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The impact of recipient choice on aid effectiveness.

ABSTRACT: This study compares the impact of several common development programs (agricultural extension, subsidized agricultural inputs and poultry transfers) to cash transfers equal to the cost of each program. Prior to program delivery, recipients were asked their valuation for each program (i.e., their cash indifference point between cash and the program) as a proxy for their preference between cash and the program. Subsequently, recipients were randomly assigned to receive cash or a program. Six months after delivery of cash and programs, we do not find that individuals who receive the intervention they value most are different from others in terms of consumption, food security, assets, psychological well-being or feelings of autonomy, and can rule out effects of any meaningful size. When comparing cash transfers directly to common development programs, the point estimates indicate no difference in impacts and confidence intervals rule out large differences. We do find that cash transfers increase feelings of autonomy and respect compared to non-cash interventions.

SUBMITTER: Shapiro J

PROVIDER: S-EPMC6358116 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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The impact of recipient choice on aid effectiveness.

Shapiro Jeremy J

World development 20190401

This study compares the impact of several common development programs (agricultural extension, subsidized agricultural inputs and poultry transfers) to cash transfers equal to the cost of each program. Prior to program delivery, recipients were asked their valuation for each program (i.e., their cash indifference point between cash and the program) as a proxy for their preference between cash and the program. Subsequently, recipients were randomly assigned to receive cash or a program. Six month ...[more]

PMID: 30944504

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Project description:BackgroundCare-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial.MethodIn this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months.Main outcome measuresShort Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost.ResultsWe randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1.ConclusionThe results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible.Trial registrationUMIN Clinical Trials Registry UMIN000012994.

Project description:Blunt head trauma is a common cause of death and disability in children worldwide. Cranial computed tomography (CT), the reference standard for the diagnosis of traumatic brain injury (TBI), exposes children to ionizing radiation which has been linked to the development of brain tumors, leukemia, and other cancers. We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home.This is a protocol for a multicenter clinician-level parallel randomized trial to compare an intervention group receiving a decision aid, 'Head CT Choice', to a control group receiving usual care. The trial will be conducted at five diverse emergency departments (EDs) in Minnesota and California. Clinicians will be randomized to decision aid or usual care. Parents visiting the ED with children who are less than 18-years-old, have experienced blunt head trauma within 24 hours, and have one or two risk factors for clinically-important TBI (ciTBI) from the Pediatric Emergency Care Applied Research Network head injury clinical prediction rules will be eligible for enrollment. We will measure the effect of Head CT Choice on: (1) parent knowledge regarding their child's risk of ciTBI, the available diagnostic options, and the risks of radiation exposure associated with a cranial CT scan (primary outcome); (2) parent engagement in the decision-making process; (3) the degree of conflict parents experience related to feeling uninformed; (4) patient and clinician satisfaction with the decision made; (5) the rate of ciTBI at seven days; (6) the proportion of patients in whom a cranial CT scan is obtained; and (7) seven-day healthcare utilization. To capture these outcomes, we will administer parent and clinician surveys immediately after each clinical encounter, obtain video recordings of parent-clinician discussions, administer parent healthcare utilization diaries, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up.This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in parents of children with minor head trauma in five diverse EDs.ClinicalTrials.gov registration number: NCT02063087. Registration date February 13, 2014.

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The impact of recipient choice on aid effectiveness.

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The impact of recipient choice on aid effectiveness.

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