A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar

Usefulness and acceptability of an animation to raise awareness to grief experienced by carers of individuals with dementia

AIM

Many carers of individuals with dementia experience high levels of grief before and after the death of the person with dementia. This study aimed to determine the usefulness, acceptability, and relevance of an animation developed to raise awareness to grief experienced by carers of people with dementia.

METHODS

This research had a cross-sectional survey design. We contacted carers of people with dementia over the phone or email. Participants evaluated the animation through an online or paper-based survey. We used descriptive statistics and analysed qualitative data using thematic analysis. We required a sample of 40 carers to adequately power the study with a target of 75% of carers finding the animation useful, acceptable, and relevant.

RESULTS

31/78 carers approached evaluated the animation. Ninety-four percent of participants found the animation relevant to their situation, meeting our target. However, we fell short of this target for usefulness (68%) and acceptability (73%). The qualitative responses suggested that participants felt the animation could help improve the understanding of grief among carers, family, friends, and healthcare professionals. Carers also shared that the animation would be most useful for carers of newly diagnosed people with dementia.

CONCLUSION

Most carers of people with dementia in this study reported that the animation was useful, acceptable, and relevant. Dissemination of the resource may be useful for the majority of carers, with the caveat that a few carers may find it distressing and need to be referred for further support.

The Role of Images on Illness Behaviour: Interdisciplinary Theory, Evidence, and Ideas

If illness behaviour is to be fully understood, the social and behavioural sciences must work together to understand the wider forms in which illness is experienced and communicated with individuals and society. The current paper synthesised literature across social and behavioural sciences exploring illness experience and communication through physical and mental images. It argues that images may have the capacity to embody and influence beliefs, emotions, and health outcomes. While four commonalities exist, facilitating understandings of illness behaviour across the fields (i.e., understanding the importance of the patient perspective; perception of the cause, sense of identity with the illness, consequences, and level of control; health beliefs influencing illness experience, behaviours, and outcomes; and understanding illness beliefs and experiences through an almost exclusive focus on the written or spoken word), we will focus on exploring the fourth commonality. The choice to focus on the role of images on illness behaviour is due to the proliferation of interventions using image-based approaches. While these novel approaches show merit, there is a scarcity of theoretical underpinnings and explorations into the ways in which these are developed and into how people perceive and understand their own illnesses using image representations. The current paper identified that the use of images can elucidate patient and practitioner understandings of illness, facilitate communication, and potentially influence illness behaviours. It further identified commonalities across the social and behavioural sciences to facilitate theory informed understandings of illness behaviour which could be applied to visual intervention development to improve health outcomes.

Co-production of "nature walks for wellbeing" public health intervention for people with severe mental illness: use of theory and practical know-how

Background

Interventions need to be developed in a timely and relatively low-cost manner in order to respond to, and quickly address, major public health concerns. We aimed to quickly develop an intervention to support people with severe mental ill-health, that is systematic, well founded both in theory and evidence, without the support of significant funding or resource. In this article we aim to open and elucidate the contents of the ‘black box’ of intervention development.

Methods

A multidisciplinary team of seven academics and health practitioners, together with service user input, developed an intervention in 2018 by scoping the literature, face-to-face meetings, email and telephone. Researcher fieldnotes were analysed to describe how the intervention was developed in four iterative steps.

Results

In step 1 and 2, scoping the literature showed that, a) people with severe mental illness have high mortality risk in part due to high levels of sedentary behaviour and low levels of exercise; b) barriers to being active include mood, stress, body weight, money, lack of programmes and facilities and stigma c) ‘nature walks’ has potential as an intervention to address the problem. In Step 3, the team agreed what needed to be included in the intervention so it addressed the “five ways to mental wellbeing” i.e., help people to connect, be active, take notice, keep learning and give. The intervention was mapped to key behavioural change concepts such as, personal relevance, relapse prevention, self-efficacy. In Step 4, the team worked out how best to implement the intervention. The intervention would be delivered over 12 weeks by members of the hospital team and community walk volunteers. Participants would receive a nature walks booklet and text messages.

Conclusions

We developed a theoretically-informed, evidence-based nature walks programme in a timely and relatively low-cost manner relevant in an era of growing mental illness and funding austerity. Further research is required to test if the intervention is effective and if this approach to intervention development works.

Guidelines for reporting non-randomised pilot and feasibility studies

As the number of submissions to Pilot and Feasibility Studies increases, there is a need for good quality reporting guidelines to help researchers tailor their reports in a way that is consistent and helpful to other readers. The publication in 2016 of the CONSORT extension to pilot and feasibility trials filled a much-needed gap, but there still remains some uncertainty as to how to report pilot and feasibility studies that are not randomised. This editorial aims to provide some general guidance on how to report the most common types of non-randomised pilot and feasibility studies that are submitted to the journal. We recommend using the CONSORT extension to pilot and feasibility trials as the main reference document—it includes detailed elaboration and explanation of each item, and in most cases, simple adaptation, or non-use of items that are not applicable, will suffice. Several checklists found on the Equator website may provide helpful supplementary guidance, when used alongside the CONSORT extension, and we give some examples.

Are consistent juror decisions related to fast and frugal decision making? Investigating the relationship between juror consistency, decision speed and cue utilisation

The aim of this study was to establish whether more consistent/accurate juror decision making is related to faster decision-making processes which use fewer cues - that is, fast and frugal heuristic processes. A correlational design was implemented with the co-variables: consistency of verdict decisions (participant decisions compared to the actual court verdicts), decision speed, and cue utilisation (the number of cues used to make a final verdict decision). Sixty participants read information about six murder trials which were based on real cases and whose outcome verdicts were deemed to be correct by the Scottish legal institution. Three of the cases had been handed down 'not guilty' verdicts, and three had been handed down 'guilty' verdicts. Participants read opening statements and were then presented with a block of prosecution evidence, followed by a block of defence evidence. They were then asked to make a final verdict. All three co-variables were significantly related. Cue utilisation and speed were positively correlated, as would be expected. Consistency was negatively and significantly related to both speed and cue utilisation. Partial correlations highlighted that cue utilisation was the only variable to have a significant relationship with consistency, and that the relationship between speed and consistency was a by-product of how frugal the juror was. Findings support the concept of frugal decisional processes being optimal within a juror context. The more frugal a decision is, the more likely jurors are to be to be accurate/consistent.

A new era for intervention development studies

This editorial introduces a new special series on intervention development in the on-line open access journal Pilot and Feasibility Studies. An intervention development study reports the rationale, decision-making processes, methods and findings which occur between the idea or inception of an intervention until it is ready for formal feasibility, pilot or efficacy testing prior to a full trial or evaluation. This editorial begins to explore some of the challenges associated with this early research stage. It commences a debate about how to produce novel interventions which are fit for purpose and which solve important health and social care problems. By transparently reporting more intervention development studies, scientific rigour will be improved and everyone can learn from the experiences of others.