M. de Bruin

Everything should be as simple as possible, but no simpler: towards a protocol for accumulating evidence regarding the active content of health behaviour change interventions

There is a need to consolidate the evidence base underlying our toolbox of methods of behaviour change. Recent efforts to this effect have conducted meta-regressions on evaluations of behaviour change interventions, deriving each methods effectiveness from its association to intervention effect size. However, there are a range of issues that raise concern about whether this approach is actually furthering or instead obstructing the advancement of health psychology theories and the quality of health behaviour change interventions. Using examples from theory, the literature and data from previous meta-analyses, these concerns and their implications are explained and illustrated. An iterative protocol for evidence base accumulation is proposed that integrates evidence derived from both experimental and applied behaviour change research, and combines theory development in experimental settings with theory testing in applied real-life settings. As evidence gathered in this manner accumulates, a cumulative science of behaviour change can develop.

Environmental interventions for altering eating behaviours of employees in the workplace: a systematic review

Environmental, or ‘choice‐architecture’, interventions aim to change behaviour by changing properties/contents of the environment and are commonly used in the workplace to promote healthy behaviours in employees. The present review aimed to evaluate and synthesize the evidence surrounding the effectiveness of environmental interventions targeting eating behaviour in the workplace. A systematic search identified 8157 articles, of which 22 were included in the current review. All included studies were coded according to risk of bias and reporting quality and were classified according to the emergent typology of choice‐architecture interventions. More than half of included studies (13/22) reported significant changes in primary measures of eating behaviour (increased fruit/veg consumption, increased sales of healthy options and reduction in calories purchased). However, only one study produced a small significant improvement in weight/body mass index. Many studies had a high or unknown risk of bias; reporting of interventions was suboptimal; and the only trial to measure compensatory behaviours found that intervention participants who ate less during the intervention ate more out with the workplace later in the day. Hence, we conclude that more rigorous, well‐reported studies that account for compensatory behaviours are needed to fully understand the impact of environmental interventions on diet and importantly on weight/body mass index outcomes.

Assessing treatment-as-usual provided to control groups in adherence trials: Exploring the use of an open-ended questionnaire for identifying behaviour change techniques

Objective: Reporting guidelines call for descriptions of control group support in equal detail as for interventions. However, how to assess the active content (behaviour change techniques (BCTs)) of treatment-as-usual (TAU) delivered to control groups in trials remains unclear. The objective of this study is to pre-test a method of assessing TAU in a multicentre cost-effectiveness trial of an HIV-treatment adherence intervention. Design: HIV-nurses (N = 21) completed a semi-structured open-ended questionnaire enquiring about TAU adherence counselling. Two coders independently coded BCTs. Main outcome measures: Completeness and clarity of nurse responses, inter-coder reliabilities and the type of BCTs reported were examined. Results: The clarity and completeness of nurse responses were adequate. Twenty-three of the 26 identified BCTs could be reliably coded (mean κ = .79; mean agreement rate = 96%) and three BCTs scored below κ = .60. Total number of BCTs reported per nurse ranged between 7 and 19 (M = 13.86, SD = 3.35). Conclusions: This study suggests that the TAU open-ended questionnaire is a feasible and reliable tool to capture active content of support provided to control participants in a multicentre adherence intervention trial. Considerable variability in the number of BCTs provided to control patients was observed, illustrating the importance of reliably collecting and accurately reporting control group support.

The interruption phenomenon for generalized continued fractions

After defining a generalized C -fraction (a kind of Jacobi-Perron algorithm) for an n -tuple of formal power series over ( n ≥ 2), the connection between interruptions in the algorithm and linear dependence over [x] of the power series is studied. Examples will be given showing that the algorithm behaves in a way similar to the Jacobi-Perron algorithm for an n -tuple of real numbers (the gcd-algorithm): there do exist n -tuples of formal power series f (1) , f (2) , …, f ( n ) with a C-n -fraction without interruptions but for which 1, f (1) , f (2) , …, f ( n ) is nevertheless linearly dependent over [x]. Moreover an example will be given of algebraic functions f, g of degree n over [x] (formally defined) for which the C-n -fraction for f, f 2 , …, f n has just one interruption and that for g, g 2 , …, g n 1 none, while of course 1. f, f 2 , …, f n and 1, g, g 2 , …, g n admit (only) one dependence relation over [x].

An algorithm for calculating generalized continued fractions

Abstract In this paper the generalization of a continued fraction in the sense of the Jacobi-Perron algorithm (called an n-fraction ) is considered. Apart from the known algorithms to calculate an n-fraction a new one is derived and the algorithms are compared with respect to the number of operations required and the time to execute these operations.

Bronchoscopy in Pulmonary Atelectasis in Children

When a main bronchus or one of its branches is occluded, then part of the lung is put out of action. Interest in the resulting clinical picture has increased during recent years. The causes leading to such an occlusion are particularly frequent in children. Now that attention is being drawn more and more to this affection, it appears that lung collapse is fairly often found in hospital practice. Often it is possible to make a diagnosis at an early stage; radiological examination is of great importance in this connection. In this way a better insight has been obtained into the different clinical forms of lung collapse and into the causes leading up to it. This is not only of importance from a diagnostic point of view, but also therapeutically, as undoubtedly in many cases bronchiectasis will develop in the collapsed lung unless the occlusion is remedied in good time.

