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Doherty DA, Tong SYC, Reilly J, Shrapnel J, McDonald S, Ahern S, Harris I, Tam CS, Brennan AL, Hodgson C, Wilcox L, Balagurunathan A, Butcher BE, Reid CM. Registry randomised trials: a methodological perspective. BMJ Open 2023; 13:e068057. [PMID: 36858472 PMCID: PMC9980340 DOI: 10.1136/bmjopen-2022-068057] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Registry randomised clinical trials (RRCTs) have the potential to provide pragmatic answers to important clinical questions. RRCTs can be embedded into large population-based registries or smaller single site registries to provide timely answers at a reduced cost compared with traditional randomised controlled trials. RRCTs can take a number of forms in addition to the traditional individual-level randomised trial, including parallel group trials, platform or adaptive trials, cluster randomised trials and cluster randomised stepped-wedge trials. From an implementation perspective, initially it is advantageous to embed RRCT into well-established registries as these have typically already overcome any issues with end point validation and adjudication. With advances in data linkage and data quality, RRCTs can play an important role in answering clinical questions in a pragmatic, cost-effective way.
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Affiliation(s)
- Dorota A Doherty
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Biostatistics and Research Design Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Steven Y C Tong
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Menzies School of Health Research, Casuarina, Nothern Territory, Australia
| | - Jennifer Reilly
- Anaesthesiology & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Shrapnel
- The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Stephen McDonald
- Central Northern Adelaide Dialysis, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Charmaine S Tam
- Northern Clinical School, Centre for Translational Data Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Leonie Wilcox
- Australasian Bone Marrow Transplant Recipient Registry, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | | | - Belinda E Butcher
- WriteSource Medical Pty Ltd, Lane Cove, New South Wales, Australia
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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2
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Li AHT, Garg AX, Grimshaw JM, Prakash V, Dunnett AJ, Dixon SN, Taljaard M, Mitchell J, Naylor KL, Faulds C, Bevan R, Getchell L, Knoll G, Kim SJ, Sontrop J, Tong A, Bjerre LM, Hyjek K, Currie D, Edwards S, Sullivan M, Harvey-Rioux L, Presseau J. Promoting deceased organ and tissue donation registration in family physician waiting rooms (RegisterNow-1): a pragmatic stepped-wedge, cluster randomized controlled registry trial. BMC Med 2022; 20:75. [PMID: 35236353 PMCID: PMC8892727 DOI: 10.1186/s12916-022-02266-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The shortage of available organs for life-saving transplants persists worldwide. While a majority support donating their organs or tissue when they die, many have not registered their wish to do so. When registered, next of kin are much more likely to follow-through with the decision to donate. In many countries, most people visit their family physician office each year and this setting is a promising, yet underused, site where more people could register for deceased organ donation. Our primary aim was to evaluate the effectiveness of an intervention to promote organ donation registration in family physician's offices. METHODS We developed an intervention to address barriers and enablers to organ donation registration that involved physician office reception staff inviting patients to register on a tablet in the waiting room while they waited for their appointment. We conducted a cross-sectional stepped-wedge cluster randomized controlled registry trial to evaluate the intervention. We recruited six family physician offices in Canada. All offices began with usual care and then every two weeks, one office (randomly assigned) started the intervention until all offices delivered the intervention. The primary outcome was registration for deceased organ donation in the provincial organ registration registry, assessed within the 7 days of the physician visit. At the end of the trial, we also conducted interviews with clinic staff to assess any barriers and enablers to delivering the intervention. RESULTS The trial involved 24,616 patient visits by 13,562 unique patients: 12,484 visits in the intervention period and 12,132 in the control period. There was no statistically significant difference in the percentage of patients registered for deceased organ donation in the intervention versus control period (48.0% vs 46.2%; absolute difference after accounting for the secular trend: 0.12%; 95% CI: - 2.30, 2.54; p=0.92). Interviews with clinic staff indicated location of the tablet within a waiting room, patient rapport, existing registration, confidence and motivation to deliver the intervention and competing priorities as barriers and enablers to delivery. CONCLUSIONS Our intervention did not increase donor registration. Nonetheless, family physician offices may still remain a promising setting to develop and evaluate better interventions to increase organ donation registration. TRIAL REGISTRATION NCT03213171.
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Affiliation(s)
- Alvin Ho-Ting Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada.
