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Field SL, Fox JRE, Jones CRG, Williams MO. "Work WITH us": a Delphi study about improving eating disorder treatment for autistic women with anorexia nervosa. J Eat Disord 2023; 11:17. [PMID: 36759874 PMCID: PMC9909870 DOI: 10.1186/s40337-023-00740-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND There is an increased prevalence of anorexia nervosa (AN) in autistic women and this group has poorer treatment outcomes compared to non-autistic women with AN. However, there is little research into improving eating disorder treatment for autistic women. This study investigated how best to support autistic women with AN within eating disorder services. METHOD A three-stage Delphi study was conducted with 49 participants with relevant expertise as a researcher, clinician, or expert by experience. RESULTS A total of 70 statements were generated, with 56 reaching consensus after the final round. Statements reaching consensus made recommendations for adaptations to treatment, staff training, and service organisation. CONCLUSIONS The results highlight the need to distinguish between autism- and AN-related difficulties, accommodate autistic traits such as sensory sensitivities and communication differences, and ensure the autistic voice is present in both the development and delivery of care. Future research should investigate the impact of these adaptations on outcomes. The applicability of these recommendations to autistic people with other eating disorders and of other genders needs to be investigated further.
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Affiliation(s)
- Sarah L Field
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, 11Th Floor, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK
| | - John R E Fox
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, 11Th Floor, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK.,Doctorate in Clinical Psychology, University of Liverpool, Liverpool, L69 7ZA, UK
| | - Catherine R G Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, CF10 3AT, UK
| | - Marc O Williams
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, 11Th Floor, Tower Building, 70 Park Place, Cardiff, CF10 3AT, UK.
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Establishing evidence to inform culturally competent mental health services: A mixed methods study protocol. PLoS One 2023; 18:e0282445. [PMID: 36917593 PMCID: PMC10013880 DOI: 10.1371/journal.pone.0282445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND COVID-19 has exacerbated the significant and longstanding mental health inequalities for ethnic minorities, who were less likely to access mental health support in primary care but more likely to end up in crisis care compared to the majority ethnic group. Services were poorly offered and accessed to respond to the increased mental health challenges. AIM To 1) establish evidence on which changes to mental health services provided in response to COVID-19 are beneficial for ethnic minorities who experience mental health difficulties in the North of England, and 2) to inform what and how culturally competent mental health services should be routinely provided. METHODS A mixed methods approach comprising 1) a rapid review to map services and models of care designed or adjusted for mental health during the pandemic, 2) an observational study of retrospective routine data to assess changes to mental health services and associated outcomes, 3) qualitative interviews to understand experiences of seeking care and factors associated with high-quality service provision, and 4) a Delphi study to establish consensus on key features of culturally competent services. From the selected areas in the North of England, adults from ethnic minorities who experience mental health difficulties will be identified from the primary, community and secondary care services and local ethnic minority communities. DISCUSSION This study will identify ways to tackle health inequalities and contribute to mental health service recovery post pandemic by providing practice recommendations on equitable and effective services to ensure culturally competent and high-quality care. A list of services and features on what and how mental health services will be provided. Working with study collaborators and public and patient involvement partners, the study findings will be widely disseminated through presentations, conferences and publications and will inform the subsequent funding application for intervention development and evaluation.
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3
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Colonna R, Tucker P, Holmes J, Wilson J, Alvarez L. Mobile-based brief interventions targeting cannabis-impaired driving among youth: A Delphi study. J Subst Abuse Treat 2022; 141:108802. [DOI: 10.1016/j.jsat.2022.108802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
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Bareham BK, Stewart J, Kaner E, Hanratty B. Factors affecting primary care practitioners' alcohol-related discussions with older adults: a qualitative study. Br J Gen Pract 2021; 71:e762-e771. [PMID: 33950854 PMCID: PMC8407858 DOI: 10.3399/bjgp.2020.1118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/20/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Risk of harm from drinking is heightened in later life, owing to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people (aged ≥50 years) to make healthier decisions about alcohol. AIM To examine primary care practitioners' perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. DESIGN AND SETTING Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. METHOD Thirty-five practitioners (GPs, practice/district nurses, pharmacists, dentists, social care practitioners, and domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. RESULTS Practitioners highlighted particular sensitivities to discussing alcohol among older people, and reservations about older people's resistance to making changes in old age; given that drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people's contact with practitioners, but management of older people's long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people and training in alcohol intervention facilitated practitioners, particularly pharmacists and practice nurses. CONCLUSION There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks (particularly those associated with old age), and tailored interventions for older people, feasible to implement in practice settings, would help primary care practitioners to address older people's alcohol use.
