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Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017--2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH. [ABSTRACT FROM AUTHOR]

Reporting of the content and delivery characteristics of comparator interventions in published articles is often incomplete. This study examines the feasibility and validity of two methods for collecting additional information on comparator interventions from trial authors. In a systematic review of smoking cessation trials (IC-Smoke), all trial authors were asked to send unpublished comparator intervention materials and complete a specially-developed comparator intervention checklist. All published and additionally obtained information from authors were coded for behaviour change techniques (BCTs) and other characteristics (type of comparator, provider, provider training, delivery mode and treatment duration). To assess representativeness, we assessed the amount of additional information obtained from trial authors compared with the amount that was published. We examined known-group and convergent validity of comparator intervention data when using only published or also unpublished information. Additional information were obtained from 91/136 (67%) of trial authors. Representativeness, known-group and convergent validity improved substantially based on the data collected by means of the comparator intervention checklist, but not by requesting authors to send any existing comparator materials. Requesting authors for unpublished comparator intervention data, using specially-developed checklists and unpublished materials, substantially improves the quality of data available for systematic reviews. [ABSTRACT FROM AUTHOR]

Although HIV incidence and mortality rates have declined over the past 20 years, HIV health disparities continue to persist among patients living in urban communities. Barriers to proficient health outcomes for persons with HIV (PWH) in urban communities include lack of access to care, resulting from limited transportation or clinic availability. While healthcare systems in rural communities provide telemedicine (TM) services to PWH to eliminate transportation and accessibility barriers, few examples exist regarding TM use for PWH in urban communities. This project's goal was to increase the provision of healthcare services in an urban setting to PWH, using TM. As guided by "Integration of Healthcare Delivery Service" theories and key principles, we created an integration framework comprised of several simultaneous, overlapping activities to include: (1) capacity building (2) clinical standardization (3) community and patient engagement and (4) evaluation performance and measurements. This paper describes major activities involved with developing, implementing and evaluating a TM program for PWH. We discuss results, challenges, and lessons learned from integrating this program into our existing healthcare system. [ABSTRACT FROM AUTHOR]

Background : Governments have relied on their citizens to adhere to a variety of transmission-reducing behaviours (TRBs) to suppress the Covid-19 pandemic. Understanding the psychological and sociodemographic predictors of adherence to TRBs will be heavily influenced by the particular theories used by researchers. This review aims to identify the theories and theoretical constructs used to understand adherence to TRBs during the pandemic within the UK social and legislative context. Methods: A systematic review identified studies to understand TRBs of adults in the UK during the pandemic. Identified theoretical constructs were coded to the Theoretical Domains Framework. Data are presented as a narrative summary. Results: Thirty-five studies (n = 211,209) investigated 123 TRBs, applied 13 theoretical frameworks and reported 50 sociodemographic characteristics and 129 psychological constructs. Most studies used social cognition theories to understand TRBs and employed cross-sectional designs. Risk of sampling bias was high. Relationships between constructs and TRBs varied, but in general, beliefs about the disease (e.g. severity and risk perception) and about TRBs (e.g. behavioural norms) influenced behavioural intentions and self-reported adherence. More studies than not found that older people and females were more adherent. Conclusions: Behavioural scientists in the UK generated a significant and varied body of work to understand TRBs during the pandemic. However, more use of theories that do not rely on deliberative processes to effect behaviour change and study designs better able to support causal inferences should be used in future to inform public health policy and practice. Prospero Registration: CRD42021282699. [ABSTRACT FROM AUTHOR]

Background and Aims: Inadequate reporting of smoking cessation intervention trials is common and leads to significant challenges for researchers. The aim of this study was to tailor CONSORT (Consolidated Standards of Reporting Trials)‐SPI (Social and Psychological Interventions) guidelines to improve reporting of trials of behavioural interventions to promote smoking cessation. Method: Informed by missing data from the IC‐SMOKE (Intervention and Comparison group support provided in SMOKing cEssation) systematic review project, this study used a multi‐stage Delphi process to examine which items could be added or modified to improve the reporting of smoking cessation trials. The first stage involved an on‐line survey of 17 international experts in smoking cessation and trial methodology voting on the importance of items for inclusion in the updated guidelines. This was followed by a face‐to‐face expert consensus meeting attended by 15 of these experts, where the final inclusion and exclusion of new items and modifications were agreed upon. A nine‐point Likert scale was used to establish consensus, with suggested modifications requiring agreement of 75% or more. Disagreements in the first stage were presented again at the second stage for discussion and a second round of voting. Only items which reached the threshold for agreement were included. Results: The experts agreed on the inclusion of 10 new items and the specification of 12 existing items. This included modifications that could apply to trials more widely (e.g. the rationale for the comparator), but also modifications that were very specific to smoking cessation trials (e.g. the reporting of smoking cessation outcomes). Conclusions: A Delphi study has developed a modified CONSORT‐SPI guideline (CONSORT‐SPI‐SMOKE) to improve the reporting of trials of behavioural interventions to promote smoking cessation. [ABSTRACT FROM AUTHOR]

Background Based on theory, COVID-19 transmission-reducing behaviors (TRBs) should become habitual because of their frequent performance. Habits have been hypothesized to develop through reflective processes and, to act in conjunction with them. Purpose We investigated the existence, development, and consequences of TRB habits, for physical distancing, handwashing, and wearing face coverings. Methods A representative sample of the Scottish population (N = 1,003) was interviewed by a commercial polling company in August–October 2020 and half were re-interviewed later. Measures included adherence, habit, personal routine tendency, reflective processes, and action control for three TRBs. Data were analyzed using general linear modeling, regression, and mediation analyses. Results Handwashing was most habitual; only face covering became more habitual over time. Routine tendencies predicted TRB habits, and adherence to handwashing and physical distancing. Those reporting greater habits reported better adherence, for physical distancing and handwashing, and this remained true after controlling for previous adherence. Reflective and habit processes independently predicted adherence for physical distancing and handwashing; only reflective processes were independently predictive for face covering. The relationship between planning and forgetting and adherence was partly direct, and partly mediated by habit. Conclusions The results confirm hypotheses from habit theory including the role of repetition and of personal routine tendency in developing habits. They are consistent with dual processing theory in finding that both reflective and habit processes predict adherence to TRBs. Action planning partly mediated the relation between reflective processes and adherence. The COVID-19 pandemic has enabled the testing and confirmation of several theoretical hypotheses about habit processes in the enactment of TRBs. [ABSTRACT FROM AUTHOR]

Background and aims: Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta‐analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions. Methods: A systematic review and meta‐regression was conducted including 172 randomised controlled trials with at least 6 months follow‐up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta‐regression was used to create a model predicting smoking cessation outcomes. This model was used to re‐estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta‐regression models and smoking cessation differences and ratios to compare relative effectiveness. Results: The meta‐regression model predicted smoking cessation rates well (pseudo R2 = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self‐help was 1.33 times (95% CI = 1.16–1.49), brief physician advice 1.61 times (95% CI = 1.31–1.90), nurse individual counselling 1.76 times (95% CI = 1.62–1.90), psychologist individual counselling 2.04 times (95% CI = 1.95–2.15) and group psychologist interventions 2.06 times (95% CI = 1.92–2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness. Conclusions: Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components. [ABSTRACT FROM AUTHOR]

