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Crawford J, Blomqvist J, Gunnarsson KU, Bendtsen P, Bendtsen M. Mediated effects of a randomised control trial for a text messaging smoking cessation intervention for online help-seekers and primary care visitors. BMC Public Health 2024; 24:1824. [PMID: 38977972 PMCID: PMC11232307 DOI: 10.1186/s12889-024-19273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND AIMS Digital smoking cessation interventions have been shown to be effective in helping individuals achieve prolonged smoking abstinence. Nonetheless, the mechanisms that drive such effects are unclear. The current study aimed to estimate a digital smoking cessation intervention's natural direct and indirect effects. METHODS This secondary analysis of mediated effects uses data from a randomised controlled trial which included participants who smoked at least one cigarette a week, had access to a mobile phone, and were 18 years or older. The comparator was existing smoking cessation support available to all members of the Swedish public. Primary outcomes were prolonged smoking abstinence and point prevalence of smoking abstinence, measured at 3- and 6-months post-randomisation. A counterfactual framework was used to estimate three hypothesised mediators of the intervention's effects: importance, knowledge of how to change (know-how), and confidence. RESULTS Between 18/09/20 and 16/06/22, 1012 participants were randomised. The intervention led to improved confidence and know-how, which both partially mediated the effects of the digital intervention on smoking abstinence at 3- and 6 months post-randomisation. CONCLUSIONS A digital smoking cessation intervention was found to partially affect smoking abstinence by improving individuals' confidence in their ability to quit smoking and developing knowledge on how to quit. Face-value single-item mediator measures, lack of blinding, and attrition limit the study. Future studies should address these limitations and assess additional mechanisms mediating intervention effects. TRIAL REGISTRATION ISRCTN13455271.
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Affiliation(s)
- Joel Crawford
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Jenny Blomqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | | | - Preben Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Medical Specialist, Motala, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Hawkins LK, Burns L, Swancutt D, Moghadam S, Pinkney J, Tarrant M. Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews. Obes Rev 2024:e13798. [PMID: 38952041 DOI: 10.1111/obr.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/10/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.
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Affiliation(s)
- Lily K Hawkins
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Lorna Burns
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Dawn Swancutt
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Shokraneh Moghadam
- Faculty of Health and Life Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Jonathan Pinkney
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- Faculty of Health, University of Plymouth, Plymouth, PL6 8BX, UK
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3
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Yin YH, Liu JYW, Välimäki M. "How difficult it is to change dietary behaviour" experience of older people with sarcopenic obesity: a qualitative study. BMC Geriatr 2024; 24:568. [PMID: 38951785 PMCID: PMC11218247 DOI: 10.1186/s12877-024-05157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention. METHODS This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data. RESULTS The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite. CONCLUSION Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join.
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Affiliation(s)
- Yue-Heng Yin
- School of Nursing, Nanjing Medical University, 101 Long Mian Avenue, Nanjing, 211166, China.
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Maritta Välimäki
- Faculty of Medicine, Department of Public Health, University of Helsinki, Helsinki, Finland
- , Turku, Finland
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Alruwaili A, King JA, Deighton K, Kelly BM, Liao Z, Innes A, Henson J, Yates T, Johnson W, Thivel D, Metz L, Thackray AE, Tolfrey K, Stensel DJ, Willis SA. The association of smoking with different eating and dietary behaviours: A cross-sectional analysis of 80 296 United Kingdom adults. Addiction 2024. [PMID: 38884138 DOI: 10.1111/add.16584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND AIMS Smokers typically have a lower body mass index (BMI) than non-smokers, while smoking cessation is associated with weight gain. In pre-clinical research, nicotine in tobacco smoking suppresses appetite and influences subsequent eating behaviour; however, this relationship is unclear in humans. This study measured the associations of smoking with different eating and dietary behaviours. DESIGN A cross-sectional analysis of data from health assessments conducted between 2004 and 2022. SETTING An independent healthcare-based charity within the United Kingdom. PARTICIPANTS A total of 80 296 men and women (mean ± standard deviation [SD]: age, 43.0 ± 10.4 years; BMI, 25.7 ± 4.2 kg/m2; 62.5% male) stratified into two groups based on their status as a smoker (n = 6042; 7.5%) or non-smoker (n = 74 254; 92.5%). MEASUREMENTS Smoking status (self-report) was the main exposure, while the primary outcomes were selected eating and dietary behaviours. Age, sex and socioeconomic status (index of multiple deprivation [IMD]) were included as covariates and interaction terms, while moderate-to-vigorous exercise and sleep quality were included as covariates only. FINDINGS Smokers had lower odds of snacking between meals and eating food as a reward or out of boredom versus non-smokers (all odds ratio [OR] ≤ 0.82; P < 0.001). Furthermore, smokers had higher odds of skipping meals, going more than 3 h without food, adding salt and sugar to their food, overeating and finding it hard to leave something on their plate versus non-smokers (all OR ≥ 1.06; P ≤ 0.030). Additionally, compared with non-smokers, smoking was associated with eating fried food more times per week (rate ratio [RR] = 1.08; P < 0.001), eating fewer meals per day, eating sweet foods between meals and eating dessert on fewer days per week (all RR ≤ 0.93; P < 0.001). Several of these relationships were modified by age, sex and IMD. CONCLUSIONS Smoking appears to be associated with eating and dietary behaviours consistent with inhibited food intake, low diet quality and altered food preference. Several of these relationships are moderated by age, sex and socioeconomic status.
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Affiliation(s)
- Arwa Alruwaili
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - James A King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - Kevin Deighton
- Nuffield Health Research Group, Nuffield Health, Epsom, Surrey, United Kingdom
| | - Benjamin M Kelly
- Nuffield Health Research Group, Nuffield Health, Epsom, Surrey, United Kingdom
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom
| | - Zhining Liao
- Nuffield Health Research Group, Nuffield Health, Epsom, Surrey, United Kingdom
| | - Aidan Innes
- Nuffield Health Research Group, Nuffield Health, Epsom, Surrey, United Kingdom
| | - Joseph Henson
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - William Johnson
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - David Thivel
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH, Clermont-Ferrand, France
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France
| | - Lore Metz
- Clermont Auvergne University, EA 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH, Clermont-Ferrand, France
- International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France
| | - Alice E Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
| | - Keith Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
- Faculty of Sport Sciences, Waseda University, Shinjuku, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Scott A Willis
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, United Kingdom
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Black N, Chung S, Tisdale C, Fialho LS, Aramrattana A, Assanangkornchai S, Blaszczynski A, Bowden-Jones H, van den Brink W, Brown A, Brown QL, Cottler LB, Elsasser M, Ferri M, Florence M, Gueorguieva R, Hampton R, Hudson S, Kelly PJ, Lintzeris N, Murphy L, Nadkarni A, Neale J, Rosen D, Rumpf HJ, Rush B, Segal G, Shorter GW, Torrens M, Wait C, Young K, Farrell M. An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders. J Clin Med 2024; 13:2154. [PMID: 38610919 PMCID: PMC11012938 DOI: 10.3390/jcm13072154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.
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Affiliation(s)
- Nicola Black
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
| | - Sophie Chung
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Calvert Tisdale
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Apinun Aramrattana
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Alex Blaszczynski
- School of Psychology, Brain and Mind Centre, Faculty of Science, University of Sydney, Sydney 2006, Australia;
| | - Henrietta Bowden-Jones
- Department of Psychiatry, University College London, London NW1 2AE, UK
- Department of Psychiatry, Cambridge University, Cambridge CB2 1QW, UK
| | - Wim van den Brink
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Adrian Brown
- Northwick Park Hospital, Central and North West London Trust, London HA1 3UJ, UK
| | - Qiana L. Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Medicine & Public Health and Health Professions, University of Florida, Homestead, FL 33031, USA
| | | | - Marica Ferri
- Department of Psychology, Faculty of Community and Health, European Monitoring Centre for Drugs and Drug Addiction, 1249-289 Lisbon, Portugal;
| | - Maria Florence
- Department of Biostatistics, School of Public Health, University of the Western Cape, Cape Town 7535, South Africa;
| | - Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06511, USA
| | | | - Suzie Hudson
- Network of Alcohol and Other Drugs Agencies, Sydney 2751, Australia;
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong 2522, Australia;
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
| | | | - Abhijit Nadkarni
- Addictions and Related Research Group, Sangath, Bardez 403501, Goa, India
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Joanne Neale
- Addictions Department, King’s College London, London SE1 9NH, UK
| | - Daniel Rosen
- School of Social Work, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Hans-Jürgen Rumpf
- Translational Psychiatry Unit, Universität zu Lübeck, 23562 Lübeck, Germany
| | - Brian Rush
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Gabriel Segal
- Department of Philosophy, King’s College London, London SE1 9NH, UK;
| | - Gillian W. Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen’s University Belfast, Belfast BT9 5AJ, UK
- Institute of Mental Health Sciences, Ulster University, Coleraine BT52 1SA, UK
| | - Marta Torrens
- Addiction Service, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Katherine Young
- International Consortium for Health Outcomes Measurement, London W12 8EU, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW, Sydney 2052, Australia
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Cooke ME, Knoll SJ, Streck JM, Potter K, Lamberth E, Rychik N, Gilman JM, Evins AE, Schuster RM. Contingency management is associated with positive changes in attitudes and reductions in cannabis use even after discontinuation of incentives among non-treatment seeking youth. Drug Alcohol Depend 2024; 256:111096. [PMID: 38277735 PMCID: PMC10923125 DOI: 10.1016/j.drugalcdep.2024.111096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND It is important to identify interventions that reduce harm in youth not motivated to change their cannabis use. This study evaluated how short-duration contingency management (CM) impacts cannabis use attitudes and behavior after abstinence incentives are discontinued among non-treatment seeking youth. METHODS Participants (N=220) were randomized to 4 weeks of abstinence-based CM (CB-Abst; n=126) or monitoring (CB-Mon; n=94). Participants completed self-report and provided biochemical measures of cannabis exposure at baseline, end-of-intervention, and 4-week follow-up. Changes in self-reported cannabis use frequency (days/week; times/week) and biochemically verified creatinine-adjusted 11-nor-9-carboxy-tetrahydrocannabinol concentrations (CN-THCCOOH) were analyzed between groups from baseline to follow-up. In CB-Abst, cannabis use goals at end-of-intervention were described and changes in cannabis use at follow-up were explored by goals and cannabis use disorder (CUD) diagnosis. RESULTS There was a group by visit interaction on cannabis use (days: beta=0.93, p=0.005; times: beta=0.71, p<0.001; CN-THCCOOH: beta=0.26, p=0.004), with reductions at follow-up detected only in CB-Abst. Following 4 weeks of abstinence, 68.4% of CB-Abst participants wanted to reduce or abstain from cannabis use following completion of CM. Those in CB-Abst who set end-of-intervention reduction goals and were without CUD had greater decreases in cannabis use frequency at follow-up (Goals*time on days/week: beta=-2.27, p<0.001; CUD*time on times/week: beta=0.48, SE=0.24, t=2.01, p=0.048). CONCLUSIONS Findings support the utility of brief incentivized abstinence for generating motivation to reduce cannabis use and behavior change even after incentives end. This study supports CM as a potentially viable harm reduction strategy for those not yet ready to quit.
