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1. Learning Statistics with Interactive Pictures Using R Shiny: Generally Preferred, but Not Generally Advantageous

Author

Zhao, Fang, Schützler, Lena, Christ, Oliver, and Gaschler, Robert

Abstract

Constructing interactive web apps has become more accessible for instructors, for example, by using the R package Shiny. Here we explored learners' preferences and the efficiency of interactive simulations versus static pictures in acquiring statistics knowledge of Cohen's d and standard normal distribution. Results revealed that students' spontaneous interaction with pictures was infrequent (pilot study, N = 26). While prompts (Exp. 1, N = 152) effectively ensured the manipulation of simulations, student exposure to interactive simulations led to longer learning times though similar test performance compared with student exposure to static pictures. Multiple interactive representations led to lower test performance than single interactive and static representations (Exp. 2, N = 117). Though no advantage was gained regarding learning outcomes, participants preferred the interactive variant (Exp. 3, N = 119). Taken together, this study demonstrates that the superiority of interactive pictures cannot be assumed to hold in general. Further work should evaluate how mental model construction can be effectively scaffolded by interactive simulations.

Published
2023
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2. Come as You Are--Small Groups in an Online Statistics Course for Highly Heterogeneous Students

Author

Schützler, Lena and Christ, Oliver

Abstract

Statistics is not the subject most psychology students are feverishly looking forward to. Fears and doubts about its relevance are quite common. This is especially pronounced at our institution, a large distance-teaching university with highly heterogeneous students. We recognized three clusters of students that might need special support: (1) students with fear of statistics, (2) students whose school time was a long time ago, (3) students who already failed the statistics exam. We gave those students the opportunity to participate in small, supervised groups to discuss learning strategies, problems, or fears. Students who did not participate served as a control group. We exploratively evaluated which kind of students were interested, and if the groups affected attitudes towards statistics, general self-efficacy, and exam-related variables. Interest and activity in the groups were low. No unique effect of participation in the groups on attitudes and grades were observable. Students stated that the groups did not help them to deal with the course. If these results prove stable in further studies with an improved design, one might conclude that setting up such small groups is not worth the effort.

Published
2022
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6. Learning statistics with interactive pictures using R Shiny: Generally preferred, but not generally advantageous.

Author

Zhao, Fang, Schützler, Lena, Christ, Oliver, and Gaschler, Robert

Subjects
*INTERACTIVE learning, *WEB-based user interfaces, *GAUSSIAN distribution, *PICTURES, *EDUCATIONAL outcomes
Abstract

Constructing interactive web apps has become more accessible for instructors, for example, by using the R package Shiny. Here we explored learners' preferences and the efficiency of interactive simulations versus static pictures in acquiring statistics knowledge of Cohen's d and standard normal distribution. Results revealed that students' spontaneous interaction with pictures was infrequent (pilot study, N = 26). While prompts (Exp. 1, N = 152) effectively ensured the manipulation of simulations, student exposure to interactive simulations led to longer learning times though similar test performance compared with student exposure to static pictures. Multiple interactive representations led to lower test performance than single interactive and static representations (Exp. 2, N = 117). Though no advantage was gained regarding learning outcomes, participants preferred the interactive variant (Exp. 3, N = 119). Taken together, this study demonstrates that the superiority of interactive pictures cannot be assumed to hold in general. Further work should evaluate how mental model construction can be effectively scaffolded by interactive simulations. [ABSTRACT FROM AUTHOR]

Published
2023
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9. Effectiveness of an additional individualized multi-component complementary medicine treatment on health-related quality of life in breast cancer patients: a pragmatic randomized trial

Author

Witt, Claudia M, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, Schützler, Lena, University of Zurich, and Witt, Claudia M

Subjects
10034 Institute of Complementary Medicine, 610 Medicine & health, 2730 Oncology, 1306 Cancer Research
Abstract

The aim of this study was to evaluate the effectiveness of an additional, individualized, multi-component complementary medicine treatment offered to breast cancer patients at the Merano Hospital (South Tyrol) on health-related quality of life compared to patients receiving usual care only. A randomized pragmatic trial with two parallel arms was performed. Women with confirmed diagnoses of breast cancer were randomized (stratified by usual care treatment) to receive individualized complementary medicine (CM group) or usual care alone (usual care group). Both groups were allowed to use conventional treatment for breast cancer. Primary endpoint was the breast cancer-related quality of life FACT-B score at 6months. For statistical analysis, we used analysis of covariance (with factors treatment, stratum, and baseline FACT-B score) and imputed missing FACT-B scores at 6months with regression-based multiple imputation. A total of 275 patients were randomized between April 2011 and March 2012 to the CM group (n=136, 56.3±10.9years of age) or the usual care group (n=139, 56.0±11.0). After 6months from randomization, adjusted means for health-related quality of life were higher in the CM group (FACT-B score 107.9; 95% CI 104.1-111.7) compared to the usual care group (102.2; 98.5-105.9) with an adjusted FACT-B score difference between groups of 5.7 (2.6-8.7, p

