Recent Efficacy Studies

Physical & Emotional Well-being Research

Sedentary Older Adults Benefit From ORCAS Physical Activity Program: Randomized Controlled Trial
ORCAS on-line program improves physical activity of sedentary older adults.

  • In a randomized trial, treatment participants maintained significant gains in all 14 outcomes after 6 months.
  • Results suggest that an online PA program can positively impact the physical activity of sedentary older adults

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Research Abstract

Web-based Intervention to Promote Physical Activity by Sedentary Older Adults

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Background: Physical activity (PA) for older adults has well-documented physical and cognitive benefits, but most seniors do not meet recommended guidelines for PA, and interventions are lacking.

Objectives: This study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen.

Methods: A total of 368 sedentary men and women (M=60.3; SD 4.9) were recruited, screened, and assessed online. They were randomized into treatment and control groups and assessed at pretest, at 12 weeks, and at 6 months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included ongoing problem solving to overcome user-identified barriers to exercise.

Results: The multivariate model indicated significant treatment effects at posttest (P=.001; large effect size) and at 6 months (P=.001; medium effect size). At posttest, intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants. At 6 months, treatment participants maintained large gains compared to the control participants on all 14 outcome measures.

Conclusions: These results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants. More research is needed to replicate the study results, which were based on self-report measures. Research is also needed on intervention effects with older populations.

Irvine A.B, Gelatt VA, Seeley JR, Macfarlane P, Gau JM.Web-based Intervention to Promote Physical Activity by Sedentary Older Adults: Randomized Controlled Trial, J Med Internet Res 2013;15(2):e19

ORCAS Develops Internet Tool Proven to Normalize Grief

In scientific testing, ORCAS internet self-help tool was proven to normalize grief.
  • The interactive program educates and supports the recently bereaved (1-6 months).
  • Treatment participants reported significant gains in multiple areas.
  • Study findings suggest the potential efficacy of an Internet-based grief support tool to support the recently bereaved.

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Research Abstract

An Internet Tool to Normalize Grief

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This research evaluated the efficacy of a psycho-educational Internet self help tool to educate and support recently (1-6 months) bereaved individuals. The goal of the website was to help users normalize their grief to enhance their adaptive adjustment. A randomized controlled trial evaluated the gains in social cognitive theory constructs and state anxiety. Compared to the control group (N = 34), treatment participants (N = 33) reported significant multivariate gains (eta-square = .191). Significant program effects were obtained on all three outcome measures: attitude (eta-square = .177), self-efficacy (eta-square = .106), and state anxiety (eta-square = .083). These findings suggest the potential efficacy of an Internet-based grief support tool to enhance adaptive adjustment of the bereaved.

Dominick, S. A., Irvine, A. B., Beauchamp, N., Seeley, J. R., Nolen-Hoeksema, S., & Doka, K. J. (2009). An Internet Tool to Normalize Grief. Journal of Death and Dying, 60(1), 71-87.

ORCAS “Get Moving” Website Proven to Encourage Physical Activity
ORCAS “Get Moving” website was scientifically tested and proven to increase the physical activity in sedentary individuals at worksites.
  • Compared with the control group, the treatment group showed significant improvement in physical activity and ten other measures.
  • Multiple visits to the website provided more improvement than one-time visits.

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Research Abstract

A Web Program that Improves Sedentary Employee Exercise Behavior

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Purpose: Develop and test a Web site to encourage physical activity (PA) by sedentary workers.

Design: Randomized control design with 30-day follow-up. Setting. Large manufacturing plant.

Subjects; Included 221 workers; average body mass index was 29.5. Intervention. Get Moving was a repeat-visit Web site providing information and support to develop a personalized PA plan.

Measures: Self-reported: PA, depression, anxiety, stage of change, attitudes, knowledge, self efficacy, intention, perceived barriers to PA, and motivation.

Analysis: Multivariate analysis of covariance and univariate analysis of covariance models were used to compare the two study conditions on posttest outcomes, controlling for baseline levels.

Results: Compared with the control group, the treatment group showed significant improvement. The multivariate test was significant (p , .001), with a large effect size (g25 .42). The treatment group differed significantly from the control participants on 11 outcomes (p , .005), with large effect sizes for PA status, min/day, and knowledge, attitudes, and behavioral intention. Medium effect sizes were measured for perceived barriers, depressive symptoms, motivation, and self-efficacy. Multiple visits resulted in significantly improved PA, motivation, self-efficacy, and intention, compared with one-time visits.

Conclusions: The Get Moving Web site had positive effects and was well received. Intervention Web sites have potential to increase the PA of sedentary individuals in worksites and elsewhere, but more research is needed into mediators of Web-based interventions.

