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In South Africa, lay HIV counsellors are at the forefront of many HIV-related behavioural interventions. However, they have limited formal counselling training and little ongoing in-service support, leading to considerable variability in approaches to counselling. We describe the use of Intervention Mapping to develop a motivational interviewing counselling training and support program, titled “Thusa-Thuso - helping you help”, for lay HIV counsellors practising in primary health care clinics in South Africa. The program is contextually relevant, locally-produced, scalable, and is designed to impart sustained motivational interviewing counselling skills in lay HIV counsellors for improved antiretroviral therapy (ART) uptake in the universal-test-and-treat era.

To evaluate the impact of a peer-referral and clinic welcome programme for reducing barriers to adolescents' uptake of family planning services in Uganda.We developed an intervention using behavioural design and carried out a stratified, randomized controlled evaluation of the intervention in girls aged 15-19 years. Sexual and reproductive health clinics were randomized into control (56 clinics) and intervention groups (60 clinics). All intervention clinics received the core intervention (materials to create an adolescent-friendly environment and referral cards to give to friends), while a subset of clinics additionally received training in youth-friendly service provision. We collected clinics' routine data on monthly numbers of visits by adults and adolescents over a 15-month baseline and 6-month intervention period, 2018-2020.In multivariate regression analysis we found significant effects of the intervention on primary outcomes in the pooled intervention group compared with control. Mean monthly visits by adolescents increased by 45% (incidence rate ratio, IRR: 1.45; 95% confidence interval, CI: 1.14-1.85), or over five additional adolescent clients per clinic per month. The mean adolescent proportion of total clients improved by 5.3 percentage points (95% CI: 0.02-0.09). Within treatment arms, clinics receiving the training in youth-friendly service provision showed the strongest effects: a 62% increase (IRR: 1.62; 95% CI: 1.21-2.17) in adolescent clients, or over seven additional adolescents per clinic per month, relative to the control group.A behavioural change intervention designed to target identified barriers can increase adolescents' uptake of family planning counselling and services.Évaluer dans quelle mesure un programme d'accueil clinique basé sur l'orientation confraternelle peut contribuer à surmonter les obstacles à l'adoption des services de planification familiale chez les adolescents en Ouganda.Nous avons mis au point une intervention en nous aidant du design comportemental, puis avons mené une évaluation randomisée contrôlée et stratifiée de cette intervention chez les jeunes filles âgées de 15 à 19 ans. Plusieurs cliniques de santé sexuelle et reproductive ont été réparties aléatoirement dans un groupe de contrôle (56 cliniques) ou d'intervention (60 cliniques). Toutes les cliniques appartenant au second groupe ont reçu l'intervention de base (des ressources servant à créer un environnement adapté aux adolescents, ainsi que des cartes de référence à distribuer autour d'eux), tandis qu'un sous-groupe de cliniques a suivi une formation spécialisée dans la prise en charge des jeunes. Nous avons récolté les données courantes des cliniques relatives au nombre mensuel de visites effectuées par des adultes et adolescents sur une période initiale de 15 mois et une période d'intervention de 6 mois, entre 2018 et 2020.L'analyse de régression multivariée nous a permis de constater que le programme avait d'importantes répercussions sur les résultats primaires au sein du groupe d'intervention par rapport au groupe de contrôle. Le nombre mensuel moyen de visites effectuées par des adolescents a augmenté de 45% (rapport de taux d'incidence, RTI: 1,45; intervalle de confiance de 95%, IC: 1,14–1,85), l'équivalent d'au moins cinq patients adolescents supplémentaires par clinique chaque mois. Le pourcentage moyen d'adolescents sur l'ensemble des patients a connu une hausse de 5,3 points de pourcentage (IC de 95%: 0,02–0,09). Dans le groupe d'intervention, les cliniques ayant suivi une formation spécialisée dans la prise en charge des jeunes ont enregistré une progression spectaculaire de 62% (RTI: 1,62; IC de 95%: 1,21–2,17) auprès des patients adolescents, ce qui signifie que chaque clinique a accueilli au moins sept adolescents supplémentaires par mois, par rapport au groupe de contrôle.Une intervention induisant un changement de comportement, conçue dans le but de déjouer des obstacles clairement identifiés, peut favoriser l'adoption des services et consultations de planification familiale chez les adolescents.Evaluar el impacto de un programa de acogida en clínicas y de referencia entre pares para reducir las barreras que impiden adoptar los servicios de planificación familiar entre los adolescentes en Uganda.Se desarrolló una intervención mediante un diseño conductual y se llevó a cabo una evaluación aleatorizada, controlada y estratificada de la intervención en mujeres de 15 a 19 años. Las clínicas de salud sexual y reproductiva se dividieron de manera aleatoria en grupos de referencia (56 clínicas) y de intervención (60 clínicas). Todas las clínicas de intervención recibieron la intervención principal (materiales para crear un entorno amigable con los adolescentes y tarjetas de referencia para entregar a los amigos), mientras que un subconjunto de clínicas