Published
2021

10. Effectiveness of an additional individualized multi-component complementary medicine treatment on health-related quality of life in breast cancer patients: a pragmatic randomized trial

Author

Witt, Claudia, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, Schützler, Lena, Witt, Claudia, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, and Schützler, Lena

Abstract

The aim of this study was to evaluate the effectiveness of an additional, individualized, multi-component complementary medicine treatment offered to breast cancer patients at the Merano Hospital (South Tyrol) on health-related quality of life compared to patients receiving usual care only. A randomized pragmatic trial with two parallel arms was performed. Women with confirmed diagnoses of breast cancer were randomized (stratified by usual care treatment) to receive individualized complementary medicine (CM group) or usual care alone (usual care group). Both groups were allowed to use conventional treatment for breast cancer. Primary endpoint was the breast cancer-related quality of life FACT-B score at 6months. For statistical analysis, we used analysis of covariance (with factors treatment, stratum, and baseline FACT-B score) and imputed missing FACT-B scores at 6months with regression-based multiple imputation. A total of 275 patients were randomized between April 2011 and March 2012 to the CM group (n=136, 56.3±10.9years of age) or the usual care group (n=139, 56.0±11.0). After 6months from randomization, adjusted means for health-related quality of life were higher in the CM group (FACT-B score 107.9; 95% CI 104.1-111.7) compared to the usual care group (102.2; 98.5-105.9) with an adjusted FACT-B score difference between groups of 5.7 (2.6-8.7, p<0.001). Thus, an additional individualized and complex complementary medicine intervention improved quality of life of breast cancer patients compared to usual care alone. Further studies evaluating specific effects of treatment components should follow to optimize the treatment of breast cancer patients.

Published
2021

11. Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partially double-blind, placebo controlled, four armed study

Author

Willich Stefan N, Melcher Friedericke, Schützler Lena, Bartsch Iris, Lüdtke Rainer, Teut Michael, Krüger Stephanie, Adler Ubiratan C, Linde Klaus, and Witt Claudia M

Subjects
Medicine (General), R5-920
Abstract

Abstract Background Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment consists of two main elements: the case history and the prescription of an individually selected homeopathic remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic case history. Methods/Design A randomized, partially double-blind, placebo-controlled, four-armed trial using a 2 × 2 factorial design with a six-week study duration per patient will be performed. 228 patients diagnosed with major depression (moderate episode) by a psychiatrist will be included. The primary endpoint is the total score on the 17-item Hamilton Depression Rating Scale after six weeks. Secondary end points are: Hamilton Depression Rating Scale total score after two and four weeks; response and remission rates, Beck Depression inventory total score, quality of life and safety at two, four and six weeks. Statistical analyses will be by intention-to-treat. The main endpoint will be analysed by a two-factorial analysis of covariance. Within this model generalized estimation equations will be used to estimate differences between verum and placebo, and between both types of case history. Discussion For the first time this study evaluates both the specific effect of homeopathic medicines and of a homeopathic case taking in patients with depression. It is an attempt to deal with the challenges of homeopathic research and the results might be useful information in the current discussion about the evidence on homeopathy Trial registration ClinicalTrials.gov: NCT01178255

Published
2011
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12. Selbstwirksamkeitserwartung, internale Kontrollüberzeugung und komplementärmedizinische Behandlungsmethoden

Author

Schützler, Lena

Subjects
validation, self-efficacy expectation, fear of illness, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit, internal health locus of control, complementary and alternative medicine
Abstract