There is a need for a measure to monitor adherence to transmission-reducing behaviours (TRBs) during pandemics. An adherence measure can monitor current TRBs, assess change over time and, potentially, predict later behaviours. The TRB adherence measure (scale consisting of seven items) includes questions based on government behavioural directives in Scotland that were common internationally, i.e., physical distancing, face covering and hand hygiene. Data were collected weekly for 6 weeks at the beginning of the pandemic, including a later follow-up repeated measure of some participants, in 20-minute structured telephone surveys with a nationally representative random sample of adults in Scotland. A total of 2969 people completed the adherence items and were highly adherent. Confirmatory factor analysis supported a unidimensional scale (CFI =.95; TLI =.93; RMSEA =.08; SRMR =.08), although internal consistency was low (Cronbach's alpha =.49). The adherence score significantly predicted adherence to a validity test item (ΔR2 =.114, F(1,2964) = 379.76, p <.001). It also predicted adherence to TRBs later over and above personal habitual styles (Creature of Habit Scale: COHS). The adherence score has been developed for routine monitoring of adherence to TRBs during the COVID-19 pandemic. It can be used to predict future similar behaviours and adherence to other behaviours, although it may be necessary to explore adherence to the specific behaviours occasionally. Adherent behaviour for one TRB is likely to be associated with adherence to government directives to other TRBs. Importantly, these TRBs are likely to be crucial in reducing COVID-19 case numbers, as well as protecting against other infectious diseases including influenza and the common cold. [ABSTRACT FROM AUTHOR]

Objectives: Self‐efficacy is important for adherence to transmission‐reducing behaviours (e.g., physical distancing) as also shown in the CHARIS project. We aimed to show that a theory‐based short message can increase physical distancing self‐efficacy and intentions to keep physical distance. Design: Structured telephone surveys with a randomly selected nationally representative sample of adults in Scotland (N = 497). Methods: Participants were randomly assigned to one of two experimental conditions: message condition (short message to increase self‐efficacy via vicarious experiences, verbal persuasion and emotional arousal) or control condition (no message). Followed by measures for self‐efficacy and intention for physical distancing on 4‐point scales. Adherence to physical distancing was assessed on a 5‐point frequency scale (never – always). Results: Using mediation analyses with bootstrapping procedures, we first confirmed that self‐efficacy was associated indirectly with adherence, via higher intentions in a partial mediation (unstandardized indirect effect.21, 95% CI.18–.25). The message increased self‐efficacy; participants receiving the message reported higher self‐efficacy (M = 4.23, SD =.80) compared to participants in the control condition (M = 4.08, SD =.77; standardized regression coefficient =.19, p <.05) and self‐efficacy affected intention (.48, p <.001). There was a small significant indirect effect of the message on intention via self‐efficacy (unstandardized indirect effect.07, CI.01–.14). Conclusions: Increasing self‐efficacy for physical distancing with a short message can successfully increase intention to physical distance via increased self‐efficacy. As both self‐efficacy and intentions are important predictors of adherence to transmission‐reducing behaviours short messages have potential to limit the spread of COVID‐19. [ABSTRACT FROM AUTHOR]

Background: To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. Methods: Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results: Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI −0.12–0.87) and the effect on weight loss was uncertain (BMI mean difference −0.17, 95% CI −1.1–0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17–0.42) and physical function (SMD 0.42, 95% CI 0.12–0.73), and moderate improvements were seen for depression symptoms (SMD −0.70, 95% CI −0.97–0.42). Studies using the BCTs 'action planning' and 'social support (practical)' reported greater physical activity and weight loss. Conclusions: Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the efficacy of a behaviour change intervention to reduce patient delay with symptoms of acute coronary syndrome. Design: A 3‐arm web‐based, parallel randomized controlled trial. Methods: The intervention comprised 12 behaviour change techniques (BCTs) embedded in a text‐only or text+visual narrative (the techniques were systematically identified through systematic review and a consensus exercise). Between February and November 2017, n = 145 people who had recently experienced acute coronary syndrome were randomly allocated to intervention ('text+visual' or 'text‐only') or control. Intentions to phone an ambulance immediately for acute coronary syndrome symptoms were assessed before and after the intervention using symptom scenarios, and the change in intention was compared across the three groups. Results: Significant increases in intention to phone an ambulance immediately for ACS symptoms were seen following the 'text+visual' intervention but not following 'text‐only' or control. However, the study was underpowered to detect any significant changes in intention between the 3 groups. There were no unintended effects on intentions for non‐urgent symptoms. Conclusions: A 'text+visual' BCT‐based intervention may significantly increase intention to phone an ambulance with symptoms of ACS. Further testing of the effect of the intervention on actual behaviour is required. [ABSTRACT FROM AUTHOR]

Objective: This study sought to integrate the NIH Science of Behaviour Change (SOBC) measures repository comprising measures of putative mechanisms with mechanisms of action (MoA) identified by the Human Behaviour‐Change Project (HBCP). Design: Participants were 30 international experts recruited from professional networks and societies. In three anonymous virtual rounds, experts established consensus on hypothesized links between 26 MoAs and 44 self‐report measures. Methods: In Round 1, experts completed a survey rating agreement with 84 pre‐identified measure‐MoA links and suggested new links. In Round 2, experts discussed 10 links in an online forum, including pre‐identified links with <50% agreement and new links suggested by 20–50% of experts. In Round 3, experts completed a survey rating all links eligible for discussion in Round 2. Results: Twenty‐seven experts completed Round 1, 23 completed Round 2 and 18 completed Round 3. In Round 1, 82 of 84 pre‐identified links reached >50% agreement and 14 new links were suggested by >50% of experts. In Round 2, experts discussed measure‐MoA links and measurement quality. In Round 3, 71 of 96 links reached ≥50% agreement. A total of 167 links reached >50% expert agreement, 33 of which reached ≥90% agreement. Conclusion: By identifying putative mechanisms (HBCP) for the 44 self‐report measures (SOBC), this study advances the cumulation of scientific results and interoperability of resources to facilitate process research. [ABSTRACT FROM AUTHOR]

