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To investigate the relationship between long-term condition (LTC) status and adherence to protective behaviours against infectious disease (face covering, physical distancing, hand hygiene).

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.

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.

Prairie gardens have become a common addition to residential communities in the midwestern United States because prairie vegetation is native to the region, requires fewer resources to maintain than turfgrass, and has been promoted to help remediate urban soil. Although prairie systems typically have deeper and more diverse root systems than traditional turfgrass, no one has tested the effect of this vegetation type on the physical properties of urban soil. We hypothesized that residential prairie gardens would yield lower soil bulk density (BD), lower penetration resistance (PR), greater soil organic matter (SOM), and greater saturated hydraulic conductivity (Ksat) compared with turfgrass lawns. To test this hypothesis, we examined 12 residential properties in Madison, WI, where homeowners had established a prairie garden within their turfgrass lawn. Despite a consistent trend in the difference between vegetation types, no significant main effects were found (i.e., a difference between vegetation types when averaged over depth) for any of the four soil properties measured in this study. Differences were found with depth and depended on a significant interaction with vegetation type. At the surface depth (0–0.15 m), soil beneath prairie gardens had 10% lower mean BD, 15% lower mean PR, 25% greater level of SOM, and 33% greater Ksatcompared with soil beneath the adjacent lawns. These differences were not detected at deeper sampling intervals of 0.15 to 0.30 m and 0.30 to 0.45 m. Although not statistically significant, the consistent trend and direction among soil variables suggest that residential prairie gardens had changed the surface soil at a rate that marginally outpaced turfgrass and calls for controlled experiments to identify the mechanisms that might enhance these trends. Four soil physical properties were similar in prairie gardens and turfgrass lawns.Hydraulic conductivity, strength, bulk density, and organic matter differ by depth.Prairie gardens show a consistent trend and directional shift in surface properties.Prairie gardens had little impact on subsoil despite their purported benefit.

Behaviour Change Technique Taxonomy v1 (BCTTv1) has been used to detect active ingredients of interventions. The purpose of this study was to evaluate effectiveness of user training in improving reliable, valid and confident application of BCTTv1 to code BCTs in intervention descriptions. One hundred sixty-one trainees (109 in workshops and 52 in group tutorials) were trained to code frequent BCTs. The following measures were taken before and after training: (i) inter-coder agreement, (ii) trainee agreement with expert consensus, (iii) confidence ratings and (iv) coding competence. Coding was assessed for 12 BCTs (workshops) and for 17 BCTs (tutorials). Trainees completed a course evaluation. Methods improved agreement with expert consensus (p< .05) but not inter-coder agreement (p= .08, p= .57, respectively) and increased confidence for BCTs assessed (both p< .05). Methods were as effective as one another at improving coding competence (p= .55). Training was evaluated positively. The training improved agreement with expert consensus, confidence for BCTs assessed, coding competence but not inter-coder agreement. This varied according to BCT.

Behaviour Change Technique Taxonomy v1 (BCTTv1) has been used to detect active ingredients of interventions. The purpose of this study was to evaluate effectiveness of user training in improving reliable, valid and confident application of BCTTv1 to code BCTs in intervention descriptions. One hundred sixty-one trainees (109 in workshops and 52 in group tutorials) were trained to code frequent BCTs. The following measures were taken before and after training: (i) inter-coder agreement, (ii) trainee agreement with expert consensus, (iii) confidence ratings and (iv) coding competence. Coding was assessed for 12 BCTs (workshops) and for 17 BCTs (tutorials). Trainees completed a course evaluation. Methods improved agreement with expert consensus (p < .05) but not inter-coder agreement (p = .08, p = .57, respectively) and increased confidence for BCTs assessed (both p < .05). Methods were as effective as one another at improving coding competence (p = .55). Training was evaluated positively. The training improved agreement with expert consensus, confidence for BCTs assessed, coding competence but not inter-coder agreement. This varied according to BCT.