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Affiliation(s)
- Bethany Kate Bareham
- Newcastle University Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne
| | - Jemma Stewart
- Newcastle University Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Eileen Kaner
- Newcastle University Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne
| | - Barbara Hanratty
- Newcastle University Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne
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5
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File D, Bőthe B, Kapitány-Fövény M, Demetrovics Z. Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome. Int J Methods Psychiatr Res 2020; 29:1-10. [PMID: 32896955 PMCID: PMC7723194 DOI: 10.1002/mpr.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups. METHODS A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy. RESULTS Data collection will be completed by July 2020, and follow-up will be completed by January 2021. CONCLUSIONS The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.
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Affiliation(s)
- Domonkos File
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Beáta Bőthe
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Département de Psychologie, Université de Montréal, Montreal, Canada
| | - Máté Kapitány-Fövény
- Department of Addiction, Semmelweis University Faculty of Health Sciences, Budapest, Hungary.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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6
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Salway S, Yazici E, Khan N, Ali P, Elmslie F, Thompson J, Qureshi N. How should health policy and practice respond to the increased genetic risk associated with close relative marriage? results of a UK Delphi consensus building exercise. BMJ Open 2019; 9:e028928. [PMID: 31289086 PMCID: PMC6615806 DOI: 10.1136/bmjopen-2019-028928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To explore professional and lay stakeholder views on the design and delivery of services in the area of consanguinity and genetic risk. (2) To identify principles on which there is sufficient consensus to warrant inclusion in a national guidance document. (3) To highlight differences of opinion that necessitate dialogue. (4) To identify areas where further research or development work is needed to inform practical service approaches. DESIGN Delphi exercise. Three rounds and one consensus conference. SETTING UK, national, web-based and face-to-face. PARTICIPANTS Recruitment via email distribution lists and professional networks. 42 participants with varied professional and demographic backgrounds contributed to at least one round of the exercise. 29 people participated in statement ranking across both rounds 2 and 3. RESULTS Over 700 individual statements were generated in round 1 and consolidated into 193 unique statements for ranking in round 2, with 60% achieving 80% or higher agreement. In round 3, 74% of statements achieved 80% or higher agreement. Consensus conference discussions resulted in a final set of 148 agreed statements, providing direction for both policy-makers and healthcare professionals. 13 general principles were agreed, with over 90% agreement on 12 of these. Remaining statements were organised into nine themes: national level leadership and coordination, local level leadership and coordination, training and competencies for healthcare and other professionals, genetic services, genetic literacy, primary care, referrals and coordination, monitoring and evaluation and research. Next steps and working groups were also identified. CONCLUSIONS There is high agreement among UK stakeholders on the general principles that should shape policy and practice responses in this area: equity of access, cultural competence, coordinated inter-agency working, co-design and empowerment and embedded evaluation. The need for strong national leadership to ensure more efficient sharing of knowledge and promotion of more equitable and consistent responses across the country is emphasised.