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Affiliation(s)
- Megan E Cooke
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA
| | - Sarah J Knoll
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Kevin Potter
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Erin Lamberth
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Natali Rychik
- Department of Psychiatry, Massachusetts General Hospital, USA
| | - Jodi M Gilman
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Randi M Schuster
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, Boston, MA, USA.
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Bendotti H, Lawler S, Gartner C, Ireland D, Marshall HM. Smoking Cessation Counseling in Practice: A Qualitative Analysis of Quitline Conversations in Queensland, Australia. HEALTH EDUCATION & BEHAVIOR 2024; 51:43-53. [PMID: 37846946 PMCID: PMC10785561 DOI: 10.1177/10901981231206068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Telephone-based services are a practical and effective behavioral support for smoking cessation, yet no in-depth analyses of this counseling have been conducted. Understanding the general content of Quitline conversations can help to improve current practices and may inform future interventions. Therefore, we aimed to independently explore conversation themes, topics, and client questions during Quitline counseling sessions with Quitline clients in Queensland, Australia. A purposive sample of 30 recorded counseling sessions, completed between January and March 2019, were de-identified, transcribed, and thematically analyzed. Seven themes, encompassing 35 topics, were derived from 26 initial calls and four follow-up calls: (1) Client details and building rapport; (2) Client history and motivation to quit; (3) Pharmacotherapy; (4) Behavioral aspects of quitting and relationship with smoking; (5) Understanding nicotine dependence and other important considerations; (6) Additional support and smoking cessation resources; and (7) Planning, goal setting and follow-up. Three themes emerged from 18 client questions including (1) Pharmacotherapy safety and contraindications; (2) Pharmacotherapy instructions and mechanism of action; and (3) Physiology of nicotine dependence. This is the first qualitative analysis of the content of Quitline counseling sessions in Australia. Counselors collect and deliver a breadth of information to provide tailored, evidence-based health care, while building rapport and trust. Findings may be translatable into personalized self-help interventions that are more accessible or appealing to people reluctant to contact Quitline. Harnessing educational opportunities regarding pharmacotherapy adherence and misconceptions can improve client confidence in the product and smoking cessation outcomes. Further research will map conversations to motivational interviewing and behavior change techniques.
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Affiliation(s)
- Hollie Bendotti
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Chermside, Australia
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Queensland, Australia
| | - Sheleigh Lawler
- School of Public Health, The University of Queensland, Herston, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - David Ireland
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Queensland, Australia
| | - Henry M. Marshall
- Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Chermside, Australia
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
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Karashiali C, Konstantinou P, Kasinopoulos O, Michael C, Papageorgiou A, Kadianaki I, Karekla M, Kassianos AP. Tensions in caring for chronic patients' medication adherence: A qualitative study in Cyprus. J Health Psychol 2024:13591053241227003. [PMID: 38282383 DOI: 10.1177/13591053241227003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
Medication adherence (MA) to recommended treatment is a multi-faceted problem and an ongoing challenge for healthcare providers (HCPs) to monitor. This qualitative study with 10 HCPs in Cyprus aims to explore HCPs' perceptions and strategies used on addressing medication non-adherence (MNA) in patients with chronic conditions. Two main themes emerged from the analysis reflecting the ways that HCPs described their reactions to MNA of their patients: (1) "Relying on information provision to improve MA" and (2) "Trying to understand patients' perspective." HCPs reported empathizing with patients and engaging in discussions to understand patients' perspective and reasons for MNA, so as to explore alternative solutions. Simultaneously, some HCPs reflected that the techniques used to improve MA are solely centered around information on medication and side-effects. HCPs experienced an internal conflict between providing patient-centered care versus using directive approaches to improve MA. Findings suggest how HCPs could thoroughly address patients' individual barriers.
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9
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Crawshaw J, Meyer C, Antonopoulou V, Antony J, Grimshaw JM, Ivers N, Konnyu K, Lacroix M, Presseau J, Simeoni M, Yogasingam S, Lorencatto F. Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals. Implement Sci 2023; 18:63. [PMID: 37990269 PMCID: PMC10664600 DOI: 10.1186/s13012-023-01318-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change. METHODS We conducted a directed content analysis of intervention descriptions in 287 randomized trials included in an ongoing Cochrane systematic review update of A&F interventions (searched up to June 2020). Three trained researchers identified and categorized BCTs in all trial arms (treatment & control/comparator) using the 93-item BCT Taxonomy version 1. The original BCT definitions and examples in the taxonomy were adapted to include A&F-specific decision rules and examples. Two additional BCTs ('Education (unspecified)' and 'Feedback (unspecified)') were added, such that 95 BCTs were considered for coding. RESULTS In total, 47/95 BCTs (49%) were identified across 360 treatment arms at least once (median = 5.0, IQR = 2.3, range = 129 per arm). The most common BCTs were 'Feedback on behaviour' (present 89% of the time; e.g. feedback on drug prescribing), 'Instruction on how to perform the behaviour' (71%; e.g. issuing a clinical guideline), 'Social comparison' (52%; e.g. feedback on performance of peers), 'Credible source' (41%; e.g. endorsements from respected professional body), and 'Education (unspecified)' (31%; e.g. giving a lecture to staff). A total of 130/287 (45%) control/comparator arms contained at least one BCT (median = 2.0, IQR = 3.0, range = 0-15 per arm), of which the most common were identical to those identified in treatment arms. CONCLUSIONS A&F interventions to improve healthcare professional practice include a moderate range of BCTs, focusing predominantly on providing behavioural feedback, sharing guidelines, peer comparison data, education, and leveraging credible sources. We encourage the use of our A&F-specific list of BCTs to improve knowledge of what is being delivered in A&F interventions. Our study provides a basis for exploring which BCTs are associated with intervention effectiveness. TRIAL REGISTRATIONS N/A.
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Affiliation(s)
- Jacob Crawshaw
- Centre for Evidence-Based Implementation, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carly Meyer
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Vivi Antonopoulou
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Jesmin Antony
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Kristin Konnyu
- Department of Health Services, Policy and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Meagan Lacroix
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Michelle Simeoni
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sharlini Yogasingam
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Fabiana Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK.
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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Karlsson ML, Hertzberg-Nyquist K, Saevarsdottir S, Lundberg IE, Demmelmaier I, Pettersson S, Chatzidionysiou K. Evaluation of an individually tailored smoking-cessation intervention for patients with rheumatoid arthritis in an outpatient clinic. Scand J Rheumatol 2023; 52:591-600. [PMID: 36815567 DOI: 10.1080/03009742.2023.2172903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate an individually tailored smoking-cessation intervention delivered in rheumatology care and compare the characteristics of patients who quit smoking with those who did not. METHOD This was an open single-group prospective intervention study over 24 months, with assessments at baseline and at 6, 12, 18, and 24 months. Current smokers with rheumatoid arthritis (RA) were invited to a smoking-cessation programme including behavioural change support, with or without pharmacotherapy. Data on disease activity, medical treatment, and patient-reported outcomes were retrieved from the Swedish Rheumatology Quality Register. The primary outcome was the proportion of patients at month 24 who reported having quit smoking with self-reported 7 day smoking abstinence. RESULTS In total, 99 patients participated in the study. Median age was 58 years (interquartile range 50-64); 69% were female and 88% rheumatoid factor and/or anti-cyclic citrullinated peptide positive. At 24 months, 21% of the patients had quit smoking. At 6, 12, and 18 months, 12%, 12%, and 14% of patients, respectively, had quit smoking. For patients still smoking at 24 months, the median number of cigarettes per day was significantly reduced from 12 to 6 (p ≤ 0.001). Among patients who had quit smoking at 24 months, a smaller proportion reported anxiety at baseline compared to those still smoking (28% vs 58%, p = 0.02). CONCLUSION A smoking-cessation intervention including behavioural change support with or without pharmacotherapy can be helpful for a substantial number of RA patients. Anxiety is associated with lower smoking-cessation success rates.
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Affiliation(s)
- M-L Karlsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | | | - S Saevarsdottir
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - I E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - I Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - S Pettersson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - K Chatzidionysiou
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
- Department of Gastroenterology, Dermatology, Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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11
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Herbert J, Schumacher T, Brown LJ, Clarke ED, Collins CE. Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review. Int J Behav Nutr Phys Act 2023; 20:110. [PMID: 37715234 PMCID: PMC10504780 DOI: 10.1186/s12966-023-01505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic. METHODS The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here. RESULTS The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%). CONCLUSIONS Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations. TRIAL REGISTRATION The scoping review protocol was not pre-registered.
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Affiliation(s)
- Jaimee Herbert
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Tracy Schumacher
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Leanne J Brown
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Erin D Clarke
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 205, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 310, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia.