Background: Reducing patient delay is key to reducing mortality in acute coronary syndrome (ACS). Interventions to date have had little success.Aim: To explore whether illness representations (Leventhal's Commonsense Model of Self-Regulation (CS-SRM)) are associated with patient delay (appraisal or illness delay) in those with symptoms of ACS.Design: A CS-SRM questionnaire studyMethods: A random sample of 182 patients who contacted NHS 24 with symptoms of ACS completed the Revised Illness Perception Questionnaire and gave access to data from their NHS 24 records.Results: Median appraisal delay was 2 hours. Median illness delay was 75 minutes. Women were more likely than men to have long appraisal delays (>2 hours) (57% vs 43%, c2(df=1)=3.93, P=0.047) but did not differ regarding illness delay. Gender and illness representations (identity, emotion and consequences) predicted appraisal delay category (c2=19.907, df=4, P=0.001).Conclusions: Appraisal and illness delays may be associated with different factors. Interventions addressing illness representations might reduce appraisal delay, especially in women.

OBJECTIVE: To test the hypothesis that interventions targeting the relief of pain and disability in musculoskeletal diseases may have differential effects on activity limitation and participation restriction as defined in the International Classification of Functioning, Disability and Health (ICF). METHODS: Full data were obtained for 3 randomized controlled trials that used the Western Ontario and McMaster Universities Osteoarthritis Measure (WOMAC), the Medical Outcomes Study Short-form 36 (SF-36), or the Oswestry Disability Questionnaire as their primary outcome measures. The trial outcomes were reanalyzed using items previously designated as assessing pure activity limitation (A) or participation restriction (P), or a mixture of the 2 (A/P) only, and the results compared with the outcomes found using the full scales, which assess a mixture of outcome domains. RESULTS: The results did not refute the hypothesis. An exercise-based intervention and injection therapies both appeared to have more effect on participation restriction (P) than on activity limitation (A), while a drug-based intervention had more effect on A than on P. CONCLUSION: Different interventions used to treat musculoskeletal disorders may have differential effects on impairment, activity limitation, and restricted participation. The use of outcome measures that do not differentiate these 3 domains may obscure the true value of an intervention.

BackgroundTelephone-assisted CPR (t-CPR), where ambulance-service call-handlers provide instructions to callers on how to perform CPR, increases rates of CPR and survival. However, up to 1/3 of bystanders do not deliver CPR even when provided instructions. If the proportion of people who initiate CPR could be increased, lives would be saved. As a part of a larger project aimed at increasing rates of CPR, we conducted a qualitative study to identify call-handlers’ perceptions of the main barriers to CPR and what they think helps people to initiate CPR.MethodsSemi-structured qualitative interviews were conducted with 30 call-handlers from seven UK ambulance services, purposively selected to ensure diversity in terms of age, gender, years of experience, geographical location, population served (size/rurality), dispatch software used (MPDS and Pathways), published outcomes for ROSC and Care Quality Commission Rating.ResultsThirty call-handlers (19F, 10M, 1 non-binary; aged 22-59) participated. Participants had between 6mths and 25yrs experience and rated their confidence in providing CPR instructions between 3 and 10/10 (mean: 9). The barriers to CPR identified most commonly were the physical challenges of getting people flat on ground; the extreme emotional state of the caller and agonal breathing leading callers to believe that CPR was not required. Call-handlers described various techniques (some suggested by protocol and some not) used to encourage people to initiate/continue CPR. Data relating to the impact of pandemic-related pressures on call-handlers’ experiences of the role also emerged.ConclusionsProviding t-CPR instructions is a challenging but rewarding and valued aspect of call-handlers role. By synthesising the collective experience of a representative sample of call-handlers we have identified techniques used to overcome barriers to CPR initiation, many of which are consistent with behavioural theory. Additional opportunities to use behavioural techniques have been identified and will be developed in partnership with call-handlers.

Disability (activity limitation) is an important and common health outcome for patients with osteoarthritis, making accurate measures essential. This paper explores self-report measures of activity limitation associated with osteoarthritis and reports on recent conceptual advances that impact on the measurement of activity limitation.