Hintergrund/Zielstellung. Wie überzeugt jemand davon ist, die eigene Gesundheit erhalten oder wiedererlangen zu können und wie die eigenen Einflussmöglichkeiten diesbezüglich eingeschätzt werden, kann individuell sehr unterschiedlich sein. Als drei Aspekte gesundheitsbezogener Überzeugungen wurden in dieser Arbeit internale gesundheitsbezogene Kontrollüberzeugung, Körper-Selbstwirksamkeitserwartung und Angst vor Krankheit/Verletzung untersucht und in einen Zusammenhang mit der Nutzung und Bewertung komplementärer und alternativer medizinischer Behandlungsverfahren (CAM) gebracht. Im Einzelnen verfolgte die Arbeit drei Ziele: (1) Übersetzung des Illness/Injury Sensitivity Index-Revised (ISI-R) aus dem Englischen ins Deutsche und Validierung der übersetzten Fassung, (2) Entwicklung des Konstruktes Körper-Selbstwirksamkeitserwartung, Entwicklung eines geeigneten Messinstrumentes und dessen Validierung unter Berücksichtigung von Zusammenhängen mit CAM, (3) Untersuchung von Zusammenhängen zwischen internaler gesundheitsbezogener Kontrollüberzeugung und Nutzung und Bewertung von CAM. Methodik. (1) Der ISI-R wurde übersetzt und in zwei Stichproben per Fragebogen validiert. Gängige Skalenkennwerte sowie Zusammenhänge mit verschiedenen Validierungsinstrumenten wurden berechnet und sowohl eine explorative als auch eine konfirmatorische Faktorenanalyse durchgeführt. (2) Körper-Selbstwirksamkeitserwartung wurde definiert und ein Messinstrument entwickelt. Dieses wurde mittels eines Online-Surveys in einer Studierendenstichprobe validiert. Die Bestimmung der Faktorstruktur erfolgte mittels explorativer Faktorenanalyse; weitere Skalenkennwerte und Korrelationen mit vielfältigen Validierungsinstrumenten wurden berechnet. Im Rahmen der Validierung wurden auch Zusammenhänge mit der Nutzung und Bewertung von CAM evaluiert. (3) Mittels der Daten desselben Online-Surveys erfolgte die Evaluierung von Zusammenhängen zwischen internaler gesundheitsbezogener Kontrollüberzeugung und der Nutzung und Bewertung von CAM. In der gesamten Arbeit erfolgten CAM-bezogene Auswertungen aufgrund der Rolle chronischer Erkrankungen als möglicher Confounder sowohl für die Gesamtstichprobe als auch getrennt für chronisch erkrankte und nichterkrankte Teilnehmende. Ergebnisse. (1) Die Übersetzung des ISI-R ergab dieselbe Faktorstruktur wie das englische Original und erwies sich als hinreichend reliabel und valide. (2) Aufgrund der Ergebnisse der Faktorenanalyse wurde die entwickelte Körper- Selbstwirksamkeitserwartungs-Skala leicht angepasst. Die angepasste Skala erwies sich als hinreichend reliabel und valide. Personen, welche CAM mehr nutzten und positiv bewerteten, wiesen eine höhere Körper- Selbstwirksamkeitserwartung auf als Personen, welche CAM weniger nutzten oder weniger positiv bewerteten. (3) Personen, welche CAM mehr nutzten und positiv bewerteten, wiesen eine höhere internale gesundheitsbezogene Kontrollüberzeugung auf als Personen, welche CAM weniger nutzten oder weniger positiv bewerteten. Das Vorliegen einer chronischen Erkrankung erwies sich für die CAM-bezogenen Auswertungen als wichtiger Confounder. Diskussion. Weitere Untersuchungen sowohl zur Rolle von Angst vor Krankheit/Verletzung im Zusammenhang mit CAM als auch in Längsschnittstudien mit gesunden und klinischen Stichproben wären wünschenswert., Background/Aim. Beliefs concerning the maintenance of health or the overcoming of illness and one’s own role in this regard may vary from person to person. Three aspects of such beliefs – internal health locus of control, body- efficacy expectation, and fear of illness/injury – and their association with complementary and alternative medicine (CAM) were focused on. There were three goals of this thesis: (1) Providing a validated German translation of the Illness/Injury Sensitivity Index-Revised (ISI-R). (2) Defining body-efficacy expectation and developing an instrument for its measurement considering associations with CAM use and appraisal during the validation process. (3) Evaluating associations between internal health locus of control and CAM use and appraisal. Methods. (1) The ISI-R was translated into German and validated in two different samples using questionnaires. An exploratory and a confirmatory factor analysis were conducted. Scale characteristics and associations between the ISI-R and different validation measures were reported. (2) Body-efficacy expectation was defined. A scale for its measurement was developed and validated via an online student survey. Exploratory factor analysis was conducted; further scale characteristics and associations with different validation measures as well as associations between body-efficacy expectation and the use and appraisal of CAM were reported. (3) Using data of the same online survey, associations between internal health locus of control and use and appraisal of CAM were evaluated. All CAM-related analyses were conducted for the total sample as well as for chronically ill and healthy participants separately as chronic conditions might be a confounder. Results. (1) The German ISI-R showed the same factor structure as the original and proved reliable and valid. (2) The scale to measure body-efficacy expectation was altered slightly taking into account the results of the exploratory factor analysis. The altered scale was reliable and valid. Participants using CAM more often and showing higher appraisal of CAM reported higher body-efficacy expectation than participants with less CAM use or appraisal. (3) Participants using CAM more often and showing higher appraisal of CAM reported higher internal health locus of control than participants with less CAM use or appraisal. Chronic conditions were an important confounder in all CAM-related analyses. Discussion. Further research considering the relation of CAM with fear of illness/injury as well as longitudinal studies with healthy and clinical samples is necessary.