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Trigg J, Skelton E, Lum A, Guillaumier A, McCarter K, Handley T, Judd L, Lye A, Bonevski B. Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review. Nicotine Tob Res 2023; 25:1709-1718. [PMID: 37338988 PMCID: PMC10475608 DOI: 10.1093/ntr/ntad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/10/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Tobacco smoking rates in high-income countries are greater in rural, regional, and remote (RRR) areas compared to cities. Yet, there is limited knowledge about interventions targeted to RRR smokers. This review describes the effectiveness of smoking cessation interventions for RRR smokers in supporting smoking abstinence. AIMS AND METHODS Seven academic databases were searched (inception-June 2022) for smoking cessation intervention studies to include if they reported on RRR residents of Australia, Canada, or the United States, and short- (<6 months) or long-term (≥6 months) smoking abstinence outcomes. Two researchers assessed study quality, and narratively summarized findings. RESULTS Included studies (n = 26) were primarily randomized control (12) or pre-post (7) designs, from the United States (16) or Australia (8). Five systems change interventions were included. Interventions included cessation education or brief advice, and few included nicotine monotherapies, cessation counseling, motivational interviewing, or cognitive behavioral therapy. Interventions had limited short-term effects on RRR smoking abstinence, decreasing markedly beyond 6 months. Short-term abstinence was best supported by contingency, incentive, and online cessation interventions, and long-term abstinence by pharmacotherapy. CONCLUSIONS Cessation interventions for RRR smokers should include pharmacotherapy and psychological cessation counseling to establish short-term abstinence, and identify effective means of maintaining abstinence beyond 6 months. Contingency designs are a suitable vehicle for psychological and pharmacotherapy support for RRR people who smoke, and intervention tailoring should be explicitly considered. IMPLICATIONS Smoking disproportionately harms RRR residents, who can encounter access barriers to smoking cessation support. High-quality intervention evidence and outcome standardization are still required to support long-term RRR smoking abstinence.
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Affiliation(s)
- Joshua Trigg
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alistair Lum
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ashleigh Guillaumier
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kristen McCarter
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Tonelle Handley
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Lucy Judd
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alexie Lye
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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13
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Mersha AG, Bryant J, Rahman T, McGuffog R, Maddox R, Kennedy M. What Are the Effective Components of Group-Based Treatment Programs For Smoking Cessation? A Systematic Review and Meta-Analysis. Nicotine Tob Res 2023; 25:1525-1537. [PMID: 37104053 PMCID: PMC10439487 DOI: 10.1093/ntr/ntad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/12/2023] [Accepted: 04/26/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION There is significant variation in the format and delivery of group-based smoking cessation programs. To guide research and healthcare program implementation, it is important to understand the active components of interventions. AIMS AND METHODS This review aimed to (1) identify behavior change techniques (BCTs) used in effective group-based smoking cessation interventions, (2) determine the effectiveness of group-based smoking cessation interventions on smoking cessation at 6-month follow-up, and (3) identify the behavior change techniques (BCTs) related to effective group-based smoking cessation. The following databases were searched in January 2000 and March 2022: MEDLINE, EMBASE, CINAHL, PsycINFO, The Cochrane Library, and Web of Science. BCTs used in each study were extracted using the BCT Taxonomy. Studies that included identified BCTs were computed, and meta-analyses were conducted to evaluate smoking cessation at 6-month follow-up. RESULTS A total of 28 BCTs were identified from 19 randomized controlled trials. Studies included an average of 5.42 ± 2.0 BCTs. The most frequent BCTs were "information about health consequences" and "problem solving." The pooled 6-month smoking cessation was higher in the group-based intervention group (OR = 1.75, 95% CI = 1.12 to 2.72, p <.001). Inclusion of the following four BCTs: "Problem solving," "Information about health Consequences," "Information about social and environmental consequences," and "Reward (outcome)" were found to be significantly associated with increased rate of 6-month smoking cessation. CONCLUSIONS Group-based smoking cessation interventions doubles the rate of smoking cessation at 6-month follow-up. Implementing group-based smoking cessation programs, that incorporate multiple BCTs, is recommended for an effective smoking cessation care. IMPLICATIONS Group-based smoking cessation programs improves smoking cessation outcomes in clinical trials. There is a need to incorporate effective individual BCTs techniques to enhance smoking cessation treatment outcomes. A robust evaluation is required to assess the effectiveness of group-based cessation programs in real world settings. There is also a need to consider the differential effectiveness of group-based programs and BCT impacts on populations, for example, indigenous peoples.
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Affiliation(s)
- Amanual Getnet Mersha
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tabassum Rahman
- Centre for Epidemiology and Biostatistics, University of Melbourne, VIC, Australia
| | - Romany McGuffog
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Raglan Maddox
- National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT, Australia
| | - Michelle Kennedy
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Whitmore K, Zhou Z, Chapman N, Huynh Q, Magnussen CG, Sharman JE, Marwick TH. Impact of Patient Visualization of Cardiovascular Images on Modification of Cardiovascular Risk Factors: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:1069-1081. [PMID: 37227327 DOI: 10.1016/j.jcmg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is unclear whether detection and patient visualization of cardiovascular (CV) images using computed tomography to assess coronary artery calcium or carotid ultrasound (CU) to identify plaque and intima-medial thickness merely prompts prescription of lipid-lowering therapy or whether it motivates lifestyle change among patients. OBJECTIVES This systematic review and meta-analysis sought to investigate whether patient visualization of CV images (computed tomography or CU) has a beneficial impact on improving overall absolute CV risk as well as lipid and nonlipid CV risk factors in asymptomatic individuals. METHODS The key words "CV imaging," "CV risk," "asymptomatic persons," "no known or diagnosed CV disease," and "atherosclerotic plaque" were searched in PubMed, Cochrane, and Embase in November 2021. Randomized trials that assessed the role of CV imaging in reducing CV risk in asymptomatic persons with no known CV disease were eligible for study inclusion. The primary outcome was a change in 10-year Framingham risk score from the trial commencement to the end of the follow-up following patient visualization of CV images. RESULTS Six randomized controlled trials (7,083 participants) were included; 4 studies used coronary artery calcium and 2 used CU to detect subclinical atherosclerosis. All studies used image visualization in the intervention group to communicate CV risk. Imaging-guidance was associated with a 0.91% improvement in 10-year Framingham risk score (95% CI: 0.24%-1.58%; P = 0.01). Significant reductions in low-density-lipoprotein, total cholesterol, and systolic blood pressure were observed (all P < 0.05). CONCLUSIONS Patient visualization of CV imaging is associated with overall CV risk reduction and improvement of individual risk factors: cholesterol and systolic blood pressure.
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Affiliation(s)
- Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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15
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Lin X, Martinengo L, Jabir AI, Ho AHY, Car J, Atun R, Tudor Car L. Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps. J Med Internet Res 2023; 25:e45984. [PMID: 37463036 PMCID: PMC10394504 DOI: 10.2196/45984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users' mental health. OBJECTIVE This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. METHODS The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple's App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. RESULTS We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 "Social support (emotional)," 4.1 "Instructions for how to perform a behavior," 11.2 "Reduce negative emotions," and 6.1 "Demonstration of the behavior." One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. CONCLUSIONS Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions.
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Affiliation(s)
- Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University Singapore, Singapore, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Butters A, Kersbergen I, Holmes J, Field M. Temporary abstinence challenges: What do we need to know? Drug Alcohol Rev 2023; 42:1087-1091. [PMID: 36808783 PMCID: PMC10947026 DOI: 10.1111/dar.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
Participation in temporary abstinence challenges (TAC) continues to increase with campaigns established in several countries. Temporarily abstaining from alcohol as part of such challenges is associated with ongoing benefits including reductions to alcohol consumption after the TAC. We identified three research priorities regarding TACs which are outlined in this paper. First, the role of temporary abstinence itself is unclear with post-TAC reductions in alcohol consumption still apparent among participants who do not remain fully abstinent throughout the challenge. It is necessary to establish to what degree temporary abstinence itself, rather than the combination of abstinence and the additional supports provided by TAC organisers (e.g., mobile applications, online support groups), contributes to changes in consumption after the TAC. Second, little is known about the psychological changes underlying these changes in alcohol consumption, with conflicting evidence as to whether increases in someone's belief in their ability to avoid drinking mediates the association between participation in a TAC and reductions in consumption afterwards. Other potential psychological and social mechanisms of change have been subjected to little, if any, scrutiny. Third, evidence of increased consumption post-TAC among a minority of participants indicates a need to establish for whom or in what circumstances participation in a TAC may result in unintended negative consequences. Focussing research in these areas would increase the confidence with which participation could be encouraged. It would also enable campaign messaging and additional supports to be prioritised and tailored to be as effective as possible in facilitating long-term change.
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Affiliation(s)
- Anna Butters
- Department of PsychologyUniversity of SheffieldSheffieldUK
| | - Inge Kersbergen
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - John Holmes
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Matt Field
- Department of PsychologyUniversity of SheffieldSheffieldUK
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Wuerstl KR, Todd K, Lawrason S, Shwed A, Holmes B, Gainforth HL. Theoretical components of smoking cessation interventions for persons with physical disabilities: A scoping review. Addict Behav 2023; 145:107762. [PMID: 37331134 DOI: 10.1016/j.addbeh.2023.107762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
Rationale Persons with physical disabilities report higher cigarette smoking rates and a lower likelihood of accessing health services (e.g., smoking cessation services). Explicit and systematic application of behaviour change theory may be a promising approach to addressing these inequities and developing impactful smoking cessation interventions for persons with physical disabilities. OBJECTIVE This scoping review aimed to explore how behaviour change theory and intervention components have been used to design smoking cessation interventions for persons with physical disabilities. METHODS Electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science) were systematically searched. Smoking cessation interventions for persons with physical disabilities were identified. Behaviour change theory and intervention components, including behaviour change techniques, intervention functions, mode of delivery, intervention source, and setting, were extracted from the included articles. RESULTS Among the eleven included articles, there were nine unique smoking cessation interventions for persons with physical disabilities. Three interventions mentioned theory, but none of these articles explicitly applied or tested the theory. Intervention components were consistently combined to deliver pharmacotherapy and behavioural counselling-based interventions. CONCLUSION The results of this review highlight the scarcity of theory-based smoking cessation interventions for persons with physical disabilities. While the interventions were not theory-based, they were evidence-based and aligned with recommendations for smoking cessation treatment (i.e., behavioural counselling plus pharmacotherapy). Future research should take a theory-based approach to intervention development to enhance the likelihood that smoking cessation interventions for persons with physical disabilities are effective, replicable, and equitable.