recibió además formación en la prestación de servicios adaptados a las necesidades de los jóvenes. Se recopilaron los datos rutinarios de las clínicas sobre el número de visitas mensuales de adultos y adolescentes durante un periodo basal de 15 meses y un periodo de intervención de 6 meses entre 2018 y 2020.En el análisis de regresión multivariante se encontraron efectos significativos de la intervención sobre los resultados primarios en el grupo de intervención agrupado en comparación con el de referencia. La media de visitas mensuales de los adolescentes aumentó en un 45 % (razón de tasas de incidencia, IRR: 1,45; intervalo de confianza del 95 %: IC: 1,14-1,85), es decir, más de cinco clientes adolescentes adicionales por clínica al mes. El porcentaje medio de adolescentes sobre el total de clientes mejoró en 5,3 puntos porcentuales (IC del 95 %: 0,02-0,09). Dentro de los grupos de tratamiento, las clínicas que recibieron la formación en la prestación de servicios adaptados a las necesidades de los jóvenes mostraron los efectos más fuertes: un aumento del 62 % (IRR: 1,62; IC del 95 %: 1,21-2,17) en los clientes adolescentes, es decir, más de siete adolescentes adicionales por clínica al mes, en relación con el grupo de referencia.Una intervención orientada al cambio de conducta, diseñada para abordar las barreras identificadas, puede hacer que los adolescentes acepten el asesoramiento y los servicios de planificación familiar.الغرض تقييم تأثير إحالة الأقران، وبرنامج الترحيب بالعيادة، لتقليل الحواجز التي تحول دون استيعاب المراهقين لخدمات تنظيم الأسرة في أوغندا. الطريقة قمنا بتطوير تدخل باستخدام التصميم السلوكي، وتنفيذ تقييم تدريجي عشوائي خاضع للتحكم للتدخل لدى الفتيات اللاتي تتراوح أعمارهن بين 15 و19 عامًا. تم ترتيب عيادات الصحة الجنسية والإنجابية بشكل عشوائي إلى مجموعة خاضعة للتحكم (56 عيادة)، ومجموعات للتدخل (60 عيادة). جميع عيادات التدخل تلقت التدخل الأساسي (مواد لإنشاء بيئة صديقة للمراهقين وبطاقات إحالة لمنحها للأصدقاء)، بينما تلقت مجموعة فرعية من العيادات بالإضافة إلى ذلك تدريباً على تقديم خدمة صديقة للشباب. قمنا بجمع البيانات الروتينية للعيادات حول الأعداد الشهرية للزيارات التي يقوم بها البالغون والمراهقون على مدى 15 شهرًا، وفترة تدخل مدتها 6 أشهر، خلال الفترة من 2018 إلى 2020. النتائج في تحليل للتحوف متعدد المتغيرات، وجدنا تأثيرات ملموسة للتدخل على النتائج الأولية في مجموعة التدخل المجمعة، مقارنةً بمجموعة التحكم. زاد متوسط الزيارات الشهرية بواسطة المراهقين بنسبة 45% (نسبة معدل وقوع الحالة (IRR): 1.45؛ وبفاصل ثقة مقداره 95%: 1.14 إلى 1.85)، أو أكثر من خمسة عملاء مراهقين إضافيين لكل عيادة شهريًا. تحسن متوسط نسبة المراهقين من إجمالي العملاء بمقدار 5.3 نقطة مئوية (وبفاصل ثقة مقداره 95%: 0.02 إلى 0.09). ضمن أذرع العلاج، أظهرت العيادات التي تتلقى التدريب في تقديم الخدمات الصديقة للشباب أقوى التأثيرات: زيادة بنسبة 62% (نسبة معدل وقوع الحالة IRR): 1.62)؛ ‏بفاصل ثقة 95%: 1.21 إلى 2.17) في العملاء المراهقين، أو أكثر من سبعة مراهقين إضافيين لكل عيادة شهريًا، بالنسبة لمجموعة التحكم. الاستنتاج يمكن أن يؤدي تدخل التغيير السلوكي، المصمم لاستهداف العوائق المحددة، إلى زيادة استيعاب المراهقين لاستشارات وخدمات تنظيم الأسرة.旨在评估为乌干达青少年接受计划生育服务减少障碍而施行的同行转诊和“诊所欢迎计划”的影响。.我们使用行为设计开发了一项干预措施，并对 15-19 岁女孩的干预措施进行分层、随机对照评估。将性健康与生殖健康诊所随机分为对照组（56 个诊所）和干预组（60 个诊所）。所有干预组诊所都接受了核心干预（创建青少年友好环境的资料和可赠送朋友的转诊卡），同时一部分诊所还接受了青少年友好服务的培训。我们收集了 2018 至 2020 年 15 个月基线和 6 个月干预期间成人和青少年每月就诊次数的诊所常规数据。.在多元回归分析中，我们发现与对照组相比，汇总后干预组的干预对主要结果有显著影响。青少年每月平均就诊次数增加了 45%（发生率比值，IRR：1.45；95% 置信区间：CI: 1.14–1.85)，或每月每个诊所增加超过五个青少年客户。总客户中青少年的平均比例提高了 5.3 个百分比（95% CI: 0.02–0.09）。在治疗组中，接受青少年友好服务培训的诊所显示出最显著的效果：青少年客户增加 62% (IRR: 1.62; 95% CI: 1.21–2.17)，或相比于对照组，每月每个诊所增加超过七个青少年。.针对已识别的障碍实施行为变化干预可以增加青少年接受计划生育咨询和服务的程度。.Оценить влияние программы по обращению к специалистам по принципу «сверстник-сверстнику» и ознакомлению с клиникой для уменьшения препятствий, мешающих подросткам пользоваться услугами по планированию семьи в Уганде.Авторы разработали мероприятие с использованием поведенческого дизайна и провели стратифицированную рандомизированную контролируемую оценку данного мероприятия среди девушек в возрасте 15–19 лет. Клиники сексуального и репродуктивного здоровья были рандомизированы на контрольные (56 клиник) и экспериментальные (60 клиник). Все экспериментальные клиники получили основные средства (материалы для создания благоприятной для подростков среды и направления к специалисту для распространения среди друзей), а отдельная подгруппа клиник дополнительно прошла обучение по оказанию услуг, учитывающих потребности молодежи. Мы собрали стандартные данные клиник о ежемесячном количестве посещений взрослых и подростков в течение 15-месячного исходного и 6-месячного экспериментального периода, 2018–2020 гг.Во время многомерного регрессионного анализа мы обнаружили значительное влияние мероприятия на первичные исходы в объединенной экспериментальной группе по сравнению с контрольной группой. Среднее ежемесячное посещение подростками увеличилось на 45% (отношение частоты случаев, ОЧС: 1,45; 95%-й доверительный интервал: ДИ: 1,14–1,85) или более чем на пять дополнительных клиентов-подростков на клинику в месяц. Средняя доля подростков в общем числе клиентов увеличилась на 5,3 процентных пункта (95% ДИ: 0,02–0,09). Среди групп воздействия клиники, прошедшие обучение по оказанию услуг, учитывающих потребности молодежи, показали самое сильное воздействие: рост на 62% (ОЧС: 1,62; 95% ДИ: 1,21–2,17) среди клиентов-подростков, или более семи дополнительных подростков на клинику в месяц по сравнению с контрольной группой.Мероприятие по изменению поведения, направленное на устранение выявленных препятствий, может повысить интерес подростков к консультированию и услугам по планированию семьи.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