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Affiliation(s)
- Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Edanur Yazici
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Nasaim Khan
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Parveen Ali
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Frances Elmslie
- South West Thames Regional Genetics Service, St George’s University Hospitals, London, UK
| | - Julia Thompson
- Children and Young People’s Public Health Team, Sheffield City Council, Sheffield, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Garnett CV, Crane D, Brown J, Kaner EFS, Beyer FR, Muirhead CR, Hickman M, Beard E, Redmore J, de Vocht F, Michie S. Behavior Change Techniques Used in Digital Behavior Change Interventions to Reduce Excessive Alcohol Consumption: A Meta-regression. Ann Behav Med 2018; 52:530-543. [PMID: 29788261 PMCID: PMC6361280 DOI: 10.1093/abm/kax029] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Digital behavior change interventions (DBCIs) appear to reduce alcohol consumption, but greater understanding is needed of their mechanisms of action. Purpose To describe the behavior change techniques (BCTs) used in DBCIs and examine whether individual BCTs, the inclusion of more BCTs or more Control Theory congruent BCTs is associated with increased effectiveness. Methods Forty-one randomized control trials were extracted from a Cochrane review of alcohol reduction DBCIs and coded for up to 93 BCTs using an established and reliable method. Random effects unadjusted and adjusted meta-regression models were performed to assess associations between BCTs and intervention effectiveness. Results Interventions used a mean of 9.1 BCTs (range 1-22), 23 different BCTs were used in four or more trials. Trials that used "Behavior substitution" (-95.112 grams per week [gpw], 95% CI: -162.90, -27.34), "Problem solving" (-45.92 gpw, 95% CI: -90.97, -0.87) and "Credible source" (-32.09 gpw, 95% CI: -60.64, -3.55) were significantly associated with greater alcohol reduction than trials without these BCTs. The "Behavior substitution" result should be treated as preliminary because it was reported in only four trials, three of which were conducted by the same research group. "Feedback" was used in 98% of trials (n = 41); other Control Theory congruent BCTs were used less frequently: for example, "Goal setting" 43% (n = 18) and "Self-monitoring" 29%, (n = 12). Conclusions "Behavior substitution," "Problem solving," and "Credible source" were associated with greater alcohol reduction. Many BCTs were used infrequently in DBCIs, including BCTs with evidence of effectiveness in other domains, such as "Self-monitoring" and "Goal setting."
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Affiliation(s)
- Claire V Garnett
- Research Department of Behavioural Science and Health, UCL, UK
- Research Department of Clinical, Educational and Health Psychology, UCL, UK
| | - David Crane
- Research Department of Clinical, Educational and Health Psychology, UCL, UK
| | - Jamie Brown
- Research Department of Behavioural Science and Health, UCL, UK
| | | | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, UK
| | | | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
| | - Emma Beard
- Research Department of Behavioural Science and Health, UCL, UK
| | - James Redmore
- School of Social and Community Medicine, University of Bristol, UK
| | - Frank de Vocht
- School of Social and Community Medicine, University of Bristol, UK
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, UCL, UK
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Crane D, Garnett C, Michie S, West R, Brown J. A smartphone app to reduce excessive alcohol consumption: Identifying the effectiveness of intervention components in a factorial randomised control trial. Sci Rep 2018; 8:4384. [PMID: 29531280 PMCID: PMC5847600 DOI: 10.1038/s41598-018-22420-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
Our aim was to evaluate intervention components of an alcohol reduction app: Drink Less. Excessive drinkers (AUDIT>=8) were recruited to test enhanced versus minimal (reduced functionality) versions of five app modules in a 25 factorial trial. Modules were: Self-monitoring and Feedback, Action Planning, Identity Change, Normative Feedback, and Cognitive Bias Re-training. Outcome measures were: change in weekly alcohol consumption (primary); full AUDIT score, app usage, app usability (secondary). Main effects and two-way interactions were assessed by ANOVA using intention-to-treat. A total of 672 study participants were included. There were no significant main effects of the intervention modules on change in weekly alcohol consumption or AUDIT score. There were two-way interactions between enhanced Normative Feedback and Cognitive Bias Re-training on weekly alcohol consumption (F = 4.68, p = 0.03) and between enhanced Self-monitoring and Feedback and Action Planning on AUDIT score (F = 5.82, p = 0.02). Enhanced Self-monitoring and Feedback was used significantly more often and rated significantly more positively for helpfulness, satisfaction and recommendation to others than the minimal version. To conclude, in an evaluation of the Drink Less smartphone application, the combination of enhanced Normative Feedback and Cognitive Bias Re-training and enhanced Self-monitoring and Feedback and Action Planning yielded improvements in alcohol-related outcomes after 4-weeks.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
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Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:689-99. [PMID: 27167074 PMCID: PMC4938847 DOI: 10.1007/s11121-016-0653-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.