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Affiliation(s)
- Kelsey R Wuerstl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.
| | - Kendra Todd
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Sarah Lawrason
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Alanna Shwed
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
| | - Ben Holmes
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada
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García-Fernández G, Krotter A, González-Roz A, García-Pérez Á, Secades-Villa R. Effectiveness of including weight management in smoking cessation treatments: A meta-analysis of behavioral interventions. Addict Behav 2023; 140:107606. [PMID: 36642013 DOI: 10.1016/j.addbeh.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The potential of weight gain after smoking cessation reduces the incentive to quit. This meta-analysis examines the efficacy of behavioral interventions for smoking cessation that also address post-cessation weight gain. METHODS Medline, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials on behavioral treatments targeting both health outcomes. Six separate meta-analyses were undertaken to assess treatment efficacy on smoking abstinence and weight outcomes at end of treatment (EOT), short-term, and long-term follow-up. Individual and treatment moderators were examined as well as methodological quality and publication bias of studies. RESULTS A total of 28 studies were included in the meta-analysis. There was a statistically significant positive impact of treatments addressing both targets on smoking outcomes at EOT (RR = 1.279, 95% CI: 1.096, 1.492, p = .002), but not at follow-ups. Age impacted on EOT abstinence rates Q (1) = 4.960, p = .026) while increasing the number of sessions significantly improved EOT abstinence rates (p = .020). There was no statistically significant impact of these treatments on weight at EOT (Hedges' g = -0.015, 95% CI: -.164, 0.135, p = .849) or follow-ups (short term: Hedges' g = 0.055, 95% CI: -0.060, 0.170, p = .347; long term: Hedges' g = -0.320, 95% CI: -.965, 0.325, p = .331). There were minimal impacts of publication bias, mostly related to sample size, meaning studies including small sample sizes revealed larger effect sizes on abstinence at EOT. DISCUSSION Addressing post-cessation weight management in treatments for smoking cessation significantly enhances tobacco abstinence at EOT though it was not found to have a lasting impact after treatment.
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Affiliation(s)
- Gloria García-Fernández
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain.
| | - Andrea Krotter
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Alba González-Roz
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Ángel García-Pérez
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Roberto Secades-Villa
- Department of Psychology, Addictive Behaviors Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
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Dawson S, Girling CJ, Cowap L, Clark-Carter D. Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 3:CD013766. [PMID: 36989170 PMCID: PMC10054300 DOI: 10.1002/14651858.cd013766.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Adherence to treatment, including inhaled therapies, is low in people with cystic fibrosis (CF). Although psychological interventions for improving adherence to inhaled therapies in people with CF have been developed, no previous published systematic review has evaluated the evidence for efficacy of these interventions. OBJECTIVES The primary objective of the review was to assess the efficacy of psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (CF). The secondary objective was to establish the most effective components, or behaviour change techniques (BCTs), used in these interventions. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, which is compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched databases (PubMed; PsycINFO; EBSCO; Scopus; OpenGrey), trials registries (World Health Organization International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), and the reference lists of relevant articles and reviews, with no restrictions on language, year or publication status. Date of search: 7 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing different types of psychological interventions for improving adherence to inhaled therapies in people with CF of any age, or comparing psychological interventions with usual care. We included quasi-RCTs if we could reasonably assume that the baseline characteristics were similar in both groups. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and completed data extraction, risk of bias assessments, and BCT coding (using the BCT Taxonomy v1) for all included trials. We resolved any discrepancies by discussion, or by consultation with a third review author as necessary. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 10 trials (1642 participants) in the review (children and adolescents in four trials; adults in five trials; and children and adults in one trial). Nine trials compared a psychological intervention with usual care; we could combine data from some of these in a number of quantitative analyses. One trial compared a psychological intervention with an active comparator (education plus problem-solving (EPS)). We identified five ongoing trials. Psychological interventions were generally multi-component and complex, containing an average of 9.6 BCTs (range 1 to 28). The two most commonly used BCTs included 'problem-solving' and 'instruction on how to perform the behaviour'. Interventions varied in their type, content and mode of delivery. They included a problem-solving intervention; a paper-based self-management workbook; a telehealth intervention; a group training programme; a digital intervention comprising medication reminders and lung function self-monitoring; a life-coaching intervention; a motivational interviewing (MI) intervention; a brief MI intervention (behaviour change counselling); and a digital intervention combined with behaviour change sessions. Intervention duration ranged from 10 weeks to 12 months. Assessment time points ranged from six to eight weeks up to 23 months. Psychological interventions compared with usual care We report data here for the 'over six months and up to 12 months' time point. We found that psychological interventions probably improve adherence to inhaled therapies (primary outcome) in people with CF compared with usual care (mean difference (MD) 9.5, 95% confidence interval (CI) 8.60 to 10.40; 1 study, 588 participants; moderate-certainty evidence). There was no evidence of a difference between groups in our second primary outcome, treatment-related adverse events: anxiety (MD 0.30, 95% CI -0.40 to 1.00; 1 study, 535 participants), or depression (MD -0.10, 95% CI -0.80 to 0.60; 1 study, 534 participants), although this was low-certainty evidence. For our secondary outcomes, there was no evidence of a difference between groups in terms of lung function (forced expiratory volume in one second (FEV1) % predicted MD 1.40, 95% CI -0.20 to 3.00; 1 study, 556 participants; moderate-certainty evidence); number of pulmonary exacerbations (adjusted rate ratio 0.96, 95% CI 0.83 to 1.11; 1 study, 607 participants; moderate-certainty evidence); or respiratory symptoms (MD 0.70, 95% CI -2.40 to 3.80; 1 study, 534 participants; low-certainty evidence). However, psychological interventions may improve treatment burden (MD 3.90, 95% CI 1.20 to 6.60; 1 study, 539 participants; low-certainty evidence). The overall certainty of the evidence ranged from low to moderate across these outcomes. Reasons for downgrading included indirectness (current evidence included adults only whereas our review question was broader and focused on people of any age) and lack of blinding of outcome assessors. Psychological interventions compared with an active comparator For this comparison the overall certainty of evidence was very low, based on one trial (n = 128) comparing an MI intervention to EPS for 12 months. We are uncertain whether an MI intervention, compared with EPS, improves adherence to inhaled therapies, lung function, or quality of life in people with CF, or whether there is an effect on pulmonary exacerbations. The included trial for this comparison did not report on treatment-related adverse events (anxiety and depression). We downgraded all reported outcomes due to small participant numbers, indirectness (trials included only adults), and unclear risk of bias (e.g. selection and attrition bias). AUTHORS' CONCLUSIONS Due to the limited quantity of trials included in this review, as well as the clinical and methodological heterogeneity, it was not possible to identify an overall intervention effect using meta-analysis. Some moderate-certainty evidence suggests that psychological interventions (compared with usual care) probably improve adherence to inhaled therapies in people with CF, without increasing treatment-related adverse events, anxiety and depression (low-certainty evidence). In future review updates (with ongoing trial results included), we hope to be able to establish the most effective BCTs (or 'active ingredients') of interventions for improving adherence to inhaled therapies in people with CF. Wherever possible, investigators should make use of the most objective measures of adherence available (e.g. data-logging nebulisers) to accurately determine intervention effects. Outcome reporting needs to be improved to enable combining or separation of measures as appropriate. Likewise, trial reporting needs to include details of intervention content (e.g. BCTs used); duration; intensity; and fidelity. Large trials with a longer follow-up period (e.g. 12 months) are needed in children with CF. Additionally, more research is needed to determine how to support adherence in 'under-served' CF populations.
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Affiliation(s)
- Sophie Dawson
- Wolfson Cystic Fibrosis Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Carla-Jane Girling
- Sheffield Clinical Trials Research Unit, ScHARR, University of Sheffield, Innovation Centre, Sheffield, UK
| | - Lisa Cowap
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - David Clark-Carter
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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Eysenbach G, Zary N, Weth D, Romo L, Mastellos N, Filippidis FT. Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment. JMIR Serious Games 2023; 11:e39975. [PMID: 36724003 PMCID: PMC9932870 DOI: 10.2196/39975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/01/2022] [Accepted: 01/21/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. OBJECTIVE This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. METHODS Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. RESULTS In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). CONCLUSIONS This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change.
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Affiliation(s)
| | | | - Dominik Weth
- NextStage Consulting, Dubai, United Arab Emirates
| | - Lucia Romo
- Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, Paris, France.,Inserm-Le Centre de Recherche en Epidémiologie et Santé des Populations 1018 UPS, Hôpital Raymond-Poincaré, Paris, France
| | - Nikolaos Mastellos
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Chan CCK, Chan AK, Chu C, Tsang YC. Theory-based behavioral change interventions to improve periodontal health. FRONTIERS IN ORAL HEALTH 2023; 4:1067092. [PMID: 36762002 PMCID: PMC9905735 DOI: 10.3389/froh.2023.1067092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.