Aim: To investigate predictors of participant eligibility, recruitment and retention in behavioural randomized controlled trials (RCTs) for smoking cessation. Method: Systematic review and pre‐specified meta‐regression analysis of behavioural RCTs for smoking cessation including adult (≥ 18‐year‐old) smokers. The pre‐specified predictors were identified through a literature review and experts' consultation and included participant, trial and intervention characteristics and recruitment and retention strategies. Outcome measures included eligibility rates (proportion of people eligible for the trials), recruitment rates, retention rates and differential retention rates. Results: A total of 172 RCTs with 89 639 participants. Eligibility [median 57.6%; interquartile range (IQR) = 34.7–83.7], recruitment (median 66.4%; IQR = 42.7–85.2) and retention rates (median 80.5%; IQR = 68.5–89.5) varied considerably across studies. For eligibility rates, the recruitment strategy appeared not to be associated with eligibility rates. For recruitment rates, use of indirect recruitment strategies (e.g. public announcements) [odds ratio (OR) = 0.30, 95% confidence interval (CI) = 0.11–0.82] and self‐help interventions (OR = 0.14, 95% CI = 0.03–0.67) were associated with lower recruitment rates. For retention rates, higher retention was seen if the sample had ongoing physical health condition/s (OR = 1.66, 95% CI = 1.04–2.63), whereas lower retention was seen amongst primarily female samples (OR = 0.83, 95% CI = 0.71–0.98) and those motivated to quit smoking (OR = 0.74, 95% CI = 0.55–0.99) when indirect recruitment methods were used (OR = 0.60, 95% CI = 0.38–0.97) and at longer follow‐up assessments (OR = 0.83, 95% CI = 0.79–0.87). For differential retention, higher retention in the intervention group occurred when the intervention but not comparator group received financial incentives for smoking cessation (OR = 1.35, 95% CI = 1.02–1.77). Conclusions: In randomized controlled trials of behavioural smoking cessation interventions, recruitment and retention rates appear to be higher for smoking cessation interventions that include a person‐to‐person rather than at‐a‐distance contact; male participants, smokers with chronic conditions, smokers not initially motivated to quit and shorter follow‐up assessments seems to be associated with improved retention; financial incentive interventions improve retention in groups receiving them relative to comparison groups. [ABSTRACT FROM AUTHOR]

Objectives: To examine the ability of four models of behaviour, namely, Protection Motivation Theory (PMT), the Common Sense Self-Regulation Model (CS-SRM), and Social Cognitive Theory and the Reasoned Action Approach (SCT and RAA) to understand adherence to transmission-reducing behaviours (TRBs) advised by national governments for suppression of SARS-CoV2.Design: A series of six cross-sectional telephone surveys of a random representative sample of adults living in Scotland.Methods: Self-reported adherence to three TRBs (physical distancing, wearing a face covering and handwashing), PMT, CS-SRM, and SCT/RAA constructs, and sociodemographic variables were measured each week for 6 weeks (n = ~500 p/w; third June-15th July) via a 15 min telephone survey.Results: Adherence was high ('Always' or 'Most times') throughout for physical distancing and handwashing, and, when mandated, for wearing a face covering. Older people were more adherent to all TRBs. Constructs from all three models predicted all three TRBs. Intention and self-efficacy (SCT/RAA) were the only beliefs to predict to all three TRBs each week and for all groups equally; intention was the strongest predictor. The predictive utility of PMT and CS-SRM varied by TRB and by group. Of note was the observation that several illness beliefs were associated with adherence only for those who believed they had not had COVID-19.Conclusions: The CHARIS project has identified beliefs about specific behaviours, the illness and the risks associated with lower adherence rates that might be addressed in national interventions. It confirms previous findings that some groups show lower levels of adherence and might be specially targeted. [ABSTRACT FROM AUTHOR]

ehaviour change is a key to addressing many health and healthcare problems and interventions have been designed to improve health outcomes. These behaviour change interventions have been evaluated in many ways, including randomised controlled trials, and over recent decades there has been considerable progress in the conduct and reporting these studies. This paper is a personal retrospection on the changes occurring that have resulted in our current improved methods and their potential for future advancement. There has been steady development of methods for conducting trials, including advances in statistical methods enabled by increase computing power and programmes, greater attention to the recruitment of participants and in the specification of outcomes. Trial reporting has improved, largely due to publication of guidelines for reporting interventions and trials, but until recently the reporting of behaviour change interventions has been quite limited. Developments in the specification of active ingredients of these interventions, the behaviour change techniques, has transformed our ability to report interventions in a manner that facilitates evidence synthesis and enables replication and implementation. However, further work using ontological approaches is needed to adequately represent the evidence contained in the mass of accumulated studies. Meanwhile, attention is gradually being paid to the comparator groups in trials leading to better reporting but with continuing challenges about how control groups are selected. These developments are important for the advancements of behavioural science – but also in consolidating the expertise needed to address global social, environmental and health challenges. [ABSTRACT FROM AUTHOR]

Background: Investigations about mental health report prevalence rates with fewer studies investigating psychological and social factors influencing mental health during the Covid-19 pandemic. Study aims: (1) identify sociodemographic groups of the adult population at risk of anxiety and depression and (2) determine if the following social and psychological risk factors for poor mental health moderated these direct sociodemographic effects: loneliness, social support, threat perception, illness representations. Methods: Cross-sectional nationally representative telephone survey in Scotland in June 2020. If available, validated instruments were used, for example, Patient Health Questionnaire (PHQ-4) to measure anxiety and depression. Simple linear regressions followed by examination of moderation effect. Results: A total of 1006 participants; median age 53 years, 61.4% female, from all levels of area deprivation (i.e., 3.8% in the most deprived decile and 15.6% in the most affluent decile). Analyses show associations of anxiety and depression with sociodemographic (age, gender, deprivation), social (social support, loneliness) and psychological factors (perceived threat and illness representations). Mental health was poorer in younger adults, women and people living in the most deprived areas. Age effects were exacerbated by loneliness and illness representations, gender effects by loneliness and illness representations and deprivation effects by loneliness, social support, illness representations and perceived threat. In each case, the moderating variables amplified the detrimental effects of the sociodemographic factors. Conclusions: These findings confirm the results of pre-Covid-19 pandemic studies about associations between sociodemographics and mental health. Loneliness, lack of social support and thoughts about Covid-19 exacerbated these effects and offer pointers for pre-emptive action. [ABSTRACT FROM AUTHOR]

Background: Melanoma incidence has quadrupled since 1970 and melanoma is now the second most common cancer in individuals under 50. Targeted immunotherapies for melanoma now potentially enable long-term remission even in advanced melanoma, but these melanoma survivors require ongoing surveillance, with implications for NHS resources and significant social and psychological consequences for patients. Total skin self-examination (TSSE) can detect recurrence earlier and improve clinical outcomes but is underperformed in the UK. To support survivors, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) intervention was developed to prompt and improve TSSE performance, with subsequent reporting of concerns and submission of skin photos to a Dermatology Nurse Practitioner (DNP). ASICA was delivered as a randomized pilot trial.Methods: This paper reports on process evaluation. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using Microsoft Excel and SPSS. We explored which participants used ASICA, and how frequently, to report any skin concerns. We also determined how the interactions had worked in terms of quality of skin photographs submitted, clinical assessments made by the DNP, and the assessments and decisions made for each concern. Finally, we explored significant events occurring during the trial. Data on participants' demographics and the concerns they reported during the trial were tabulated and displayed using SPSS. A semi-structured interview was undertaken with the DNP to gain perspective on the range of concerns presented and how they were resolved.Results: Of 121 recruited melanoma patients receiving ASICA for 12 months, 69 participants submitted a total of 123 reports detailing 189 separate skin-related concerns and including 188 skin photographs. Where participants fully complied with follow-up by the DNP, concerns were usually resolved remotely, but 19 (10.1%) were seen at a secondary care clinic and 14 (7.4%) referred to their GP. 49 (25.9%) of concerns were not completely resolved due to partial non-compliance with DNP follow-up.Conclusion: Melanoma patients randomized to the ASICA intervention were able to report skin-related concerns that could be resolved remotely through interaction with a DNP. Feasibility issues highlighted by ASICA will support further development and optimization of this digital tool.Trial Registration: Clinical Trials.gov , NCT03328247 . Registered on 1 November 2017. [ABSTRACT FROM AUTHOR]