Irvine, A. B., Philips, L., Duncan, S., Seeley, J., Wyant, R., & Moore, R. W. (2011). A web program that improves sedentary employee exercise behavior. Am J Health Promotion, 25(3), 199-206. doi: 10.4278/ajhp.04121736

Condition & Self-Management Research

Sports Concussion Training for Youth Coaches Proven Effective
ORCAS online sports concussion program for youth coaches tested to be effective at
  • Increasing coaches’ knowledge about sports concussions including management and prevention
  • Increasing coaches’ intentions to identify and address sports concussions
  • Increasing coaches’ confidence in effectively addressing concussions

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Research Abstract

Online Training in Sports Concussion for Youth Sports Coaches

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The purpose of this study was to evaluate ACTive: Athletic Concussion Training using Interactive Video Education, an interactive e-learning program designed to train community coaches of youth ages 10–18 in effective sports concussion prevention and management practices. Seventy-five youth sports coaches from across the country completed the study over the Internet. Results of a randomized control trial demonstrated significant differences between treatment and control participants on measures of: (a) knowledge about sports concussion, management, andprevention; (b) attitudes about the importance of preventing sports concussion; and (c) intention and self-efficacy in sports concussion management and prevention. The results suggest that ACTive is an effective method of training youth sports coaches who are in an important position to reduce risks associated with sports concussion.

Keywords: Coach Education, E-Learning, Traumatic Brain Injury

Glang, A., Koester, M., Vondy Beaver, S., Clay, J., & McLaughlin, K. (2010). Online training in sports concussion for youth sports coaches. International Journal of Sports Science and Coaching, 5(1), 1-12.

Interactive Program Effectively Teaches Bicycle Safety
ORCAS “Bike Smart” interactive program teaches bicycle safety behaviors to young children.
  • Regardless of gender, cohort, and grade the participants in the treatment group learned bicycle safety and correct helmet use from the program.
  • Findings suggest that the Bike Smart program can be a low cost, effective component of safety training.

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Research Abstract

The Effectiveness of a Bicycle Safety Program for Improving Safety-Related Knowledge and Behavior in Young Elementary Students

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Objective: The purpose of this study was to evaluate the ‘‘Bike Smart’’ program, an eHealth software program that teaches bicycle safety behaviors to young children.

Methods: Participants were 206 elementary students in grades kindergarten to 3. A random control design was employed to evaluate the program, with students assigned to either the treatment condition (Bike Smart) or the control condition (a video on childhood safety). Outcome measures included computer-based knowledge items (safety rules, helmet placement, hazard discrimination) and a behavioral measure of helmet placement.

Results: Results demonstrated that regardless of gender, cohort, and grade the participants in the treatment group showed greater gains than control participants in both the computer-presented knowledge items (p>.01) and the observational helmet measure (p>.05).

Conclusions: Findings suggest that the Bike Smart program can be a low cost, effective component of safety training packages that include both skills-based and experiential training.

Keywords: accidents and injuries; children; computer applications/eHealth; educational interventions; health promotion and prevention; randomized control trial.

McLaughlin, K. A., & Glang, A. (2010). The effectiveness of a bicycle safety program for improving safety-related knowledge and behavior in young elementary students. Journal of Pediatric Psychology, 35(4), 343-353. doi: jsp076 [pii] 10.1093/jpepsy/jsp076

Interactive Multimedia Program Effectively Teaches Pedestrian Skills to Young Children
ORCAS interactive program uses animation and video to teach children critical skills for safely crossing streets.
  • Significant effects were found on the computer-delivered and behavioral measures.
  • Findings suggest children can use the interactive program to learn traffic safety and transfer that knowledge to real-life environments.

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Research Abstract

Using Interactive Multimedia to Teach Pedestrian Safety: An Exploratory Study

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Objectives: To evaluate an interactive multimedia (IMM) program that teaches young children safe pedestrian skills.

Methods: The program uses IMM (animation and video) to teach children critical skills for crossing streets safely. A computer-delivered video assessment and a real-life street simulation were used to measure effectiveness of the program in teaching safe street-crossing skills.

Results: Significant effects were found on the computer-delivered and behavioral measures.

Conclusion: Findings suggest that children can learn to discriminate dangerous elements in traffic situations using the IMM program and transfer that knowledge to real-life environments.

Keywords: interactive multimedia, pedestrian safety, safety education, child safety

Glang, A., Noell, J., Ary, D., & Swartz, L. (2005). Using interactive multimedia to teach pedestrian safety: an exploratory study. Am J Health Behav, 29(5), 435-442. doi: 10.5555/ajhb.2005.29.5.435

Interactive Program for Step Families Positively Influences Family Functioning
An interactive, web-based program for step families from ORCAS was evaluated for efficacy.
  • Program uses behavior-modeling videos to demonstrate effective couple, parenting, and step parenting practices.
  • Participation in the stepfamily education program positively influenced several key areas of parenting and family functioning at post-program and follow-up.

