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Background: Domestic violence during pregnancy is especially concerning due to its significant detrimental impact on a woman's health and that of her unborn child. The study aims to evaluate the effects of a behavioural intervention package (BIP) delivered during pregnancy on the quality of life (QOL), domestic violence (DV), and reproductive and child health (RCH) of women experiencing DV. Methods: A randomised controlled trial was conducted on 211 pregnant women recruited between 18 and 20 weeks of pregnancy and randomly assigned to one of two groups: intervention (n = 105) or control (n = 106). The intervention group received BIP and standard care, while the control group received only standard care for 28 weeks. Study tools included socio-demographic variables, a short-form health survey, an abuse assessment screening tool, and an RCH checklist. The tools were completed once before the intervention and again at 6 weeks postnatal. The tools and their subscales were compared pre- and post-intervention using a paired t-test, or Wilcoxon signed test as appropriate to estimate the effect size at baseline and post-intervention. Results: Post-intervention, the QOL scores were found to be significant, with a positive effect favouring the intervention as compared to the control group. The BIP intervention, which was found to be significantly effective (P ≤ 0.001) in reducing DV for pregnant women experiencing DV, was higher in the intervention group than in the control group. Conclusion: The BIP may be an appropriate method for treating pregnant women experiencing DV from low socioeconomic strata who attend public hospitals in India to improve their QOL. The approach may offer an intervention that healthcare institutions or other organizations in contact with women at risk of violence can implement. Trial registration: Indian Registry of Clinical Trials CTRI/2019/01/017009. Registered on 09/01/2019. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common among infants and can have a serious impact on the health and wellbeing of both child and parents. To sustainably promote infant sleep on a population level, it is necessary to develop evidence-based programs that can be implemented on a large scale. The Youth Health Care setting, with its focus on prevention, child health promotion and services widely available for parents, can be a suitable setting to do so. Currently however, sleep health promotion in this setting seems to be suboptimal. To promote healthy infant sleep on a population level, programs need to be accessible and comprehensible for all parents, including parents with limited (health) literacy. Therefore, this study aims to develop, implement and evaluate a program called 'Sleep on number 1', that is tailored to Dutch Youth Health Care, to sustainably promote healthy sleep in 0-2-year-old infants. Methods: The program was developed based on co-creation with parents and Youth Health Care professionals, evidence-based behaviour change theories and sleep health promotion methods. Program effectiveness is investigated with a quasi-experimental study design comparing the program group with the care as usual control group. Participants consist of parents of 0-2-year-old children. Primary outcome is infant sleep quality at the age of 10 weeks and 6, 9, 14 and 24 months, measured with a sleep diary. The primary data analysis focuses on night awakenings at 9 months. Secondary outcomes focus on parental behaviour regarding infant sleep, related behavioural determinants and parental satisfaction with Youth Health Care sleep advice. Program effectiveness is analysed using a linear mixed-model in case of data clustering, and an independent samples T-test or linear regression in case no substantial clustering effects are found. A mixed methods process evaluation is performed with parents and Youth Health Care professionals, assessing program reach, adoption, implementation, maintenance and working mechanisms. Discussion: The 'Sleep on number 1' program is an evidence-based sleep health program for 0-2-year-old children, tailored to Dutch Youth Health Care. If effective, this program has the potential to improve infant sleep on a population level. Trial registration: ISRCTN, ISRCTN27246394, registered on 10/03/2023. https://www.isrctn.com/ISRCTN27246394. [ABSTRACT FROM AUTHOR]

In the context of a couples cohort established to evaluate an optimised couples-focused behavioural intervention in rural South Africa, we examined: (1) Is couples' relationship quality (RQ) associated with couples HIV testing and counselling (CHTC) uptake? (2) Does CHTC uptake or the intervention components uptake improve subsequent RQ? Enrolled couples, (n = 218), previously naïve to couples HIV testing, were invited to two group sessions and offered four couples counselling sessions (CS1-CS4), as part of the intervention and administered a questionnaire individually at baseline, four weeks, and four months, which included item-scales to measure RQ: satisfaction, intimacy, dyadic trust, conflict, and mutual constructive communication. Logistic models indicated that no baseline RQ measures were significantly associated with CHTC uptake. Linear regression models showed that CHTC uptake before four weeks assessment significantly improved couples' satisfaction and trust at four weeks, and intimacy at four months. Attending at least one CS was associated with increased satisfaction, intimacy, and decreased conflict within couples at four weeks; the improvement in intimacy was sustained at four months. Consistent with the theoretical interdependence model, our findings suggest that CHTC and CS seemed to strengthen aspects of relationship quality, possibly leading to further collaboration in managing lifestyle changes and treatment adherence. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigates how the Prostate Cancer Patient Empowerment Program (PC-PEP) helps men with prostate cancer by promoting patient empowerment and activation. This program encourages patients to engage actively in their care, fostering healthy living habits daily, over six months. Involving 128 patients, this research found that those participating in the PC-PEP experienced significant improvements in self-efficacy and emotional responses, leading to reduced psychological distress compared to those receiving standard care. These findings underscore the importance of integrating the PC-PEP into clinical practice to enhance mental health and patient care strategies. Understanding how interventions reduce psychological distress in patients with prostate cancer is crucial for improving patient care. This study examined the roles of self-efficacy, illness perceptions, and heart rhythm coherence in mediating the effects of the Prostate Cancer Patient Empowerment Program (PC-PEP) on psychological distress compared to standard care. In a randomized controlled trial, 128 patients were assigned to either the PC-PEP intervention or standard care. The PC-PEP, a six-month program emphasizing daily healthy living habits, included relaxation and stress management, diet, exercise, pelvic floor muscle exercises, and strategies to improve relationships and intimacy, with daily activities supported by online resources and live sessions. Participants in the intervention group showed significant improvements in self-efficacy and specific illness perceptions, such as personal control and emotional response, compared to the control group. These factors mediated the relationship between the intervention and its psychological benefits, with self-efficacy accounting for 52% of the reduction in psychological distress. No significant differences in heart rhythm coherence were observed. This study highlights the critical role of self-efficacy and illness perceptions in enhancing psychological health in prostate cancer patients through the PC-PEP. The results underscore this program's effectiveness and the key mechanisms through which it operates. Given the high rates of distress among men undergoing prostate cancer treatments, these findings emphasize the importance of integrating the PC-PEP into clinical practice. The implementation of the PC-PEP in clinical settings can provide a structured approach to reducing psychological distress and improving overall patient well-being. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is characterised by breathlessness and fatigue that impacts negatively on patients' intentions to prioritise physical activity (PA). Healthcare professionals (HCPs) experience challenges when motivating patients to increase PA. It is essential to develop an understanding of how to support HCPs to deliver PA interventions. We aimed to identify active ingredients of HCP training interventions to enable delivery of PA interventions to HF patients. Nine databases were searched. Data were extracted on study characteristics, active ingredients, outcomes, and fidelity measures. Data were synthesised narratively, and a promise analysis was conducted on intervention features. Ten RCTs, which reported a training intervention for HCPs were included (N = 22 HCPs: N = 1,414 HF patients). Two studies reported the use of theory to develop HCP training. Seven behaviour change techniques (BCTs) were identified across the 10 training interventions. The most 'promising' BCTs were 'instruction on how to perform the behaviour' and 'problem solving'. Two studies reported that HCP training interventions had been formally evaluated. Fidelity domains including study design, monitoring and improving the delivery of treatment, intervention delivery, and provider training were infrequently reported. Future research should prioritise theory-informed development and robust evaluation of training interventions for HCPs to enable faithful and quality delivery of patient interventions. [ABSTRACT FROM AUTHOR]

