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2401 to 2425 of 2,546Relaxation training with and without Comprehensive Behavioral Intervention for Tics for Tourette's disorder: A multiple baseline across participants consecutive case series.
Background and objectives: Behavioral therapies such as the Comprehensive Behavioral Intervention for Tics (CBIT) are recommended as the first-line treatment for Tourette's Disorder. This treatment approach is comprised of three central components: habit reversal training, functional assessment/intervention, and relaxation training. Despite its combined efficacy, the contribution of each therapeutic component in CBIT for reducing tic severity remains undetermined. The study evaluated the efficacy of relaxation training alone or alongside other CBIT components for reducing tic severity.
Methods: In this multiple-baseline study, participants completed a baseline assessment (A), 4 weekly sessions of relaxation training followed by a posttreatment assessment (B), 8 weekly sessions of CBIT followed by a posttreatment assessment (C), and a 1 month posttreatment follow up assessment (D). Six pa…
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Smith R, Michalopoulou M, Reid H, Riches SP, Wango YN, Kenworthy Y, Roman C, Santos M, Hirst JE, Mackillop L (2022)MEDLINE-indexed journal, not yet read by usBMC pregnancy and childbirth24 citations Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes.
Background: Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population.
Methods: The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain…
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A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees.
The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N = 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the interv…
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Stanton-Fay SH, Hamilton K, Chadwick PM, Lorencatto F, Gianfrancesco C, de Zoysa N, Coates E, Cooke D, McBain H, Heller SR, Michie S, DAFNEplus study group (2021)MEDLINE-indexed journal, not yet read by usDiabetic medicine : a journal of the British Diabetic Association29 citations The DAFNEplus programme for sustained type 1 diabetes self management: Intervention development using the Behaviour Change Wheel.
Aims: Self-management programmes for type 1 diabetes, such as the UK's Dose Adjustment for Normal Eating (DAFNE), improve short-term clinical outcomes but difficulties maintaining behavioural changes attenuate long-term impact. This study used the Behaviour Change Wheel (BCW) framework to revise the DAFNE intervention to support sustained behaviour change.
Methods: A four-step method was based on the BCW intervention development approach: (1) Identifying self-management behaviours and barriers/enablers to maintain them via stakeholder consultation and evidence synthesis, and mapping barriers/enablers to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. (2) Specifying behaviour change techniques (BCTs) in the existing DAFNE intervention using the Behaviour Change Techniques Taxonomy (BCTTv1). (3) Identifying additional BCTs to target the barriers/enablers using the BCW and …
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How Does the Understanding, Experience, and Enactment of Self-Regulation Behaviour Change Techniques Vary with Age? A Thematic Analysis.
Background: Self-regulatory behaviour change techniques (BCTs) appear less effective in promoting physical activity amongst older than younger adults. This study aimed to identify reasons for this by examining how participants of different ages understand, experience, and use these BCTs.
Methods: Twelve participants (aged 39-75) in a walking intervention study were interviewed twice: immediately post-intervention and 3 months later to examine understanding and enactment of self-regulation BCTs. Thematic analysis was used, organised using the framework approach.
Results: Participants acknowledged the importance of setting realistic goals and found pedometers useful. In older adults, the use of goal setting was influenced by previous experience in work settings of this BCT. Occupational status appeared to influence the participants' responses to action planning, irrespective of age, with r…
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Brewer NT (2021)MEDLINE-indexed journal, not yet read by usAcademic pediatrics125 citations What Works to Increase Vaccination Uptake.
Behavioral science offers several ideas about what it takes to get people to vaccinate. Colleagues and I previously reviewed the evidence for these propositions and put forward what has become known as the Increasing Vaccination Model. To make the model more accessible to practitioners, the current paper summarizes the main insights from the earlier work. First, observational studies show clearly that thoughts and feelings are correlated with vaccine uptake. Such constructs include perceived risk of harm from infectious disease and confidence in vaccine safety and efficacy. However, interventions have not generally shown that changing thoughts and feelings increases vaccine uptake. Second, social processes are promising in observational studies. Such constructs include social norms, altruism, and sharing through social media. More research is needed in this promising area before it will …
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Garcia D, Blizzard AM, Peskin A, Rothenberg WA, Schmidt E, Piscitello J, Espinosa N, Salem H, Rodriguez GM, Sherman JA, Parlade MV, Landa AL, Davis EM, Weinstein A, Garcia A, Perez C, Rivera JM, Martinez C, Jent JF (2021)MEDLINE-indexed journal, not yet read by usPrevention science : the official journal of the Society for Prevention Research25 citations Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications.
