Development and Evaluation of a Framework for Authentic Online Co-Design: Partnership-Focussed Principles-Driven Online Co-Design.

INTRODUCTION: Co-design in health research involves patient and public involvement and engagement (PPIE) in intervention or service design. Traditionally, co-design is undertaken in-person; however, exploring online delivery is warranted. PPIE in co-design must be considered carefully, and assumptions that in-person approaches will transition automatically to an online environment should be avoided. Currently, there are a lack of evidence-informed approaches to facilitating co-design online. This study aimed to develop and evaluate a framework for authentically adapting health research co-design into an online environment. MATERIALS AND METHODS: The initial framework was developed through a literature review, synthesis of in-person co-design principles, and alignment of online strategies. The framework was then applied to a co-design project with 10 participants across relevant PPIE groups (end-users [n = 4], clinicians [n = 2], coaches [n = 2] and clinician-researchers [n = 2]). Participants' experiences of the online co-design process were evaluated via a mixed-methods design using surveys and semi-structured interviews. Evaluation data were analysed using descriptive statistics and reflexive thematic analysis to inform a revised framework. RESULTS: The developed framework, Partnership-focussed Principles-driven Online co-Design (P-POD) was used to design eight 90 min online co-design workshops. Evaluation data involved 46 survey responses, and eight participants were interviewed on project completion. Survey data indicated that the process was satisfying, engaging and adhered to the P-POD framework. Themes derived from interview data describe a respectful and collaborative online culture, valuing of diverse perspectives and space for healthy debate, how power was perceived as being shared but not equal and multiple definitions of success within and beyond the process. A final, refined P-POD framework is presented. CONCLUSION: With evaluation of the initial P-POD framework showing evidence of adherence to co-design principles, positive participant experiences and goal achievement for both the project and the participants, the refined P-POD framework may be used and evaluated within future intervention or service design. PATIENT OR PUBLIC CONTRIBUTION: This study involved the participants (end-users, clinicians and service providers) in the co-design process described, interpretation of the results through member-checking interview responses, assisting in development of the final framework and as co-authors for this manuscript.

Charismatic Nonverbal Displays by Leaders Signal Receptivity and Formidability, and Tap Approach and Avoidance Motivational Systems.

Status cues and signals act as guidance systems by regulating social approach and avoidance. Applied to leadership, we hypothesized that nonverbal displays conveying the dual-status messages of receptivity and formidability and the approach/avoidance motives they activate set conditions for charismatic, leader-follower relationships. We investigated perceptions of charisma, the nonverbal signals associated with them, the motives they energize, and the relationships they support across levels of analysis. At the social-perceptual level (studies 1a-d), eligible voters rated political leaders' traits after viewing silent, 30-s videos of speeches presented online. As predicted, perceptions of politicians' receptivity (warmth and attractiveness) and formidability (competence and power) were independently associated with perceptions of their charisma; perceptions of trustworthiness and authenticity showed weaker or negligible associations. Results were similar when the stimuli were female, Jamaican educational leaders. Leaders' nonverbal behavior was linked to perceptions of their receptivity, formidability, and charisma in study 2. At the brain systems level, studies 3a and 3b tested predictions that charismatic nonverbal performances stimulate equivalent degrees of approach and avoidance motivation in observers. Brain recordings via electroencephalography (EEG) were made while undergraduates viewed leaders rated high or low in charisma. Discrepancies in alpha activity in the left and the right frontal hemispheres (associated with approach and avoidance, respectively) were relatively diminished when participants viewed highly charismatic political leaders, indicating that approach and avoidance motives are energized in response to charismatic performances. The EEG patterns for Jamaican leaders were similar but not significant. At the group level of analysis, study 4 sought evidence that charismatic leaders create uniquely influential relationships with followers. Video recordings of student leaders interacting with pairs of unfamiliar students during a group decision-making task were assessed for leader receptivity, formidability, and charisma by independent sets of undergraduate judges. Perceptions of student leaders' receptivity and formidability predicted their charisma, and charismatic leaders were most influential in bringing followers to privately accept a controversial group decision. Across studies, evidence generally supported hypotheses generated from status cues theory: charismatic leadership builds upon the nonverbal projection of dual-status messages and the approach/avoidance motives they engender, setting conditions for a uniquely powerful brand of influence.