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Crane D, Garnett C, Brown J, West R, Michie S. Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies. Front Public Health 2017; 5:39. [PMID: 28421175 PMCID: PMC5376568 DOI: 10.3389/fpubh.2017.00039] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/20/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimize engagement and reduce the high rates of attrition associated with the use of digital interventions, it is necessary to ensure that an app's design and functionality is appropriate for its intended purposes and target population. AIMS To understand the usability of an app to help people reduce their alcohol consumption. METHOD The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a "think aloud" study performed with people using the app for the first time and a semistructured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the "think aloud" and interview transcripts was conducted by one coder and verified by a second. RESULTS Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were "Feeling lost and unsure of what to do next," "Make the app easy to use," and "Make the app beneficial and rewarding to use." These themes reflected participants' need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached. CONCLUSION First-time and experienced users want an alcohol reduction app to be easy, rewarding, and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help, and be esthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress, and demonstrate credibility. Users need help when first using the app, and they need a compelling reason to continue using it.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England. Br J Gen Pract 2017; 66:e1-9. [PMID: 26719481 PMCID: PMC4684029 DOI: 10.3399/bjgp16x683149] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Brief interventions have a modest but meaningful effect on promoting smoking cessation and reducing excessive alcohol consumption. Guidelines recommend offering such advice opportunistically and regularly but incentives vary between the two behaviours. AIM To use representative data from the perspective of patients to compare the prevalence and characteristics of people who smoke or drink excessively and who receive a brief intervention. DESIGN AND SETTING Data was from a representative sample of 15,252 adults from household surveys in England. METHOD Recall of brief interventions on smoking and alcohol use, sociodemographic information, and smoking and alcohol consumption patterns were assessed among smokers and those who drink excessively (AUDIT score of ≥8), who visited their GP surgery in the previous year. RESULTS Of 1775 smokers, 50.4% recalled receiving brief advice on smoking in the previous year. Smokers receiving advice compared with those who did not were more likely to be older (odds ratio [OR] 17-year increments 1.19, 95% confidence interval [CI] =1.06 to 1.34), female (OR 1.35, 95% CI =1.10 to 1.65), have a disability (OR 1.44, 95% CI = 1.11 to 1.88), have made more quit attempts in the previous year (compared with no attempts: one attempt, OR 1.65, 95% CI = 1.32 to 2.08; ≥2 attempts, OR 2.02, 95% CI =1.49 to 2.74), and have greater nicotine dependence (OR 1.17, 95% CI =1.05 to 1.31) but were less likely to have no post-16 qualifications (OR 0.81, 95% CI = 0.66 to 1.00). Of 1110 people drinking excessively, 6.5% recalled receiving advice in their GP surgery on their alcohol consumption in the previous year. Those receiving advice compared with those who did not had higher AUDIT scores (OR 1.17, 95% CI =1.12 to 1.23) and were less likely to be female (OR 0.44, 95% CI = 0.23 to 0.87). CONCLUSION Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, <10% of those who drink excessively report having received advice on their alcohol consumption.
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12
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Brown J, West R, Beard E, Brennan A, Drummond C, Gillespie D, Hickman M, Holmes J, Kaner E, Michie S. Are recent attempts to quit smoking associated with reduced drinking in England? A cross-sectional population survey. BMC Public Health 2016; 16:535. [PMID: 27443348 PMCID: PMC4957412 DOI: 10.1186/s12889-016-3223-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/27/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Alcohol consumption during attempts at smoking cessation can provoke relapse and so smokers are often advised to restrict their alcohol consumption during this time. This study assessed at a population-level whether smokers having recently initiated an attempt to stop smoking are more likely than other smokers to report i) lower alcohol consumption and ii) trying to reduce their alcohol consumption. METHOD Cross-sectional household surveys of 6287 last-year smokers who also completed the Alcohol Use Disorders Identification Test consumption questionnaire (AUDIT-C). Respondents who reported attempting to quit smoking in the last week were compared with those who did not. Those with AUDIT-C≥5 were also asked if they were currently trying to reduce the amount of alcohol they consume. RESULTS After adjustment for socio-demographic characteristics and current smoking status, smokers who reported a quit attempt within the last week had lower AUDIT-C scores compared with those who did not report an attempt in the last week (βadj = -0.56, 95 % CI = -1.08 to -0.04) and were less likely to be classified as higher risk (AUDIT-C≥5: ORadj = 0.57, 95 % CI = 0.38 to 0.85). The lower AUDIT-C scores appeared to be a result of lower scores on the frequency of 'binge' drinking item (βadj = -0.25, 95 % CI = -0.43 to -0.07), with those who reported a quit attempt within the last week compared with those who did not being less likely to binge drink at least weekly (ORadj = 0.54, 95 % CI = 0.29 to 0.999) and more likely to not binge drink at all (ORadj = 1.70, 95 % CI = 1.16 to 2.49). Among smokers with higher risk consumption (AUDIT-C≥5), those who reported an attempt to stop smoking within the last week compared with those who did not were more likely to report trying to reduce their alcohol consumption (ORadj = 2.98, 95 % CI = 1.48 to 6.01). CONCLUSION Smokers who report starting a quit attempt in the last week also report lower alcohol consumption, including less frequent binge drinking, and appear more likely to report currently attempting to reduce their alcohol consumption compared with smokers who do not report a quit attempt in the last week.