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent-Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May…
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Identification of Modifiable Social and Behavioral Factors Associated With Childhood Cognitive Performance.
Importance: Inequities in social environments are likely associated with a large portion of racial disparities in childhood cognitive performance. Identification of the specific exposures associated with cognitive development is needed to inform prevention efforts.
Objective: To identify modifiable factors associated with childhood cognitive performance.
Design, setting, and participants: This longitudinal pregnancy cohort study included 1503 mother-child dyads who were enrolled in the University of Tennessee Health Science Center-Conditions Affecting Neurodevelopment and Learning in Early Life study between December 1, 2006, and July 31, 2011, and assessed annually until the children were aged 4 to 6 years. The analytic sample comprised 1055 mother-child dyads. A total of 155 prenatal, perinatal, and postnatal exposures were included to evaluate environment-wide associations. Participan…
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"It's a Life Thing, Not a Few Months Thing": Profiling Patterns of the Physical Activity Change Process and Associated Strategies of Women With Prediabetes Over 1 Year.
Objectives: Engagement in regular physical activity (PA) is a cornerstone prevention strategy for individuals at risk of developing type 2 diabetes. Interventions targeting PA often fail to result in long-term behaviour changes. "Small Steps for Big Changes" is a 3-week diabetes prevention program that promotes PA behaviour changes in individuals with prediabetes through motivational interviewing-informed counselling.
Methods: In this study, we aimed to: a) profile patterns of women's perceived PA journey over 1 year and b) understand strategies used to engage in and maintain PA. Fourteen women (mean age, 60 years) engaged in 4 semistructured interviews (preprogram, postprogram and 3 and 12 months postprogram) over 1 year (56 total interviews). A trajectory approach was used, coupled with a deductive‒inductive thematic analysis. Findings are presented descriptively and chronologically ov…
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Hall CL, Sanderson C, Brown BJ, Andrén P, Bennett S, Chamberlain LR, Davies EB, Khan K, Kouzoupi N, Mataix-Cols D, McKenzie C, Murphy T, Townsend M, Hollis C, Murray E (2020)MEDLINE-indexed journal, not yet read by usTrials27 citations Opportunities and challenges of delivering digital clinical trials: lessons learned from a randomised controlled trial of an online behavioural intervention for children and young people.
Background: Despite being the gold standard of research to determine effectiveness, randomised controlled trials (RCTs) often struggle with participant recruitment, engagement and retention. These issues may be exacerbated when recruiting vulnerable populations, such as participants with mental health issues. We aimed to update understanding of the scope of these problems in trials of health technology and identify possible solutions through reflecting on experiences from an exemplar trial (Online Remote Behavioural Intervention for Tics; ORBIT).
Method: We extracted anonymised data on recruitment, retention and requests for more funding and time from trials funded by the largest funder of health technology trials in the UK (the National Institute of Health Research Health Technology Assessment) between 2010 and 2020, and compared these with data from a recent, successful trial (ORBIT). …
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Evidence, theory and context: using intervention mapping in the development of a community-based self-management program for chronic low back pain in a rural African primary care setting - the good back program.
Background: Rural Nigeria has one of the greatest burdens of low back pain but there are no effective evidence-based interventions to manage it in this population. This paper presents the application of the intervention mapping (IM) approach in the development of a complex behavior change intervention - The Good Back program, aimed at reducing non-specific chronic low back pain (CLBP) disability in rural Nigeria.
Methods: The first four steps of IM were applied. A critical review of the literature, 2 qualitative studies and a population-based cross-sectional study in rural Nigeria helped to identify two key program objectives in order to reduce CLBP disability in this population: reduce the impact of illness perceptions, fear avoidance beliefs, catastrophising, anxiety and depression by targeting maladaptive illness perceptions about CLBP; and facilitate the adoption of exercises and goo…
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An evaluation of behaviour change techniques in health and lifestyle mobile applications.
