Do burned-out and work-engaged employees differ in the functioning of the hypothalamic-pituitary-adrenal axis?

OBJECTIVES: The central aim of the present study was to examine differences in the functioning of the hypothalamic-pituitary-adrenal (HPA) axis between 29 burned-out, 33 work-engaged, and 26 healthy reference managers, as identified with the Maslach Burnout Inventory-General Survey and the Utrecht Work Engagement Scale. METHODS: All of the managers were employed in a large Dutch telecommunications company. Salivary cortisol was sampled on three consecutive workdays and one nonworkday to determine the cortisol awakening response. Salivary dehydroepiandrosterone-sulfate (DHEAS), a cortisol counterbalancing product of the HPA axis, was measured on these days 1 hour after managers awakened. The dexamethasone suppression test was used to investigate the feedback sensitivity of the HPA axis. RESULTS: The morning cortisol levels were higher on the workdays than on the nonworkday, but this effect did not differ between the three groups. The burned-out, work-engaged, and reference groups did not differ in the cortisol and DHEAS levels, the slope of the cortisol awakening response, and the cortisol : DHEAS ratio. The work-engaged group showed a stronger cortisol suppression in response to the dexamethasone suppression test than the other two groups, the finding suggesting higher feedback sensitivity among work-engaged managers. CONCLUSIONS: Burned-out and work-engaged managers only differ marginally in HPA-axis functioning.

Adult↗
PubMedDate not supplied

Engagement-involvement and blood pressure change: a methodological inquiry.

In a study that examined further Singer's model of engagement-involvement in a community nursing setting, 31 black inner-city women conversed informally with a nurse while their blood pressure was monitored at two-minute intervals using a Hoffman-LaRoche Arteriosonde. Type A (coronary-prone) and hypertensive subjects were judged to not display greater engagement than type B and normotensive subjects, respectively. Within-subject correlations between observers' ratings of engagement and blood pressure showed substantial differences across subjects. Nevertheless, for correlations based on engagement judgments corresponding to the minute immediately preceding the blood pressure determination the mean within-subject values ranged from .14 to .32 (mean = .20) and were all significantly different from zero. Attention is directed to the need for refining the criteria used for judging engagement and to identifying patients for whom increased engagement may invalidate blood pressure measurements in a clinical setting.

Blood Pressure↗
PubMed1999

Serial TCR engagement and down-modulation by peptide:MHC molecule ligands: relationship to the quality of individual TCR signaling events.

In the present study, we examined the relationships among quantitative aspects of TCR engagement as measured by receptor down-modulation, functional responses, and biochemical signaling events using both mouse and human T cell clones. For T cells from both species, ligands that are more potent in inducing functional responses promote TCR down-modulation more efficiently than weaker ligands. At low ligand density, the number of down-modulated TCR exceeds the number of available ligands by as much as 80-100:1 in the optimal human case, confirming the previous description of serial ligand engagement of TCR (Valitutti, et al. 1995. Nature 375:148-151). A previously unappreciated relationship involving TCR down-modulation, the pattern of proximal TCR signaling, and the extent of serial engagement was revealed by analyzing different ligands for the same TCR. Functionally, more potent ligands induce a higher proportion of fully tyrosine phosphorylated zeta-chains and a greater amount of phosphorylated ZAP-70 than less potent ligands, and the number of TCR down-modulated per available ligand is higher with ligands showing this full agonist-like pattern. The large number of receptors showing partial zeta phosphorylation following exposure to weak ligands indicates that the true extent of TCR engagement and signaling, and thus the amount of sequential engagement, is underestimated by measurement of TCR down-modulation alone, which depends on full receptor activation. These data provide new insight into T cell activation by revealing a clear relationship among intrinsic ligand quality, signal amplification by serial engagement, functional T cell responses, and observable TCR clearance from the cell surface.

Amino Acid Sequence↗
PubMed1997

Drop-out and failure to engage in individual outpatient cognitive behavior therapy for bulimic disorders.