The invasion of jumping worms, a small group of pheretimoid earthworm species from Asia, has increasingly become an ecological, environmental and conservation issue in forest ecosystems and urban-suburban landscapes around the world. Their presence is often noticed due to their high abundance, distinctive "jumping" behavior, and prominent granular casts on the soil surface. Although they are known to affect soil carbon dynamics and nutrient availability, no single paper has summarized their profound impacts on soil biodiversity, plant community, and animals of all trophic groups that rely on soil and the leaf litter layer for habitat, food, and shelter. In this study, we summarize the biology, invasion, and ecological impacts of invasive jumping worms across North America. We highlight potential impacts of this second wave of earthworm invasion, contrast them with the preceding European earthworm invasion in temperate forests in North America, and identify annual life cycle, reproductive and cocoon survival strategies, casting behavior and co-invasion dynamics as the key factors that contribute to their successful invasion and distinct ecological impacts. We then suggest potential management and control strategies for practitioners and policy makers, underscore the importance of coordinated community science projects in tracking the spread, and identify knowledge gaps that need to be addressed to understand and control the invasion. [ABSTRACT FROM AUTHOR]

To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT). Method: The Medical Research Council framework, 'Developing and evaluating complex interventions', was used to develop the cognitive rehabilitation intervention. We conducted a combined analysis of the existing evidence base for PSCI rehabilitation alongside qualitative exploration of the perspectives of stroke survivors, their families, and healthcare professionals providing stroke care, on the necessary components for a cognitive rehabilitation intervention for PSCI. The Template for Intervention Description and Replication checklist was used as a structural framework for the description of the intervention. Results: The intervention comprises a five-week intervention integrating group-based activities, supported by a clinical neuropsychologist, with home-based activities to encourage self-efficacy through the practice of adjustment and compensatory strategies learned in the group format to achieve the patients' identified goals in managing their PSCI. Conclusion: A cognitive rehabilitation intervention for patients with PSCI has been developed and described. We are in the process of developing a structured intervention manual to standardise the content and delivery of the intervention for further testing in a pilot RCT. [ABSTRACT FROM AUTHOR]

Background: The competence of the person delivering person-to-person behaviour change interventions may influence the effectiveness of the intervention. However, we lack a framework for describing the range of competences involved. The objective of the current work was to develop a competency framework for health behaviour change interventions. Method: A preliminary framework was developed by two judges rating the relevance of items in the competency framework for cognitive behaviour therapies; adding relevant items from reviews and other competency frameworks; and obtaining feedback from potential users on a draft framework. The Health Behaviour Change Competency Framework (HBCCF) was used to analyse the competency content of smoking cessation manuals. Results: Judges identified 194 competency items as relevant, which were organised into two domains: foundation (12 competency topics comprising 56 competencies) and behaviour change (12 topics, 54 competencies); several of the 54 and 56 competencies were composed of sub-competencies (84 subcompetencies in total). Smoking cessation manuals included 14 competency topics from the foundation and behaviour change competency domains. Conclusion: The HBCCF provides a structured method for assessing and reporting competency to deliver behaviour change interventions. It can be applied to assess a practitioner's competency and training needs and to identify the competencies needed for a particular intervention. To date, it has been used in self-assessments and in developing training programmes. We propose the HBCCF as a practical tool for researchers, employers, and those who design and provide training. We envisage the HBCFF maturing and adapting as evidence that identifies the essential elements required for the effective delivery of behaviour change interventions emerges. [ABSTRACT FROM AUTHOR]

Despite its importance, underreporting of the active content of experimental and comparator interventions in published literature has not been previously examined for behavioural trials. We assessed completeness and variability in reporting in 142 randomised controlled trials of behavioural interventions for smoking cessation published between 1/1996 and 11/2015. Two coders reliably identified the potential active components of experimental and comparator interventions (activities targeting behaviours key to smoking cessation and qualifying as behaviour change techniques, BCTs) in published, and in unpublished materials obtained from study authors directly. Unpublished materials were obtained for 129/204 (63%) experimental and 93/142 (65%) comparator groups. For those, only 35% (1200/3403) of experimental and 26% (491/1891) of comparator BCTs could be identified in published materials. Reporting quality (#published BCTs/#total BCTs) varied considerably between trials and between groups within trials. Experimental (vs. comparator) interventions were better reported (B(SE) = 0.34 (0.11), p <.001). Unpublished materials were more often obtained for recent studies (B(SE) = 0.093 (0.03), p =.003) published in behavioural (vs. medical) journals (B(SE) = 1.03 (0.41), p =.012). This high variability in underreporting of active content compromises reader's ability to interpret the effects of individual trials, compare and explain intervention effects in evidence syntheses, and estimate the additional benefit of an experimental intervention in other settings. [ABSTRACT FROM AUTHOR]

Researchers, practitioners, and policymakers develop interventions to change behavior based on their understanding of how behavior change techniques (BCTs) impact the determinants of behavior. A transparent, systematic, and accessible method of linking BCTs with the processes through which they change behavior (i.e. their mechanisms of action [MoAs]) would advance the understanding of intervention effects and improve theory and intervention development. The purpose of this study is to triangulate evidence for hypothesized BCT–MoA links obtained in two previous studies and present the results in an interactive, online tool. Two previous studies generated evidence on links between 56 BCTs and 26 MoAs based on their frequency in literature synthesis and on expert consensus. Concordance between the findings of the two studies was examined using multilevel modeling. Uncertainties and differences between the two studies were reconciled by 16 behavior change experts using consensus development methods. The resulting evidence was used to generate an online tool. The two studies showed concordance for 25 of the 26 MoAs and agreement for 37 links and for 460 "nonlinks." A further 55 links were resolved by consensus (total of 92 [37 + 55] hypothesized BCT–MoA links). Full data on 1,456 possible links was incorporated into the online interactive Theory and Technique Tool (https://theoryandtechniquetool.humanbehaviourchange.org/). This triangulation of two distinct sources of evidence provides guidance on how BCTs may affect the mechanisms that change behavior and is available as a resource for behavior change intervention designers, researchers and theorists, supporting intervention design, research synthesis, and collaborative research. [ABSTRACT FROM AUTHOR]