Beliefs about back pain and pain management behaviours, and their associations in the general population: a systematic review

Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain‐related outcomes. Five databases were searched up until April 2017. Quantitative studies which reported a measure of agreement with a belief about back pain, cross‐sectional associations, or associations between beliefs and future outcomes were eligible. Eligibility was assessed and data extracted independently by two authors. Results were tabulated and narratively synthesized. Nineteen studies from 10 countries were eligible (median study n [IQR] = 990.5 [524.75–2387.5]). Beliefs were measured using eight questionnaires and 57 stand‐alone items. Beliefs about back pains negative consequences were common across countries and populations, whereas most samples did not hold fear‐avoidance beliefs. Beliefs about back pains consequences were associated with pain and disability, but only one study investigated this specific relationship prospectively. No studies investigated whether beliefs are associated with future pain management behaviours. Agreement with certain beliefs (e.g. about negative consequences) was associated with sociodemographic characteristics (e.g. older age) and poorer self‐rated health. Interventions may benefit from targeting beliefs about the perceived negative consequences of back pain in these populations. However, future research should explore how beliefs prospectively influence the management of back pain.

Enhancing Behavior Change Technique Coding Methods: Identifying Behavioral Targets and Delivery Styles in Smoking Cessation Trials

BACKGROUND The behavior change technique (BCT) taxonomy v1 is often used in systematic reviews for identifying active components of interventions. Its utility could be enhanced by linking BCTs to specific target behaviors and qualifying BCT delivery style. PURPOSE To determine whether behavioral targets and delivery styles of BCTs can be coded reliably and to determine the utility of coding these characteristics. METHODS As part of a large systematic review of 142 smoking cessation trials, two researchers independently coded publicly and privately held intervention and comparator group materials, specifying the behavioral target (quitting, abstinence, medication adherence, or treatment engagement) and delivery style (tailored vs. not tailored; active participation vs. passive receipt) of each BCT. RESULTS Researchers coded 3,843 BCTs, which were reliably attributed to behavioral targets (AC1 = 0.92, PABAK = 0.91). Tailoring (AC1 = 0.80, PABAK = 0.74) and participation (AC1 = 0.71, PABAK = 0.64) were also coded reliably. There was considerable variability between groups in quitting and abstinence BCTs (ranges: 0-41; 0-18) and in tailoring and participation (ranges: 0-20; 0-32), but less variability for medication adherence and treatment engagement (ranges: 0-6; 0-7). CONCLUSIONS Behavioral targets and delivery styles of BCTs can be reliably identified and occur with sufficient frequency in smoking cessation trials for inclusion in quantitative syntheses (e.g., meta-regression analyses). Systematic reviewers could consider adopting these methods to evaluate the impact of intervention components targeting different behaviors, as well as the benefits of different BCT delivery styles.

Environmental interventions for altering eating behaviours of employees in the workplace: a systematic review: Environmental interventions in eating

Environmental, or ‘choice‐architecture’, interventions aim to change behaviour by changing properties/contents of the environment and are commonly used in the workplace to promote healthy behaviours in employees. The present review aimed to evaluate and synthesize the evidence surrounding the effectiveness of environmental interventions targeting eating behaviour in the workplace. A systematic search identified 8157 articles, of which 22 were included in the current review. All included studies were coded according to risk of bias and reporting quality and were classified according to the emergent typology of choice‐architecture interventions. More than half of included studies (13/22) reported significant changes in primary measures of eating behaviour (increased fruit/veg consumption, increased sales of healthy options and reduction in calories purchased). However, only one study produced a small significant improvement in weight/body mass index. Many studies had a high or unknown risk of bias; reporting of interventions was suboptimal; and the only trial to measure compensatory behaviours found that intervention participants who ate less during the intervention ate more out with the workplace later in the day. Hence, we conclude that more rigorous, well‐reported studies that account for compensatory behaviours are needed to fully understand the impact of environmental interventions on diet and importantly on weight/body mass index outcomes.

P03 What do people in the general population think about back pain – and does it matter? a systematic review

Background Mass media campaigns have aimed to change the public’s beliefs about back pain to ultimately change behaviours like healthcare utilisation. Most campaigns demonstrated shifts in beliefs without concomitant changes in behaviours. This raises the question of whether the beliefs targeted by campaigns were prevalent and related to the behaviours they tried to change. The objectives of this review were to: i) describe the prevalence of particular beliefs about back pain, ii) identify any cross-sectional relationships between these beliefs and other (e.g. sociodemographic) factors, and iii) assess the evidence for beliefs about back pain to predict future back pain-related outcomes within the general population. Methods A systematic review of the literature was carried out using searches for ‘back pain’, ‘beliefs’ and ‘general population’ in five literature databases (MEDLINE, PsycINFO, Embase, ISI Web of Science, CINAHL). Articles were screened, data was extracted and quality was assessed by two reviewers. Results across the three aims were tabulated and narratively synthesised. Results 4480 unique records were identified and 30 articles were included. Beliefs about back pain were measured using eight questionnaire instruments and 57 unique items. These represented beliefs about: consequences, fearing and avoiding pain/activities, catastrophising, and other specific beliefs. Where a given construct was assessed by more than one study, most samples agreed, on average, with beliefs about negative consequences of back pain (8/12), while most disagreed with fear avoidance beliefs about activity (4/5). Negative beliefs about consequences were consistently associated with being older, unemployed, having completed less education, lower self-rated health, and more pain and disability; they were predictive of future back pain-related outcomes. Discussion Most samples agreed with beliefs about back pain’s negative consequences and these beliefs predicted some back pain-related outcomes. However, based on current evidence, we cannot say whether these beliefs impact future management behaviours. The relationships between other belief constructs and future management behaviours has not been investigated in the general population. Previous campaigns’ mixed success could, in part, be due to not targeting beliefs which were related to behaviours they hoped to change. Existing evidence suggests that this relationship has not been assessed in the general population; it must be elucidated prior to developing future campaigns.