While strong inhibitory control is critical for health and wellbeing, there are no broadly applicable effective behavioural interventions that enhance it. This meta-analysis examined the neurocognitive rationale for combined physical and cognitive training and synthesised the rapidly growing body of evidence examining combined paradigms to enhance inhibitory control. Across the research to date, there was a small positive effect (n studies = 16, n participants = 832) of combined training on improving inhibitory control. Sub-group analyses showed small-moderate positive effects when the physical component of the combined training was moderately intense, as opposed to low or vigorous intensities; moderate positive effects were found in older adults, as compared to adolescents and adults; and healthy individuals and those with vascular cognitive impairment, as compared to ADHD, ASD, mild cognitive impairment and cancer survivors. This is the first meta-analysis to provide evidence that combined physical, specifically when moderately intense, and cognitive training has the capacity to improve inhibitory control, particularly when delivered to healthy individuals and those experiencing age-related decline.

Obesity is regarded as a civilization disease that increases mortality and the risk of cardiovascular complications. In Poland, the prevalence of excess body weight in the paediatric population has been steadily increasing. The consequences of excess body weight in the developmental age population affect children’s health and destabilize their development. Appropriate dietary interventions are the main non-invasive methods of preventing and treating obesity. They should be aimed at the whole family, optimally with the use of simple tools such as the Healthy Eating Pyramid. Due to the increasing prevalence of excess body weight in the developmental age population and the problems with the treatment of this condition, studies were undertaken in order to determine the impact of a dietary intervention on anthropometric and biochemical parameters in children with excess body weight. A total of 68 (72.3%) children completed the study. Based on BMI SDS, 59 (86.8%) were diagnosed with obesity and 9 (13.2%) with overweight. After the completion of the one-year dietary educational program, a significant improvement in weight loss, waist and hip circumference, as well as the value of the WHtR index was demonstrated. There was also a significant increase in the percentage of muscle tissue and a decrease in the content of adipose tissue in the bodies of examined children. A significant improvement in the parameters of carbohydrate metabolism, and almost all parameters of lipid metabolism, except for total cholesterol. A significant (by 28.0%) reduction in the incidence of fatty liver was also noted. No influence of dietary education on arterial blood pressure was observed.