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De Zylva R, Mortimer E, Miller E, Tsourtos G, Lawn S, Wilson C, Karnon J, Woodman R, Ward P. Efficacy of mindfulness and goal setting interventions for increasing resilience and reducing smoking in lower socio-economic groups: randomised controlled trial protocol. Addict Sci Clin Pract 2023; 18:7. [PMID: 36747294 PMCID: PMC9900553 DOI: 10.1186/s13722-022-00355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Smoking and resulting health problems disproportionately impact low socioeconomic status (SES) individuals. Building resilience presents an approach to 'closing the gap'. Mindfulness-based interventions and setting realistic goals are preferred in low socioeconomic communities. We aim to test if these interventions, delivered online and consolidated with peer support offered via ex-smokers, are successful in promoting smoking cessation and resilience. Our conceptualisation of resilience encompasses the inner capacity/skills and external resources (e.g., social support) which smokers utilise to bounce back from adversity. We include a process evaluation of barriers/facilitators to interventions and cost-effectiveness analysis (from health system perspective). METHODS We plan a four-arm parallel 12-month RCT with a 6-month follow-up to test the efficacy of three group-based interventions each followed by peer support. Arm 1: mindfulness-integrated cognitive behavioural therapy; Arm 2: mindfulness training; Arm 3: setting realistic goals; Arm 4: active control group directed to quit services. All interventions will be administered online. Participants are adult smokers in Australia (N = 812) who have an average weekly household income less than $457AUD or receive welfare benefits. Group-based interventions will occur over 6 months, followed by 6 months of forum-based peer support. PRIMARY OUTCOME self-reported 14-day period prevalence of smoking abstinence at 6 months, with remote biochemical verification of saliva cotinine (< 30 ng/mL). Secondary outcomes include: internal resilience (Connor-Davidson Resilience Scale-25); external resilience (ENRICHD social support tool); quality adjusted life years (EQ-5D-5L); self-efficacy for smoking abstinence (Smoking-Abstinence Self-Efficacy Questionnaire); motivation to quit smoking (Biener and Abrams Contemplation Ladder); nicotine dependence (Fagerstrom Test for Nicotine Dependency); equanimity (Equanimity Scale-16); stress (Perceived Stress Scale-10); goal assessment/attainment (Problems and Goals Assessment Scale). DISCUSSION This study is the first to compare resilience interventions for low SES smokers which have been identified by them as acceptable. Our various repeated measures and process evaluation will facilitate exploration of mechanisms of impact. We intervene within the novel framework of the Psychosocial Model of Resilience, applying a promising paradigm to address a critical and inequitable public health problem. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12621000445875, registered 19 April 2021 ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381007&isReview=true ). The Universal Trial Number is U1111-1261-8951.
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Affiliation(s)
- Reece De Zylva
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St, Adelaide, SA, 8000, Australia.
| | - Elissa Mortimer
- grid.449625.80000 0004 4654 2104Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St, Adelaide, SA 8000 Australia ,grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
| | - Emma Miller
- grid.1010.00000 0004 1936 7304The Stretton Institute, The University of Adelaide, Adelaide, SA Australia
| | - George Tsourtos
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
| | - Sharon Lawn
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
| | - Carlene Wilson
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia ,grid.1018.80000 0001 2342 0938School of Psychology and Public Health, La Trobe University, Bundoora, VIC Australia ,grid.410678.c0000 0000 9374 3516Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC Australia
| | - Jonathan Karnon
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
| | - Richard Woodman
- grid.1014.40000 0004 0367 2697College of Medicine and Public Health, Flinders University, Bedford Park, SA Australia
| | - Paul Ward
- grid.449625.80000 0004 4654 2104Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield St, Adelaide, SA 8000 Australia
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Metz G, Peters GJY, Crutzen R. Acyclic behavior change diagrams: a tool to report and analyze interventions. Health Psychol Behav Med 2022; 10:1216-1228. [PMCID: PMC9744208 DOI: 10.1080/21642850.2022.2149930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Behavior change interventions have a vital role in enhancing human health and well-being. Nevertheless, concerns have been raised about suboptimal reporting of behavior change interventions, making analyses, replications, and intervention re-use hard or impossible to conduct. Objective This paper introduces acyclic behavior change diagrams (ABCDs) to achieve more transparent development, evaluation, and reporting of behavior change interventions. ABCDs are a visual representation of the assumptions regarding causal-structural chains that underlie putative active ingredients of behavior change interventions. These causal-structural chains link the behavior change principles that are applied in an intervention to the (determinants of) behavior targeted in that intervention. Conclusions ABCDs are helpful in making implicit assumptions explicit and help communicate assumptions with team members and other stakeholders. Moreover, we believe they make evaluation easier, and their machine-readability allows for ABCDs to be imported directly into (systematic review) databases with negligible costs while disclosing complete and accurate data. Finally, the ABCD approach fits well with other initiatives to gain a deeper understanding and synthesis of the literature on active intervention elements.
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Affiliation(s)
- Gido Metz
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands, Gido Metz Department of Health Promotion, Maastricht University/CAPHRI, P.O. Box 616, Maastricht6200 MD, The Netherlands
| | - Gjalt-Jorn Ygram Peters
- Department of Methods and Statistics, Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University/CAPHRI, Maastricht, The Netherlands
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Barnes LAJ, Longman J, Adams C, Paul C, Atkins L, Bonevski B, Cashmore A, Twyman L, Bailie R, Pearce A, Barker D, Milat AJ, Dorling J, Nicholl M, Passey M. The MOHMQuit (Midwives and Obstetricians Helping Mothers to Quit Smoking) Trial: protocol for a stepped-wedge implementation trial to improve best practice smoking cessation support in public antenatal care services. Implement Sci 2022; 17:79. [PMID: 36494723 PMCID: PMC9734467 DOI: 10.1186/s13012-022-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking during pregnancy is the most important preventable cause of adverse pregnancy outcomes, yet smoking cessation support (SCS) is inconsistently provided. The MOMHQUIT intervention was developed to address this evidence-practice gap, using the Behaviour Change Wheel method by mapping barriers to intervention strategies. MOHMQuit includes systems, leadership and clinician elements. This implementation trial will determine the effectiveness and cost-effectiveness of MOHMQuit in improving smoking cessation rates in pregnant women in public maternity care services in Australia; test the mechanisms of action of the intervention strategies; and examine implementation outcomes. METHODS A stepped-wedge cluster-randomised design will be used. Implementation of MOHMQuit will include reinforcing leadership investment in SCS as a clinical priority, strengthening maternity care clinicians' knowledge, skills, confidence and attitudes towards the provision of SCS, and clinicians' documentation of guideline-recommended SCS provided during antenatal care. Approximately, 4000 women who report smoking during pregnancy will be recruited across nine sites. The intervention and its implementation will be evaluated using a mixed methods approach. The primary outcome will be 7-day point prevalence abstinence at the end of pregnancy, among pregnant smokers, verified by salivary cotinine testing. Continuous data collection from electronic medical records and telephone interviews with postpartum women will occur throughout 32 months of the trial to assess changes in cessation rates reported by women, and SCS documented by clinicians and reported by women. Data collection to assess changes in clinicians' knowledge, skills, confidence and attitudes will occur prior to and immediately after the intervention at each site, and again 6 months later. Questionnaires at 3 months following the intervention, and semi-structured interviews at 6 months with maternity service leaders will explore leaders' perceptions of acceptability, adoption, appropriateness, feasibility, adaptations and fidelity of delivery of the MOHMQuit intervention. Structural equation modelling will examine causal linkages between the strategies, mediators and outcomes. Cost-effectiveness analyses will also be undertaken. DISCUSSION This study will provide evidence of the effectiveness of a multi-level implementation intervention to support policy decisions; and evidence regarding mechanisms of action of the intervention strategies (how the strategies effected outcomes) to support further theoretical developments in implementation science. TRIAL REGISTRATION ACTRN12622000167763, registered February 2nd 2022.
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Affiliation(s)
- Larisa Ariadne Justine Barnes
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Jo Longman
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Catherine Adams
- Northern New South Wales Local Health District, Byron Central Hospital, Ewingsdale Rd, Byron Bay, NSW 2480 Australia
| | - Christine Paul
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Lou Atkins
- grid.83440.3b0000000121901201University College London, Centre for Behaviour Change, Gower Street, London, WC1E 6BT UK
| | - Billie Bonevski
- grid.1014.40000 0004 0367 2697Flinders University, College of Medicine & Public Health, Flinders Health and Medical Research Institute, Sturt Road, Bedford Park, SA 5042 Australia
| | - Aaron Cashmore
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Laura Twyman
- grid.266842.c0000 0000 8831 109XTobacco Control Unit, Cancer Prevention and Advocacy Division, Cancer Council NSW, and Conjoint Fellow, School of Medicine and Public Health, University of Newcastle, 153 Dowling St., Woolloomooloo, NSW 2011 Australia
| | - Ross Bailie
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Alison Pearce
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, and Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Camperdown, NSW 2006 Australia
| | - Daniel Barker
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Andrew J. Milat
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Julie Dorling
- grid.492318.50000 0004 0619 0853Western NSW Local Health District, 7 Commercial Avenue, Dubbo, NSW 2830 Australia
| | - Michael Nicholl
- grid.1013.30000 0004 1936 834XClinical Excellence Commission-NSW Health and The University of Sydney Faculty of Medicine and Health, 1 Reserve Road, St. Leonards, NSW 2065 Australia
| | - Megan Passey
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
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25
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Doğru OC, Webb TL, Norman P. Can behavior change techniques be delivered via short text messages? Transl Behav Med 2022; 12:979-986. [PMID: 36190350 DOI: 10.1093/tbm/ibac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Despite significant advancements in behavioral science it is unclear whether behavior change techniques (or BCTs) can be delivered to large numbers of people in a cost-effective and reliable way. The current study investigated whether it is possible to reliably deliver BCTs using short text messages. Short text messages were designed to deliver each of the 93 BCTs specified in the BCT taxonomy v1. Following initial coding and refinement by the team, a Delphi study with a panel of 15 experts coded which BCT each short text message was designed to deliver and also rated whether they were likely to be understood by recipients and easily converted to target different behaviors. After two iterations, the experts correctly assigned 66 of the 93 messages to the BCT that they were designed to deliver and indicated that these messages were likely to be easy to apply to a range of behaviors and understood by recipients. Experts were not able to identify which BCT 27 of the messages were designed to deliver and it was notable that some clusters of BCTs (e.g., "Goals and planning") were easier to deliver via short text messages than other clusters (e.g., "Scheduled consequences"). The findings suggest that short text messages can be a reliable way to deliver many, but not all, BCTs. The implications of the current study are discussed with respect to the delivery of specific BCTs and clusters of the taxonomy, as well as the need to test the acceptability of interventions delivered via short messages and the impact of messages on behavior.
