Michelle Richardson

The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions.

BackgroundCONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity.ObjectivesThe objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions.MethodsIn a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed.ResultsThis resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above.Conclusions“BCT taxonomy v1,” an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.

Psychological correlates of university students' academic performance: a systematic review and meta-analysis.

A review of 13 years of research into antecedents of university students grade point average (GPA) scores generated the following: a comprehensive, conceptual map of known correlates of tertiary GPA; assessment of the magnitude of average, weighted correlations with GPA; and tests of multivariate models of GPA correlates within and across research domains. A systematic search of PsycINFO and Web of Knowledge databases between 1997 and 2010 identified 7,167 English-language articles yielding 241 data sets, which reported on 50 conceptually distinct correlates of GPA, including 3 demographic factors and 5 traditional measures of cognitive capacity or prior academic performance. In addition, 42 non-intellective constructs were identified from 5 conceptually overlapping but distinct research domains: (a) personality traits, (b) motivational factors, (c) self-regulatory learning strategies, (d) students approaches to learning, and (e) psychosocial contextual influences. We retrieved 1,105 independent correlations and analyzed data using hypothesis-driven, random-effects meta-analyses. Significant average, weighted correlations were found for 41 of 50 measures. Univariate analyses revealed that demographic and psychosocial contextual factors generated, at best, small correlations with GPA. Medium-sized correlations were observed for high school GPA, SAT, ACT, and A level scores. Three non-intellective constructs also showed medium-sized correlations with GPA: academic self-efficacy, grade goal, and effort regulation. A large correlation was observed for performance self-efficacy, which was the strongest correlate (of 50 measures) followed by high school GPA, ACT, and grade goal. Implications for future research, student assessment, and intervention design are discussed.

Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review

Background: Numerous studies have shown that the quality of the therapeutic relationship (TR) between the patient and the clinician is an important predictor of the outcome of different forms of psychotherapy. It is less clear whether the TR also predicts outcomes of psychiatric treatment programmes in patients with psychosis (i.e. outside conventional psychotherapy). Methods: We conducted a systematic review and identified 9 primary studies that prospectively tested the association of the TR with 3 outcomes, i.e. hospitalisation, symptom levels and functioning. Because of the heterogeneity of the methods used, a meta-analysis was not feasible. A vote counting method was used to determine the number of statistically significant effects in the hypothesised direction (i.e. that a more positive TR predicts more favourable outcomes). Results: For each outcome, a χ2 analysis showed that the number of statistically significant findings in the hypothesised direction was greater than expected if the null hypothesis of no association were true. However, studies had methodological shortcomings, and the effect sizes of positive associations were rather small. Conclusion: It may be concluded that there is some, but not overwhelming, evidence that the TR predicts outcomes of complex psychiatric treatment programmes in patients with psychosis, and that methodologically more rigorous research is required. Such research should measure the TR at initial stages of treatment and use validated assessment instruments for both TR and outcomes.

Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research

BACKGROUNDnAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by age-inappropriate levels of inattention, impulsivity and hyperactivity. School can be particularly challenging for children with ADHD. Few reviews have considered non-pharmacological interventions in school settings.nnnOBJECTIVESnTo assess the effectiveness of non-pharmacological interventions delivered in school settings for pupils with, or at risk of, ADHD and to explore the factors that may enhance, or limit, their delivery.nnnDATA SOURCESnTwenty electronic databases (including PsycINFO, MEDLINE, EMBASE, Education Resources Information Centre, The Cochrane Library and Education Research Complete) were searched from 1980 to February-August 2013. Three separate searches were conducted for four systematic reviews; they were supplemented with forward and backwards citation chasing, website searching, author recommendations and hand-searches of key journals.nnnREVIEW METHODSnThe systematic reviews focused on (1) the effectiveness of school-based interventions for children with or at risk of ADHD; (2) quantitative research that explores attitudes towards school-based non-pharmacological interventions for pupils with ADHD; (3) qualitative research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; and (4) qualitative research exploring the experience of ADHD in school among pupils, their parents and teachers more generally. Methods of synthesis included a random-effects meta-analysis, meta-regression and narrative synthesis for review 1, narrative synthesis for review 2 and meta-ethnography and thematic analysis for reviews 3 and 4.nnnRESULTSnFor review 1, 54 controlled trials met the inclusion criteria. For the 36 meta-analysed randomised controlled trials, beneficial effects (pu2009<u20090.05) were observed for several symptom and scholastic outcomes. Mean weighted effect sizes ranged from very small (d +u2009<u20090.20) to large (d +u2009≥u20090.80), but substantial heterogeneity in effect size estimates across studies was reported. Moderator analyses were not able to clarify which intervention features were linked with effectiveness. For review 2, 28 included studies revealed that educators attitudes towards interventions ranged in positivity. Most interventions were rated positively or neutrally across different studies. The only intervention that consistently recorded positive attitudes from educators was daily report cards. For review 3, 33 studies met the inclusion criteria. Key findings included tensions regarding the preferred format of interventions, particularly how structured interventions were and the extent to which they are tailored to the child with ADHD. There were mixed views about the impact of interventions, although it was clear that interventions both influence and are influenced by the relationships held by children with ADHD and participants attitudes towards school and ADHD. For review 4, 34 studies met the inclusion criteria. Key findings included the importance of causal attributions that teachers, parents and pupils made about ADHD symptoms, the decisions teachers made about treatment, the self-perceptions pupils developed about themselves, the role of the classroom environment and stigma in aggravating ADHD symptoms, and the significant barrier to treatment posed by the common presence of conflict in relationships between pupils-teachers, parents-teachers and pupils-peers in relation to ADHD. An overarching synthesis of the four reviews highlighted the importance of the context affecting interventions. It suggested that ADHD psychoeducation and relationship-building skills are potential implications for interventions.nnnLIMITATIONSnThe breadth of both interventions and outcomes in the reviewed studies presented a challenge for categorisation, analysis and interpretation in reviews 1-3. Across reviews, relatively few studies were conducted in the UK, limiting the applicability of findings to UK education. In reviews 1 and 2, the poor methodological quality of some included studies was identified as a barrier to establishing effectiveness or comparing attitudes. In review 3 the descriptive analysis used by the majority of studies constrained theorising during synthesis. Studies in review 4 lacked detail regarding important issues like gender, pupil maturity and school level.nnnCONCLUSIONnFindings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies. The qualitative reviews demonstrate the importance of the context in which interventions are used. Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts. Gaps in current research present opportunities for the development and testing of standardised tools to describe interventions, agreement on gold-standard outcome measures assessing ADHD behaviour and testing a range of potential moderators alongside intervention trials.nnnSTUDY REGISTRATIONnThis study is registered as PROSPERO CRD42011001716.nnnFUNDINGnThe National Institute for Health Research Health Technology Assessment programme.