Purpose of review Time-restricted eating (TRE) entails consuming energy intake within a 4- to 10-h window, with the remaining time spent fasting. Although studies have reported health benefits from TRE, little is known about the impact of TRE on common chronic diseases such as type 2 diabetes, cancer and cardiovascular disease. This review summarizes and critically evaluates the most recent TRE research findings relevant to managing and treating these chronic diseases. Recent findings Most recent TRE studies have been in populations with overweight/obesity or metabolic syndrome; two have been in populations with diabetes, three in cancer survivors and none in populations with cardiovascular disease. Collectively, these studies showed that participants could adhere to TRE and TRE is well tolerated. These studies also showed preliminary efficacy for improved glucose regulation and insulin sensitivity, a reduction in body fat and blood pressure, reduced cardiovascular risk scores and increased quality of life. More research is required to define the most effective TRE protocol (i.e. length and timing of eating window, intervention duration). Summary TRE has demonstrated benefits on cardiovascular, metabolic and clinical outcomes relevant to the underlying pathophysiology, but there are limited data on TRE implemented specifically within populations with diabetes, cancer or cardiovascular disease.

PurposeThe processes and mechanisms of action which explain how behavioural interventions for chemotherapy-induced peripheral neuropathy (CIPN) work or not are unclear. We describe a co-design process for developing an evidence and theory-based behavioural intervention to reduce the impact of CIPN symptoms on patients’ quality of life.Methods Guided by the Medical Research Council Framework for developing and evaluating complex interventions, our process of intervention development was informed by: (a) findings of systematic reviews, (b) inductive analysis of thirty-nine hours of observational fieldwork, twelve patient and eleven clinician interviews, (c) deductive analysis using the Common-Sense Self-Regulation Model and (d) fifteen patients and twenty clinicians being actively involved as co-designers. ResultsCIPN perception and coping behaviours (including, for example, self-monitoring of symptoms and engaging in self-management and safety strategies to reduce impact of CIPN symptoms) were highlighted as processes to target when co-designing an intervention. To address these behaviours, a psychoeducational approach was deemed suitable. Four behavioural change techniques informed the co-design of the intervention: (a) information about health consequences, (b) salience of consequences, (c) instruction on how to perform a behaviour and (d) action planning.ConclusionCurrent behavioural interventions for CIPN have rarely involved stakeholders, e.g. patients and clinicians, in their development process. We developed a logic model for documenting the proposed mechanism of action of our co-designed intervention for reducing impact of CIPN symptoms. This model will be refined and tested in a subsequent process evaluation as part of a feasibility trial of the intervention.

In the past decade, behavioural science has gained influence in policymaking but suffered a crisis of confidence in the replicability of its findings. Here, we describe a nascent heterogeneity revolution that we believe these twin historical trends have triggered. This revolution will be defined by the recognition that most treatment effects are heterogeneous, so the variation in effect estimates across studies that defines the replication crisis is to be expected as long as heterogeneous effects are studied without a systematic approach to sampling and moderation. When studied systematically, heterogeneity can be leveraged to build more complete theories of causal mechanism that could inform nuanced and dependable guidance to policymakers. We recommend investment in shared research infrastructure to make it feasible to study behavioural interventions in heterogeneous and generalizable samples, and suggest low-cost steps researchers can take immediately to avoid being misled by heterogeneity and begin to learn from it instead. Behavioural science increasingly informs policy, but findings are not always replicated. Bryan et al. describe an emerging heterogeneity revolution. They recommend that researchers use heterogeneity in treatment effects to develop more robust theories of causality and strengthen the field.

Objectives To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low‐income and lower‐middle‐income countries, an underrepresented area in the literature. Methods The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low‐income and lower‐middle‐income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full‐text review, with 13 studies included in the final narrative synthesis. Results Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists. Conclusions Multi‐faceted bundle interventions that combine regulation enforcement with face‐to‐face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use.

Purpose\ud \ud Persistent physical symptoms (PPS) are often associated with profound physical disability and psychological distress. Interventions for PPS that promote behavioural change aim to reduce levels of symptoms and improve overall functioning in patients. The evidence for these interventions is mixed, with effective relationships between patients and health practitioners (HPs) reported as the key to the success of primary care interventions. The objectives of this systematic review were to synthesize the qualitative evidence and to evaluate the acceptability of behavioural interventions for PPS in primary care, from the perspective of both patients and HPs.\ud \ud \ud Methods\ud \ud A comprehensive literature search was conducted in seven major electronic bibliographic databases, to February 2019. The aim was to identify a broad range of literature including, qualitative research, mixed methods research, and qualitative data embedded in trial reports or process evaluations. Fifty‐eight full papers were screened against the inclusion criteria. Nine studies were included and quality‐assessed. A qualitative evidence synthesis was conducted using thematic synthesis.\ud \ud \ud Results\ud \ud Some patients and HPs reported positive gains from taking part in or delivering interventions, with appropriate support and explanation of their symptoms important for patients. Barriers appeared to be underpinned by the relationship between the patients and HPs, and by beliefs and attitudes held by both parties.\ud \ud \ud Conclusions\ud \ud Patients should be provided with adequate information to make an informed decision about whether an intervention is appropriate for them, and interventions should not end suddenly or without adequate follow‐up. HPs should receive training and supervision to address their lack of confidence, and improve their knowledge of PPS.

