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Little P, Bradbury K, Stuart B, Barnett J, Krusche A, Steele M, Heber E, Easton S, Smith KA, Slodkowska-Barabasz J, Payne L, Corbett T, Yao G, Pollet S, Smith J, Joseph J, Lawrence M, Bohning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Muller A, Neal R, Osborne R, Rathod S, Richardson A, Grimmett C, Sharman G, Bacon R, Turner L, Stephens R, Burford T, Wilde L, Middleton K, Liddiard M, Rogers K, Raftery J, Zhu S, Webley F, Griffiths G, Nutall J, Chalder T, Wilkinson CE, Watson E, Yardley L. A randomised controlled trial of a digital intervention (Renewed) to support symptom management, wellbeing and quality of life in cancer survivors. Br J Gen Pract 2023:BJGP.2023.0262. [PMID: 38164562 DOI: 10.3399/bjgp.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Many cancer survivors following primary treatment have prolonged poor quality of life. AIM To determine the effectiveness of a bespoke digital intervention to support cancer survivors. DESIGN Pragmatic parallel open randomised trial. SETTING UK general practices. METHODS People having finished primary treatment (<= 10 years previously) for colo-rectal, breast or prostate cancers, with European-Organization-for-Research-and-Treatment-of-Cancer QLQ-C30 score <85, were randomised by online software to: 1)detailed 'generic' digital NHS support ('LiveWell';n=906), 2) a bespoke complex digital intervention ('Renewed';n=903) addressing symptom management, physical activity, diet, weight loss, distress, or 3) 'Renewed-with-support' (n=903): 'Renewed' with additional brief email and telephone support. RESULTS Mixed linear regression provided estimates of the differences between each intervention group and generic advice: at 6 months (primary time point: n's respectively 806;749;705) all groups improved, with no significant between-group differences for EORTC QLQ-C30, but global health improved more in both intervention groups. By 12 months there were: small improvements in EORTC QLQ-C30 for Renewed-with-support (versus generic advice: 1.42, 95% CIs 0.33-2.51); both groups improved global health (12 months: renewed: 3.06, 1.39-4.74; renewed-with-support: 2.78, 1.08-4.48), dyspnoea, constipation, and enablement, and lower NHS costs (generic advice £265: in comparison respectively £141 (153-128) and £77 (90-65) lower); and for Renewed-with-support improvement in several other symptom subscales. No harms were identified. CONCLUSION Cancer survivors quality of life improved with detailed generic online support. Robustly developed bespoke digital support provides limited additional short term benefit, but additional longer term improvement in global health enablement and symptom management, with substantially lower NHS costs.
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Affiliation(s)
- Paul Little
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Katherine Bradbury
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Beth Stuart
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Jane Barnett
- University of Southampton, Southampton, United Kingdom
| | - Adele Krusche
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Mary Steele
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Elena Heber
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Steph Easton
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Kirsten Ailsa Smith
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Liz Payne
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | | | - Guiqing Yao
- University of Leicester, Department of Health Sciences, Leicester, United Kingdom
| | - Sebastien Pollet
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Jazzine Smith
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Judith Joseph
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Megan Lawrence
- University of Southampton, Clinical Trials Unit, Southampton, United Kingdom
| | - Dankmar Bohning
- University of Southampton School of Mathematical Sciences, Southampton, United Kingdom
| | - Tara Cheetham-Blake
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Diana Eccles
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Claire Foster
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Adam W A Geraghty
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | | | - Andre Muller
- National University of Singapore, Singapore, Singapore
| | | | | | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Alison Richardson
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Chloe Grimmett
- University of Southampton, Department of Psychology, Southampton, United Kingdom
| | - Geoff Sharman
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Roger Bacon
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Lesley Turner
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Richard Stephens
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Tamsin Burford
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Laura Wilde
- Coventry University, Coventry, United Kingdom
| | - Karen Middleton
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Megan Liddiard
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - Kirsty Rogers
- University of Southampton, Primary Care Research Centre, Southampton, United Kingdom
| | - James Raftery
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Shihua Zhu
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Fran Webley
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Gareth Griffiths
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Jaqui Nutall
- University of Southampton Faculty of Medicine Health and Life Sciences, Southampton, United Kingdom
| | - Trudie Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | | | - Eila Watson
- Oxford Brookes University, Oxford, United Kingdom
| | - Lucy Yardley
- Oxford Brookes University, Oxford, United Kingdom
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Morton K, Dennison L, Band R, Stuart B, Wilde L, Cheetham-Blake T, Heber E, Slodkowska-Barabasz J, Little P, McManus RJ, May CR, Yardley L, Bradbury K. Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation. Implement Sci 2021; 16:57. [PMID: 34039390 PMCID: PMC8152066 DOI: 10.1186/s13012-021-01123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/29/2021] [Indexed: 01/28/2023] Open
Abstract
Background A high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’ home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation. Methods One hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients’ medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol. Results Mean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients. Conclusions This mixed-methods process evaluation provided novel insights into practitioners’ decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients’ readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. Implementation of one-way notification systems could be facilitated by enabling patients to send a brief acknowledgement response. Trial registration (ISRCTN13790648). Registered 14 May 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01123-1.