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Affiliation(s)
- Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- National Centre for Smoking Cessation and Training, London, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Alan Brennan
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- Sheffield Alcohol Research Group, ScHARR, The University of Sheffield, Sheffield, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Duncan Gillespie
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- Sheffield Alcohol Research Group, ScHARR, The University of Sheffield, Sheffield, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Holmes
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- Sheffield Alcohol Research Group, ScHARR, The University of Sheffield, Sheffield, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- National Centre for Smoking Cessation and Training, London, UK
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Garnett C, Crane D, Michie S, West R, Brown J. Evaluating the effectiveness of a smartphone app to reduce excessive alcohol consumption: protocol for a factorial randomised control trial. BMC Public Health 2016; 16:536. [PMID: 27392430 PMCID: PMC4939028 DOI: 10.1186/s12889-016-3140-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background Excessive alcohol consumption is a leading cause of death and morbidity worldwide and interventions to help people reduce their consumption are needed. Interventions delivered by smartphone apps have the potential to help harmful and hazardous drinkers reduce their consumption of alcohol. However, there has been little evaluation of the effectiveness of existing smartphone interventions. A systematic review, amongst other methodologies, identified promising modular content that could be delivered by an app: self-monitoring and feedback; action planning; normative feedback; cognitive bias re-training; and identity change. This protocol reports a factorial randomised controlled trial to assess the comparative potential of these five intervention modules to reduce excessive alcohol consumption. Methods A between-subject factorial randomised controlled trial. Hazardous and harmful drinkers aged 18 or over who are making a serious attempt to reduce their drinking will be randomised to one of 32 (25) experimental conditions after downloading the ‘Drink Less’ app. Participants complete baseline measures on downloading the app and are contacted after 1-month with a follow-up questionnaire. The primary outcome measure is change in past week consumption of alcohol. Secondary outcome measures are change in AUDIT score, app usage data and usability ratings for the app. A factorial between-subjects ANOVA will be conducted to assess main and interactive effects of the five intervention modules for the primary and secondary outcome measures. Discussion This study will establish the extent to which the five intervention modules offered in this app can help reduce hazardous and harmful drinking. This is the first step in optimising and understanding what component parts of an app could help to reduce excessive alcohol consumption. The findings from this study will be used to inform the content of a future integrated treatment app and evaluated against a minimal control in a definitive randomised control trial with long-term outcomes. Trial registration ISRCTN40104069 Date of registration: 10/2/2016 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3140-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.
| | - David Crane
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, UK.,Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme. Int J Integr Care 2016; 16:7. [PMID: 27616951 PMCID: PMC5015544 DOI: 10.5334/ijic.2457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. METHODS A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. RESULTS Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. CONCLUSION Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders.
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Crane D, Garnett C, Brown J, West R, Michie S. Behavior change techniques in popular alcohol reduction apps: content analysis. J Med Internet Res 2015; 17:e118. [PMID: 25977135 PMCID: PMC4468601 DOI: 10.2196/jmir.4060] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/28/2015] [Accepted: 02/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
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Fitzgerald N, Platt L, Heywood S, McCambridge J. Large-scale implementation of alcohol brief interventions in new settings in Scotland: a qualitative interview study of a national programme. BMC Public Health 2015; 15:289. [PMID: 25886312 PMCID: PMC4391282 DOI: 10.1186/s12889-015-1527-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/12/2015] [Indexed: 02/04/2023] Open
Abstract
Background This study aimed to explore experiences of implementation of alcohol brief interventions (ABIs) in settings outside of primary healthcare in the Scottish national programme. The focus of the study was on strategies and learning to support ABI implementation in settings outside of primary healthcare in general, rather on issues specific to any single setting. Methods 14 semi-structured telephone interviews were conducted with senior implementation leaders in antenatal, accident and emergency and wider settings and audio-recorded. Interviews were analysed inductively. Results The process of achieving large-scale, routine implementation of ABI proved challenging for all involved across the settings. Interviewees reported their experiences and identified five main strategies as helpful for strategic implementation efforts in any setting: (1) Having a high-profile target for the number of ABIs delivered in a specific time period with clarity about whose responsibility it was to implement the target; (2) Gaining support from senior staff from the start; (3) Adapting the intervention, using a pragmatic, collaborative approach, to fit with current practice; (4) Establishing practical and robust recording, monitoring and reporting systems for intervention delivery, prior to widespread implementation; and (5) Establishing close working relationships with frontline staff including flexible approaches to training and readily available support. Conclusions This qualitative study suggests that even with significant national support, funding and a specific delivery target, ABI implementation in new settings is not straightforward. Those responsible for planning similar initiatives should critically consider the relevance and value of the five implementation strategies identified.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, , Scotland, UK. .,Institute for Health and Wellbeing Research, Robert Gordon University, Riverside Campus, Aberdeen, AB10 7GJ, UK.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Susie Heywood
- Glasgow City Community Health Partnership, North-East Sector, Eastbank Health Promotion & Training Centre, Academy Street, Glasgow, G32 9AA, UK.