Summary: Sleep disturbances in children with epilepsy are prevalent, and are associated with substantial adverse medical and psychosocial consequences. This study is a 5‐year follow‐up of a clinic‐based sleep intervention study that randomized 100 toddlers and preschool‐age children with epilepsy to a usual care group or a sleep intervention group. The intervention group received standard paediatric neurology care plus three education sessions during the child's routine clinic visit. The outcomes measured were: (1) child sleep by actigraphy and parental report; and (2) maternal sleep and depression. We aimed to evaluate the long‐term benefits of a clinic‐based sleep intervention for paediatric epilepsy. In total, 42 families (42.0%) participated. The average child's age at follow‐up was 9.55 years. Thirty‐eight (90.5%) children were not obtaining sufficient sleep at baseline, and 40 (95.2%) at the 5‐year follow‐up. The numbers of children with clinically significant sleep disturbances were 40 (95.2%) at baseline and 36 (85.7%) at the 5‐year follow‐up. Fourteen mothers (33.3%) had poor sleep quality and high depressive symptoms at both assessment time points. There were no differences (P > 0.05) in the child and maternal outcomes between the two trial arms. Overall, there was no evidence that a clinic‐based sleep intervention that effectively improved multiple aspects of sleep in toddlers and preschool‐age children with epilepsy had long‐lasting beneficial effects. Our findings suggest that sleep interventions for families of children with epilepsy require ongoing reinforcement and monitoring during routine paediatric neurology care to prevent sleep problems from persisting or recurring. [ABSTRACT FROM AUTHOR]

Background: The Prostate Cancer—Patient Empowerment Program (PC-PEP) is a six-month daily home-based program shown to improve mental health and urinary function. This secondary analysis explores weight loss in male PC-PEP participants. Methods: In a randomized clinical trial with 128 men undergoing curative prostate cancer (PC) treatment, 66 received 'early' PC-PEP, while 62 were assigned to the 'late' waitlist-control group, receiving 6 months of standard-of-care treatment followed by 6 months of PC-PEP. PC-PEP comprised 182 daily emails with video-based exercise and dietary (predominantly plant-based) education, live online events, and 30 min strength training routines (using body weight and elastic bands). Weight and height data were collected via online surveys (baseline, 6 months, and 12 months) including medical chart reviews. Adherence was tracked weekly. Results: No attrition or adverse events were reported. At 6 months, the early PC-PEP group experienced significant weight loss, averaging 2.7 kg (p < 0.001) compared to the waitlist-control group. Weight loss was noted in the late intervention group of PC-PEP, albeit less pronounced than in the early group. Early PC-PEP surgery patients lost on average 1.4 kg (SE = 0.65) from the trial's start to surgery day. High adherence to exercise and dietary recommendations was noted. Conclusions: PC-PEP led to significant weight loss in men undergoing curative prostate cancer treatment compared to standard-of-care. [ABSTRACT FROM AUTHOR]

Simple Summary: In this research, we explore the effectiveness of a unique home-based 6-month comprehensive program designed to empower prostate cancer patients during their treatment. The Prostate Cancer-Patient Empowerment Program (PC-PEP) aims to enhance the quality of life for men undergoing curative treatment for prostate cancer, focusing on improving urologic function. Through a blend of physical activities, dietary education and recommendations, stress management, and social support, PC-PEP offers an innovative approach to patient care. This study rigorously assesses the impact of PC-PEP through a detailed 6-month comparison with standard care, evaluating its potential to significantly improve patient-reported outcomes. Our findings hold the promise of reshaping patient care strategies, presenting a potentially valuable addition to clinical practices for men battling prostate cancer, with the hope of improving not just their physical well-being but also their overall quality of life. Purpose: This is a secondary analysis examining a six-month home-based Prostate Cancer-Patient Empowerment Program (PC-PEP) on patient-reported urinary, bowel, sexual, and hormonal function in men with curative prostate cancer (PC) against standard of care. Methods: In a crossover clinical trial, 128 men scheduled for PC surgery (n = 62) or radiotherapy with/without hormones (n = 66) were randomized to PC-PEP (n = 66) or waitlist-control and received the standard of care for 6 months, and then PC-PEP to the end of the year. PC-PEP included daily emails with video instructions, aerobic and strength training, dietary guidance, stress management, and social support, with an initial PFMT nurse consultation. Over 6 months, participants in the PC-PEP received optional text alerts (up to three times daily) reminding them to follow the PFMT video program, encompassing relaxation, quick-twitch, and endurance exercises; compliance was assessed weekly. Participants completed baseline, 6, and 12-month International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC) questionnaires. Results: At 6 months, men in the PC-PEP reported improved urinary bother (IPSS, p = 0.004), continence (EPIC, p < 0.001), and irritation/obstruction function (p = 0.008) compared to controls, with sustained urinary continence benefits at 12 months (p = 0.002). Surgery patients in the waitlist-control group had 3.5 (95% CI: 1.2, 10, p = 0.024) times and 2.3 (95% CI: 0.82, 6.7, p = 0.11) times higher odds of moderate to severe urinary problems compared to PC-PEP at 6 and 12 months, respectively. Conclusions: PC-PEP significantly improves lower urinary tract symptoms, affirming its suitability for clinical integration alongside established mental health benefits in men with curative prostate cancer. [ABSTRACT FROM AUTHOR]

Aim: To analyse adolescents' self‐reported experiences and behavioural outcomes of a person‐centred, theory‐based intervention in comparison with conventional information/instruction for improved oral hygiene. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person‐centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three‐hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. Results: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p <.01). Conclusions: The person‐centred, theory‐based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self‐reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusionTo determine the effectiveness of interventions to increase physical activity (PA) in people with spinal cord injury (SCI).Online databases PubMed, Medline, AMED and CINAHL were searched from the earliest date available to July 2022. Randomised controlled trials (RCT) exploring the effect of interventions on physical activity in people with SCI were eligible. The search identified 1191 studies, after screening 16 reports of 15 RCT’s were included. Data were extracted on participant characteristics, intervention characteristics and physical activity outcomes. Methodological quality was assessed using the PEDro Scale and certainty of evidence assessed using GRADE. Post intervention means and standard deviations were pooled in meta-analyses to calculate standardised mean differences or mean differences and 95% confidence intervals.Fifteen trials with 693 participants (mean age 41–52) were included. There was moderate certainty evidence that exercise interventions had no effect on subjectively or objectively measured PA. There was moderate to high certainty evidence that behavioural interventions and combined behavioural and exercise interventions increased subjectively, but not objectively measured physical activity.Behaviour change techniques are an important intervention component for increasing PA in people with SCI.IMPLICATIONS FOR REHABILITATIONOnly half of people with spinal cord injury (SCI) meet physical activity guidelinesPhysical activity (PA) is important in managing primary and secondary complicationsExercise intervention alone does not increase PA in people with SCIInterventions should include behavioural techniques to increase PA in people with SCIInterventions that include behavioural techniques are shown to be effective across a wide range of SCI populationsOnly half of people with spinal cord injury (SCI) meet physical activity guidelinesPhysical activity (PA) is important in managing primary and secondary complicationsExercise intervention alone does not increase PA in people with SCIInterventions should include behavioural techniques to increase PA in people with SCIInterventions that include behavioural techniques are shown to be effective across a wide range of SCI populations [ABSTRACT FROM AUTHOR]

Background: Timely detection and management of gestational diabetes mellitus (GDM) have been identified as a high priority for policymakers in low- and middle-income countries (LMICs). The GUIDES trial will evaluate a package of three interconnected film-based interventions aimed at improving the timely detection and management of GDM. The protocol for this trial has previously been published; this publication outlines the statistical analysis plan for the trial. Methods and design: The GUIDES study is a multi-country cluster-randomised controlled trial consisting of one trial conducted in Uganda and one in India (30 clusters in each country). Mixed effects models will be used to compare the primary study outcomes of the proportion of women who are tested for GDM between 24 and 32 weeks of pregnancy and the mean fasting blood sugar of women with GDM at 34-week follow-up while accounting for clustering. Secondary analyses will compare the proportion of women with self-reported GDM diagnosis at 32 weeks of pregnancy and the proportion of women with adverse perinatal outcomes related to GDM up to 4 weeks after birth in each trial arm. Trial status and discussion: Follow-up is expected to end in March 2023 in Uganda and in May 2023 in India. Analyses will be carried out following this statistical analysis plan in the month following trial completion. Trial registration: ClinicalTrials.gov NCT03937050. Registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605. Registered on 26 February 2020. [ABSTRACT FROM AUTHOR]