The effects of a course of intranasal oxytocin on social behaviors in youth diagnosed with autism spectrum disorders: a randomized controlled trial.

BACKGROUND: There is increasing interest in oxytocin as a therapeutic to treat social deficits in autism spectrum disorders (ASD). The aim of this study was to investigate the efficacy of a course of oxytocin nasal spray to improve social behavior in youth with ASD. METHODS: In a double-blind, placebo-controlled trial across two Australian university sites between February 2009 and January 2012, 50 male participants aged between 12 and 18 years, with Autistic or Asperger's Disorder, were randomized to receive either oxytocin (n = 26) or placebo (n = 24) nasal sprays (either 18 or 24 International Units), administered twice-daily for 8 weeks. Participants were assessed at baseline, after 4- and 8-weeks of treatment, and at 3-month follow-up. Primary outcomes were change in total scores on the caregiver-completed Social Responsiveness Scale and clinician-ratings on the Clinical Global Impressions-Improvement scale. Secondary assessments included caregiver reports of repetitive and other developmental behaviors and social cognition. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry www.anzctr.org.au ACTRN12609000513213. RESULTS: Participants who received oxytocin showed no benefit following treatment on primary or secondary outcomes. However, caregivers who believed their children received oxytocin reported greater improvements compared to caregivers who believed their child received placebo. Nasal sprays were well tolerated and there was no evidence of increased side effects resulting from oxytocin administration. CONCLUSIONS: This is the first evaluation of the efficacy for a course of oxytocin treatment for youth with ASD. Although results did not suggest clinical efficacy, further research is needed to explore alternative delivery methods, earlier age of intervention, and the influence of caregiver expectation on treatment response.

Adult outcomes in autism: community inclusion and living skills.

Longitudinal research has demonstrated that social outcomes for adults with autism are restricted, particularly in terms of employment and living arrangements. However, understanding of individual and environmental factors that influence these outcomes is far from complete. This longitudinal study followed a community sample of children and adolescents with autism into adulthood. Social outcomes in relation to community inclusion and living skills were examined, including the predictive role of a range of individual factors and the environment (socio-economic disadvantage). Overall, the degree of community inclusion and living skills was restricted for the majority, and while childhood IQ was an important determinant of these outcomes, it was not the sole predictor. The implications of these findings in relation to interventions are discussed.

Trajectory of behavior and emotional problems in autism.

High rates of behavior and emotional problems have been consistently reported in children and adolescents with autism. Elevated rates of mental health problems have also been reported in adults with autism. Little is known, however, about the longitudinal development of behavior and emotional problems in autism. This study followed a cohort of children and adolescents over 18 years. Outcomes were evaluated in terms of behavior and emotional problems and autism symptomatology. The role of childhood factors (age, gender, IQ, behavior, and emotional problems) and the environment (socioeconomic disadvantage) were considered in terms of adult outcomes. Overall, improvements in comorbid behavior and emotional problems and autism symptomatology were observed. However, rates of comorbid behavior and emotional problems in adulthood remained high.

Employment of deaf people as influenced by potential employers' perceptions: pathological compared with sociocultural perspectives.

Two basic perspectives contrast how people perceive deafness: the pathological and sociocultural perspectives. The pathological perspective focuses on the medical issues related to hearing impairment. The sociocultural perspective views deafness as a cultural difference. This study investigated whether these perspectives influenced assessments of deaf job candidates in a mock hiring scenario. Undergraduates were given information supporting either the pathological or sociocultural perspectives. They later rated deaf and hearing job candidates who were presented as having identical qualifications. The hypothesis was not supported in this study; the experiment did not significantly alter the views of future prospective employers. Also, education about the deaf culture did not appear to have an impact on deaf and hearing relations.