Asian pheretimoid earthworms of the genera Amynthas and Metaphire (jumping worms) are leading a new wave of coinvasion into Northeastern and Midwestern states, with potential consequences for native organisms and ecosystem processes. However, little is known about their distribution, abundance, and habitat preferences in urban landscapes—areas that will likely influence their range expansion via human-driven spread. We led a participatory field campaign to assess jumping worm distribution and abundance in Madison, Wisconsin, in the United States. By compressing 250 person-hours of sampling effort into a single day, we quantified the presence and abundance of three jumping worm species across different land-cover types (forest, grassland, open space, and residential lawns and gardens), finding that urban green spaces differed in invasibility. We show that community science can be powerful for researching invasive species while engaging the public in conservation. This approach was particularly effective in the present study, where broad spatial sampling was required within a short temporal window. [ABSTRACT FROM AUTHOR]

Purpose: Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action.Methods: Iterative consensus (O'Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques.Results: We propose a worldwide network of 'Centres for Understanding Behaviour Change' (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide.Conclusion: Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID-19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions. [ABSTRACT FROM AUTHOR]

Background: Behavioral interventions typically include multiple behavior change techniques (BCTs). The theory informing the selection of BCTs for an intervention may be stated explicitly or remain unreported, thus impeding the identification of links between theory and behavior change outcomes.Purpose: This study aimed to identify groups of BCTs commonly occurring together in behavior change interventions and examine whether behavior change theories underlying these groups could be identified.Methods: The study involved three phases: (a) a factor analysis to identify groups of co-occurring BCTs from 277 behavior change intervention reports; (b) examining expert consensus (n = 25) about links between BCT groups and behavioral theories; (c) a comparison of the expert-linked theories with theories explicitly mentioned by authors of the 277 intervention reports.Results: Five groups of co-occurring BCTs (range: 3-13 BCTs per group) were identified through factor analysis. Experts agreed on five links (≥80% of experts), comprising three BCT groups and five behavior change theories. Four of the five BCT group-theory links agreed by experts were also stated by study authors in intervention reports using similar groups of BCTs.Conclusions: It is possible to identify groups of BCTs frequently used together in interventions. Experts made shared inferences about behavior change theory underlying these BCT groups, suggesting that it may be possible to propose a theoretical basis for interventions where authors do not explicitly put forward a theory. These results advance our understanding of theory use in multicomponent interventions and build the evidence base for further understanding theory-based intervention development and evaluation. [ABSTRACT FROM AUTHOR]

Aims: To estimate the strengths of associations between use of behaviour change techniques (BCTs) and clusters of BCTs in behavioural smoking cessation interventions and comparators with smoking cessation rates. Method: Systematic review and meta‐regression of biochemically verified smoking cessation rates on BCTs in interventions and comparators in randomized controlled trials, adjusting for a priori‐defined potential confounding variables, together with moderation analyses. Studies were drawn from the Cochrane Tobacco Addiction Group Specialised Register. Data were extracted from published and unpublished (i.e. obtained from study authors) study materials by two independent coders. Adequately described intervention (k = 143) and comparator (k = 92) groups were included in the analyses (n = 43 992 participants). Using bivariate mixed‐effects meta‐regressions, while controlling for key a priori confounders, we regressed smoking cessation on (a) three BCT groupings consistent with dual‐process theory (i.e. associative, reflective motivational and self‐regulatory), (b) 17 expert‐derived BCT groupings (i.e. BCT taxonomy version 1 clusters) and (c) individual BCTs from the BCT taxonomy version 1. Results: Among person‐delivered interventions, higher smoking cessation rates were predicted by BCTs targeting associative and self‐regulatory processes (B = 0.034, 0.041, P < 0.05), and by three individual BCTs (prompting commitment, social reward, identity associated with changed behaviour). Among written interventions, BCTs targeting taxonomy cluster 10a (rewards) predicted higher smoking cessation (B = 0.394, P < 0.05). Moderation effects were observed for nicotine dependence, mental health status and mode of delivery. Conclusions: Among person‐delivered behavioural smoking cessation interventions, specific behaviour change techniques and clusters of techniques are associated with higher success rates. [ABSTRACT FROM AUTHOR]

Objective: Over 90 behaviour change techniques (BCTs) have been specified but there is limited guidance to assist non-specialist practitioners in the choice of which BCTs to select for use with clients. This paper describes the development of MAP, a theory-based mnemonic designed to aid practitioners in their use of BCTs. Each BCT is MAPed to one or more of three recognized routes to behaviour change, namely Motivation development, Action control, and Prompted or cued route.Design: A cross-sectional online discriminant content validity (DCV) questionnaire.Methods: Fourteen judges participated, decided whether each BCT affects behaviour via each of the three routes, and provided a confidence rating for each judgement. Wilcoxon one-sample tests classified each BCT to a route or combination of routes. Intraclass correlation coefficients (ICC) assessed agreement between judges.Results: Fifty-eight BCTs were judged to affect behaviour via a single route; 28, 21, and nine BCTs were judged to act via the Motivation, Action, or Prompted routes, respectively. Judges did not agree on a route for 35 BCTs. Overall ICC (0.89) value was high and did not differ between routes.Conclusions: There was good agreement on candidate BCTs for interventions designed to operate through Motivation, Action, or Prompted/Cued psychological processes. MAP is a mnemonic that can be used by non-specialist practitioners who implement behaviour change with their clients. MAP is not a replacement for sophisticated theory-based organization of BCTs required for theory testing. While providing practical guidance, further work is necessary to establish effectiveness of BCTs tailored to each route. [ABSTRACT FROM AUTHOR]

Aims: To examine variability and effectiveness of interventions provided to comparator (control) groups in smoking cessation trials. Methods: Systematic review with meta‐analysis of randomized controlled trials (RCTs) of behavioral interventions for smoking cessation, with or without stop‐smoking medication. We searched the Cochrane Tobacco Addiction Group Specialized Register for RCTs with objective outcomes measured at ≥ 6 months. Study authors were contacted to obtain comprehensive descriptions of their comparator interventions. Meta‐regression analyses examined the relationships of smoking cessation rates with stop‐smoking medication and behavior change techniques. Results: One hundred and four of 142 eligible comparator groups (n = 23 706) had complete data and were included in analyses. There was considerable variability in the number of behavior change techniques delivered [mean = 15.97, standard deviation (SD) = 13.54, range = 0–45] and the provision of smoking cessation medication (43% of groups received medication) throughout and within categories of comparator groups (e.g. usual care, brief advice). Higher smoking cessation rates were predicted by provision of medication [B = 0.334, 95% confidence interval (CI) = 0.030–0.638, P = 0.031] and number of behavior change techniques included (B = 0.020, 95% CI = 0.008–0.032, P < 0.001). Modelled cessation rates in comparator groups that received the most intensive support were 15 percentage points higher than those that received the least (23 versus 8%). Conclusions: Interventions delivered to comparator groups in smoking cessation randomized controlled trials vary considerably in content, and cessation rates are strongly predicted by stop‐smoking medication and number of behavior change techniques delivered. [ABSTRACT FROM AUTHOR]