Objectives: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. Design: Online cross‐sectional survey design. Methods: Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval‐Based Estimates of Relevance (CIBER). Results: Seventy‐nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 =.34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR =.41 [.18,.94]) and 'negative emotions' (OR =.50 [.32,.77]). In the multiple linear regression (R2 =.29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p =.02) and professional role (b = 6.72, p =.03); the significant barriers were 'negative emotions' (b = −4.74, p =.04) and 'barriers to prioritisation' (b = −5.00, p =.01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. Conclusion: Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization. [ABSTRACT FROM AUTHOR]

Background: Timely detection and management of gestational diabetes mellitus (GDM) have been identified as a high priority for policymakers in low- and middle-income countries (LMICs). The GUIDES trial will evaluate a package of three interconnected film-based interventions aimed at improving the timely detection and management of GDM. The protocol for this trial has previously been published; this publication outlines the statistical analysis plan for the trial. Methods and design: The GUIDES study is a multi-country cluster-randomised controlled trial consisting of one trial conducted in Uganda and one in India (30 clusters in each country). Mixed effects models will be used to compare the primary study outcomes of the proportion of women who are tested for GDM between 24 and 32 weeks of pregnancy and the mean fasting blood sugar of women with GDM at 34-week follow-up while accounting for clustering. Secondary analyses will compare the proportion of women with self-reported GDM diagnosis at 32 weeks of pregnancy and the proportion of women with adverse perinatal outcomes related to GDM up to 4 weeks after birth in each trial arm. Trial status and discussion: Follow-up is expected to end in March 2023 in Uganda and in May 2023 in India. Analyses will be carried out following this statistical analysis plan in the month following trial completion. Trial registration: ClinicalTrials.gov NCT03937050. Registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605. Registered on 26 February 2020. [ABSTRACT FROM AUTHOR]

Summary: We assessed the preference for two behavioural weight loss programs, Diabetes Prevention Program (DPP) and Healthy Weight for Living (HWL) in adults with obesity. A cross‐sectional survey was fielded on the Amazon Mechanical Turk. Eligibility criteria included reporting BMI ≥30 and at least two chronic health conditions. Participants read about the programs, selected their preferred program, and answered follow‐up questions. The estimated probability of choosing either program was not significantly different from.5 (N = 1005, 50.8% DPP and 49.2% HWL, p =.61). Participants' expectations about adherence, weight loss magnitude, and dropout likelihood were associated with their choice (p <.0001). Non‐White participants (p =.040) and those with monthly income greater than $4999 (p =.002) were less likely to choose DPP. Participants who had postgraduate education (p =.007), did not report high serum cholesterol (p =.028), and reported not having tried losing weight before (p =.025) were more likely to choose DPP. Those who chose HWL were marginally more likely to report that being offered two different programs rather than one would likely affect their decision to enrol in one of the two (p =.052). The enrolment into DPP and HWL was balanced, but race, educational attainment, income, previous attempt to lose weight, and serum cholesterol levels had significant associations with the choice of weight loss program. [ABSTRACT FROM AUTHOR]

Background: : Dysphagia is prevalent in subjects with Parkinson's disease (PD). Swallowing intervention to improve or maintain swallowing function is of major importance as dysphagia may considerably impact physical and psycho‐social health. Aims: : A mixed methods systematic review was conducted to summarize and appraise literature reporting (1) effects of behavioural interventions for swallowing in individuals with PD; and (2) participants' perspectives of swallowing interventions. Methods & Procedures: : Electronic databases were searched systematically in July 2020 for articles published between 2014 and 2020. In addition, studies published between 2000 and 2014 were identified non‐systematically through previous reviews. Peer‐reviewed quantitative and qualitative research in English or German documenting behavioural interventions for swallowing in individuals with a diagnosis of PD was eligible for inclusion. Participants at all disease stages were included. Behavioural interventions included rehabilitative and compensatory strategies. Studies reporting swallowing outcomes with and without a comparative group were included. For each study, the National Health and Medical Research Council level of evidence was defined. Included studies were critically appraised using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. An integrated synthesis was performed after separate analysis of effect data and data reflecting participants' experiences. This review was conducted based on published JBI methodology and the guideline from the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis system was followed. Main Contribution: : A total of 33 studies published in English met the inclusion criteria. Thirty‐one studies reported quantitative data, one was qualitative and one was mixed methods. Intervention effects on swallowing function, swallowing safety and swallowing‐related quality of life were reported for various treatment approaches. Three studies explored how participants perceived the intervention. Overriding themes including subjects' views regarding treatment schedules and levels of effort or comfort associated with the intervention were identified across these studies. Combining evidence of intervention effects and subjects' experiences was possible for one rehabilitative and one compensatory intervention. Conclusions & Implications: : Beneficial effects of swallowing interventions have been reported; however, most experiments were case studies of variable methodological quality. Randomized‐controlled trials with robust methodology to explore treatment effects in larger samples is needed to guide clinical practice. Research reporting subjects' views is scarce. More studies exploring how individuals perceive behavioural interventions for swallowing are necessary to inform clinical decision‐making. WHAT THIS PAPER ADDS: What is already known on the subject: Dysphagia is common in individuals with PD. Swallowing intervention is of major importance as dysphagia may negatively affect physical and psycho‐social health of subjects with PD. What this study adds: Beneficial effects of behavioural interventions for swallowing, including rehabilitative and compensatory strategies, have been reported; however, available data are mostly based on case studies of variable quality. Data on how participants perceive specific behavioural interventions are lacking. Based on the available data, integration of efficacy data and individuals' experiences is limited. What are the clinical implications of this work?: Given the current evidence of intervention effects and individuals' views on behavioural treatment strategies, interventions implemented into clinical practice require careful evaluation on a case‐by‐case basis. More high‐quality research is needed to examine interventions' short‐ and long‐term effects in larger samples to guide clinical practice. In addition to studies evaluating intervention effects, research exploring participants' experiences with interventions is required as a foundation for clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: The growing burden of type 2 diabetes mellitus (T2DM) and the rising cost of healthcare worldwide make it imperative to identify interventions that can promote sustained self-management behaviour in T2DM populations while minimising costs for healthcare systems. The present FEEDBACK study (Fukushima study for Engaging people with type 2 Diabetes in Behaviour Associated Change) aims to evaluate the effects of a novel behaviour change intervention designed to be easily implemented and scaled across a wide range of primary care settings. Methods: A cluster randomised controlled trial (RCT) with a 6-month follow-up will be conducted to evaluate the effects of the FEEDBACK intervention. FEEDBACK is a personalised, multi-component intervention intended to be delivered by general practitioners during a routine diabetes consultation. It consists of five steps aimed at enhancing doctor-patient partnership to motivate self-management behaviour: (1) communication of cardiovascular risks using a 'heart age' tool, (2) goal setting, (3) action planning, (4) behavioural contracting, and (5) feedback on behaviour. We aim to recruit 264 adults with T2DM and suboptimal glycaemic control from 20 primary care practices in Japan (cluster units) that will be randomly assigned to either the intervention or control group. The primary outcome measure will be the change in HbA1c levels at 6-month follow-up. Secondary outcome measures include the change in cardiovascular risk score, the probability to achieve the recommended glycaemic target (HbA1c <7.0% [53mmol/mol]) at 6-month follow-up, and a range of behavioural and psychosocial variables. The planned primary analyses will be carried out at the individual level, according to the intention-to-treat principle. Between-group comparisons for the primary outcome will be analysed using mixed-effects models. This study protocol received ethical approval from the research ethics committee of Kashima Hospital, Fukushima, Japan (reference number: 2022002). Discussion: This article describes the design of a cluster RCT that will evaluate the effects of FEEDBACK, a personalised, multicomponent intervention aimed at enhancing doctor-patient partnership to engage adults with T2DM more effectively in self-management behaviour. Trial registration: The study protocol was prospectively registered in the UMIN Clinical Trials Registry (UMIN-CTR ID UMIN000049643 assigned on 29/11/2022). On submission of this manuscript, recruitment of participants is ongoing. [ABSTRACT FROM AUTHOR]