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Research Abstract

An Interactive Web-Based Program for Parents in Stepfamilies: Development and Evaluation of Efficacy

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This study evaluated the efficacy of a family life education program for step families that is self-administered, interactive, and web-based. The program uses behavior-modeling videos to demonstrate effective couple, parenting, and step parenting practices. A diverse sample of 300 parents/stepparents of a child aged 11 – 15 years were randomized into either treatment or delayed-access control groups. Findings suggest that participation in the step family education program positively influenced several key areas of parenting and family functioning at post-program and follow-up. No gender differences were noted in the findings.

Keywords: at-risk children and families, divorce and remarriage, family life education, family stress and conflict, stepparent education.

Gelatt, V. A., Adler-Baeder, F., & Seeley, J. R. (2010). An interactive web-based program for parents in stepfamilies: Development and evaluation of efficacy. Family Relations, 59(5), 572-586. doi: 10.1111/j.1741-3729.2010.00624.x

Professional Caregiver Training Research

Aggressive Behaviors Training

Research clearly shows that Nurse Aides (NAs) in nursing homes are often subjected to verbal and physical assaults by residents, but staff are not trained to deal with resident aggression.  In response, ORCAS developed a Web-based training program to help NAs prevent or if necessary deal safely with assaults by residents. The research below demonstrates that our Web-based training is an effective approach to shaping appropriate reactions to aggressive resident behaviors.

National Internet Study Shows Online Aggressive Resident Behavior Training Effective for Nurse Aids
Results published in The Gerontologist demonstrate improved caregiver communication and response skills.
  • Training uses video modeling and quizzes with remediation to build knowledge and confidence in communicating with challenging residents.
  • Nurse aides completed four online courses—two on fundamental skills and two on advanced skills.
  • Randomized trial found significant positive effects on knowledge, attitudes, self-efficacy and behavioral intention after eight weeks, with large effect sizes.

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Research Abstract

Internet Training to Respond to Aggressive Resident Behaviors

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Purpose: This research evaluated an individualized Internet training designed to teach nurse aides (NAs) strategies to prevent or, if necessary, react to resident aggression in ways that are safe for the resident as well as the caregiver.

Design and Methods: A randomized treatment and control design was implemented, with baseline, 1-, and 2-month assessments for 158 NAs. The training involved 2 weekly visits. The Internet intervention was a behaviorally focused and video-based training that included content on skills for safely dealing with physical aggression. Measures included video situation testing and assessment of psychosocial constructs associated with behavior change.

Results: Analysis of covariance showed positive results for knowledge, attitudes, self-efficacy, and empathy, with medium–large effect sizes maintained after 2 months. The training was well received by participants.

Implications: Internet training is a viable approach to shape appropriate NA reactions to aggressive resident behaviors. This format has future potential because it offers fidelity of presentation and automated documentation, with minimal supervision.

Key words: Resident aggression, Training, Internet, Nurse aides, Long-term care

Irvine, A.B., Billow, M.B, Gates, D., Fitzwater, E., Seeley, J.R., & Bourgeois, M (2012). Internet Training to Respond to Aggressive Resident Behaviors. The Gerontologist, 52(1), 13-23. doi10.1093/geront/gnr069

Nursing Home Study: Training Reduces Assaults By Residents
ORCAS study demonstrates effectiveness of web-based aggressive resident behavior training
  • The same Internet program shown effective with a national sample of CNAs on the Web (above), was used to train CNAs in 6 nursing homes.
  • In a randomized trail, analysis showed significant training effects resulting in a decrease in resident assaults after 16 weeks.
  • Training effects improved over time as users gained experience using the techniques.

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Research Abstract

An Internet Training to Reduce Assaults in Long Term Care

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Physical and verbal assaults by residents on care staff are not uncommon in long-term residential care facilities (LTCs). This research evaluated an Internet training designed to teach Nurse Aides (NAs) strategies to work with aggressive resident behaviors. Six LTCs were randomized in an immediate treatment (IT) and delayed treatment (DT) design, and NAs were recruited in each (IT: n = 58; DT; n = 45). The treatment involved two weekly visits to the on-line training. Hard copy assessments collected participant responses at baseline (T1), 8 weeks (T2), and at 16 weeks (T3). The DT group viewed the program after T2. HLM models show significant group differences at T2 in knowledge and the levels were maintained at T3. The number of aggressive incidents reported per day by the IT group were non-significant at T2, but decreased significantly from T1 to T3 with a very large effect size. The program was well received by users. These results suggest that the Internet training was an effective tool to reduce assaults in LTCs, and training effects may improve over time as NAs gain experience using the techniques.