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Affiliation(s)
- Onur Cem Doğru
- Department of Psychology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Tsemach R, Enden‐Izhaki A, Amit Aharon A. Intervention training of urology healthcare staff to counsel acute care inpatients on smoking cessation: An evaluation study. Nurs Open 2022; 10:828-837. [PMID: 36059078 PMCID: PMC9834151 DOI: 10.1002/nop2.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/24/2022] [Accepted: 08/22/2022] [Indexed: 01/16/2023] Open
Abstract
AIM To evaluate the differences, following intervention training, in the knowledge, attitudes, role perception, self-capacity and intention of urology staff to counsel inpatients on smoking cessation. DESIGN A descriptive evaluation study of intervention training in counselling on smoking cessation. The study was designed following guidance by the Medical Research Council. METHODS The evaluation was based on a closed-end questionnaire with four time-point measurements from May 2018-December 2019 (N = 29 at each time-point). A repeated measure within-subjects ANOVA was conducted to explore the variance in participants' attitudes, role perception, self-capacity and intention to counsel patients regarding smoking cessation. Eta squared and Bonferroni post hoc tests were used to interpret the results. RESULTS No change was observed in the research variables after theoretical science-based learning of the smoking hazards and the benefits of cessation. A statistically significant difference was found following procedural knowledge based on training, practical experience and skill development.
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Affiliation(s)
- Ronit Tsemach
- Urology DepartmentTel Aviv Sourasky Medical CenterTel AvivIsrael,Nursing Department, Steyer School of Health Professions, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Anat Enden‐Izhaki
- Macabi Health ServicesSecretary of the Israel Medical Association for Smoking Prevention and CessationTel AvivIsrael
| | - Anat Amit Aharon
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Hartmann-Boyce J, Ordóñez-Mena JM, Livingstone-Banks J, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural programmes for cigarette smoking cessation: investigating interactions between behavioural, motivational and delivery components in a systematic review and component network meta-analysis. Addiction 2022; 117:2145-2156. [PMID: 34985167 DOI: 10.1111/add.15791] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/07/2021] [Indexed: 01/29/2023]
Abstract
AIMS To investigate the comparative and combined effectiveness of four types of components of behavioural interventions for cigarette smoking cessation: behavioural (e.g. counselling), motivational (e.g. focus on reasons to quit), delivery mode (e.g. phone) and provider (e.g. nurse). DESIGN Systematic review and component network meta-analysis of randomised controlled trials identified from Cochrane reviews. Interventions included behavioural interventions for smoking cessation (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials), compared with another behavioural intervention or no support. Building on a 2021 review (CD013229), we conducted three analyses, investigating: comparative effectiveness of the components, whether models that allowed interactions between components gave different results to models assuming additivity, and predicted effect estimates for combined effects of components that had showed promise but where there were few trials. SETTING Community and health-care settings. PARTICIPANTS Adults who smoke tobacco. MEASUREMENTS Smoking cessation at ≥6 months, preferring sustained, biochemically validated outcomes where available. FINDINGS Three hundred and twelve trials (250 563 participants) were included. Fifty were at high risk of bias using Cochrane risk of bias tool, V1 (ROB1); excluding these studies did not change findings. Head-to-head comparisons of components suggested that support via text message (SMS) compared with telephone (OR 1.48, 95% CrI 1.13-1.94) or print materials (OR 1.44, 95% CrI 1.14-1.83) was more effective, and individual delivery was less effective than delivery as part of a group (OR 0.78, 95% CrI 0.64-0.95). There was no conclusive evidence of synergistic or antagonistic interactions when combining components that were commonly used together. Adding multiple components that are commonly used in behavioural counselling suggested clinically relevant and statistically conclusive evidence of benefit. Components with the largest effects that could be combined, but rarely have been, were estimated to increase the odds of quitting between two and threefold. For example, financial incentives delivered via SMS, with tailoring and a focus on how to quit, had an estimated OR of 2.94 (95% CrI 1.91-4.52). CONCLUSIONS Among the components of behavioural support for smoking cessation, behavioural counselling and guaranteed financial incentives are associated with the greatest success. Incorporating additional components associated with effectiveness may further increase benefit, with delivery via text message showing particular promise.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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28
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Javornik N, Powell DJH, Eisma MC, Johnston M, Campbell MK, Hartmann-Boyce J, Michie S, West R, Black N, de Bruin M. Pragmatic evaluation of methods for retrieving unpublished information on comparator interventions in a systematic review of smoking cessation trials. Psychol Health 2022; 39:1-17. [PMID: 35876093 PMCID: PMC10911680 DOI: 10.1080/08870446.2022.2081688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Reporting of the content and delivery characteristics of comparator interventions in published articles is often incomplete. This study examines the feasibility and validity of two methods for collecting additional information on comparator interventions from trial authors. METHODS & MEASURES In a systematic review of smoking cessation trials (IC-Smoke), all trial authors were asked to send unpublished comparator intervention materials and complete a specially-developed comparator intervention checklist. All published and additionally obtained information from authors were coded for behaviour change techniques (BCTs) and other characteristics (type of comparator, provider, provider training, delivery mode and treatment duration). To assess representativeness, we assessed the amount of additional information obtained from trial authors compared with the amount that was published. We examined known-group and convergent validity of comparator intervention data when using only published or also unpublished information. RESULTS Additional information were obtained from 91/136 (67%) of trial authors. Representativeness, known-group and convergent validity improved substantially based on the data collected by means of the comparator intervention checklist, but not by requesting authors to send any existing comparator materials. CONCLUSIONS Requesting authors for unpublished comparator intervention data, using specially-developed checklists and unpublished materials, substantially improves the quality of data available for systematic reviews.
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Affiliation(s)
- Neža Javornik
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel J. H. Powell
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion K. Campbell
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute of Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Technology Addiction Team, Brain and Mind Centre, University of Sydney, Australia
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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29
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Burke MV, Cha S, Shumaker TM, LaPlante M, McConahey L, Graham AL. Delivery of smoking cessation treatment via live chat: An analysis of client-centered coaching skills and behavior change techniques. PATIENT EDUCATION AND COUNSELING 2022; 105:2183-2189. [PMID: 34887156 DOI: 10.1016/j.pec.2021.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This qualitative study explored whether evidence-based tobacco cessation treatment components can be deployed via web-based live chat coaching. METHODS N = 100 randomly selected chats were coded. Researchers used a structured coding guide to note the presence of 3 Motivational Interviewing (MI) skills and 61 behavior change techniques (BCTs). RESULTS MI skills were observed in 86% of chats: 31 chats incorporated one skill, 31 incorporated two, and 24 incorporated all three. Open-ended questions were most common (76%), followed by affirmations (47%) and reflective listening statements (38%). BCTs were observed in 100% of chats: 21% involved one-five BCTs, 69% involved six-10 BCTs, and 10% involved 11 or more BCTs. Mean number of BCTs per chat was 7.25 (SD=2.5; range 2-17). The most common BCTs were Social Support (99%), Reward/Threat (95%), Natural Consequences (82%), Regulation (82%), Goals/Planning (64%), and Self Belief (42%). CONCLUSIONS Tobacco cessation coaching using MI skills and evidence-based BCTs can be delivered via live chat. This synchronous modality allows the delivery of an intervention tailored to the user's motivations and goals. PRACTICE IMPLICATIONS Web-based live chat can broaden the reach of tobacco treatment specialists to deploy evidence-based counseling skills and behavior change techniques in personalized, accessible coaching.
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Affiliation(s)
- Michael V Burke
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA.
| | | | | | - Laura McConahey
- Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.
| | - Amanda L Graham
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Innovations Center, Truth Initiative, Washington, DC, USA.
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30
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Schöttl SE, Niedermeier M, Kopp-Wilfling P, Frühauf A, Bichler CS, Edlinger M, Holzner B, Kopp M. Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2022; 14:115. [PMID: 35729669 PMCID: PMC9210718 DOI: 10.1186/s13102-022-00498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. METHODS Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). RESULTS Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04). CONCLUSIONS Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).
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Affiliation(s)
- Stefanie E Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Carina S Bichler
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Monika Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
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31
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Buss VH, Varnfield M, Harris M, Barr M. A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study. JMIR Hum Factors 2022; 9:e35065. [PMID: 35536603 PMCID: PMC9131155 DOI: 10.2196/35065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
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Affiliation(s)
- Vera Helen Buss
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Le Foll B, Piper ME, Fowler CD, Tonstad S, Bierut L, Lu L, Jha P, Hall WD. Tobacco and nicotine use. Nat Rev Dis Primers 2022; 8:19. [PMID: 35332148 DOI: 10.1038/s41572-022-00346-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/04/2023]
Abstract
Tobacco smoking is a major determinant of preventable morbidity and mortality worldwide. More than a billion people smoke, and without major increases in cessation, at least half will die prematurely from tobacco-related complications. In addition, people who smoke have a significant reduction in their quality of life. Neurobiological findings have identified the mechanisms by which nicotine in tobacco affects the brain reward system and causes addiction. These brain changes contribute to the maintenance of nicotine or tobacco use despite knowledge of its negative consequences, a hallmark of addiction. Effective approaches to screen, prevent and treat tobacco use can be widely implemented to limit tobacco's effect on individuals and society. The effectiveness of psychosocial and pharmacological interventions in helping people quit smoking has been demonstrated. As the majority of people who smoke ultimately relapse, it is important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.
