Power and sample size calculations for cluster randomized trials with binary outcomes when intracluster correlation coefficients vary by treatment arm

The Effect of School-Linked Module-Based Friendly-Health Education on Adolescents' Sexual and Reproductive Health Knowledge, Guji Zone, Ethiopia - Cluster Randomized Controlled Trial

Background

Although access to sexual and reproductive health information is the right and a critical component of health policy, it is not well addressed in pastoral communities. This study assessed the effect of School-Lined Module-based friendly health education on adolescents' sexual and reproductive health knowledge in the pastoral community of Guji Zone, Ethiopia.

Methods

A two-arm cluster Randomized control trial study with pre-post evaluation was conducted among interventions (n=375) compared with control (n=384) in Gorodola and Wadara high schools. Comparing an intervention to a control group, pre-posttests, and post-posttests were used to evaluate the effectiveness of the intervention. The data was collected using 25 Self-administered questionnaires and analyzed using paired-sample independent t-tests and linear regressions to study the relationship between the outcome and independent variables.

Results

We collected the data from 759 adolescents among 15 intervention and 15 control clusters. The results have shown that as compared to control arms, the mean sexual and reproductive health Knowledge score was significant higher in the intervention clusters (375) 73.3%, vs (384) 66.5%%, p<0.001, 95% CI, (0.05395-0.08347). Information (β: 0.038, 95% CI: 0.028-0.052), confidence (β: 0.045, 95% CI: 0.033-0.057), knowledge (β: 0.05, 95% CI: 0.035-0.066), and compassionate care (β: 0.107, 95% CI: 0.092-0.122) were significantly associated with SRH knowledge prediction. The proportion of SRH knowledge increased from 168(44%) baseline to 244(65%) end line in the intervention versus 235(60% to 238(62%) in control arms.

Conclusion

The execution of school-linked module-based friendly health education has proved to have a significant effect on mean SRH knowledge. Individual-level and behavioral-level factors significantly explain variability in enhancing SRH knowledge in the pastoral community. We recommend scaling up the School-Linked Module-based friendly health education intervention.

Trial Registration

We registered clinical trial PACTR202107905622610 on 16 July 2021.

Effect of a school-linked life skills intervention on adolescents' sexual and reproductive health skills in Guji zone, Ethiopia (CRT)-A generalized linear model

Background

Although appropriate life skills are recognized as a fundamental right for adolescents and a critical component of health policy, they are often overlooked and rarely researched in pastoral communities. Life skills encompass the ability to adopt positive behaviors, which enable individuals to effectively deal with the demands and challenges of everyday life. This study aimed to evaluate the effectiveness of a school-linked life skills intervention program on adolescents' sexual and reproductive health skills in the pastoral community of Guji zone.

Methods

A two-arm cluster randomized control trial with a pretest-posttest experimental design was conducted, involving the intervention group (N = 375) and the control group (N = 384). This study assessed the effect of a school-linked adolescent-friendly life skills intervention in comparison to the usual RH curriculum, used as a control arm. Pretest-posttest and posttest-posttest scores of the control group and trial groups were compared, and the data were collected using 27 self-administered questions. The collected data were analyzed using paired-sample independent t-tests and a generalized linear model to examine the relationship between the dependent and independent variables.

Results

Data were collected from 759 adolescents in 15 intervention and 15 control clusters. The findings have shown that the proportion of mean life skills score was significantly higher in the intervention clusters than controls [(375) 70.49% vs. (384) 62.25%, P < 0.001 95% CI (0.06 and 0.1)]. Adolescents who were trained in school-linked life skills (β = 1.915, 95% CI: 1.411-2.418), were confident to make safe and informed decisions (β = 1.999, 95% CI: 1.562-2.436), and had life skills to deal with SRH issues (β = 1.66, 95% CI: 1.233-2.087) were significantly correlated with predicting the relevant life skills. The proportion of adolescents with SRH life skills increased from 384 (52%) at baseline to 375 (70%) at end line in the intervention group compared to 384 (60.31%) at baseline to 384 (62.31%) in control arms, respectively.

Conclusions

The implementation of a school-linked life skills intervention program proved to have a significant effect on SRH life skills development. Furthermore, individual-level and behavioral-level variables were significant in explaining variability in life skills development within the pastoral community. Therefore, we recommend scaling up this intervention in all high schools.

Trial registration

Trial registration PACTR202107905622610, registered on 16 July 2021.

Evaluating person-centered care in residential care facilities from the perspective of caregivers in South Korea: a survey

BACKGROUND

As many older people spend their time in residential care facilities, the demand for person-centered care (PCC), which affects their quality of life, is increasing. Many residential care facility residents have cognitive problems, such as dementia and strokes. Providing quality care upholds their rights as human beings. Currently, the PCC tools used in South Korea are only translations of foreign tools into Korean, so it is necessary to develop tools for older adult care facilities that reflect the reality of Korean care facilities for older adults. This study aims to develop a tool for measuring PCC in residential care facilities for older people from the perspectives of care givers.

METHODS

The draft of 34 questions was developed through literature reviews, interviews with LTC practitioners and researchers. This developed questionnaire was then administered to 402 direct caregivers working in the residential care facilities because many of the residents had cognitive problems. By measuring the interrater reliability, the items with high levels of agreement were selected and the validity of the construct was checked through factor analysis. To determine whether the domains adequately measured each concept, we calculated correlation coefficients and Cronbach's α.

RESULTS

Four domains and 32 items concerning service conditions, resident's right to self-determination, a comfortable living environment for all residents, and resident and staff satisfaction are derived, thus explaining 24.7%, 23.6%, 14.6%, and 8.00% of the total variance, respectively. Cronbach's alphas for each domain are 0.965, 0.948, 0.652, and 0.525, respectively, thus demonstrating internal consistency. The inter-rater agreement is high (66.7%~100.0%). The correlation between service conditions and resident's right to self-determination (r = 0.643, p < 0.001), a comfortable living environment for all residents, resident and staff satisfaction (r = 0.674, p < 0.001), and resident's right to self-determination and comfortable living environment (r = 0.695, p < 0.001) is strong.

CONCLUSIONS

It is important that caregivers recognize PCC and provide services. When evaluating the residential care services, measuring the degree of PCC should be made compulsory. If the facility becomes more person-centered, it will be possible to promote quality of life for older people.

TRIAL REGISTRATION

Not applicable.