OBJECTIVES To assess the efficacy of a community-based childhood obesity prevention intervention targeting Sugar-sweetened beverage (SSB) consumption on self-rated oral health among children and their parents/caregivers. METHODS This study is a secondary analysis of data from a pilot site-randomized intervention (H2 GO!) targeting SSB consumption and obesity risk among children. The 6-week SSB behavioural intervention was implemented in two Massachusetts Boys and Girls Club sites that were matched for size and racial/ethnic composition. Children ages 9-12 years and their parents/caregivers were eligible to participate. Data on self-rated oral health and sociodemographics were obtained via self-report surveys at baseline, 2 and 6 months. Generalized linear mixed regression models were used to estimate 2- and 6-month change in oral health associated with the intervention. RESULTS Data are from 100 child participants (46% female; 38% Black, 20% Hispanic, 13% White, 12% Multiracial, 11% Asian) and 87 parent participants (78.2% female; 37.9% Hispanic, 29.9% Black, 14.9% Asian, 10.3% White). At baseline, 47% of child participants rated their oral health as good, followed by very good (32%), fair (11%) and excellent (10%). Among parents, 46.3% rated their oral health as good, followed by very good (29.3%), excellent (9.8%), fair (9.7%) and poor (4.9%). The intervention was associated with 2- and 6-month improvements in child participants' mean self-rated oral health scores (β = 0.78; 95% CI: 0.48, 1.087; P

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

Although some people within LGBTQ communities are at risk of developing some cancers at higher rates than non-LGBTQ people, there is limited evidence of the outcomes of targeted cancer prevention and screening interventions for these communities. This scoping review examined key findings regarding the feasibility, acceptability and efficacy of evaluated intervention studies conducted in high income settings and published in peer reviewed literature (2014-2020) by combining evidence of both cancer risk-reducing behavioural interventions and screening and preventative practice interventions. While there is limited evidence of stronger outcomes from targeted interventions with cohorts of gender and sexuality diverse communities, compared with the use of mainstream or untailored interventions, there is stronger evidence that targeted interventions are more acceptable to these communities and may be more feasible in some contexts. Thus, there is benefit in understanding what targeting entails in these interventions, and to understand what influences acceptability, to inform the design and delivery of such interventions.

Purpose of review The aim of this study was to briefly summarize the contribution of the PREDIMED (PREvencion con DIeta MEDiterranea) trial on cardiovascular evidence and examine in depth its groundbreaking trajectory.PREDIMED was conducted during 2003-2010 and represented the largest primary prevention trial ever testing the effects of changes in a complete food pattern (namely, the Mediterranean diet) on cardiovascular disease (CVD). Major contributions relied on the relevant changes in the food pattern attained by the behavioural intervention and their robust effect in reducing hard clinical end-points. Given some potential concerns, which were appropriately addressed with supporting analyses, this review is timely and relevant. Recent findings PREDIMED has continued contributing to the existing literature with extensive, robust and abundant new evidence on the benefits of the Mediterranean diet, particularly on cardiovascular health, including recent studies using high-throughput metabolomic techniques. After robustly addressing some controversies, the conclusions of the original trial remained unaltered. Summary The Mediterranean diet represents an effective and robust nutritional strategy against CVD in high cardiovascular risk populations. Recent findings from the PREDIMED have identified a metabolic signature of the Mediterranean diet that can objectively determine dietary adherence and predict CVD risk. This metabolomic signature opens up a new era for nutritional epidemiology and personalized nutrition.

Objective: Various smoke-free policies and practices (carbon monoxide monitoring, nicotine replacement therapy, pharmacotherapy, behavioural interventions) have been introduced to manage tobacco dependence in inpatient drug and alcohol facilities. Since the introduction of a smoke-free policy to our inpatient drug and alcohol facility, there has been no objective evaluation of its practices or patients’ views. Methods: We administered a questionnaire to 42 inpatients identified as smokers. A retrospective record review was performed on those patients for demographic data, substance use, psychiatric conditions and tobacco dependence assessment and management. Descriptive analyses and tests of association were conducted. Open-ended questions were subjected to content analysis. Results: Tobacco dependence assessment was mostly completed with daily cigarette consumption documented for 41 (98%), time to first cigarette for 39 (93%) and CO monitoring performed for 42 (100%) patients. Patients’ views of the various management strategies were positive, although many were underutilised. Those with high tobacco dependence were more likely to approve of nicotine replacement therapy patches than those with low tobacco dependence ( p = 0.009). Conclusion: The results demonstrate that while the various interventions provided were reported to be helpful, many were underutilised. Future research could consider why certain strategies were not utilised and help improve uptake.

Behavioural change techniques are currently used by many global organisations and public institutions. The amassing evidence base is used to answer practical and scientific questions regarding what cognitive, affective, and environment factors lead to successful behavioural change in the laboratory and in the field. In this piece we show that there is also value to examining interventions that inadvertently fail in achieving their desired behavioural change (e.g., backfiring effects). We identify the underlying causal pathways that characterise different types of failure, and show how a taxonomy of causal interactions that result in failure exposes new insights that can advance theory and practice.