Keywords: resident aggression, training, Internet, Nurse Aides, long term care, nursing homes

Irvine, A. B., Billow, M., Gates, D., Fitzwater, E., Seeley, J. R., & Bourgeois, M. (2012). An internet training to reduce assaults in long term care. Geriatric Nursing, 33(1), 28-40. doi: 10.1016/j.gerinurse.2011.10.004,

Mental Illness Behaviors Training
While mental illness is a problem in nursing homes, care workers are not trained to deal with it. In response, ORCAS developed a Web-based training program for nursing home workers. Three program evaluations below establish the efficacy of our Internet training to help care staff respond appropriately to challenging behaviors related to mental illness.

National Internet Study: Mental Illness Training for Nursing Staff
ORCAS conducts randomized trial to show effectiveness of web-based mental illness training program.
  • The fully developed internet-based training utilizes video modeling for communication skill building, and self quizzes with remediation for knowledge building.
  • Licensed care staff (76% RNs and LPNs) recruited on the Internet were shown two courses that provided fundamental skills, and two courses that provided advance-skills.
  • In a randomized trail, ANCOVA analysis showed significant positive effects at 2 month follow-up, with medium-large effect sizes, and the training was well received by the users.

Research Abstract & Full Article »

Research Abstract

Mental Illness Training for Licensed Staff in Long Term Care

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Licensed care staff working in long term care facilities may be poorly prepared to work with residents with mental illness. This research reports on the program evaluation of Caring Skills: Working with Mental Illness, a training program delivered on the Internet. It was tested with a randomized treatment-control design, with eight week follow-up. The training provided video-based behavioral skills and knowledge training. Measures included video situations testing and assessment of psycho-social constructs associated with behavior change. ANCOVA analysis at posttest and one-month follow-up showed significant positive effects, with medium-large effect sizes. The training was well-received by the users.

Keywords: Mental Illness, Internet, training, nurses, education, behaviors, communication, long term care.

Irvine, A. B., Billow, M. B., Eberhage, M. G., Seeley, J. R., McMahon, E., & Bourgeois, M. (in press). Mental illness training for licensed staff in long term care. Issues in Mental Health Nursing.

Nursing Home Study: Mental Illness Training for All Direct Care Staff
ORCAS evaluation of web-based mental illness training program shows large effects.
  • The same internet program shown effective with Licensed care workers (above), was used to train all CNAs in 3 nursing homes.
  • Participants were shown two courses that provided fundamental skills, and two courses that provided advance-skills.
  • Using a multiple baseline within-group design with three nursing homes, results indicated that for the entire sample, and for each site separately, significant positive change in self-efficacy and knowledge with a large effect size.

Manuscript in preparation.

Dementia Training
In spite of the growth of the training industry in the past decade, surveys of nursing aides (NAs) reveal increasing job dissatisfaction and turnover rates. NAs pointed to the need for more and better training programs, particularly for providing effective care to residents with cognitive impairments such as Dementia. In response, ORCAS developed a Web-based training program to help NAs use behavioral skills with residents exhibiting symptoms of dementia. The study below demonstrates that our Web-based training is an effective approach to shaping appropriate reactions to dementia-related behaviors.
Prototype Study: Professional Training Program Helps Care Workers Develop Communication Skills for Residents with Dementia
ORCAS tested an online dementia training program for professional caregivers in a randomized trial.
  • The program used video modeling with a mastery learning instructional design to provide behavioral skills training and knowledge building for Nurse Aids working with residents with dementia.
  • Analysis showed significant positive effects on knowledge, self-efficacy and behavioral intention.
  • The training was well received by Nurse Aides

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Research Abstract

An Interactive Multimedia Program to Train Professional Caregivers

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An interactive multimedia computer training program on CD-ROM was compared with a videotaped lecture-based training program for professional caregivers of patients with dementia. Both programs promoted use of appropriate communication skills including speaking skills, reacting skills, redirection skills, and use of communication cards for redirection. Professional and paraprofessional caregivers (N=88) were recruited as participants and randomly assigned to view one of the training programs. In a pretest-posttest design, participants rated caregiver responses in video vignettes of specific caregiving situations. At posttest, those who viewed the interactive program were significantly more likely to: (a) identify the correct responses, (b) intend to use correct strategies, and (c) have increased self-efficacy to use correct strategies, compared to participants who saw the videotaped lecture.

Keywords: computer training, staff training, in-service, dementia communication skills, interactive multimedia; CD-ROM, mastery learning

Irvine, A., Ary, D., & Bourgeois, M. (2003). An interactive multimedia program to train professional caregivers. Journal of Applied Gerontology, 22(2), 269-288.