Published
2016

14. A consultation training program for physicians for communication about complementary medicine with breast cancer patients: a prospective, multi-center, cluster-randomized, mixed-method pilot study

Author

Blödt, Susanne, Mittring, Nadine, Schützler, Lena, Fischer, Felix, Holmberg, Christine, Horneber, Markus, Stapf, Adele, Witt, Claudia M, Blödt, Susanne, Mittring, Nadine, Schützler, Lena, Fischer, Felix, Holmberg, Christine, Horneber, Markus, Stapf, Adele, and Witt, Claudia M

Abstract

BACKGROUND: The aim was to develop and evaluate a training program for physicians for communicating with breast cancer patients about complementary medicine (CM). METHODS: In a cluster-randomized pilot trial eight breast cancer centers (two physicians per center) were randomized to either a complementary communication training program (9 h e-learning + 20 h on-site skills training) or to a control group without training. Each physician was asked to consult ten patients for whom he or she is not the physician in charge. We used mixed methods: Quantitative outcomes included physicians' assessments (empathy, complexity of consultation, knowledge transfer) and patients' assessments (satisfaction, empathy, knowledge transfer). For qualitative analyses, 15 (eight in the training and seven in the control group) videotaped consultations were analyzed based on grounded theory, and separate focus groups with the physicians of both groups were conducted. RESULTS: A total of 137 patients were included. Although cluster-randomized, physicians in the two groups differed. Those in the training group were younger (33.4 ± 8.9 vs. 40.0 ± 8.5 years) and had less work experience (5.4 ± 8.9 vs. 11.1 ± 7.4 years). Patient satisfaction with the CM consultation was relatively high on a scale from 0 to 24 and was comparable in the two groups (training group: 19.4 ± 4.6; control group 20.5 ± 4.1). The qualitative findings showed that physicians structured majority of consultations as taught during the training. Comparing only the younger and less CM experienced physicians, those trained in CM communication felt more confident discussing CM-related topics than those without training. CONCLUSION: A CM communication-training program might be especially beneficial for physicians with less consulting experience when communicating about CM-related issues. A larger trial using more suitable quantitative outcomes needs to confirm this.

Published
2016

16. Effectiveness of an additional individualized multi-component complementary medicine treatment on health-related quality of life in breast cancer patients: a pragmatic randomized trial

Author

Witt, Claudia M, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, Schützler, Lena, Witt, Claudia M, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, and Schützler, Lena

Abstract

The aim of this study was to evaluate the effectiveness of an additional, individualized, multi-component complementary medicine treatment offered to breast cancer patients at the Merano Hospital (South Tyrol) on health-related quality of life compared to patients receiving usual care only. A randomized pragmatic trial with two parallel arms was performed. Women with confirmed diagnoses of breast cancer were randomized (stratified by usual care treatment) to receive individualized complementary medicine (CM group) or usual care alone (usual care group). Both groups were allowed to use conventional treatment for breast cancer. Primary endpoint was the breast cancer-related quality of life FACT-B score at 6 months. For statistical analysis, we used analysis of covariance (with factors treatment, stratum, and baseline FACT-B score) and imputed missing FACT-B scores at 6 months with regression-based multiple imputation. A total of 275 patients were randomized between April 2011 and March 2012 to the CM group (n = 136, 56.3 ± 10.9 years of age) or the usual care group (n = 139, 56.0 ± 11.0). After 6 months from randomization, adjusted means for health-related quality of life were higher in the CM group (FACT-B score 107.9; 95 % CI 104.1-111.7) compared to the usual care group (102.2; 98.5-105.9) with an adjusted FACT-B score difference between groups of 5.7 (2.6-8.7, p < 0.001). Thus, an additional individualized and complex complementary medicine intervention improved quality of life of breast cancer patients compared to usual care alone. Further studies evaluating specific effects of treatment components should follow to optimize the treatment of breast cancer patients.