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Affiliation(s)
- Kate Morton
- Academic Unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research, University of Southampton, Southampton, UK
| | - Laura Wilde
- Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tara Cheetham-Blake
- NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Elena Heber
- GET.ON Institut, Hamburg, Germany, & University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
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Ellis J, Band R, Kinsella K, Cheetham-Blake T, James E, Ewings S, Rogers A. Optimising and profiling pre-implementation contexts to create and implement a public health network intervention for tackling loneliness. Implement Sci 2020; 15:35. [PMID: 32429961 PMCID: PMC7238736 DOI: 10.1186/s13012-020-00997-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background The implementation of complex interventions experiences challenges that affect the extent to which they become embedded and scaled-up. Implementation at scale in complex environments like community settings defies universal replication. Planning for implementation in such environments requires knowledge of organisational capacity and structure. Pre-implementation work is an important element of the early phase of preparing the setting for the introduction of an intervention, and the factors contributing towards the creation of an optimal pre-implementation community context are under-acknowledged. Methods To explore the factors contributing towards the creation of an optimal pre-implementation context, a quasi-ethnographic approach was taken. The implementation of a social network intervention designed to tackle loneliness in a community setting acts as the case in example. Observations (of meetings), interviews (with community partners) and documentary analysis (national and local policy documents and intervention resources) were conducted. Layder’s adaptive theory approach was taken to data analysis, with the Consolidated Framework for Implementation Research (CFIR) and a typology of third-sector organisations used to interpret the findings. Results Community settings were found to sit along a continuum with three broad categories defined as Fully Professionalised Organisations; Aspirational Community, Voluntary and Social Enterprises; and Non-Professionalised Community-Based Groups. The nature of an optimal pre-implementation context varied across these settings. Using the CFIR, the results illustrate that some settings were more influenced by political landscape (Fully professional and Aspirational setting) and others more influenced by their founding values and ethos (Non-Professionalised Community-Based settings). Readiness was achieved at different speeds across the categories with those settings with more resource availability more able to achieve readiness (Fully Professional settings), and others requiring flexibility in the intervention to help overcome limited resource availability (Aspirational and Non-Professionalised Community-Based settings). Conclusions The CFIR is useful in highlighting the multiple facets at play in creating the optimal pre-implementation context, and where flex is required to achieve this. The CFIR illuminates the similarities and differences between and across settings, highlighting the complexity of open system settings and the important need for pre-implementation work. Trial registration ISRCTN19193075
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Affiliation(s)
- J Ellis
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK.
| | - R Band
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - K Kinsella
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - T Cheetham-Blake
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - E James
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - S Ewings
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - A Rogers
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
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Band R, Ewings S, Cheetham-Blake T, Ellis J, Breheny K, Vassilev I, Portillo MC, Yardley L, Blickem C, Kandiyali R, Culliford D, Rogers A. Study protocol for 'The Project About Loneliness and Social networks (PALS)': a pragmatic, randomised trial comparing a facilitated social network intervention (Genie) with a wait-list control for lonely and socially isolated people. BMJ Open 2019; 9:e028718. [PMID: 31427326 PMCID: PMC6701612 DOI: 10.1136/bmjopen-2018-028718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Loneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of the Project About Loneliness and Social networks (PALS) study is to assess the effectiveness and cost-effectiveness of a guided social network intervention within a community setting among individuals experiencing loneliness and isolation and to understand implementation of Generating Engagement in Network Involvement (Genie) in the context of different organisations. METHODS AND ANALYSIS The PALS trial will be a pragmatic, randomised controlled trial comparing participants receiving the Genie intervention to a wait-list control group. Eligible participants will be recruited from organisations working within a community setting: any adult identified as socially isolated or at-risk of loneliness and living in the community will be eligible. Genie will be delivered by trained facilitators recruited from community organisations. The primary outcome will be the difference in the SF-12 Mental Health composite scale score at 6-month follow-up between the intervention and control group using a mixed effects model (accounting for clustering within facilitators and organisation). Secondary outcomes will be loneliness, social isolation, well-being, physical health and engagement with new activities. The economic evaluation will use a cost-utility approach, and adopt a public sector perspective to include health-related resource use and costs incurred by other public services. Exploratory analysis will use a societal perspective, and explore broader measures of benefit (capability well-being). A qualitative process evaluation will explore organisational and environmental arrangements, as well as stakeholder and participant experiences of the study to understand the factors likely to influence future sustainability, implementation and scalability of using a social network intervention within this context. ETHICS AND DISSEMINATION This study has received NHS ethical approval (REC reference: 18/SC/0245). The findings from PALS will be disseminated widely through peer-reviewed publications, conferences and workshops in collaboration with our community partners. TRIAL REGISTRATION NUMBER ISRCTN19193075.
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Affiliation(s)
- Rebecca Band
- Psychology, University of Southampton, Southampton, UK
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Sean Ewings
- Health Sciences, University of Southampton, Southampton, UK
| | - Tara Cheetham-Blake
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Jaimie Ellis
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Katie Breheny
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Ivaylo Vassilev
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Mari Carmen Portillo
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Rebecca Kandiyali
- Centre for Child and Adolescent Health, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - David Culliford
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
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Krusche A, Bradbury K, Corbett T, Barnett J, Stuart B, Yao GL, Bacon R, Böhning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Müller A, Neal RD, Osborne R, Rathod S, Richardson A, Sharman G, Summers K, Watson E, Wilde L, Wilkinson C, Yardley L, Little P. Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors. BMJ Open 2019; 9:e024862. [PMID: 30826763 PMCID: PMC6429898 DOI: 10.1136/bmjopen-2018-024862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management. METHODS AND ANALYSIS A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support. ETHICS AND DISSEMINATION The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN96374224; Pre-results.
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Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, Southampton, UK
| | | | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Biostatistics Research Group, University of Leicester, Leicester, UK
| | - Roger Bacon
- Patient and Public Involvement team for the CLASP project
| | - Dankmar Böhning
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Diana Eccles
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Andre Müller
- Saw Swee Hock Public School of Health, National University of Singapore, Singapore
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Kevin Summers
- Patient and Public Involvement team for the CLASP project
| | - Eila Watson
- School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Laura Wilde
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
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