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Affiliation(s)
- Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
- Departments of Family and Community Medicine, Psychiatry, Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Megan E Piper
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA
| | - Christie D Fowler
- Department of Neurobiology and Behaviour, University of California Irvine, Irvine, CA, USA
| | - Serena Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Laura Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lin Lu
- Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
- National Institute on Drug Dependence, Peking University Health Science Center, Beijing, China
| | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
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Struik L, Rodberg D, Sharma RH. The Behavior Change Techniques Used in Canadian Online Smoking Cessation Programs: Content Analysis. JMIR Ment Health 2022; 9:e35234. [PMID: 35230253 PMCID: PMC8924781 DOI: 10.2196/35234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/13/2022] [Accepted: 02/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Smoking rates in Canada remain unacceptably high, and cessation rates have stalled in recent years. Online cessation programs, touted for their ability to reach many different populations anytime, have shown promise in their efficacy. The Government of Canada has therefore funded provincial and national smoking cessation websites countrywide. However, little is known about the behavior change techniques (BCTs) that underpin the content of these websites, which is key to establishing the quality of the websites, as well as a way forward for evaluation. OBJECTIVE The purpose of this study, therefore, is to apply the BCTTv1 taxonomy to Canadian provincial and federal websites, and to determine which BCTs they use. METHODS A total of 12 government-funded websites across Canada were included for analysis. Using deductive content analysis and through training in applying the BCTTv1 taxonomy, the website content was coded according to the 93 BCTs across the 16 BCT categories. RESULTS Of the 16 BCT categories, 14 were present within the websites. The most widely represented BCT categories (used in all 12 websites) included goals and planning, social support, natural consequences, and regulation. Implementation of BCTs within these categories varied across the sites. CONCLUSIONS Analyzing the content of online smoking cessation websites using the BCTTv1 taxonomy is an appropriate method for identifying the behavior change content of these programs. The findings offer programmers and researchers tangible directions for prioritizing and enhancing provincial and national smoking cessation programs, and an evaluation framework to assess smoking cessation outcomes in relation to the web-based content.
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Affiliation(s)
- Laura Struik
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Danielle Rodberg
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Ramona H Sharma
- School of Social Work, University of British Columbia, Kelowna, BC, Canada
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Weinberger AH, Pang RD, Ferrer M, Kashan RS, Estey DR, Segal KS, Esan H. A novel smoking-specific self-control task: An initial study of feasibility, acceptability, and changes in self-control and cigarette smoking behaviors among adults using cigarettes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:28-38. [PMID: 34081484 PMCID: PMC8639834 DOI: 10.1037/adb0000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Self-control is a key factor in quitting cigarettes and practicing general self-control tasks may strengthen self-control. This study examined the feasibility and acceptability of a novel smoking-related self-control task. Method: Seventy-five adults with current cigarette smoking (Mage = 44.8, 74.7% male, 63.5% Black, 74.3% non-Latinx) were randomly assigned to practice a smoking-specific self-control task (Delay Smoking Task, n = 39) or a general self-control task (Posture Task, n = 36) for 1 week. Assessments included cigarettes per day (CPD), motivation to quit smoking, self-control, and task acceptability. Results: Most participants completed both appointments with no difference between task groups (p = .69). The Delay Smoking Task group rated the task as more difficult (p = .04) and more helpful for quitting smoking (p = .005) than did the Posture Task group. Self-control task groups did not differ in task effort (p = .66), task success (p = .14), or self-control used to practice the task (p = .13). Both task groups reported increased quit desire, expected quit success, quit confidence, and quit motivation (p < .05; partial η²s = 0.108-0.333). The time by task group interaction approached significance for expected quit success (p = .06; partial η² = .053), with the Delay Smoking Task group showing greater increases than the Posture Task group. Over the week, smoking decreased an average of 1.0 CPD with no difference between groups (p = .72; partial η² = 0.165). Conclusions: Practicing self-control was associated with increases in motivation to quit, confidence in quitting, and expected success at quitting smoking with similar changes for those practicing a smoking-specific versus a general self-control task. Self-control tasks may be useful for increasing motivation to quit cigarettes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Raina D. Pang
- Keck School of Medicine at University of Southern California, Department of Preventive Medicine, Los Angeles, California, USA
| | - Michelle Ferrer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- Hackensack Meridian Health, Hackensack, New Jersey USA
| | - Rachel S. Kashan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
| | - David R. Estey
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
| | - Kate S. Segal
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- James J. Peters VA Medical Center, Bronx, New York USA
| | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York USA
- Addiction Institute of Mount Sinai, Mount Sinai Hospital, New York, New York USA
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Bricca A, Swithenbank Z, Scott N, Treweek S, Johnston M, Black N, Hartmann-Boyce J, West R, Michie S, de Bruin M. Predictors of recruitment and retention in randomized controlled trials of behavioural smoking cessation interventions: a systematic review and meta-regression analysis. Addiction 2022; 117:299-311. [PMID: 34159677 DOI: 10.1111/add.15614] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/06/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023]
Abstract
AIM To investigate predictors of participant eligibility, recruitment and retention in behavioural randomized controlled trials (RCTs) for smoking cessation. METHOD Systematic review and pre-specified meta-regression analysis of behavioural RCTs for smoking cessation including adult (≥ 18-year-old) smokers. The pre-specified predictors were identified through a literature review and experts' consultation and included participant, trial and intervention characteristics and recruitment and retention strategies. Outcome measures included eligibility rates (proportion of people eligible for the trials), recruitment rates, retention rates and differential retention rates. RESULTS A total of 172 RCTs with 89 639 participants. Eligibility [median 57.6%; interquartile range (IQR) = 34.7-83.7], recruitment (median 66.4%; IQR = 42.7-85.2) and retention rates (median 80.5%; IQR = 68.5-89.5) varied considerably across studies. For eligibility rates, the recruitment strategy appeared not to be associated with eligibility rates. For recruitment rates, use of indirect recruitment strategies (e.g. public announcements) [odds ratio (OR) = 0.30, 95% confidence interval (CI) = 0.11-0.82] and self-help interventions (OR = 0.14, 95% CI = 0.03-0.67) were associated with lower recruitment rates. For retention rates, higher retention was seen if the sample had ongoing physical health condition/s (OR = 1.66, 95% CI = 1.04-2.63), whereas lower retention was seen amongst primarily female samples (OR = 0.83, 95% CI = 0.71-0.98) and those motivated to quit smoking (OR = 0.74, 95% CI = 0.55-0.99) when indirect recruitment methods were used (OR = 0.60, 95% CI = 0.38-0.97) and at longer follow-up assessments (OR = 0.83, 95% CI = 0.79-0.87). For differential retention, higher retention in the intervention group occurred when the intervention but not comparator group received financial incentives for smoking cessation (OR = 1.35, 95% CI = 1.02-1.77). CONCLUSIONS In randomized controlled trials of behavioural smoking cessation interventions, recruitment and retention rates appear to be higher for smoking cessation interventions that include a person-to-person rather than at-a-distance contact; male participants, smokers with chronic conditions, smokers not initially motivated to quit and shorter follow-up assessments seems to be associated with improved retention; financial incentive interventions improve retention in groups receiving them relative to comparison groups.
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Affiliation(s)
- Alessio Bricca
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark, Slagelse, Denmark
| | - Zoe Swithenbank
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Neil Scott
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Technology Addiction Team, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
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Abstract
Antibiotic use (and misuse) accelerates antimicrobial resistance (AMR), and addressing this complex problem necessitates behaviour change related to infection prevention and management and to antibiotic prescribing and use. As most antibiotic courses are prescribed in primary care, a key focus of antimicrobial stewardship (AMS) is on changing behaviours outside of hospital. Behavioural science draws on behaviour change theories, techniques and methods developed in health psychology, and can be used to help understand and change behaviours related to AMR/AMS. Qualitative methodologies can be used together with a behavioural science approach to explore influences on behaviour and develop and evaluate behavioural interventions. This paper provides an overview of how the behavioural science approach, together with qualitative methods, can contribute and add value to AMS projects. First, it introduces and explains the relevance of the behavioural science approach to AMR/AMS. Second, it provides an overview of behaviour change ‘tools’: behaviour change theories/models, behavioural determinants and behaviour change techniques. Third, it explains how behavioural methods can be used to: (i) define a clinical problem in behavioural terms and identify behavioural influences; (ii) develop and implement behavioural AMS interventions; and (iii) evaluate them. These are illustrated with examples of using qualitative methods in AMS studies in primary care. Finally, the paper concludes by summarizing the main contributions of taking the behavioural science approach to qualitative AMS research in primary care and discussing the key implications and future directions for research and practice.
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Affiliation(s)
- Aleksandra J. Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Corresponding author. E-mail:
| | - Marta Santillo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
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Crawshaw J, Li AH, Garg AX, Chassé M, Grimshaw JM, Presseau J. Identifying behaviour change techniques within randomized trials of interventions promoting deceased organ donation registration. Br J Health Psychol 2021; 27:822-843. [PMID: 34889488 DOI: 10.1111/bjhp.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Increasing deceased organ donation registration may increase the number of available organs for transplant to help save lives. This study aimed to identify which behaviour change techniques (BCTs; or 'active ingredients') are reported within randomized trials of interventions promoting deceased organ donation registration and of those, which are associated with a larger intervention effect. METHODS We conducted a secondary analysis of 45 trials included in a Cochrane systematic review of deceased organ donation registration interventions. Two researchers used the BCT Taxonomy v1 to independently code intervention content in all trial groups. Outcome data were pooled and we used meta-regression to explore associations between individual and combinations of recurring BCTs and effect on registration intention and/or registration behaviour. RESULTS A total of 27 different BCTs (mean = 3.7, range = 1-9) were identified in intervention groups across the 45 trials. The five most common BCTs were: 'Information about health consequences' (71%); 'Instruction on how to perform the behaviour' (47%); 'Salience of consequences' (40%); 'Adding objects to the environment' (28%); and 'Credible source' (27%). Comparator groups in 20/45 trials also included identifiable BCTs (n = 12, mean = 3.1, range = 1-7). Meta-regression revealed that a combination of the three most common BCTs was associated with a larger intervention effect size for registration behaviour (k = 8, β = .19, p = .02). CONCLUSIONS Trials of deceased organ donation registration interventions focus predominantly on providing information, instruction, and a means to register. While potentially effective, a much wider set of possible BCTs could be leveraged to address known barriers to registration.