OBJECTIVE: It was the aim of this study to explore the characteristics of bulimics who fail to complete therapy. Noncompleters were divided into those who failed to engage and those who dropped out, so that these groups could be directly compared. METHOD: Participants were 50 women (bulimia nervosa or anorexia nervosa of the bulimic subtype) recruited from a case series of referrals to an eating disorders clinic, who were offered individual cognitive-behavior therapy. The women (28 completers; 7 failure to engage; 15 drop-outs) were compared on standardized measures of eating, psychological, and family characteristics. RESULTS: The noncompleting groups both had high levels of borderline psychopathology and more severe perceived bulimic characteristics than the completers. However, the "drop-out" and "failures to engage" had very different patterns of perceived family emotional involvement, with the failures to engage reporting relatively healthy functioning. DISCUSSION: Our understanding of the eating disorders (and of the effectiveness of treatment) is skewed by the nature of the samples involved. The characteristics of noncompleters could be used at initial assessment to target clinical work towards lowering rates of drop-out and failure to engage.

Adaptation, Psychological↗
PubMed2003

Intrapartum assessment of fetal head engagement: comparison between transvaginal digital and transabdominal ultrasound determinations.

OBJECTIVE: To test the null hypothesis that no correlation exists between transvaginal digital examination and the gold standard technique of intrapartum transabdominal ultrasound determination of fetal head engagement, and secondarily to compare the performance of attending physicians and senior residents in depicting fetal head engagement by transvaginal digital examination. METHODS: Two hundred and twenty-two consecutive patients in labor > 37 weeks' gestation with normal singleton cephalic-presenting fetuses and with either ruptured or intact membranes were included. Of these, 119 were nulliparous and 103 were multiparous. Transvaginal digital examinations were performed by either attending physicians or senior residents and were followed immediately by transverse suprapubic sonographic assessments by a single sonographer. The fetal head was considered engaged on transvaginal digital examination if the leading part of the fetal head was positioned at least at maternal ischial spine station 0, and on transverse suprapubic ultrasound if the fetal biparietal diameter was below the maternal pelvic inlet. Examiners were blinded to each other's findings and the effect of examiner experience on the rate of agreement between the two techniques was assessed. The effect of several other independent variables upon the rate of agreement between the two modalities was also assessed. RESULTS: Overall, transvaginal digital examinations were consistent with ultrasound determinations with a raw percent agreement rate of 85.6% (95% confidence interval (CI), 80.8-90.3); kappa = 69.5% (95% CI, 59.4-73.9; P < 0.001). When stratified according to parity, the raw percent agreement rate for nulliparous patients was 81.5% (95% CI, 73.4-88.0); kappa = 60.7% (95% CI, 45.9-64.1; P < 0.001), and for multiparous patients it was 90.3% (95% CI, 84.1-95.9); kappa = 80.4% (95% CI, 63.0-87.5; P < 0.001). Maternal age, gravidity, maternal body mass index, gestational age, cervical dilatation, effacement, membrane status, ischial spine station of the fetal head, fetal head position at ultrasound assessment, birth weight and mode of delivery did not significantly affect rate of agreement. Parity did not affect examination consistency in multiparous patients, but in the whole group increasing parity increased the rate of agreement between modalities. Presence of combined spinal epidural anesthesia significantly increased the rate of agreement in the complete group and among multiparous but not among nulliparous patients. CONCLUSION: These data demonstrate a high rate of agreement (85.6%) between ultrasound determination and transvaginal digital assessment of fetal head engagement. Examiner experience had no effect. These data support the use of intrapartum transabdominal assessment of fetal head engagement.

Adult↗
PubMed2005

Emotional engagement in professional ethics.

Recent results from two different studies show evidence of strong emotional engagement in moral dilemmas that require personal involvement or ethical problems that involve significant inter-personal issues. This empirical evidence for a connection between emotional engagement and moral or ethical choices is interesting because it is related to a fundamental survival mechanism rooted in human evolution. The results lead one to question when and how emotional engagement might occur in a professional ethical situation. However, the studies employed static dilemmas or problems that offered only two choices whose outcome was certain or nearly so, whereas actual problems in professional ethics are dynamic and typically involve considerable uncertainty. The circumstances of three example cases suggest that increasing personal involvement and uncertainty could have been perceived as changes, threats, or opportunities and could therefore have elicited an emotional response as a way to ensure the reputation, integrity or success of oneself or a group to which one belongs. Such emotional engagement is only suggested and more studies and experiments are required to better characterize the role of emotional engagement in professional ethics.

Decision Making↗