Background and objective: Individuals with asthma are more likely to develop sleep‐disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms. Methods: This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre‐ and post‐intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health‐related quality of life and anxiety and depression levels were conducted. Results: Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma‐symptom‐free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma‐related quality of life questionnaire and a reduction in anxiety symptoms. Conclusion: Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Indirect evidence suggests that using waiting list control designs in behavioural research may have unintended consequences. The aim of this study was to estimate the effects of a waiting list design on alcohol consumption among individuals who had looked online for help. A two-arm randomised controlled trial was employed. The intervention group was informed that they belonged to the intervention group and would receive immediate access to a digital alcohol intervention. The waiting list control group was informed that they belonged to the group that had to wait four weeks to be given access to the intervention and in the meantime, they would be given a summary of their drinking. However, both groups received immediate access to the same digital alcohol intervention; the experimental contrast was thus between being told to wait or not. We randomised 3388 participants (intervention: 1692, waiting list: 1696). Data were available for 954 participants at 1-month follow-up. We found no strong evidence that alcohol consumption differed between groups, but the evidence pointed towards the intervention group reporting lowering weekly alcohol consumption compared to the waiting list control group (IRR = 0.95, 95 % CI = 0.83; 1.08, probability of effect = 78.8 %). We found no strong evidence that being informed that access to an intervention would be delayed produced differential self-reported alcohol consumption compared to being informed that access would be immediate. We did find a difference in engagement with the intervention materials, indicating that the experimental manipulation was successful. • Direct evidence of the effects of using a waiting list control condition is scarce. • This randomised controlled trial estimated the effects of a waiting list design. • No strong evidence a waiting list design altered self-reported alcohol consumption. • The waiting list group nonetheless reported somewhat higher alcohol consumption. • Further study of waiting lists as control conditions is needed. [ABSTRACT FROM AUTHOR]

• Investigates the impact of simple behavioural modifications on crowd evacuation efficiency. • Significant improvements in evacuation efficiency through behavioural interventions. • Influencing exit choice adaptation resulted in higher efficiency gains compared to exit choice. • Partial adoption of beneficial strategies can still enhance evacuation outcomes. • Poor strategies can have more detrimental effects than the benefits of good strategies. Crowded environments are inherently vulnerable to a range of risks, including earthquakes, fires, violent attacks, and terrorism. In such scenarios, every second counts in an evacuation, as it can significantly impact the number of lives saved. This paper introduces a novel approach to optimising crowd evacuation processes, focusing on behavioural modification rather than traditional methods such as mathematical optimisation models or architectural adjustments. We propose that by altering the behaviours of individuals within a crowd, overall system efficiency can be enhanced from within. We explore the effects of imparting simple, easily understandable strategies or instructions to individuals that can improve evacuation efficiency. The current work concentrates on how modifications in individual decision-making— namely, exit-choice and exit-choice-changing behaviour — can influence evacuation dynamics. We present the results of six major evacuation experiments, encompassing nearly 100 experimental scenarios and repetitions, which specifically investigate the effect of influencing exit choice and adaptation in exit-choice behaviour. The investigation revolves around three core questions: (a) the impact of effective strategies (b) the potential consequences of detrimental strategies, indicative of common misconceptions or poor advice, and (c) the influence of varying levels of strategy adoption, examining how system efficiency changes as more individuals embrace either beneficial or harmful strategies. The findings indicate that behavioural modification can substantially influence evacuation efficiency. Interestingly, the negative impact of poor strategies outweighs the benefits of effective ones. With respect to beneficial strategies, a significant increase in efficiency is observed at initial and intermediate levels of strategy adoption/uptake, suggesting that complete compliance is not necessary to enhance overall system performance. The benefit of influencing decision adaptation behaviour is considerably more tangible than influencing exit choice behaviour. These insights establish a novel perspective in evacuation safety. They lay a foundational framework for developing targeted public education and training programs based on empirical evidence. They highlight the importance of awareness and self-regulation among crowds, showcasing their potential to significantly increase both efficiency and safety in evacuation scenarios, potentially saving lives. [ABSTRACT FROM AUTHOR]

• Explores enhancing evacuation efficiency through behavioural modifications. • Focusing on behaviour at bottlenecks, reaction time, and movement speed (pace). • Incremental behavioural adjustments significantly improve evacuation efficiency. • Observing a nearly linear relationship between behaviour adoption rate and efficiency gains. • Interventions targeting physical movement are more straightforward to implement and yield higher efficiency returns than decision-making interventions. In the context of evacuating crowded spaces during acute crises, every second is pivotal and can be the determinant in life-or-death situations. It is, therefore, important to explore and implement any measures or interventions that could streamline and expedite the evacuation process in such scenarios. This study aims to explore how the modification of individual behaviours can be leveraged to improve the efficiency of crowd evacuations, with a specific focus on the physical aspects of movement. We examine three crucial elements of physical movement: behaviours at bottlenecks, the initiation time of individual movement, and the pace of movement. A series of dedicated experiments, each tailored to one of these behavioural aspects, has been conducted. In these experiments, the behaviour of interest is modified incrementally within the crowd, with increases of 20% at each stage. This methodology allows for a detailed assessment of system efficiency at varying levels of instructed behaviour adoption/injection. The findings reveal that changes in each aspect of physical movement significantly influence overall efficiency. Most notably, the relationship between the uptake and increase in efficiency is nearly linear, and the rate of efficiency increase does not notably diminish with uptake, unlike interventions pertaining decision-making aspects of behaviour. This suggests that behavioural interventions targeting physical aspects of movement will likely yield higher efficiency returns. Moreover, in comparison with a related study focusing on decision-making aspects of evacuation behaviour, this research observes that modifying physical aspects of behaviour is generally more straightforward. The success rates of individuals in implementing physical movement instructions are higher, and the impact on the system is more pronounced than that observed in decision-making modifications. These results provide insights for developing simple, actionable instructions that can be effectively communicated to the public. These instructions can be disseminated as part of training and education programs or even provided on the spot during an evacuation. [ABSTRACT FROM AUTHOR]

The constant developments in the industry influence organisational practices. The latter often require personnel to adapt their behaviours and comply with policies and rules to realise business objectives while ensuring safety. Although risk perception and risk communication are significant contributors to safe behaviours, there is a lack of a comprehensive approach to behavioural safety which encompasses those two essential aspects while accounting for interactions within systems. This research identified and assessed eleven behavioural intervention frameworks and eight intervention functions for inclusivity of risk perception and communication factors through a scoping review. The results, which were discussed against studies and practice in the aviation industry as a representative safety-critical and high-reliability sector, showed notable fluctuations of inclusivity parameters across intervention frameworks and functions. The combination of "enablement", "education", and "environmental restructuring" emerged as the most promising functions, and the "Recognition Primed Decision Making" framework was found as the most inclusive relatively to the rest intervention frameworks reviewed. Nonetheless, as even the functions and framework assessed as relatively more inclusive still miss several aspects of system agent interactions and risk perception and communication factors, considering all those parameters in future research is warranted. [ABSTRACT FROM AUTHOR]