In 2019, President Trump announced a new initiative, Ending the HIV Epidemic: A Plan for America (EHE). EHE will use 3 key strategies—diagnose, treat, and prevent—to reduce new HIV infections at least 90% by 2030, as well as new laboratory methods and epidemiological techniques to respond quickly to potential outbreaks. Partnerships are an important component in the initiative's success. Pharmacists and pharmacies can play important roles in EHE, including dispensing antiretroviral therapy and providing HIV screening, adherence counseling, medication therapy management, preexposure prophylaxis, and nonprescription syringe sales. The objective of this report is to discuss potential roles that pharmacists and pharmacies can play under the key strategies of EHE. [ABSTRACT FROM AUTHOR]

Prairie plants of the U.S. Midwest are used for stormwater management because of their purported belowground biomass, but species‐specific data are lacking by which hundreds of prairie species may be evaluated with respect to potential biomass. We hypothesize that aboveground traits could be used to define differences in biomass accumulation to leaves, stems, and roots among prairie plants. Sixteen species of wet‐mesic prairie vegetation common to urban plantings of the Midwest were grown in monoculture to quantify accumulated biomass after 2 yr. Species were grouped in accordance with aboveground morphology and flowering phenology to test for differences in biomass accrual and crown characteristics. Although the species of forbs were as different from one another in leaf, stem, and root biomass as were all forbs together vs. graminoids, grouping plants by aboveground form and flowering phenology helped discern functional differences. Differences among groupings based on aboveground traits are supported by conceptual frameworks through which plant biomass accrual is linked to crown height, leaf area, and growth strategy. These results suggest aboveground traits could inform the selection and/or substitution of prairie species for different uses within urban plantings. [ABSTRACT FROM AUTHOR]

Prairie plants of the U.S. Midwest are used for stormwater management because of their purported belowground biomass, but species-specific data are lacking by which hundreds of prairie species may be evaluated with respect to potential biomass. We hypothesize that aboveground traits could be used to define differences in biomass accumulation to leaves, stems, and roots among prairie plants. Sixteen species of wet-mesic prairie vegetation common to urban plantings of the Midwest were grown in monoculture to quantify accumulated biomass after 2 yr. Species were grouped in accordance with aboveground morphology and flowering phenology to test for differences in biomass accrual and crown characteristics. Although the species of forbs were as different from one another in leaf, stem, and root biomass as were all forbs together vs. graminoids, grouping plants by aboveground form and flowering phenology helped discern functional differences. Differences among groupings based on aboveground traits are supported by conceptual frameworks through which plant biomass accrual is linked to crown height, leaf area, and growth strategy. These results suggest aboveground traits could inform the selection and/or substitution of prairie species for different uses within urban plantings. [ABSTRACT FROM AUTHOR]

Introduction Scientific progress and translation of evidence into practice is impeded by poorly described interventions. The Template for Intervention Description and Replication (TIDieR) was developed to specify the minimal intervention elements that should be reported. Objectives (1) To assess the extent to which outpatient pharmacy interventions were adequately reported. (2) To examine the dimension(s) across which reporting quality varies. (3) To examine trial characteristics that predict better reporting. Methods The sample comprised 86 randomised controlled trials identified in a Cochrane review of the effectiveness of pharmacist interventions on patient health outcomes. Duplicate, independent application of a modified 15-item TIDieR checklist was undertaken to assess the intervention reporting. The reporting/non-reporting of TIDieR items was analysed with principal component analysis to evaluate the dimensionality of reporting quality and regression analyses to assess predictors of reporting quality Results In total, 422 (40%) TIDieR items were fully reported, 395 (38%) were partially reported and 231 (22%) were not reported. A further 242 items were deemed not applicable to the specific trials. Reporting quality loaded on one component which accounted for 26% of the variance in TIDieR scores. More recent trials reported a slightly greater number of TIDieR items (0.07 (95% CI 0.02 to 0.13) additional TIDieR items per year of publication). Trials reported an 0.09 (95% CI 0.04 to 0.14) additional TIDieR items per unit increase in impact factor (IF) of the journal in which the main report was published. Conclusions Most trials lacked adequate intervention reporting. This diminished the applied and scientific value of their research. The standard of intervention reporting is, however, gradually increasing and appears somewhat better in journals with higher IFs. The use of the TIDieR checklist to improve reporting could enhance the utility and replicability of trials, and reduce research waste. [ABSTRACT FROM AUTHOR]

Background: Understanding the mechanisms through which behavior change techniques (BCTs) can modify behavior is important for the development and evaluation of effective behavioral interventions. To advance the field, we require a shared knowledge of the mechanisms of action (MoAs) through which BCTs may operate when influencing behavior.Purpose: To elicit expert consensus on links between BCTs and MoAs.Methods: In a modified Nominal Group Technique study, 105 international behavior change experts rated, discussed, and rerated links between 61 frequently used BCTs and 26 MoAs. The criterion for consensus was that at least 80 per cent of experts reached agreement about a link. Heat maps were used to present the data relating to all possible links.Results: Of 1,586 possible links (61 BCTs × 26 MoAs), 51 of 61 (83.6 per cent) BCTs had a definite link to one or more MoAs (mean [SD] = 1.44 [0.96], range = 1-4), and 20 of 26 (76.9 per cent) MoAs had a definite link to one or more BCTs (mean [SD] = 3.27 [2.91], range = 9). Ninety (5.7 per cent) were identified as "definite" links, 464 (29.2 per cent) as "definitely not" links, and 1,032 (65.1 per cent) as "possible" or "unsure" links. No "definite" links were identified for 10 BCTs (e.g., "Action Planning" and "Behavioural Substitution") and for six MoAs (e.g., "Needs" and "Optimism").Conclusions: The matrix of links between BCTs and MoAs provides a basis for those developing and synthesizing behavioral interventions. These links also provide a framework for specifying empirical tests in future studies. [ABSTRACT FROM AUTHOR]

Background: Despite advances in behavioral science, there is no widely shared understanding of the "mechanisms of action" (MoAs) through which individual behavior change techniques (BCTs) have their effects. Cumulative progress in the development, evaluation, and synthesis of behavioral interventions could be improved by identifying the MoAs through which BCTs are believed to bring about change.Purpose: This study aimed to identify the links between BCTs and MoAs described by authors of a corpus of published literature.Methods: Hypothesized links between BCTs and MoAs were extracted by two coders from 277 behavior change intervention articles. Binomial tests were conducted to provide an indication of the relative frequency of each link.Results: Of 77 BCTs coded, 70 were linked to at least one MoA. Of 26 MoAs, all but one were linked to at least one BCT. We identified 2,636 BCT-MoA links in total (mean number of links per article = 9.56, SD = 13.80). The most frequently linked MoAs were "Beliefs about Capabilities" and "Intention." Binomial test results identified up to five MoAs linked to each of the BCTs (M = 1.71, range: 1-5) and up to eight BCTs for each of the MoAs (M = 3.63, range: 1-8).Conclusions: The BCT-MoA links described by intervention authors and identified in this extensive review present intervention developers and reviewers with a first level of systematically collated evidence. These findings provide a resource for the development of theory-based interventions, and for theoretical understanding of intervention evaluations. The extent to which these links are empirically supported requires systematic investigation. [ABSTRACT FROM AUTHOR]