OBJECTIVE: To explore whether commonly used osteoarthritis (OA) health outcome instruments (and items) are measuring single or multiple health outcomes using the International Classification of Functioning, Disability and Health (ICF) definitions. METHODS: Ten expert judges allocated 342 items from 13 instruments to one or more ICF construct, i.e., Impairment (I), Activity Limitation (A), and Participation Restriction (P). One-sample t tests were used to classify each item as measuring uniquely I, A, or P or some combination (i.e., IA, IP, AP, or IAP). RESULTS: Overall, 12 of the 13 instruments had items that measured a combination of outcome domains (i.e., IA, IP, AP, or IAP). Only the American Knee Society Score (AKS) had all items uniquely measuring either I or A. The instrument with the best representation of items for Impairment was the AKS, for Activity Limitation the WOMAC and Lequesne knee index, and for Participation Restriction the Disease Repercussion Profile. CONCLUSION: All the existing OA outcome instruments, except one, had some items that were assessing more than one health outcome. Use of these instruments may either mask true treatment effects or make an effect difficult to attribute if the content is unclear. We determined which instruments were the best for measuring each health outcome. To improve the assessment of health outcomes in OA, new instruments that uniquely measure the 3 ICF constructs should be developed and all 3 should be included in relevant studies.

Presents several pictures depicting the activities of U.S. navy.

Background. Previous research has demonstrated that control cognitions predict functional limitations following stroke. This paper reports a preliminary evaluation of the effects of a workbook intervention, designed to enhance perceptions of control, in reducing disability in patients discharged from hospital following stroke. Methods. Thirty‐nine patients living at home who had had a stroke within the 2 previous years completed baseline assessments of functional limitations, mood and perceived control. They were then randomly allocated to either a Workbook Intervention or a Wait control group and functional limitation and mood outcomes were assessed 1 month later. Results. Results showed no benefit of the intervention, but both groups showed reduced functional limitations. Reductions in functional limitations were correlated with increases in perceptions of control. Conclusions. Clearly, the workbook intervention needs to be strengthened before a full evaluation would be worthwhile for this clinical group. It is possible that both groups demonstrated spontaneous recovery or may have benefited from the additional attention given by the researcher. These benefits were associated with enhanced perceptions of control, contributing to previous findings suggesting that control cognitions may be both a consequence and a determinant of functional limitations.

Objectives. To investigate whether poor psychological status predicts shorter survival, faster progress of disease and greater disability in patients with ALS/MND (amyotrophic lateral sclerosis/motor neurone disease). Design. A prospective study of mood as a predictor of 6‐month outcome in a consecutive cohort of patients with ALS/MND. Methods. A cohort of 38 consecutive patients completed mood, self‐esteem, wellbeing and disability measures at the time of diagnosis and 6 weeks later. Survival and disability were assessed at 6 months. Results. The 10 patients who died had poorer overall mood at the 6‐week interviews. Low mood early in disease also predicted greater disability at 6 months. The poor outcomes of patients with poor psychological well‐being were not due to confounding associations between mood and disease severity. Conclusions. The data confirm McDonald, Weidenfeld, Hillel, Carpenter & Walter's (1994) finding that poor psychological status predicts poor survival in ALS/MND. This study also extend their findings by (a) recruiting patients at the point of diagnosis and therefore controlling for effects due to the duration of disease, and (b) demonstrating that mood also predicts disease progression and disability. The findings are unlikely to be due to simple spurious association of the psychological status measures with recognized indices of disease or of expected survival. Explanations for the results can be considered in the context of other findings of mood predicting outcomes of life‐threatening disease and the possible value of psychological interventions may be considered.