The COVID-19 vaccination program was made available in Romania first to vulnerable and at-risk groups in specific state-run centers, where people could get an appointment and receive the shot. People Living with HIV/AIDS (PLWHA) represent such a group. In the context of widespread misinformation and debate about the need for vaccination, our team took a proactive approach to assess vaccination levels and intentions among the unvaccinated. 100 PLWHA who declared ambivalent or unprepared to take the vaccine were offered one online or in-person counseling session. As part of the standard counseling protocol, psychologists asked patients about their intention to get vaccinated on a scale from 1 to 10 at the beginning of the session and again at the end. The protocol imposed that the counselor uses any combination of one or more of the following five behavior change techniques (BCTs): information about social and environmental consequences, credible sources, comparative imagining of future outcomes, anticipated regret, and action planning. Additionally, counselors could use other techniques on an ad-hoc basis if they evaluated this as necessary. Out of the 100 PLWHA at the end of the evaluation, 43 reported they took the vaccine. Sixteen patients in the sample said they took the vaccine by their own decision before the counselor reached out. For the entire group, the intention to get vaccinated increased by 3.36 points (t= -13.25, p< .05). At the follow-up evaluation, there was a 3.16-point increase for the group that did not vaccinate (t= -11.38, p< .05); and 4-point increase for PLWHA who did vaccinate (-6.92, p<.05). Overall, the people in the unvaccinated group started with a significantly lower intention at the beginning of the session than those who eventually got the shot (mean 1.96 versus 3.25). The number of BCTs used was similar in the groups, regardless of vaccination status at the end of the assessment. Our experience shows that an increase in the intention to be vaccinated is possible among ambivalent patients, even when the intervention is limited to one session. The intervention helped approximately 32% of the patients. They were able to act and take the steps necessary to receive the COVID vaccine, while the ones who did not yet act reported a higher intention at the end of the intervention. The baseline intention could indicate the necessary number of follow-up sessions until a successful outcome. Health psychologists must further define the set of BCTs needed for subsequent interventions. [ABSTRACT FROM AUTHOR]

Background: Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist 'Tier 3' Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods: This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion: This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration: ISRCTN number 22088800. [ABSTRACT FROM AUTHOR]

Introduction: Despite the importance of intervention fidelity in interpreting the outcomes of complex public health interventions, there is a lack of both reporting fidelity trial protocols and uniformity. In evaluating complex, adaptable/pragmatic interventions in resource-strapped settings with systemic issues, unique challenges to intervention adherence and monitoring are introduced, increasing the importance of a fidelity protocol. We aim to describe the intervention fidelity and monitoring protocol for the Healthy Life Trajectories Initiative (HeLTI) South Africa, a complex four-phase intervention set in urban Soweto, starting preconceptionally and continuing through to pregnancy, infancy, and early childhood to improve the health of young women and reduce the intergenerational risk of obesity.Methods: The HeLTI SA fidelity protocol was based on the NIH Behaviour Change Consortium (NIH BCC) Treatment Fidelity Framework, outlining the following components of intervention fidelity: study design, provider training, intervention delivery, intervention receipt, and intervention enactment. Context-specific fidelity challenges were identified. The intervention fidelity components and associated monitoring strategies were developed to align with HeLTI SA. Strategies for fidelity monitoring include, amongst others, qualitative process evaluation methods, reviewing observed and recorded intervention sessions, monitoring of activity logs, standardized training, and intervention session checklists. Possible challenges to fidelity and fidelity monitoring include high provider turnover, lack of qualification amongst providers, difficulty tracing participants for follow-up sessions, participant health literacy levels, and the need to prioritize participants' non-health-related challenges. Solutions proposed include adapting intervention delivery methods, recruitment methods, and provider training methods.Discussion: The NIH BCC Treatment Fidelity Framework provided a solid foundation for reporting intervention fidelity across settings to improve intervention validity, ability to assess intervention effectiveness, and transparency. However, context-specific challenges to fidelity (monitoring) were identified, and transparency around such challenges and possible solutions in low- and middle-income settings could help foster solutions to improve adherence, reporting, and monitoring of intervention fidelity in this setting.Trial Registration: Pan African Clinical Trials Registry PACTR201903750173871 . Registered on 27 March 2019. [ABSTRACT FROM AUTHOR]

Background: Between 2012 and 2015, the Uthando Lwethu (UL) study demonstrated that a theory-based behavioural couples-focused intervention significantly increased participation in couples HIV testing and counselling (CHTC) among South African couples who had never previously tested for HIV together or mutually disclosed their HIV status, 42% compared to 12% of the control group at 9 months follow-up. Although effective, we were nonetheless concerned that in this high prevalence setting the majority (58%) of intervention couples chose not to test together. In response we optimised the UL intervention and in a new study, 'Igugu Lethu', we are evaluating the success of the optimised intervention in promoting CHTC.Methods: One hundred eighty heterosexual couples, who have been in a relationship together for at least 6 months, are being recruited and offered the optimised couples-focused intervention. In the Igugu Lethu study, we have expanded the health screening visit offered to couples to include other health conditions in addition to CHTC. Enrolled couples who choose to schedule CHTC will also have the opportunity to undertake a random blood glucose test, blood pressure and BMI measurements, and self-sample for STI testing as part of their health screening. Individual surveys are administered at baseline, 4 weeks and 4 months follow-up. The proportion of couples who decide to test together for HIV will be compared to the results of the intervention arm in the UL study (historical controls). To facilitate this comparison, we will use the same recruitment and follow-up strategies in the same community as the previous UL study.Discussion: By strengthening communication and functioning within the relationship, the Igugu Lethu study, like the previous UL study, aims to transform the motivation of individual partners from a focus on their own health to shared health as a couple. The Igugu Lethu study findings will answer whether the optimised couples-focused behavioural intervention and offering CHTC as part of a broader health screening for couples can increase uptake of CHTC by 40%, an outcome that would be highly desirable in populations with high HIV prevalence.Trial Registration: Retrospectively registered. ISRCTN Registry ISRCTN 46162564 Registered on 26th May 2022. [ABSTRACT FROM AUTHOR]

Background: About 85% of patients receiving opioid agonist therapy (OAT) for opioid dependence are smoking tobacco. Although smoke-related pulmonary diseases are significant contributors to morbidity and mortality, few smoking cessation interventions are evaluated within this group, and few OAT patients are offered smoking cessation as an integrated part of their addiction treatment. This study protocol describes an integrated smoking cessation intervention aimed at patients receiving OAT and smoking tobacco.Methods: This is a multicentre, randomised controlled clinical trial that will recruit 266 daily tobacco smoking patients receiving OAT in OAT outpatient clinics in Bergen and Stavanger, Norway. The patients randomised for the intervention arm will be offered smoking cessation therapy consisting of weekly brief behavioural interventions and prescription-free nicotine replacement products. In the control arm, patients will receive standard care without any added interventions related to smoking cessation. The smoking cessation intervention includes psychoeducational techniques with components from motivational interviewing, and nicotine replacement products such as nicotine lozenges, patches, and chewing gum. The duration of the intervention is 16 weeks, with the option of extending it by a further 8 weeks. The main outcomes are measured at 16 weeks after initiation of the intervention, and sustained effects are evaluated 1 year after intervention initiation. The primary outcome is smoking cessation verified by carbon monoxide (CO) levels or at least a 50% reduction in the number of cigarettes smoked. Secondary outcomes are changes in psychological well-being, biochemical inflammation markers, changes in physical health, quality of life, and fatigue.Discussion: Integration of other treatments to standard OAT care improves adherence and completion rates providing another rationale for integrated smoking cessation treatment. Thus, if integrated smoking cessation treatment is superior to standard care, this trial provides important information on further scale-up.Trial Registration: ClinicalTrials.gov NCT05290025. Registered on 22 March 2022. [ABSTRACT FROM AUTHOR]