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

Background There is a need to develop cost-effective weight loss maintenance interventions to prolong the positive impact of weight loss on health outcomes. Conducting pre-trial health economic modelling is recommended to inform the design and development of behavioural interventions. We aimed to use health economic modelling to estimate the maximum cost per-person (justifiable cost) of a cost-effective behavioural weight loss maintenance intervention, given an estimated intervention effect for individuals with: i) a Body Mass Index (BMI) of 28 kg/m2 or above without diabetes and ii) a diagnosis of type 2 diabetes prescribed a single non-insulin diabetes medication. Methods The School for Public Health Research Diabetes prevention model was used to estimate the lifetime Quality-adjusted life year (QALY) gains, healthcare costs, and maximum justifiable cost associated with a weight loss maintenance intervention. Based on a meta-analysis, the estimated effect of a weight loss maintenance intervention following a 9 kg weight loss, was a regain of 1.33 kg and 4.38 kg in years one and two respectively compared to greater regain of 2.84 kg and 5.6 kg in the control group. Sensitivity analysis was conducted around the rate of regain, duration of effect and initial weight loss. Results The justifiable cost for a weight loss maintenance intervention at an ICER of £20,000 per QALY was £104.64 for an individual with a BMI of 28 or over and £88.14 for an individual with type 2 diabetes. Within sensitivity analysis, this varied from £36.42 to £203.77 for the former, and between £29.98 and £173.05 for the latter. Conclusions Researchers developing a weight loss maintenance intervention should consider these maximum justifiable cost estimates and the potential impact of the duration of effect and initial weight loss when designing intervention content and deciding target populations. Future research should consider using the methods demonstrated in this study to use health economic modelling to inform the design and budgetary decisions in the development of a behavioural interventions.

Background There is a need for effective behavioural interventions in dentistry. This paper presents an innovative behavioural intervention for young adults with dental caries, in an interdisciplinary collaboration between dental personnel and licensed psychologist in general dental care. The intervention has been evaluated in an RCT, with positive effects on oral health behaviour. Method The intervention, Acceptance and Commitment Therapy (ACT), a recent form of cognitive behaviour therapy (CBT), was adapted to young adult patients (18–25 years of age) with high dental caries activity. Results The intervention included two individual sessions, provided by a clinical psychologist at general dental clinics. The rationale for selecting ACT as the theory base is presented, together with the treatment manual and a case illustration. Conclusions ACT may be a promising alternative for behavioural interventions in dentistry for patients with oral diseases, specifically dental caries. Interprofessional collaboration between psychologists and dental personnel opens up for new possibilities to help and treat patients with various health issues in public dental care. Trial registration TRN ISRCTN15009620www.isrctn.com, retrospectively registered 14/03/2018.

BACKGROUND AND AIMS: The development of cirrhosis-related smartphone applications for remote monitoring is increasing. Whether patients with cirrhosis will welcome such new technology, however, is uncertain. METHODS: We prospectively enrolled patients with cirrhosis (N = 102) to determine predictors of acceptance and utilization of a smartphone application for cirrhosis management using a 12-item Technology Acceptance Model (TAM) survey. Patients were then shown the EncephalApp(©) and evaluated for their willingness to download and use the application. RESULTS: Patients had a median age of 61.3 years and 63.7% had a history of hepatic decompensation. Intention to use the hypothetical application was associated with perceived usefulness (β: 0.4, 95% CI: 0.3–0.5) and the presence of a caregiver (β: 1.1, 95% CI: 0.2–2.0). Of the eligible participants, 71% agreed to download the EncephalApp(©) and the decision was influenced by computer anxiety, behavioural intent, caregiver presence and disease state factors. Actual usage was 32% and not associated with baseline characteristics or the technology acceptance model. CONCLUSIONS: Patient acceptance of smartphone applications for the management of cirrhosis is high and related to their attitudes towards technology and the presence of a caregiver. However, usage was low. Future research must employ behavioural interventions to optimize uptake and utilization of remote monitoring technology.

Objectives To describe how children’s time spent in the 24-h movement behaviours of physical activity (PA), sedentary behaviour (SB) and sleep change, individually and collectively, across the transition from primary to secondary school. Design Systematic review. Methods Six electronic databases were searched from January 1990 to May 2019. Eligibility criteria included longitudinal studies reporting time spent in PA, SB and/or sleep, with baseline assessments conducted during the last two years of primary school and at least one follow-up during the first two years of secondary school. For studies reporting only SB, this review considered those published from November 2015 onwards to update a previous systematic review. Results The present review identified six articles that reported changes in PA (n = 5) or PA and SB concurrently (n = 1). Most articles had a high risk of bias (n = 4/6). There was limited but consistent evidence of a change in PA over the school transition period; in particular a decrease in total daily PA and during specific time periods (i.e., in-school, after-school and leisure time). A concurrent but opposite change was observed in SB. No studies were identified that assessed changes in sleep, or all three movement behaviours concurrently. Conclusions Further research exploring concurrent changes in all movement behaviours (PA, SB and sleep) and associated factors is warranted to inform future behavioural interventions and policies for promoting an optimal 24 h movement behaviour pattern during this critical developmental period.