Previous work has shown that doctors, nurses and relatives are inaccurate at estimating the comprehension problem of stroke patients. Possible factors that influence the accuracy of these judgements were studied, including confidence of the respondents, the severity of the comprehension problems of the patients and factors specific to relatives (educational background and the length of the relative's relationship with the patient). Doctors, nurses and relatives involved with 30 recently aphasic stroke patients were asked to estimate how patients would perform on the comprehension sections of two tests (Western Aphasia Battery and Functional Communication Profile). Results show that although all respondents over-estimated patients' comprehension abilities, they were more accurate for patients who had mild problems. Doctors and nurses who were more confident about their predictions tended to be more accurate on some parts of the tests than those with less confidence, whereas relatives were equally inaccurate when giving high and low confidence judgements. Length of relationship and educational level did not predict relative's accuracy.Les travaux publicés jusqu'ici révélent que lorsqu'il s'agit d'estimer les difficultés de compréhension des malades qui ont souffert une attaque, les médecins, infirmièrs et infirmèires, ainsi que les proches commettent des erreurs. Les études ont porti sur les facteurs qui pourraient influencer l'exactitude de ces jugements, parmi lesquels le niveau de confiance des sujets interrogés en leur propre jugement, la sévérité des problèmes de comprehénsion des malades et certains facteurs qui ont trait aux proches (leur niveau d'éducation et la durée de leurs rapports avec le malade). Ici l'on a demandé aux docteurs, infirmièrs et infirmèires ainsi qu'aux proches de trente malades atteints d'aphasie récente par suite d'une attaque, d'évaluer d'avance les résultats qu'obtiendraient ces derniers quant aux sections de compréhension de deux tests (Western Aphasia Battery et Functional Communication Profile). Les résultats ont montré que toutes les personnes interrogées ont tendu a surestimer les capacityés de compréhension des malades; cependant les erreurs étaient moindres si ceux-ci n'avaient que de légères difficultés. Les docteurs, infirmiers et infirmèeres qui se sentaient plus sûrs de leurs pronostics tendaient à commettre moins d'erreurs sur certaines parlies des tests que ceux dont le jugement itait plus réservi. Par contre les proches se trompaient tout autant lorsqu'ils itaient surs de leurs jugements que lorsqu'ils ne l'étaient pas, et ni la durie de leurs relations avec le malade, ni leur niveau d'éducation ne semblaient influer sur I'exactitude de leurs estimations.Vorangegangene Arbeiten haben gezeigt, dass Ärzte, Krankenpfleger und Verwandte nur ungenau die Sprachverständnisprobleme von Schlaganfallpatienten einschälzen. Wir untersuchten Faktoren, die möglicherweise einen Einfluss auf die Genauigkeit dieser Beurteilungen ausübten, darunter das Selbstvertrauen der Bewerter, der Schweregrad des Problems der Patienten und Faktoren, die sich spezifisch auf die Verwandten beziehen (Erziehung, Dauer der Beziehung mil dem Patienten). Wir haben Ärzte, Krankenpfleger und Verwandte, die mit dreissig neuen aphasischen Schlaganfallpatieten zu tun hatten, gebeten einzuschätzen, wie die Patienten in zwei Tests (Western Aphasia Battery, Functional Communication Profile) abschneiden wiirden, insbesondere in den Teilen, die das Sprachverständnis untersuchen. Die Ergebnisse zeigen, dass während alle Bewerter die Verständnisfähigkeii der Patienten zu hoch einschätzten, sie bei Patienten mit massigen Problemen genauer waren. Arzte und Krankenpfleger die von ihren eigenen Voraussagungen überzeugt waren, waren gewöhnlich in manchen Teilen der Tests genauer als andere, die weniger uberzeugt waren. Dagegen waren die Verwandten sowohl mit grösserer als auch niedrigerer Überzeugung gleichermassen ungenau. Von der Dauer der Beziehung und ihrer Erziehung her konnte man bei den Verwandten die Genauigkeit nicht vorhersagen.

The proposal that theories in health psychology are becoming more "intra-active" may arise because earlier "intra-active" theories which were unsuccessful have been omitted from the analysis. A greater problem for health psychology would appear to be the lack of well-developed theories.

The use of a mood and activity diary kept by a patient more clearly defined the relationship between patient and carer and identified those problems that could be tackled. It helped to reduce feelings of helplessness and to restore some control to the patient.