| | - Amit X Garg
- Lawson Health Research Institute, London, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Division of Nephrology, Western University, London, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Stephanie N Dixon
- Lawson Health Research Institute, London, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Kyla L Naylor
- Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada
- Department of Family Medicine, Western University, London, ON, Canada
| | - Cathy Faulds
- Department of Family Medicine, Western University, London, ON, Canada
| | - Rachel Bevan
- Department of Family Medicine, Western University, London, ON, Canada
| | - Leah Getchell
- Lawson Health Research Institute, London, ON, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - S Joseph Kim
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jessica Sontrop
- Lawson Health Research Institute, London, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES) Western, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Lise M Bjerre
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karyn Hyjek
- Trillium Gift of Life Network, Toronto, ON, Canada
| | | | | | | | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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3
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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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4
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Guillot M, Asad S, Lalu MM, Lemyre B, Castillo G, Thébaud B, Presseau J. So You Want to Give Stem Cells to Babies? Neonatologists and Parents' Views to Optimize Clinical Trials. J Pediatr 2019; 210:41-47.e1. [PMID: 31005276 DOI: 10.1016/j.jpeds.2019.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/22/2019] [Accepted: 03/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify barriers and enablers that may influence parents' and neonatologists' participation in clinical trials of mesenchymal stromal cells for bronchopulmonary dysplasia. STUDY DESIGN This qualitative study involved one-on-one semistructured interviews with parents of extremely preterm infants (n = 18) and neonatologists (n = 16). Interview guides and directed content analysis were framed using the theoretical domains framework, a tool specifically developed for implementation research to identify influences on behavior. RESULTS Key barriers for parents included their lack of knowledge about clinical trial processes in general, stem cells, and concerns about their risks and side effects. Importantly, parents preferred to be approached for recruitment directly by a neonatologist, either before delivery or 1 or 2 weeks after birth. However, the majority of neonatologists felt that approaching parents was not part of their role. Neonatologists reported competing priorities, time commitment, costs, and lack of institutional support as significant barriers to their ability to recruit patients. CONCLUSIONS By integrating stakeholders early into the development of a clinical trial of mesenchymal stromal cell therapy, we identified and can address important barriers to enrollment. Some identified barriers were unanticipated and could have compromised recruitment had they not been identified by this study. We suggest that this approach can be used more broadly for other early phase clinical trials in pediatrics.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gisell Castillo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Bernard Thébaud
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ontario, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Molecular Biomedicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Hemming K, Taljaard M, Grimshaw J. Introducing the new CONSORT extension for stepped-wedge cluster randomised trials. Trials 2019; 20:68. [PMID: 30658677 PMCID: PMC6339370 DOI: 10.1186/s13063-018-3116-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
The use of the stepped-wedge cluster randomised trial (SW-CRT) is on the increase, and although there are still relatively few SW-CRTs currently published its use is bound to show an increase in the near future. An extension of the CONSORT reporting guideline for SW-CRTs has recently been developed. By making reporting guidelines for this innovative design available relatively early in its development, it is possible that the methodological conduct and reporting of future SW-CRTs will not be at the same risk of low-quality of reporting as is the case with many other study designs. We provide a brief overview of this reporting guideline and encourage authors to use it appropriately; and for journal editors to endorse its use.
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Affiliation(s)
- Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y4E9, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Hemming K, Taljaard M, McKenzie JE, Hooper R, Copas A, Thompson JA, Dixon-Woods M, Aldcroft A, Doussau A, Grayling M, Kristunas C, Goldstein CE, Campbell MK, Girling A, Eldridge S, Campbell MJ, Lilford RJ, Weijer C, Forbes AB, Grimshaw JM. Reporting of stepped wedge cluster randomised trials: extension of the CONSORT 2010 statement with explanation and elaboration. BMJ 2018; 363:k1614. [PMID: 30413417 PMCID: PMC6225589 DOI: 10.1136/bmj.k1614] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Hooper
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Andrew Copas
- London Hub for Trials Methodology Research, MRC Clinical Trials Unit at University College London, London, UK
| | - Jennifer A Thompson
- London Hub for Trials Methodology Research, MRC Clinical Trials Unit at University College London, London, UK
- Department for Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Adelaide Doussau
- Biomedical Ethics Unit, McGill University School of Medicine, Montreal, QC, Canada
| | | | | | - Cory E Goldstein
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | | | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | | | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Araújo-Soares V, Hankonen N, Presseau J, Rodrigues A, Sniehotta FF. Developing Behavior Change Interventions for Self-Management in Chronic Illness: An Integrative Overview. EUROPEAN PSYCHOLOGIST 2018; 24:7-25. [PMID: 31496632 PMCID: PMC6727632 DOI: 10.1027/1016-9040/a000330] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 02/21/2018] [Accepted: 04/19/2018] [Indexed: 12/24/2022]
Abstract
More people than ever are living longer with chronic conditions such as obesity, type 2 diabetes, and heart disease. Behavior change for effective self-management can improve health outcomes and quality of life in people living with such chronic illnesses. The science of developing behavior change interventions with impact for patients aims to optimize the reach, effectiveness, adoption, implementation, and maintenance of interventions and rigorous evaluation of outcomes and processes of behavior change. The development of new services and technologies offers opportunities to enhance the scope of delivery of interventions to support behavior change and self-management at scale. Herein, we review key contemporary approaches to intervention development, provide a critical overview, and integrate these approaches into a pragmatic, user-friendly framework to rigorously guide decision-making in behavior change intervention development. Moreover, we highlight novel emerging methods for rapid and agile intervention development. On-going progress in the science of intervention development is needed to remain in step with such new developments and to continue to leverage behavioral science's capacity to contribute to optimizing interventions, modify behavior, and facilitate self-management in individuals living with chronic illness.
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Affiliation(s)
- Vera Araújo-Soares
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,School of Psychology, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Tampere, Finland
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada.,School of Psychology, University of Ottawa, Canada
| | - Angela Rodrigues
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse. The UK Clinical Research Collaboration Centre for Translational Research in Public Health
| | - Falko F Sniehotta
- Institute of Health & Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Fuse. The UK Clinical Research Collaboration Centre for Translational Research in Public Health
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