Objective: The effectiveness of a cognitive behavioural intervention to prevent perinatal depression in low-income Latina immigrant pregnant women and mothers receiving WIC services was evaluated i...

Internet-delivered intervention may be an acceptable alternative for the more than 90% of problem gamblers who are reluctant to seek face-to-face support. Thus, we aimed to (1) develop a low-dropout unguided intervention named GAMBOT integrated with a messaging app; and (2) investigate its effect. The present study was a randomised, quadruple-blind, controlled trial. We set pre-to-post change in the Problem Gambling Severity Index (PGSI) as the primary outcome and pre-to-post change in the Gambling Symptom Assessment Scale (G-SAS) as a secondary outcome. Daily monitoring, personalised feedback, and private messages based on cognitive behavioural theory were offered to participants in the intervention group through a messaging app for 28 days (GAMBOT). Participants in the control group received biweekly messages only for assessments for 28 days (assessments only). A total of 197 problem gamblers were included in the primary analysis. We failed to demonstrate a significant between-group difference in the primary outcome (PGSI - 1.14, 95% CI - 2.75 to 0.47, p = 0.162) but in the secondary outcome (G-SAS - 3.14, 95% CI - 0.24 to - 6.04, p = 0.03). Only 6.7% of the participants dropped out during follow-up and 77% of the GAMBOT group participants (74/96) continued to participate in the intervention throughout the 28-day period. Integrating intervention into a chatbot feature on a frequently used messaging app shows promise in helping to overcome the high dropout rate of unguided internet-delivered interventions. More effective and sophisticated contents delivered by a chatbot should be sought to engage over 90% of problem gamblers who are reluctant to seek face-to-face support.

This systematic review aims to evaluate the efficacy of cognitive and behavioral interventions for improving fall-related psychological concerns. A systematic search yielded eight randomized controlled trials eligible for inclusion. All studies compared a cognitive and behavioral intervention with a control. The meta-analysis showed that cognitive and behavioral treatments had beneficial effects on fear of falling outcomes (lower score better) immediately after treatment (random-effects standardized mean difference [SMD]: −0.3, 95% confidence interval [CI] [−0.50, −0.10]) and at the longer term follow-up (random-effects SMD: −0.29, 95% CI [−0.49, −0.09]). Cognitive and behavioral treatments also showed a positive effect on falls efficacy outcomes (higher score better) immediately after treatment (fixed-effects SMD: 0.19, 95% CI [0.04, 0.34]) and over the longer term (fixed-effects SMD: 0.13, 95% CI [−0.00, 0.25]). However, the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.

Aims To assess fidelity of the Healthier You: NHS Diabetes Prevention Programme (NHS‐DPP), a behavioural intervention for people in England at high risk of developing type 2 diabetes, to the specified programme features. Methods Document analysis of the NHS‐DPP programme specification, including National Institute for Health and Care Excellence (NICE) PH38 diabetes prevention guidance. This was compared with the intervention design (framework response documents and programme manuals) from all four independent providers delivering the NHS‐DPP. Documents were coded using the Template for Intervention Description and Replication framework (describing service parameters) and the Behaviour Change Technique Taxonomy v1. Results Providers demonstrated good fidelity to service parameters of the NHS‐DPP. The NHS‐DPP specification indicated 19 unique behaviour change techniques. Framework responses for the four providers contained between 24 and 32 distinct behaviour change techniques, and programme manuals contained between 23 and 45 distinct behaviour change techniques, indicating variation in behaviour change content between providers’ intervention documents. Thus, each provider planned to deliver 74% of the unique behaviour change techniques specified, and a large amount of behaviour change content not mandated. Conclusions There is good fidelity to the specified service parameters of the NHS‐DPP; however, the four providers planned to deliver approximately three‐quarters of behaviour change techniques specified by the NHS‐DPP. Given that behaviour change techniques are the ‘active ingredients’ of interventions, and some of these techniques in the programme manuals may be missed in practice, this highlights possible limitations with fidelity to the NHS‐DPP programme specification at the intervention design stage., What's new? The National Health Service (NHS) Diabetes Prevention Programme (NHS‐DPP) is a behavioural intervention for adults in England at risk of developing type 2 diabetes.This is the first fidelity evaluation and first known assessment of the behaviour change technique content of a national intervention.The NHS‐DPP intervention design demonstrated good fidelity to the service parameters itemized in the programme specification, but programme manuals included only 74% of the specified behaviour change techniques.As behaviour change techniques are active ingredients that produce behaviour change, this highlights possible limitations with fidelity to the NHS‐DPP programme specification and dilution of likely effect in NHS‐DPP delivery.