Recently, there has been growing interest in the development of methods for recording disability as an outcome measure to monitor treatment effectiveness in chronic pain patients. Where these methods have relied on self-report, further information is needed about the validity and reliability of the results. Three such studies are reported on the Oswestry Low Back Pain Disability Questionnaire (ODQ. These involved comparing actual performance on lifting, sitting and walking tasks with reported limitation on the relevant subsections of the ODQ. The results were able to show encouraging validity and reliability. A factor-analytic study was also undertaken, which determined that there were two distinct factors of disability measured by this instrument. A small cohort of patients were followed up after a pain rehabilitation programme and reductions in disability were found to be reliably measured by the ODQ. The relationships between reported disability and the emotional and cognitive context in which the pain is experienced are discussed.

Medicine and environmental changes have had tremendous success in controlling the infectious diseases that were the major causes of death in the last century. However, the consequential extension of life has been accompanied by an increase in the number of persons living with and dying of chronic illness.1 Despite these changes and their implications, the means by which people cope with such illnesses has only recently begun to receive the attention the subject warrants. 2,3 Such diseases have a high prevalence in the population and self-detection and self-management are critical to the treatment and control of chronic disease and disability.4This paper examines how people cope with motor neurone disease and sets this in the context of earlier research on psychological aspects of chronic disease and current theoretical approaches to coping with long-term ill health.

The aim of this study was to investigate the factors that contribute to the stress reported by nurses and patients. Thirty-four nurses in a London teaching hospital completed the nurse stress index and the Spielberger state trait anxiety inventory and attitudes towards the ward and nursing care were measured in 52 patients. Nurses in the sample reported significantly greater problems than the norm in dealing with stress (as measured by the nurse stress index). In particular; they expressed difficulty in dealing with patients and their relatives, with conflict between home and work, and with and pressure resulting from problems concerning confidence and competence in the role. Patients were generally satisfied with the health care they received. There was a positive relationship between the time that patients spent talking to nurses and the degree to which nurses were perceived as helpful. Results are discussed in terms of possibilities for further research and implications for the design of future intervention programmes aimed at reducing job-related stress in hospitals.

The purpose of the current study was to determine which psychological models are most useful in predicting uptake of a prenatal screening test, maternal-serum alphafetoprotein screening for spina bifida and Down's syndrome. 1000 women eligible for the test completed standardised self-report questionnaires at two routine clinic visits to an antenatal clinic prior to the time when the test could take place. 902 underwent the screening test; 51 declined the test; and 47 did not undergo the test, giving no reason for this to staff. Knowledge of the test, the subjective expected utility attached to the test, and attitudes to doctors and medicine were all significant predictors of uptake behaviour. Results of a discriminant function analysis demonstrated distinct psychological processes underlying each of these three uptake behaviours, explaining 21% of the variance in uptake of screening. If uptake of screening is examined not as a dichotomous variable but as a group of behaviours, predictive models are identified accordingly. This would lead to rnodels of health-related behaviours as a heterogeneous rather than homogeneous phenomena, predicted and influenced by different causes.

The behaviour of health professionals is rarely considered systematically by psychologists. This paper makes the following argument: first, that the behaviour of health professionals is influenced by other factors as well as medical knowledge; second, that various psychological models of human behaviour previously used only in considering the behaviour of patients may also be used to explain, predict and change the behaviour of health professionals; third, to implement effective care the behaviour of health professionals needs to be considered alongside that of patients.

The main approach to rectifying the well documented poor basic life support (BLS) skills of doctors and nurses, based on a Skills Model, has met with only partial success. This study compares the utility of a Skills Model with one that incorporates a cognitive component in predicting BLS skills. Outcome-expectancy, self-efficacy, training and experience of BLS, and BLS ability were assessed in 53 trained nurses. Ability was unrelated to training or experience of BLS. Nurses who scored highest on the BLS skills assessment perceived the procedure as significantly more successful than those with lower scores. Self-efficacy was unrelated to ability, but was related to status: senior nurses were significantly more confident but no more competent in performing BLS than junior nurses. Nurses who had attended more arrests, while more confident, were no more competent than those who had attended fewer. Assessment of BLS skills reduced self-efficacy beliefs. A model for predicting the relationship between self-assessed ability and objectively assessed skill is outlined.