Background: Smoking poses a serious risk of early preventable death and disease especially for women living with socio-economic disadvantage (SED). A smoking cessation programme, 'We Can Quit', was developed in Ireland tailored to SED women. This includes group-based support delivered by trained lay local community facilitators (CFs) and free nicotine replacement therapy (NRT). The intervention was pilot tested in a cluster randomised controlled trial, 'We Can Quit 2'. This paper reports on the WCQ2 process evaluation which assessed feasibility and acceptability of the programme and trial processes.Methods: Embedded qualitative design using the UK Medical Research Council's process evaluation framework. Semi-structured interviews with trial participants (N = 21) and CFs (N = 8). Thematic analysis was utilised.Results: Peer-modelling, a non-judgemental environment, CFs facilitation of group support were viewed as acceptable programme related factors. Some participants expressed concerns about NRT side effects. Provision of free NRT was welcomed and accepted by participants, although structural barriers made access challenging. Pharmacists took on a role that became larger than originally envisaged - and the majority provided additional support to women in their quit attempts between group meetings which augmented and supplemented the intervention sessions provided by the CFs. Participants reported good acceptance of repeated measures for data collection, but mixed acceptability of provision of saliva samples. Low literacy affected the feasibility of some women to fully engage with programme and trial-related materials. This was despite efforts made by intervention developers and the trial team to make materials (e.g., participant intervention booklet; consent forms and participant information leaflets) accessible while also meeting requirements under 2018 European General Data Protection Regulation legislation. Hypothetical scenarios of direct (e.g., researcher present during programme delivery) and indirect (e.g., audio recordings of programme sessions) observational fidelity assessments for a future definitive trial (DT) were acceptable.Conclusions: Intervention and trial-related processes were generally feasible and acceptable to participants and CFs. Any future DT will need to take further steps to mitigate structural barriers to accessing free NRT; and the established problem of low literacy and low educational attainment in SED areas, while continuing to comply within the contemporary legislative research environment.Trial Registration: WCQ2 pilot trial ( ISRCTN74721694 ). [ABSTRACT FROM AUTHOR]

Background: Sending a social norms feedback letter to general practitioners who are high prescribers of antibiotics has been shown to reduce antibiotic prescribing. The 2017-9 Quality Premium for primary care in England sets a target for broad-spectrum prescribing, which should be at or below 10% of total antibiotic prescribing. We tested a social norm feedback letter that targeted broad-spectrum prescribing and the addition of a chart to a text-only letter that targeted overall prescribing.Methods: We conducted three 2-armed randomised controlled trials, on different groups of practices: Trial A compared a broad-spectrum message and chart to the standard-practice overall prescribing letter (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively high overall prescribing). Trial C compared a broad-spectrum message and a chart to a no-letter control (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively moderate overall prescribing). Trial B compared an overall-prescribing message with a chart to the standard practice overall letter (practices whose percentage of broad-spectrum prescribing was below 10% but who had relatively high overall prescribing). Letters were posted to general practitioners, timed to be received on 1 November 2018. The primary outcomes were practices' percentage of broad-spectrum prescribing (trials A and C) and overall antibiotic prescribing (trial B) each month from November 2018 to April 2019 (all weighted by the number and characteristics of patients registered in the practice).Results: We randomly assigned 1909 practices; 58 closed or merged during the trial, leaving 1851 practices: 385 in trial A, 674 in trial C, and 792 in trial B. AR(1) models showed that there were no statistically significant differences in our primary outcome measures: trial A β = - .199, p = .13; trial C β = .006, p = .95; trial B β = - .0021, p = .81. In all three trials, there were statistically significant time trends, showing that overall antibiotic prescribing and total broad-spectrum prescribing were decreasing.Conclusion: Our broad-spectrum feedback letters had no effect on broad-spectrum prescribing; adding a bar chart to a text-only letter had no effect on overall antibiotic prescribing. Broad-spectrum and overall prescribing were both decreasing over time.Trial Registration: ClinicalTrials.gov NCT03862794. March 5, 2019. [ABSTRACT FROM AUTHOR]

Background: People with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance.Methods: The RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the 'in-group' targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months.Discussion: This is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work.Trial Registration: ISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021. [ABSTRACT FROM AUTHOR]

Background: Fidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.Methods: The delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0-5) to assess competence and completeness of delivery for each technique and delivery process. "Competent delivery" was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.Results: The mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0-2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.Conclusions: This study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving. [ABSTRACT FROM AUTHOR]

Background and purpose: Medication overuse headache is a prevalent disorder, with a strong biobehavioural component. Hence, behavioural interventions might effectuate reduction of the overused medication. We assessed in a double‐blind manner the efficacy of a behavioural intervention during medication withdrawal therapy. Methods: In this concealed, double‐blind, randomized controlled trial in medication overuse headache, conducted at the Leiden University Medical Centre, we compared the effect of maximal versus minimal behavioural intervention by a headache nurse during withdrawal therapy. Maximal intervention consisted of an intensive contact schedule, comprising education, motivational interviewing, and value‐based activity planning during 12 weeks of withdrawal therapy. Minimal intervention consisted of a short contact only. Patients were unaware of the existence of these treatment arms, as the trial was concealed in another trial investigating botulinum toxin A. Endpoints were successful withdrawal and monthly days of acute medication use after the withdrawal period. Results: We enrolled 179 patients (90 maximal, 89 minimal intervention). At Week 12, most patients achieved withdrawal in both groups (82/90 [93%] maximal intervention vs. 75/89 [86%] minimal intervention, odds ratio = 2.44, 95% confidence interval [CI] = 0.83–7.23, p = 0.107). At Week 24, patients in the maximal intervention group had fewer medication days (mean difference = −2.23, 95% CI = −3.76 to −0.70, p = 0.005). This difference receded over time. Change in monthly migraine days did not differ between groups (−6.75 vs. −6.22). Conclusions: This trial suggests modest benefit of behavioural intervention by a headache nurse during withdrawal therapy for medication overuse headache, to reduce acute medication use during and shortly after intervention, but extension seems warranted for a prolonged effect [ABSTRACT FROM AUTHOR]

• There is limited evidence on lifestyle interventions and breast cancer survival. • Exercise interventions may improve breast cancer survival and quality of life. • Psychosocial interventions demonstrated a positive impact on quality of life. • Breast cancer survivors will benefit from adopting a healthy lifestyle. • Future longer-term randomized controlled trials are required for conclusive recommendations to be made. Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations. [ABSTRACT FROM AUTHOR]

Background: More than one million people acquire sexually transmitted infections (STIs) every day globally. It is possible that predicting an individual's future risk of HIV/STIs could contribute to behaviour change or improve testing. We developed a series of machine learning models and a subsequent risk-prediction tool for predicting the risk of HIV/STIs over the next 12 months. Methods: Our data included individuals who were re-tested at the clinic for HIV (65,043 consultations), syphilis (56,889 consultations), gonorrhoea (60,598 consultations), and chlamydia (63,529 consultations) after initial consultations at the largest public sexual health centre in Melbourne from 2 March 2015 to 31 December 2019. We used the receiver operating characteristic (AUC) curve to evaluate the model's performance. The HIV/STI risk-prediction tool was delivered via a web application. Results: Our risk-prediction tool had an acceptable performance on the testing datasets for predicting HIV (AUC = 0.72), syphilis (AUC = 0.75), gonorrhoea (AUC = 0.73), and chlamydia (AUC = 0.67) acquisition. Conclusions: Using machine learning techniques, our risk-prediction tool has acceptable reliability in predicting HIV/STI acquisition over the next 12 months. This tool may be used on clinic websites or digital health platforms to form part of an intervention tool to increase testing or reduce future HIV/STI risk. [ABSTRACT FROM AUTHOR]