Published
2015

17. Internal health locus of control in users of complementary and alternative medicine: a cross-sectional survey

Author

Schützler, Lena, Witt, Claudia M, Schützler, Lena, and Witt, Claudia M

Abstract

Background Complementary and alternative medicine (CAM) is widely used in Germany, with some treatments eligible for health insurance reimbursements. CAM encourages patients to play an active role in their healing process. The belief that a person’s own behavior influences health is assessed as the internal health locus of control (IHLOC). Studies on the association between IHLOC and CAM use yield inconsistent results. Using various indicators of CAM use, we evaluated whether there were differences in IHLOC between different groups of CAM users. Methods A cross-sectional online survey was conducted. IHLOC was compared between participants with high and low appraisal of CAM, between participants who used different types of medications (none, CAM, conventional, both), and who consulted with different health care professionals (none, CAM, conventional, both). Independent samples t-tests and ANOVAs were conducted for the total group and for subgroups of chronically ill and healthy participants. Post-hoc, we conducted a multivariate linear regression evaluating which indicators of CAM use or other characteristics showed the strongest association with IHLOC. Results A total of 1,054 undergraduate students completed the survey. Participants with high CAM appraisal showed higher IHLOC than those with low CAM appraisal, regardless of whether they were chronically ill (p < .001). Participants without chronic conditions showed higher IHLOC when only using CAM medications than when using either conventional medications alone or both conventional and CAM medications (p < .05). All participants showed higher IHLOC when visiting only CAM practitioners than when visiting either only conventional or both conventional and CAM practitioners (p < .05). CAM appraisal was associated the strongest with IHLOC in the linear regression model. Conclusions Generally, participants using CAM more or exclusively, and participants with higher appraisal of CAM showed higher IHLOC than those with le

Published
2014

22. Effectiveness of additional self-care acupressure for women with menstrual pain compared to usual care alone: using stakeholder engagement to design a pragmatic randomized trial and study protocol

Author

Blödt, Susanne, primary, Schützler, Lena, additional, Huang, Wenjing, additional, Pach, Daniel, additional, Brinkhaus, Benno, additional, Hummelsberger, Josef, additional, Kirschbaum, Barbara, additional, Kuhlmann, Kirsten, additional, Lao, Lixing, additional, Liang, Fanrong, additional, Mietzner, Anna, additional, Mittring, Nadine, additional, Müller, Sabine, additional, Paul, Anna, additional, Pimpao-Niederle, Carolina, additional, Roll, Stephanie, additional, Wu, Huangan, additional, Zhu, Jiang, additional, and Witt, Claudia M, additional

Published
2013
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28. Effectiveness of an additional individualized multi-component complementary medicine treatment on health-related quality of life in breast cancer patients: a pragmatic randomized trial

Author

Witt, Claudia, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, Schützler, Lena, Witt, Claudia, Außerer, Oskar, Baier, Susanne, Heidegger, Herbert, Icke, Katja, Mayr, Oswald, Mitterer, Manfred, Roll, Stephanie, Spizzo, Gilbert, Scherer, Arthur, Thuile, Christian, Wieser, Anton, and Schützler, Lena

Abstract

The aim of this study was to evaluate the effectiveness of an additional, individualized, multi-component complementary medicine treatment offered to breast cancer patients at the Merano Hospital (South Tyrol) on health-related quality of life compared to patients receiving usual care only. A randomized pragmatic trial with two parallel arms was performed. Women with confirmed diagnoses of breast cancer were randomized (stratified by usual care treatment) to receive individualized complementary medicine (CM group) or usual care alone (usual care group). Both groups were allowed to use conventional treatment for breast cancer. Primary endpoint was the breast cancer-related quality of life FACT-B score at 6months. For statistical analysis, we used analysis of covariance (with factors treatment, stratum, and baseline FACT-B score) and imputed missing FACT-B scores at 6months with regression-based multiple imputation. A total of 275 patients were randomized between April 2011 and March 2012 to the CM group (n=136, 56.3±10.9years of age) or the usual care group (n=139, 56.0±11.0). After 6months from randomization, adjusted means for health-related quality of life were higher in the CM group (FACT-B score 107.9; 95% CI 104.1-111.7) compared to the usual care group (102.2; 98.5-105.9) with an adjusted FACT-B score difference between groups of 5.7 (2.6-8.7, p<0.001). Thus, an additional individualized and complex complementary medicine intervention improved quality of life of breast cancer patients compared to usual care alone. Further studies evaluating specific effects of treatment components should follow to optimize the treatment of breast cancer patients.

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