Patients participating in an in vim fertilisation with embryo transfer (IVF and ET) programme face uncertainty at each stage of the procedure. Research on heuristics and on stress lead to predictions about behaviour in situations of uncertainty. It was predicted that IVF and ET participants would overestimate the likelihood of success, due to publicity the process has received, and would underestimate the likelihood of an earlier, less publicised. stage in the procedure. Both predictions were confirmed in a total of 70 participants (26 women at out-patient clines, 23 of their partners and 21 surgical in-patients). All the men and all but one woman overestimated the likelihood of becoming pregnant and having a baby. and most of the surgical patients underestimated the likelihood of egg recovery. Estimates were not related to patients' confidence about their information, confirming previous evidence about confidence in inaccurate judgements based on heuristics. Data on patients' distress as indicated by mood rating show high anxiety at points of uncertainty and Pailure, as found in other studies of stress. While the couples shared their inaccurate judgements. they did not necessarily share their distress. The results are discussed in terms of patients' decision making. coping strategies and the implications for doctor-patient communication.

Health psychology is the study of psychological and behavioural processes in health, illness and health care. As a relatively young discipline, the challenge for health psychology is to demonstrate that it can and does make a difference to the investigation of the health of the population. The tenth annual European Health Psychology Society Conference, held in Dublin in September 1996, focused on health psychology in chronic disease. The challenge was whether health psychology makes a difference to the science of the prevention and management of our major Chronic di seases. Conference presentations illustrated that health psychology makes a difference by using all methods of investigation [including description, measurement, prediction, explanation and intervention] and by studying a wide range of chronic diseases.

Communication of the diagnosis of motor neurone disease (MND) is a particularly difficult task for doctors in view of the poor prognosis and the lack of significant treatment. This study examined patients' views of being given the diagnosis and of how it was communicated. Fifty people who had been diagnosed with MND more than six months previously were interviewed about their experience of the diagnosis. The majority reported positive aspects of being told, especially having a label for their condition. The most frequently mentioned critical aspect of how they were told was the directness and clarity with which they were given the information. Patients were more critical if the diagnosis was worse than expected (as it was for most patients) and more satisfied if they felt they had been able to ask questions. There was no evidence that unsatisfactory communications were associated with later mood disturbance. A longitudinal study is recommended to overcome limitations in this cross-sectional design.

Objectives. To explore the hypothesized mediating effects of cognitions and emotional distress on the pain‐disability relationship.

This article first appeared in May 1996 in The Psychologist, Volume 9, Number 5, Pages 205-210. Permission to reproduce the article in Physiotherapy Theory and Practice has been granted by the author and the publisher of The Psychologist, the British Psychological Society. The article is based on the author' 1995 Presidents' Award Lecture at the British Psychological Society' Annual Conference held at the University of Warwick in April 1995.

Background: Hospitals offer snacks for sale to patients, staff and visitors.Aim: As food choice is heavily influenced by the options available, the present study (a) audited snack availability and purchase in NHS hospital sites across a large UK city; and (b) tested the potential effects of changes to this availability in an online choice experiment.Methods: In Study 1 (audit), single-serve snacks (n=376) available in 76 hospital food retail units were audited. Purchasing data were obtained from six food retail units over four weeks (27,989 sales). In Study 2 (online experiment), participants (n=159) chose snacks from pictured ranges containing 25% (minority), 50% (equivalent) or 75% (majority) healthy options.Results: Available single-serve snacks varied markedly in calorie (18–641 kcals), fat (0–39 g), sugar (0.1–76 g) and salt (0–2.9 g). Only 30% of available snacks were healthy options and only 25% of the most commonly purchased snacks were healthy options. In Study 2, snack choice was significantly associated with the availability of healthy options in the choice array (X2 (2)= 59.71, p<.01). More participants made healthy choices when product ranges contained 75% healthy options compared to 50% (p<.01) and 50% healthy options compared with 25% (p<.01).Conclusions: Healthy snacks are readily available in NHS sites but there is a greater relative variety of unhealthy snack products. Many consumers continue to purchase unhealthy items. Further increasing the availability and variety of healthy options may support consumers to make healthier choices.

Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.

Focuses on the 80th anniversary of the 'All Hands' serial publications. History of the publication; Change of publication title; Improvements of the text and photographs.