Background: One of the striking regularities of human behavior is that a prolonged physical, cognitive, or emotional activity leads to feelings of fatigue. Fatigue could be due to (1) depletion of a finite resource of physical and/or psychological energy or (2) changes in motivation, attention, and goal-directed effort (e.g. motivational control theory).Purpose: To contrast predictions from these two views in a real-time study of subjective fatigue in nurses while working.Methods: One hundred nurses provided 1,453 assessments over two 12-hr shifts. Nurses rated fatigue, demand, control, and reward every 90 min. Physical energy expenditure was measured objectively using Actiheart. Hypotheses were tested using multilevel models to predict fatigue from (a) the accumulated values of physical energy expended, demand, control, and reward over the shift and (b) from distributed lag models of the same variables over the previous 90 min.Results: Virtually all participants showed increasing fatigue over the work period. This increase was slightly greater when working overnight. Fatigue was not dependent on physical energy expended nor perceived work demands. However, it was related to perceived control over work and perceived reward associated with work.Conclusions: Findings provide little support for a resource depletion model; however, the finding that control and reward both predicted fatigue is consistent with a motivational account of fatigue. [ABSTRACT FROM AUTHOR]

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

Purpose: Healthy eating, physical activity and smoking interventions for low-income groups may have small, positive effects. Identifying effective intervention components could guide intervention development. This study investigated which content and delivery components of interventions were associated with increased healthy behavior in randomised controlled trials (RCTs) for low-income adults.Method: Data from a review showing intervention effects in 35 RCTs containing 45 interventions with 17,000 participants were analysed to assess associations with behavior change techniques (BCTs) and delivery/context components from the template for intervention description and replication (TIDieR) checklist. The associations of 46 BCTs and 14 delivery/context components with behavior change (measures of healthy eating, physical activity and smoking cessation) were examined using random effects subgroup meta-analyses. Synergistic effects of components were examined using classification and regression trees (meta-CART) analyses based on both fixed and random effects assumptions.Results: For healthy eating, self-monitoring, delivery through personal contact, and targeting multiple behaviors were associated with increased effectiveness. Providing feedback, information about emotional consequences, or using prompts and cues were associated with reduced effectiveness. In synergistic analyses, interventions were most effective without feedback, or with self-monitoring excluding feedback. More effective physical activity interventions included behavioral practice/rehearsal or instruction, focussed solely on physical activity or took place in home/community settings. Information about antecedents was associated with reduced effectiveness. In synergistic analyses, interventions were most effective in home/community settings with instruction. No associations were identified for smoking.Conclusion: This study identified BCTs and delivery/context components, individually and synergistically, linked to increased and reduced effectiveness of healthy eating and physical activity interventions. The identified components should be subject to further experimental study to help inform the development effective behavior change interventions for low-income groups to reduce health inequalities. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Optimisation of non‐prescription medicine (NPM) supply from community pharmacies could reduce demand on other healthcare providers, including general practitioners and emergency department personnel. Outcomes can be maximised if patients disclose relevant information, for example concomitant medication, during pharmacy‐based consultations. Strategies to promote information disclosure are needed. This study used the psychometric paradigm of risk to explore whether the public's risk perception of NPMs was associated with information disclosure. Methods: This national, cross‐sectional population study used a random sample of 3000 adults (aged ≥ 18 years) from the Scottish Electoral register. Postal questionnaires collected data on risk perceptions, information disclosure and demographic information. Exploratory factor analysis was used to determine constructs to which the risk questions could be grouped. Factors were scored and the scores compared across demographics. Key findings: Just over half (57%) of the 927 respondents perceived NPMs to be associated with low general risk. For 19 of the 23 statements (83%), respondents indicated general agreement, that is low‐risk perception of NPMs. Individuals with higher risk perception of NPMs were less likely to disclose information during consultations compared with respondents with lower risk perception. Conclusion: There is general low public risk perception of NPMs. Individuals with higher risk perception are less likely to disclose information. Interventions that raise risk perception are unlikely to enhance the safe and effective supply of NPMs. [ABSTRACT FROM AUTHOR]

Objectives: Self-efficacy - an individual's judgement of their ability to successfully perform a behaviour - is commonly used to explain and predict behaviour. It is measured through self-report questionnaires. These scales require good content validity, that is must measure the full scope and content of the construct without contamination from similar constructs. This study uses a systematic, transparent quantitative method (discriminant content validation, DCV) to assess the content validity of a variety of self-efficacy items and qualitatively explores participant interpretations of these items.Design: A quantitative DCV and qualitative think-aloud study of self-efficacy item interpretation.Methods: Participants (n = 21) were presented with items designed to measure self-efficacy and related constructs following standard DCV methodology. Items were rated against construct definitions to determine whether they measured a particular construct (yes/no). Judges' confidence in each assessment was also assessed (%) and used to establish quantitative estimates of content validity for each item. A qualitative think-aloud study explored the judgements made in a subset of participants.Results: 8/8 self-efficacy items were found to measure self-efficacy; however, 2/8 of these also measured motivation. 6/8 items displayed discriminant content validity and thus can be considered 'pure' measures of self-efficacy. The think-aloud study indicated that item wording is a likely cause of item misinterpretation.Conclusions: Self-efficacy items vary in terms of their content validity with only some of the items assessed providing 'pure' measures of the self-efficacy construct. Item wording should be considered during study design to avoid misinterpretation. Statement of contribution What is already known on this subject? For decades, questions have been raised relating to the content validity of self-efficacy scales, with suggestions of possible construct contamination. Previous studies have shown that manipulation of the wording of self-efficacy scale items results in varied participant interpretations. While self-efficacy items have been found to be distinguishable from other similar constructs, it is equally important to ensure that they are uncontaminated by different constructs within the same theory. Otherwise, when the theory is used to investigate behaviour, variance attributable to self-efficacy may be attributed to a different construct or vice versa. The present study uses discriminant content validation to test this and a think-aloud study to explore participants' interpretation of classic self-efficacy items. What does this study add? The study uses discriminant content validity methodology to assess the content validity of self-efficacy scales. Self-efficacy items which are contaminated with content from other constructs are identified. Information is presented on 'pure' self-efficacy items which can be used to guide item selection in future studies. [ABSTRACT FROM AUTHOR]