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Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada
| | - Alvin H Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Amit X Garg
- Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Quebec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ontario, Canada
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de Ruijter D, Mergelsberg E, Crone M, Smit E, Hoving C. Identifying active ingredients, working mechanisms and fidelity characteristics reported in smoking cessation interventions in Dutch primary care: a systematic review. Nicotine Tob Res 2021; 24:654-662. [PMID: 34788849 PMCID: PMC8962690 DOI: 10.1093/ntr/ntab236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
Background Evidence-based smoking cessation interventions provided by healthcare professionals can be successful in helping citizens to quit smoking. Yet, evidence is needed about the active ingredients of these interventions, how these ingredients work and how they are implemented in practice. Such knowledge is required to effectively support healthcare professionals to optimally put evidence-based smoking cessation interventions to (inter)national practice. Objective To identify active ingredients (including behavior change techniques), mechanisms of action and implementation fidelity reported in smoking cessation interventions in Dutch primary care settings and to relate these to intervention effectiveness. Methods A systematic review was conducted by searching nine national intervention or funding databases, five international scientific databases and consulting 17 national smoking cessation experts. Out of 1066 identified manuscripts, 40 interventions were eligible for this review. Based on published protocols, information regarding behavior change techniques and mechanisms of action was systematically abstracted. Additionally, information regarding study characteristics and other active ingredients, effects on smoking behavior and implementation fidelity was abstracted. Comparative effectiveness concerning abstracted intervention characteristics was qualitatively explored. Results Active ingredients, mechanisms of action and implementation fidelity were moderately to poorly reported. Interventions applying behavior change techniques and interventions with a single behavioral target (i.e. smoking-only versus multiple behaviors) seemed to provide stronger evidence for successfully changing smoking behavior. Conclusion Attention to and reporting on interventions’ active ingredients (e.g. behavior change techniques), mechanisms of action and implementation fidelity are prerequisites for developing more effective evidence-based smoking cessation interventions to be successfully implemented in primary healthcare. Implications This systematic review provides an overview of smoking cessation interventions in Dutch primary care settings, identified since the year 2000. Smoking cessation support is offered in various forms, but our qualitative findings show that interventions including more behavior change techniques and interventions targeting only smoking cessation (compared to multiple behaviors) might be more effective. Results also show that—based on available intervention reports—it is difficult to distinguish patterns of active ingredients (such as behavior change techniques), mechanisms of action and fidelity of implementation in relation to interventions’ effectiveness. This means (quality of) reporting on these intervention characteristics should improve.
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Affiliation(s)
- Dennis de Ruijter
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Enrique Mergelsberg
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.,School of Population Health, Curtin University, Bentley, Perth, Australia
| | - Matty Crone
- Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Eline Smit
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, NG Amsterdam, the Netherlands
| | - Ciska Hoving
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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Johnston M. Progress in conducting and reporting behaviour change intervention studies: a prospective retrospection. Health Psychol Behav Med 2021; 9:567-581. [PMID: 34211803 PMCID: PMC8218683 DOI: 10.1080/21642850.2021.1939701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND ehaviour change is a key to addressing many health and healthcare problems and interventions have been designed to improve health outcomes. These behaviour change interventions have been evaluated in many ways, including randomised controlled trials, and over recent decades there has been considerable progress in the conduct and reporting these studies. This paper is a personal retrospection on the changes occurring that have resulted in our current improved methods and their potential for future advancement. ADVANCES There has been steady development of methods for conducting trials, including advances in statistical methods enabled by increase computing power and programmes, greater attention to the recruitment of participants and in the specification of outcomes. Trial reporting has improved, largely due to publication of guidelines for reporting interventions and trials, but until recently the reporting of behaviour change interventions has been quite limited. Developments in the specification of active ingredients of these interventions, the behaviour change techniques, has transformed our ability to report interventions in a manner that facilitates evidence synthesis and enables replication and implementation. However, further work using ontological approaches is needed to adequately represent the evidence contained in the mass of accumulated studies. Meanwhile, attention is gradually being paid to the comparator groups in trials leading to better reporting but with continuing challenges about how control groups are selected. CONCLUSIONS These developments are important for the advancements of behavioural science - but also in consolidating the expertise needed to address global social, environmental and health challenges.
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Affiliation(s)
- Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, Aberdeen, UK
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Kwok SWH, Pang PCP, Chung MH, Wu CST. Faculty Service-Learning Students as Home-Visitors: Outcomes of a Lifestyle Modification Program for Vulnerable Families With Residents in Rural Indonesian Communities. Front Public Health 2021; 9:597851. [PMID: 34055707 PMCID: PMC8149593 DOI: 10.3389/fpubh.2021.597851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Risks attributed to chronic diseases, cancer, musculoskeletal discomfort, and infectious diseases among Indonesians were found to be associated with lifestyle behaviors, particularly in rural areas. The aim of this study was to examine the outcomes of a home-visiting lifestyle modification program on improving health risk behaviors among Indonesians living in rural areas. Methods: A total of 160 Indonesians living in rural hamlets in the Yogyakarta Region of Indonesia participated in the program in the period of June 21 to July 21, 2019. In the pre-intervention home interview, learning needs of diet, exercise, hand hygiene, and substance use were identified by using structured assessment tools. In the next home visit, the visitors provided health education and facilitated lifestyle planning based on the related affective and cognitive domains of learning. Subsequent follow-up interviews were conducted 3 weeks after intervention. Results: The results showed that the self-reported intake of vegetables, fruits, meat and salt, cooking with less oil, hand hygiene before eating, number of cigarettes smoked, and symptoms of muscle stiffness significantly improved after the intervention. The lifestyle modification program consisted of the affective and cognitive domains of learning, and could lead to the target behavioral changes in self-reported and observable measures over 1 month. Conclusions: The findings contributed to the framework of community-based health education for health risk reduction and behavioral modification in developing rural communities where health care resources were limited. Further studies with control groups and vigorous objective measures were recommended to elucidate its long-term impacts. The factors leading to its sustainability concerning collaborative care partnerships between community residents and faculty resources are worthy of continued exploration.
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Affiliation(s)
| | | | | | - Cynthia Sau Ting Wu
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Boeckmann M, Dogar O, Saeed S, Majidulla A, Swami S, Khan A, Siddiqi K, Kotz D. Measuring fidelity to delivery of a new smoking cessation intervention integrated into routine tuberculosis care in Pakistan and Bangladesh: Contextual differences and opportunities. Tob Induc Dis 2021; 19:24. [PMID: 33841063 PMCID: PMC8029647 DOI: 10.18332/tid/133054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Tobacco smoking among tuberculosis (TB) patients leads to poorer treatment outcomes. Smoking cessation support should be integrated into routine TB care. We measured healthcare providers' fidelity to a smoking cessation intervention integrated into routine TB care, in Bangladesh and Pakistan. We aimed to understand the role of providers and settings in the implementation of behavior support (BS) messages for TB and smoking cessation. METHODS The integrated BS intervention was implemented in TB clinics (24 public and 1 private). Cross-sectional data were collected on the fidelity of delivery of the BS intervention using a predefined fidelity index based on an existing validated method of measuring intervention fidelity. Audio-recordings of patient-provider BS sessions were coded using the fidelity index. Intervention fidelity was presented as the proportion of sessions that implemented BS messages. RESULTS A total of 96 sessions were conducted, 37 in Bangladesh and 59 in Pakistan. In public settings, TB medication advice was offered in 91.9% (95% CI: 78.7- 97.2) of sessions in Bangladesh, and in 75.5% (95% CI: 62.4-85.1) of sessions in Pakistan; whilst it was offered in 83.3% (95% CI: 43.7-97.0) of sessions in the private setting in Pakistan. Patients' smoking status was assessed in 70.3% (95% CI: 54.2-82.5) of sessions in Bangladesh, and in 34.0% (95% CI: 22.7-47.4) of sessions in the public setting and in 66.7% (95% CI: 30.0-90.3) of sessions in the private setting in Pakistan. A quit date was set in 32.4% (95% CI: 19.6-48.5) of all sessions in Bangladesh, and in 33.3% (95% CI: 9.6-70.0) of all sessions in the public setting in Pakistan. CONCLUSIONS Fidelity to the intended delivery of the intervention was found to be high for TB-related messages but not for smoking cessation messages. Clinic contexts may play a mediating role in health workers' opportunities to deliver the intervention as planned. TRIAL REGISTRATION International Standard Randomized Clinical Trial Number (ISRCTN43811467). Registered 23 March 2016, https://doi.org/10.1186/ISRCTN43811467.
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Affiliation(s)
- Melanie Boeckmann
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Health Sciences, University of York, York, United Kingdom
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Shilpi Swami
- Department of Health Sciences, University of York, York, United Kingdom
- Evidera, London, United Kingdom
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013229. [PMID: 33411338 DOI: 10.1002/14651858.cd013229.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness. OBJECTIVES To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary. METHODS This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components. MAIN RESULTS We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies. AUTHORS' CONCLUSIONS Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Abstract
Individuals diagnosed with schizophrenia or bipolar disorder have a life expectancy 15-20 years shorter than that in the general population. The rate of unnatural deaths, such as suicide and accidents, is high for these patients. Despite this increased proportion of unnatural deaths, physical conditions account for approximately 70% of deaths in patients with either schizophrenia or bipolar disorder, with cardiovascular disease contributing 17.4% and 22.0% to the reduction in overall life expectancy in men and women, respectively. Risk factors for cardiovascular disease, such as smoking, unhealthy diet and lack of exercise, are common in these patients, and lifestyle interventions have been shown to have small effects. Pharmacological interventions to reduce risk factors for cardiovascular disease have been proven to be effective. Treatment with antipsychotic drugs is associated with reduced mortality but also with an increased risk of weight gain, dyslipidaemia and diabetes mellitus. These patients have higher risks of both myocardial infarction and stroke but a lower risk of undergoing interventional procedures compared with the general population. Data indicate a negative attitude from clinicians working outside the mental health fields towards patients with severe mental illness. Education might be a possible method to decrease the negative attitudes towards these patients, thereby improving their rates of diagnosis and treatment.
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