Summary: Insomnia is the most frequent sleep disorder, and the COVID‐19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct viral contamination. KANOPEE_2 is a smartphone‐based application that provides interactions with a virtual agent to autonomously screen and alleviate insomnia symptoms through an intervention programme giving personalized advices regarding sleep hygiene, relaxation techniques and stimulus‐control. In this proof‐of‐concept study, we tested the effects of KANOPEE_2 among users from all over the country (France) who downloaded the app between 1 June and 26 October 2020 (to focus on effects after the end of COVID‐19 confinement). Outcome measures include insomnia severity (Insomnia Severity Index) and sleep/wake schedules measured by a sleep diary. One‐thousand and thirty‐four users answered the screening interview (Mage = 43.76 years; SD = 13.14), and 108 completed the two‐step programme (Mage = 46.64 years; SD = 13.63). Of those who answered the screening, 42.8% did not report sleep complaints, while 57.2% presented mild‐to‐severe insomnia symptoms. At the end of the intervention, users reported significantly fewer sleep complaints compared with the beginning of the intervention (Insomnia Severity Indexbeginning = 13.58; Insomnia Severity Indexend = 11.30; p < 0.001), and significantly increased their sleep efficiency (sleep efficiencybeginning = 76.46%; sleep efficiencyend = 80.17%; p = 0.013). KANOPEE_2 is a promising solution both to provide autonomous evaluation of individuals' sleep hygiene and reduce insomnia symptoms over a brief and simple intervention. These results are very encouraging for addressing the issue of insomnia management in people exposed to major psychosocial stress and the consequences of COVID‐19 infection. [ABSTRACT FROM AUTHOR]

Aim: To test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control. Materials and Methods: Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results: Three‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion: A person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098). [ABSTRACT FROM AUTHOR]

Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods: A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion: The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration: ISRCTN Registry, ISRCTN80017020. Date of confirmation is 4/11/2019. [ABSTRACT FROM AUTHOR]

Summary: Background: Access to evidence‐ and family‐based childhood obesity (FBCO) treatment interventions is a challenge, especially in underserved regions where childhood obesity disparities persist. Objective: Compare two 6‐month FBCO treatment interventions, iChoose (high intensity, parent–child dyads) and Family Connections (low intensity, parents only), in one underserved US region. Methods: This unblinded, RCT reports on effectiveness and implementation outcomes. Eligibility included children ages 5–12 with BMI ≥85th percentile. Analyses included descriptive statistics and intention‐to‐treat Heckman treatment effect models. Results: Enrolled children (n = 139, mean age 10.1 ± 1.7 years, 30% with overweight, 70% with obesity, 45% black, 63% Medicaid) were randomly assigned to iChoose (n = 70) or Family Connections (n = 69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6‐month BMI z‐score changes were not statistically significant within iChoose [BMI z‐score 0.03 (95% CI = −0.13, 0.19)] or Family Connections [BMI z‐score 0.00 (95% CI = −0.16, 0.16)]. Likewise, parents' BMI changes were not statistically significant. No adverse events were reported. Both programmes were delivered with high fidelity (77%–100%). Engagement in core components was 25%–36% for iChoose and 52%–61% for Family Connections. Implementation costs per child with improved BMI z‐score were $2841 for iChoose and $955 for Family Connections. Conclusions: Neither intervention yielded significant improvements in child BMI z‐score or parent BMI, yet both were delivered with high fidelity. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections—suggesting that a lower intensity and parent‐focused programme may better fit the intended audience's context. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of a behaviour intervention for child sleep problems on the mother's internalizing behaviour. Sixty-two mothers who participated in an intervention for childhood insomnia through a programme designed for parents were evaluated using the Adult Self Report. Assessments were conducted one week before and one week after treatment completion. The child sleep problem score and mother internalizing behaviour score were significantly lower after the treatment of child sleep problems when compared to the pre-treatment period. However, adjusted analyses demonstrated that only maternal adaptive functioning continued to exert a significant and independent effect on the mother's internalizing behaviour even after adjustment for maternal age and child sleep problems (β = −0.518; p < 0.01). The current study demonstrated that a behavioural intervention for improving child sleep problems through a programme designed for parents also benefited the mother's internalizing behaviour. [ABSTRACT FROM AUTHOR]

Objective: To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.Design: We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.Setting: NA.Participants: NA.Results: We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.Conclusions: Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other. [ABSTRACT FROM AUTHOR]

Summary: Infant sleep problems are one of the first challenges for parents, negatively influencing infants and mothers. The present study examined the effects of preventive behavioural sleep intervention (BSI) on infant sleep patterns, maternal sleep quality, and depression. A clinical randomised multicentre controlled trial was conducted involving 82 mothers and their infants aged 2–4 months in Iran from August 2018 to April 2019. The intervention group received BSI, which included one individual 90‐min class session, booklet, voice messages, and follow‐up calls; while the control group received training on general infant safety. Details of infant sleep, maternal sleep quality, and postnatal depression were measured through the sleep diary, Pittsburgh Sleep Quality Index, and Edinburgh Postnatal Depression Scale, respectively, before and at 8 weeks after the training. In the intervention group, both the mean infant "night‐time sleep period" and infant "longest self‐regulated sleep period" were 81 min longer than the controls (p <.001). With an improvement of 160 min, the mean infant bedtime was decreased to 22:20 hours in the intervention group, substantially earlier than the controls (00:30 hours). The mean infant "night‐time awakenings with signals" did not significantly change (2.6‐ and 2.5‐times in the intervention and control groups, respectively). The intervention led to a significant improvement in maternal sleep quality and depression (p <.05). The present study acknowledges the positive effects of an early preventive infant BSI on infant sleep, maternal mood, and maternal sleep. Our present results also imply the importance of considering sleep patterns differences and cultural‐based intervention's design. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a nurse‐led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes. Design: The PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow‐up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs). Methods: A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse‐led personalized advice, while the SMSs group will receive 4–5 brief SMSs a week. Participants in both groups will receive evidence‐based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post‐intervention effects. Discussion: Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone‐based intervention led by nurses in the amelioration of risk factors associated with diabetes. Impact: Findings from this study will offer health services decision‐makers sound evidence regarding an alternative method to face‐to‐face consultations that could be practical, acceptable and inexpensive, and that concretely answers the need for easily implementable prevention strategies. Trial Registration: NCT04735640 (ClinicalTrials.gov identifier). Protocol version: V1.0, 18/02/2021. [ABSTRACT FROM AUTHOR]

Developing and/or tailoring psychological interventions to align with patient preferences is a critical component of patient-centered care and has the potential to improve patient engagement and treatment outcomes. Discrete choice experiments (DCEs) are a quantitative method of assessing patient preferences that offer numerous strengths (i.e., ability to account for trade-offs), but are not routinely incorporated into health psychology coursework, likely leaving many unaware of the potential benefits of this methodology. To highlight the potential applications of DCEs within health psychology, this systematic review synthesises previous efforts to utilise DCEs to inform the design of patient-centered psychological care, defined as interventions targeting psychological (e.g., depression, anxiety) or behavioural health (e.g., pain management, adherence) concerns. Literature searches were conducted in March 2017 and November 2019 for articles reporting on DCEs using the terms 'discrete choice', 'conjoint', or 'stated preference'. Thirty-nine articles met all inclusion criteria and used DCEs to understand patient preferences regarding psychosocial clinical services (n = 12), lifestyle behaviour change interventions (n = 11), HIV prevention and/or intervention services (n = 10), disease self-management programmes (n = 4), or other interventions (n = 2). Clinical implications as well as limitations and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: This randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognitive task intervention (memory cue + mental rotation instructions + computer game "Tetris" for at least 20 min) or control (podcast, similar time). We planned follow-ups at one-week, 1-month, and where possible, 3- and 6-months post-trauma. Anticipated enrolment was N = 148. Results: The RCT was terminated prematurely after recruiting N = 16 participants. The COVID-19 pandemic prevented recruitment/testing in the ED because: (i) the study required face-to-face contact between participants, psychology researchers, ED staff, and patients, incurring risk of virus transmission; (ii) the host ED site received COVID-19 patients; and (iii) reduced flow of patients otherwise presenting to the ED in non-pandemic conditions (e.g. after trauma). We report on delivery of study procedures, recruitment, treatment adherence, outcome completion (primary outcome: number of intrusive memories during week 5), attrition, and limitations. The information presented and limitations may enable our group and others to learn from this terminated study. Trial registration ClinicalTrials.gov: NCT04185155 (04-12-2019) [ABSTRACT FROM AUTHOR]