Despite the current popularity and potential use of mobile applications (apps) in the area of behaviour change, health promotion, and well-being for young people, it is unclear whether their design is underpinned by theory-based behaviour change techniques. Understanding the design of these apps may improve the way they can be used to support young people's well-being. The objectives of this study were to investigate what behaviour change techniques are included in the content of health and lifestyle apps, and determine which of these are prominent in app design. Thirty of the top-listed health and lifestyle apps across three categories (physical activity, diet, and sleep) were freely downloaded from the two most popular app stores (GooglePlay™ and AppStore™). Selected apps were used by trained researchers and the features identified coded against the Behaviour Change Techniques Taxonomy…
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Avgerinou C, Gardner B, Kharicha K, Frost R, Liljas A, Elaswarapu R, Manthorpe J, Drennan VM, Goodman C, Iliffe S, Walters K (2019)MEDLINE-indexed journal, not yet read by usHealth & social care in the community15 citations Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers.
Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi-structured interviews with 16 older people with mild frailty who received a pilot home-based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio-recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most parti…
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Hagger MS, Weed M (2019)MEDLINE-indexed journal, not yet read by usThe international journal of behavioral nutrition and physical activity118 citations DEBATE: Do interventions based on behavioral theory work in the real world?
Background: Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes.
Discussion: Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the 'real world'. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective…
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The therapeutic role of emotion regulation and coping strategies during a stand-alone DBT Skills training program for alcohol use disorder and concurrent substance use disorders.
Clinical trials on Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone intervention for alcohol use disorder (AUD) showed promising outcomes. Improvements in difficulties with emotion regulation (DER) played a mediating role on abstinence maintenance. However, the effect of DER, together with specific coping strategies, have not been considered yet in the treatment of clinical features associated to AUD and concurrent substance use disorders (CO-SUDs). The current study aims at investigating changes in the number of consecutive days of abstinence (CDA), severity of AUD and CO-SUDs (Shorter PROMIS Questionnaire; SPQ alcohol, prescription, illicit drugs subscale), DER (Difficulties in Emotion Regulation Scale; DERS) and coping strategies (DBT Way of Coping Checklist; DBT-WCCL) during a 3-month DBT-ST program for the treatment of AUD and CO-SUDs. Furthermore, four indepen…
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Tailoring lifestyle interventions to low socio-economic populations: a qualitative study.
Background: People living in deprived areas are more likely to be overweight or obese, have poorer health outcomes, and tend to benefit less from interventions than those from more affluent backgrounds. One approach to address such health inequalities is to tailor existing interventions to low socio-economic populations, yet there is limited evidence to inform their design. This study aims to identify how best to tailor lifestyle interventions to low socio-economic populations to improve outcomes.
Methods: Following direct observations of community-run weight loss groups, we interviewed 11 group facilitators and 14 service users from a health improvement service in a low socio-economic area in the North West of England. Audio-recorded interviews were transcribed verbatim and analysed thematically.
Results: We identified two overarching themes within the data. The first theme, managing di…
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Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD.
Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior …
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Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain.
As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda. Workgroups were established and asked to reach consensus recommendations on clinical and research pr…
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The Coaching on Lifestyle (CooL) Intervention for Overweight and Obesity: A Longitudinal Study into Participants' Lifestyle Changes.
Combined lifestyle interventions (CLIs) can be effective in reducing weight and improving lifestyle-related behaviours but it is unclear how CLIs can best be implemented in practice in order to achieve sustained lifestyle changes. The Coaching on Lifestyle programme (CooL) is a CLI in the Netherlands, in which professional lifestyle coaches counsel adults and children (and/or their parents) who are obese or at high risk of obesity to achieve a sustained healthier lifestyle. The CooL intervention consists of group and individual sessions addressing the topics of physical activity, dietary behaviours, sleep and stress. Our longitudinal one-group pre-post study aimed to identify lifestyle changes among participants (adults, children and their parents) at 8 and 18 months after initiation. We assessed constructs ranging from motivation and behaviour-specific cognitions to behaviours and healt…
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Improving adherence to multiple medications in older people in primary care: Selecting intervention components to address patient-reported barriers and facilitators.
Background: Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst multimorbid older people prescribed multiple medications. Interventions targeting adherence often lack a theoretical underpinning and this may impact on effectiveness. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence.