| | - Jim McCambridge
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Mittnacht AM, Bulik CM. Best nutrition counseling practices for the treatment of anorexia nervosa: a Delphi study. Int J Eat Disord 2015; 48:111-22. [PMID: 24976176 DOI: 10.1002/eat.22319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To use Delphi methodology to evaluate the extent to which a panel of registered dietitians (RDs) who treat anorexia nervosa (AN) concur on parameters related to nutrition counseling for AN. METHOD The twenty-one panelists who participated in this study: (i) were RDs (ii) had specialized in nutritional counseling for eating disorders for 5 years or more, and (iii) had Internet access at home or work. Over a 10-week period (between 8/2013 and 11/2013), panelists completed three iterative questionnaires. Questionnaire 1 included 12 open-ended questions regarding nutrition counseling for patients with AN. Subsequent questionnaires were developed based on a content analysis of responses to the first questionnaire, and panelists were asked to rank their level of agreement with these items. RESULTS Consensus was defined as 85% agreement and was achieved for 47 (35.3%) of the 133 items included in the third questionnaire. Items achieving consensus described nutrition counseling approaches that are applicable to all patients with AN, and their wording typically allowed for consideration of individual needs. Some items that did not achieve consensus reflected approaches for which individual tailoring may be necessary depending on age, stage of illness, and other patient factors. Consensus was also not shown for approaches for which there is little evidence. DISCUSSION Nutritional counseling intervention for AN has some consensus features, but the need for individualization was apparent. A stronger evidence-base for nutritional counseling interventions for AN would provide guidance and facilitate greater consistency among RDs regarding how to best care for this patient population.
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Affiliation(s)
- Anne M Mittnacht
- Department of Nutrition at the University of North Carolina at Chapel Hill, North Carolina
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KANER EILEEN. NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England. Drug Alcohol Rev 2010; 29:589-95. [DOI: 10.1111/j.1465-3362.2010.00236.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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McCormick R, Docherty B, Segura L, Colom J, Gual A, Cassidy P, Kaner E, Heather N. The research translation problem: Alcohol screening and brief intervention in primary care – Real world evidence supports theory. DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687630903286800] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Eileen Kaner
- Institute of Health and Society, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne NE24HH, UK.
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AMARAL MICHAELAB, RONZANI TELMOM, SOUZA-FORMIGONI MARIALUCIAO. Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil. Drug Alcohol Rev 2009; 29:162-8. [DOI: 10.1111/j.1465-3362.2009.00120.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Crawford MJ, Price K, Rutter D, Moran P, Tyrer P, Bateman A, Fonagy P, Gibson S, Weaver T. Dedicated community-based services for adults with personality disorder: Delphi study. Br J Psychiatry 2008; 193:342-3. [PMID: 18827303 DOI: 10.1192/bjp.bp.107.043042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dedicated community-based services have been recommended for people with personality disorder, but little is known about how such services should be configured. We conducted a Delphi survey to assess opinions about this. A panel of expert authors, service providers and service users agreed on only 21 (39%) of 54 statements on the organisation and delivery of care. Consensus was not reached on important issues such as working with people with a history of violent offending, the role of community outreach and the use of compulsory treatment. Further work needs to be undertaken before the optimal organisation of dedicated personality disorder services can be agreed.
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Affiliation(s)
- Mike J Crawford
- Department of Psychological Medicine, Faculty of Medicine, Imperial College London, London, UK.
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