Background: Understanding links between behaviour change techniques (BCTs) and mechanisms of action (the processes through which they affect behaviour) helps inform the systematic development of behaviour change interventions.Purpose: This research aims to develop and test a methodology for linking BCTs to their mechanisms of action.Methods: Study 1 (published explicit links): Hypothesised links between 93 BCTs (from the 93-item BCT taxonomy, BCTTv1) and mechanisms of action will be identified from published interventions and their frequency, explicitness and precision documented. Study 2 (expert-agreed explicit links): Behaviour change experts will identify links between 61 BCTs and 26 mechanisms of action in a formal consensus study. Study 3 (integrated matrix of explicit links): Agreement between studies 1 and 2 will be evaluated and a new group of experts will discuss discrepancies. An integrated matrix of BCT-mechanism of action links, annotated to indicate strength of evidence, will be generated. Study 4 (published implicit links): To determine whether groups of co-occurring BCTs can be linked to theories, we will identify groups of BCTs that are used together from the study 1 literature. A consensus exercise will be used to rate strength of links between groups of BCT and theories.Conclusions: A formal methodology for linking BCTs to their hypothesised mechanisms of action can contribute to the development and evaluation of behaviour change interventions. This research is a step towards developing a behaviour change 'ontology', specifying relations between BCTs, mechanisms of action, modes of delivery, populations, settings and types of behaviour. [ABSTRACT FROM AUTHOR]

Objective: Communication of the content of a behaviour change intervention (BCI) involves clear description followed by appropriate recognition and interpretation. We investigated accuracy of recognition of BCI descriptions and the effects of training in the behaviour change taxonomy BCTTv1. Methods: Materials were 166 written descriptions of two BCIs previously written by 166 separate writers after viewing a video of the BCI. Each of the current participants (12 naïve and 12 trained in BCTTv1) was presented with a random sample of the written descriptions and asked to form groups of descriptions they judged to be describing the same intervention. For each participant, we assessed the number of groupings of BCI descriptions, their purity (containing only one BCI) and their differentiation (having a dominant BCI). Results: All except one participant classified the descriptions into more than two groupings. Naïve participants created significantly more groupings, fewer ‘pure’ groupings and less differentiated groupings (all Mann-Whitney p < .05). Conclusions: Written communications of BCI contents may not be recognised and interpreted adequately to support implementation. BCT taxonomy training may lead to some progress in interpreting the active content of interventions but, based on this limited study, further progress is needed if BCIs for accurate implementation. [ABSTRACT FROM AUTHOR]

Earthworm invasions are one of the most serious causes of ecological deterioration in the temperate deciduous forests of North America. Non-native earthworms impact understory vegetation, leaf litter layer, carbon dynamics, nutrient availability, and the associated food webs. Here we report a significant status change and confirm expansion of known range of Amynthas agrestis, one of the most serious invasive species in North America, and two of its close relatives, A. tokioensis and Metaphire hilgendorfi. The three species have never been confirmed to co-occur in North American ecosystems. We examined 1760 earthworms collected from 30 sites across northeastern USA, and identified them using a new morphological key. Our data show that sympatric occurrence of at least two, and often all three, species is more common than having only one species. In addition, A. tokioensis was dominant in many of these earthworm communities. The status change in species composition from only one species to two or three and the shift in dominance are most likely caused by previous incorrect species identification. Our results support expansion of known range of A. tokioensis and M. hilgendorfi northward and westward into states with colder winters. This range expansion may have taken place alongside that of A. agrestis in the last 10-20 years, but has long been overlooked. Altogether, results highlight an urgent need for correct species identification. The recognition of an expanding multi-species system represents a unique opportunity to further evaluate complex interactions among co-invading and resident species, and to investigate whether interspecific interactions have unexpected non-additive impacts on ecological processes. [ABSTRACT FROM AUTHOR]

Background: Delayed cancer diagnosis leads to poorer patient outcomes. During short consultations, General Practitioners (GPs) make quick decisions about likelihood of cancer. Patients’ facial cues are processed rapidly and may influence diagnosis. Aim: To investigate whether patients’ facial characteristics influence immediate perception of cancer risk by GPs. Design and setting: Web-based binary forced choice experiment with GPs from Northeast Scotland. Method: GPs were presented with a series of pairs of face prototypes and asked to quickly select the patient more likely to have cancer. Faces were modified with respect to age, gender, and ethnicity. Choices were analysed using Chi-squared goodness-of-fit statistics with Bonferroni corrections. Results: Eighty-two GPs participated. GPs were significantly more likely to suspect cancer in older patients. Gender influenced GP cancer suspicion, but this was modified by age: the male face was chosen as more likely to have cancer than the female face for young (72% of GPs;95% CI 61.0–87.0) and middle-aged faces (65.9%; 95% CI 54.7–75.5); but 63.4% (95% CI 52.2–73.3) decided the older female was more likely to have cancer than the older male (p = 0.015). GPs were significantly more likely to suspect cancer in the young Caucasian male (65.9% (95% CI 54.7, 75.5)) compared to the young Asian male (p = 0.004). Conclusion: GPs’ first impressions about cancer risk are influenced by patient age, gender, and ethnicity. Tackling GP cognitive biases could be a promising way of reducing cancer diagnostic delays, particularly for younger patients. [ABSTRACT FROM AUTHOR]

Implementing research findings into healthcare practice and policy is a complex process occurring in diverse contexts; it invariably depends on changing human behaviour in many parts of an intricate implementation system. Questions asked with the aim of improving implementation are multifarious variants of 'What works, compared with what, how well, with what exposure, with what behaviours (for how long), for whom, in what setting and why?'. Relevant evidence is being published at a high rate, but its quantity, complexity and lack of shared terminologies present challenges. The achievement of efficient, effective and timely synthesis of evidence is facilitated by using 'ontologies' to systematically structure and organise the evidence about constructs and their relationships, using a controlled, well-defined vocabulary. [ABSTRACT FROM AUTHOR]

Background: Behaviour change is key to addressing both the challenges facing human health and wellbeing and to promoting the uptake of research findings in health policy and practice. We need to make better use of the vast amount of accumulating evidence from behaviour change intervention (BCI) evaluations and promote the uptake of that evidence into a wide range of contexts. The scale and complexity of the task of synthesising and interpreting this evidence, and increasing evidence timeliness and accessibility, will require increased computer support. The Human Behaviour-Change Project (HBCP) will use Artificial Intelligence and Machine Learning to (i) develop and evaluate a 'Knowledge System' that automatically extracts, synthesises and interprets findings from BCI evaluation reports to generate new insights about behaviour change and improve prediction of intervention effectiveness and (ii) allow users, such as practitioners, policy makers and researchers, to easily and efficiently query the system to get answers to variants of the question 'What works, compared with what, how well, with what exposure, with what behaviours (for how long), for whom, in what settings and why?'.Methods: The HBCP will: a) develop an ontology of BCI evaluations and their reports linking effect sizes for given target behaviours with intervention content and delivery and mechanisms of action, as moderated by exposure, populations and settings; b) develop and train an automated feature extraction system to annotate BCI evaluation reports using this ontology; c) develop and train machine learning and reasoning algorithms to use the annotated BCI evaluation reports to predict effect sizes for particular combinations of behaviours, interventions, populations and settings; d) build user and machine interfaces for interrogating and updating the knowledge base; and e) evaluate all the above in terms of performance and utility.Discussion: The HBCP aims to revolutionise our ability to synthesise, interpret and deliver evidence on behaviour change interventions that is up-to-date and tailored to user need and context. This will enhance the usefulness, and support the implementation of, that evidence. [ABSTRACT FROM AUTHOR]