Summary: Understanding the predictors of weight loss with lifestyle interventions can help to ascertain the probable outcomes of individuals with obesity who undergo such interventions. This systematic review assessed the evidence of predictors of successful weight loss among individuals who are overweight or with obesity undergoing lifestyle interventions. Four electronic databases (PubMed, Cochrane Reviews, PsychInfo and Wiley) were searched to find relevant literature published in the past 20 years. A total of 1351 titles were identified in the initial search, of which 23 studies were finally included. Predictors were synthesized in the domains of socio‐demographic factors, anthropometric parameters, psychological and behavioural factors and intervention‐based factors. The overall quality of evidence on predictors was then appraised using an adapted GRADE approach. Patient‐specific factors such as being male, older in age, having existing cardiometabolic comorbidities and limited fat intake were significantly associated with weight loss success. Amongst intervention specific predictors, greater initial weight loss and higher adherence to lifestyle advice were associated with greater weight loss success. In this review, initial weight loss came out to be as the most important predictor of successful weight loss outcome. [ABSTRACT FROM AUTHOR]

Background: Multimodal intervention incorporating psychosocial intervention and medication is recommended for school‐aged children with attention deficit hyperactivity disorder (ADHD). This randomized controlled trial (RCT) investigates the adjunctive benefit of the self‐help version of the New Forest Parenting Programme (NFPP‐SH) when offered in addition to treatment as usual (TAU) compared with TAU alone. Method: Fifty‐two children, receiving medication for ADHD as part of their usual care, were randomized to receive NFPP‐SH + TAU or TAU alone. Results: When used in adjunct to TAU, NFPP‐SH may have beneficial effects for parenting efficacy (F = 6.28, p = 0.02), child social performance in school and negative comments made by parents during a recorded speech sample. However, the self‐help intervention did not have any additional effect on child behaviour. Conclusions: This study provides further support for self‐help interventions as potentially low‐intensity and cost‐effective alternatives to therapist‐led parenting interventions. The findings require replication in larger samples before any firm conclusions about adjunctive efficacy of NFPP‐SH can be drawn but underline the potential for self‐help within routine treatment (ClinicalTrials.gov Identifier: NCT02174952). [ABSTRACT FROM AUTHOR]

The male condom is the most cost-effective method for prevention of HIV and other sexually transmitted infections (STIs), yet in high-burden countries, promotion of its use remains difficult to achieve, especially among high-risk individuals. This review reports on women's perspectives of male condom use and identifies outcome measures that will assist in understanding barriers to male condom use in a South African setting. The Boolean search method was used to retrieve literature, from which 18 studies met the inclusion criteria. The use of the male condom was generally low and inconsistent. Use was higher among women who engaged in transactional sex. Most women had difficulty in negotiating condom use with their partners, particularly if they were in male-dominated relationships or were financially dependent on their partner. Women with higher education levels were able to negotiate use more easily. Interventions for assertive negotiation skills were useful. However, the stigma of infidelity and HIV infection are barriers to condom use. Incorrect use further reduces protection. This review emphasises that women are a vulnerable group who are not always able to control their own protection. Further implementation of the health policies promoting interventions for condom use are required to assist women in taking control of their own protection. Intervention measures should be adapted to include the male population so that they understand and accept condom use. Education to address unequal gender dynamics within relationships is also essential. Much work is required to make women feel less vulnerable in their relationships. [ABSTRACT FROM AUTHOR]

This study aimed to identify predictors of learning and adherence to a previously validated compensatory calendar and note-taking system (Memory Support System; MSS) in persons with amnestic mild cognitive impairment (aMCI). Age, education, global cognition, depression, and memory-related self-efficacy were studied as predictors of individuals' ability to learn the use of the MSS during the two-week training and of their adherence to the MSS 6, 12, and 18 months after training. How well an individual was able to learn the use of the MSS was itself examined as a predictor of adherence. Two-hundred-and-fifteen older adults with aMCI and their study partners (e.g., spouse, adult child) received MSS training one-hour daily for 10 days. Ordinal logistic regression analyses indicated that (1) global cognition predicted MSS learning at end of training, and (2) MSS learning at end of trainng predicted MSS adherence at 6, 12, and 18 months post-training. The current study suggests that offering compensatory strategies as early as possible for those with MCI might be of most benefit, and might have implications for long-term adherence. [ABSTRACT FROM AUTHOR]

Pica is the persistent consumption of non‐nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co‐morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement‐based, response interruption, "other" interventions, and punishment‐based procedures. Interventions that resulted in near‐zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High‐quality trials are needed. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the effectiveness of nutritional intervention compared to behavioural intervention to increase food acceptance and improve the nutritional status among children with avoidant/restrictive food intake disorder. Method: Six participants (3-4 years old) diagnosed with avoidant/restrictive food intake disorder took part in the study. They were randomly assigned to one of the two interventions, either a nutritional or behavioural approach. Results: The percentage of food acceptance increased for patients in the behavioural intervention group, but not for the nutritional intervention group (until later implementation of behavioural intervention). Moreover, the z-score for body mass index increased only after implementing behavioural intervention. The total score on the Montreal Children's Hospital Feeding Scale decreased only after implementation of intervention based on behavioural approach. Inappropriate mealtime behaviour decreased across all participants after implementation of behavioural intervention. Discussion: Behavioural intervention seems to be promising for children with avoidant/restrictive food intake disorder to increase the oral intake of solid food and improve their growth. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of behavioural interventions on levels of physical activity after hip or knee joint replacement. Materials and methods: A systematic review with meta-analysis of randomised controlled trials to determine the effectiveness of behavioural interventions to increase physical activity levels after hip or knee joint replacement. Six databases were searched. Standardised mean differences (SMD) were calculated. The GRADE approach was used to evaluate the level of evidence of each meta-analysis. Results: From a yield of five trials, physical activity was quantified as active minutes per day, daily energy expenditure and daily steps. There was low to moderate-quality evidence from three meta-analyses with observed positive effects that could not conclude whether behavioural interventions increased physical activity in active minutes per day (SMD = 0.18, 95% CI −0.14, 0.51), daily energy expenditure (SMD = 0.31, 95% CI −0.24, 0.87) or daily steps (MD = 844.7, 95% CI −178.6, 1,868.0). Conclusions: The effectiveness of behavioural interventions to address the low levels of physical activity levels observed after hip or knee joint replacement remains uncertain. Physical activity levels after hip or knee joint replacements fail to meet recommended daily activity guidelines, increasing the associated risk of cardiovascular disease and early mortality. Rehabilitation interventions that target behaviour change may have an impact in increasing physical activity levels after hip or knee joint replacement surgery. The optimal type and timing of behavioural interventions to effectively increase physical activity levels in this cohort remains unclear. Rehabilitation professionals are advised to highlight the benefits of meeting physical activity recommendations (150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity per week) to people who have undergone hip or knee joint replacement, and that behavioural intervention may support patients to meet these recommendations. [ABSTRACT FROM AUTHOR]