Objectives: This study aimed to (i) identify determinants (barriers, facilitators) of adherence to multiple medications from older people's perspectives; (ii) identify key domains to target for behaviour change; and (iii) map key domains to intervention components [behaviour change techniques (BCTs)] that could be delivered in an intervention by community pharmacists.
Method: Focus groups were conducted with older people (>65 years) receiving ≥4 medications. Questions …
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Using network analysis for the prediction of treatment dropout in patients with mood and anxiety disorders: A methodological proof-of-concept study.
There are large health, societal, and economic costs associated with attrition from psychological services. The recently emerged, innovative statistical tool of complex network analysis was used in the present proof-of-concept study to improve the prediction of attrition. Fifty-eight patients undergoing psychological treatment for mood or anxiety disorders were assessed using Ecological Momentary Assessments four times a day for two weeks before treatment (3,248 measurements). Multilevel vector autoregressive models were employed to compute dynamic symptom networks. Intake variables and network parameters (centrality measures) were used as predictors for dropout using machine-learning algorithms. Networks for patients differed significantly between completers and dropouts. Among intake variables, initial impairment and sex predicted dropout explaining 6% of the variance. The network anal…
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Ecological momentary assessment of self-attitudes in response to dietary lapses.
Objective: To examine whether self-attitudes and self-efficacy after dietary lapses relate to lapse frequency or predict risk for lapsing again on the same day.
Method: Adults with overweight/obesity (n = 91) completed ecological momentary assessment for 14 days at the start of a lifestyle modification program. At each survey, participants reported whether they had experienced a dietary lapse, and, if so, reported their self-attitudes (i.e., self-criticism, self-forgiveness, self-regard) and self-efficacy. The relationships between participants' typical (i.e., average level for each participant across lapses) self-attitudes/self-efficacy after lapsing and lapse frequency were examined using correlations. Generalized estimating equations examined whether participants' typical (average across lapses; between-person effect) self-attitudes/self-efficacy or momentary (i.e., level of each vari…
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Effect of a nurse-led intervention programme on professional quality of life and post-traumatic growth in oncology nurses.
Aim: To evaluate the effects of a nurse-led intervention programme on compassion fatigue, compassion satisfaction, and burnout, which are indicators of the professional quality of life and post-traumatic growth of oncology nurses.
Method: The study was designed in a single group with pre-test and post-test comparisons. The nurse-led intervention programme was carried out in two face-to-face sessions and two counselling follow-up sessions by phone with 43 nurses who care for oncology patients at a university hospital. The nurse-led intervention sessions consisted of a lecture on a relevant topic, background reading, baksi dance and mandala painting; motivational text messages and counselling. The Professional Quality of Life-IV Scale and the Post-Traumatic Growth Inventory were used, and data were evaluated using the "paired groups t test" analysis. Data for the study were acquired betwee…
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Credibility-enhancing displays promote the provision of non-normative public goods.
Promoting the adoption of public goods that are not yet widely accepted is particularly challenging. This is because most tools for increasing cooperation-such as reputation concerns1 and information about social norms2-are typically effective only for behaviours that are commonly practiced, or at least generally agreed upon as being desirable. Here we examine how advocates can successfully promote non-normative (that is, rare or unpopular) public goods. We do so by applying the cultural evolutionary theory of credibility-enhancing displays3, which argues that beliefs are spread more effectively by actions than by words alone-because actions provide information about the actor's true beliefs. Based on this logic, people who themselves engage in a given behaviour will be more effective advocates for that behaviour than people who merely extol its virtues-specifically because engaging in a…
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'It's like a personal motivator that you carried around wi' you': utilising self-determination theory to understand men's experiences of using pedometers to increase physical activity in a weight management programme.
Background: Self-monitoring using pedometers is an effective behaviour change technique to support increased physical activity (PA). However, the ways in which pedometers operate as motivational tools in adoption and maintenance of PA is not well understood. This paper investigates men's experiences of pedometers as motivational tools both during and after their participation in a 12-week group-based, weight management programme for overweight/obese men, Football Fans in Training (FFIT).
Methods: Semi-structured telephone interviews were conducted with 28 men, purposively sampled to include men who did and did not achieve 5% weight loss during the programme. Data were analysed thematically utilising the framework approach, using Self-Determination Theory (SDT) - namely concepts of behavioural regulation and the basic needs of relatedness, competence and autonomy - as an analytical lens.
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