Factorial validity and measurement equivalence of the Client Assessment of Treatment Scale for psychiatric inpatient care — A study in three European countries

Patients views of inpatient care need to be assessed for research and routine evaluation. For this a valid instrument is required. The Client Assessment of Treatment Scale (CAT) has been used in large scale international studies, but its psychometric properties have not been well established. The structural validity of the CAT was tested among involuntary inpatients with psychosis. Data from locations in three separate European countries (England, Spain and Bulgaria) were collected. The factorial validity was initially tested using single sample confirmatory factor analyses in each country. Subsequent multi-sample analyses were used to test for invariance of the factor loadings, and factor variances across the countries. Results provide good initial support for the factorial validity and invariance of the CAT scores. Future research is needed to cross-validate these findings and to generalise them to other countries, treatment settings, and patient populations.

Reliability of Identification of Behavior Change Techniques in Intervention Descriptions

PurposeThe aim of this paper is to assess the frequency of identification as well as the inter-coder and test–retest reliability of identification of behavior change techniques (BCTs) in written intervention descriptions.MethodsForty trained coders applied the “Behavior Change Technique Taxonomy version 1” (BCTTv1) to 40 intervention descriptions published in protocols and repeated this 1xa0month later.ResultsEighty of 93 defined BCTs were identified by at least one trained coder, and 22 BCTs were identified in 16 (40xa0%) or more of 40 descriptions. Good inter-coder reliability was observed across 80 BCTs identified in the protocols: 66 (80xa0%) achieved mean prevalence and bias-adjusted kappa (PABAK) scores of 0.70 or greater, and 59 (74xa0%) achieved mean scores of 0.80 or greater. There was good within-coder agreement between baseline and 1xa0month, demonstrating good test–retest reliability.ConclusionsBCTTv1 can be used by trained coders to identify BCTs in intervention descriptions reliably. However, some frequently occurring BCT definitions require further clarification.

Association of treatment satisfaction and psychopathological sub-syndromes among involuntary patients with psychotic disorders

PurposePrevious research has shown a link between treatment satisfaction and global psychopathology in different groups of psychiatric patients. However, neither the relationship between treatment satisfaction and the sub-syndromes of global psychopathology nor their temporal ordering have been explored.MethodsParticipants admitted involuntarily to psychiatric wards in the UK and diagnosed with psychotic disorders (Nxa0=xa0232) were included. Treatment satisfaction and psychopathological sub-syndromes (i.e., manic excitement, anxiety-depression, negative symptoms, positive symptoms) were measured within 1xa0week and at 1xa0month after admission.ResultsRepeated measures ANOVAs showed that higher treatment satisfaction is associated with lower scores on the manic excitement, anxiety-depression and positive symptom sub-syndromes, while no significant association was found for negative symptoms. However, cross-lagged panel analyses showed that treatment satisfaction predicted change only in positive symptoms while none of the paths from the relevant sub-syndromes to treatment satisfaction was significant.ConclusionTreatment satisfaction can be regarded as an antecedent of changes in positive symptoms only. These results underline the importance of examining psychopathological sub-syndromes separately as they may relate differentially to other important correlates of psychoses.

Aggression on inpatient units: Clinical characteristics and consequences

Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.

ADHD, parent perspectives and parent–teacher relationships: grounds for conflict

Educational policy and the school effectiveness movement often involve rhetoric about the benefit of parent involvement in schools, but high-quality relationships between parents and teachers are not always straightforwardly achieved, and this may be particularly true in the case of parents of children presenting with academic problems and/or social, emotional and behavioural difficulties. A systematic review of qualitative research was conducted to explore the school-related experiences of parents of pupils diagnosed with attention deficit hyperactivity disorder (ADHD). Six studies reported in seven papers met the inclusion criteria. High-quality parent–teacher relationships were found to be the exception, with mothers feeling silenced and criticised. Findings show commonalities with wider research about parents, but identify additional grounds for conflict resulting from parental blame for pupils disruptive behaviour, and the ambivalent nature of the concept of ADHD.

Aggression on inpatient units

Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.