Background: There is growing evidence to suggest that children with neurodevelopmental disorders may evidence differences in their sensory processing. The aim of this study was to compare sensory processing patterns in three genetic syndromes associated with sensory difference. Methods: Sensory processing in Angelman syndrome (n = 91), Cornelia de Lange syndrome (n = 28) and Fragile X syndrome (n = 40) was examined using the informant report measure the Sensory Experiences Questionnaire (SEQ). Results: All three groups were associated with a heightened prevalence of unusual sensory processing in comparison with normative data, evidenced in over 80% of all participants. Cross-syndrome comparisons highlighted syndrome-specific sensory processing profiles, with heightened hypo responsivity in Cornelia de Lange syndrome and sensory seeking in Angelman syndrome. Conclusions: The results have important implications for the understanding of sensory processing in genetic syndromes and the development of tailored behavioural interventions.

Objective:To describe relationships among baseline characteristics, engagement indicators and outcomes for rural participants enrolled in SIPsmartER, a behavioural intervention targeting sugar-sweetened beverage (SSB) intake.Design:A secondary data analysis. Bivariate analyses determined relationships among baseline characteristics (e.g. age, gender, race, education, income), engagement indicators (completion of 6-month health screening, class attendance, call completion) and SSB outcomes (SSB ounce reduction (i.e. US fluid ounces; 1 US fl. oz = 29·57 ml), reduced ≥12 ounces, achieved ≤8 ounce intake). Generalized linear models tested for significant effects of baseline characteristics on engagement indicators and of baseline characteristics and engagement indicators on SSB outcomes.Setting:South-west Virginia, USA, a rural, medically underserved region.Participants:Participants’ (n 155) mean age was 41 years; most were female (81 %), White (91 %) and earned ≤$US 20 000 per annum (61 %).Results:All final models were significant. Engagement models predicted 12–17 % of variance, with age being a significant predictor in all three models. SSB outcome models explained 5–70 % of variance. Number of classes attended was a significant predictor of SSB ounce reduction (β = −6·12, P < 0·01). Baseline SSB intake significantly predicted SSB ounce reduction (β = −0·90, P < 0·001) and achieved ≤8 ounce intake (β = 0·98, P < 0·05).Conclusions:The study identifies several participant baseline characteristics that may impact engagement in and outcomes from a community-based intervention targeting SSB intake. Findings suggest greater attendance of SIPsmartER classes is associated with greater reduction in overall SSB intake; yet engagement variables did not predict other outcomes. Findings will inform the future implementation of SIPsmartER and research studies of similar design and intent.

Self-regulation processes assume a major role in health behaviour theory and are postulated as important mechanisms of action in behavioural interventions to improve health prevention and management. The need to better understand mechanisms of behaviour change interventions for cardiovascular diseases (CVD) called for conducting a meta-review of meta-analyses for interventions targeting self-regulation processes. The protocol, preregistered on Open Science Framework (OSF), found 15 eligible meta-analyses, published between 2006 and August 2019, which quantitatively assessed the role of self-regulatory mechanisms and behaviour change techniques (BCTs). Quality of the meta-analyses varied widely according to AMSTAR-2 criteria. Several BCTs, assumed to engage self-regulatory mechanisms, were unevenly represented in CVD meta-analytic reviews. Self-monitoring, the most frequently studied self-regulatory BCT, seemed to improve health behaviour change and health outcomes but these results merit cautious interpretation. Findings for other self-regulatory BCTs were less promising. No studies in the CVD domain directly tested engagement of self-regulation processes. A general challenge for this area stems from reliance on post-hoc tests of the effects of BCTs in multiple-component interventions. Recent advances in BCT taxonomies and the experimental medicine approach to engaging self-regulation mechanisms, however, provide opportunities to improve CVD prevention and management behavioural interventions.

ObjectiveLondon has one of the highest identified prevalence of chemsex (sexualised recreational drug use) among men who have sex with men (MSM) in Europe. We examine MSM’s patterns of chemsex and its association with HIV/STI risk behaviours, STI diagnoses and sexual healthcare-seeking behaviours, including if HIV testing behaviour met UK national guidelines (three monthly if engaging in chemsex).MethodsCross-sectional survey data from 2013 (n=905) and 2016 (n=739) were collected using anonymous, self-administered questionnaires from MSM recruited in commercial gay venues in London, UK. Descriptive and multivariable analyses, stratified by self-reported HIV status, were conducted. Adjusted prevalence ratios (aPR) with 95% CIs were calculated.ResultsComparing the 2013 and 2016 surveys, chemsex prevalence in the past year remained stable, in both HIV-negative/unknown-status MSM (20.9% in 2013 vs 18.7% in 2016, p=0.301) and HIV-positive MSM (41.6% in 2013 vs 41.7% in 2016, p=0.992). Combined 2013–2016 data showed that compared with other MSM, those reporting chemsex were more likely to report HIV/STI risk behaviours, including condomless anal intercourse with serodifferent HIV-status partners (HIV-negative/unknown-status men: aPR 2.36, 95% CI 1.68 to 3.30; HIV-positive men: aPR 4.19, 95% CI 1.85 to 9.50), and STI diagnoses in the past year (HIV-negative/unknown-status men: aPR 2.10, 95% CI 1.64 to 2.69; HIV-positive men: aPR 2.56, 95% CI 1.57 to 4.20). 68.6% of HIV-negative/unknown-status men reporting chemsex attended sexual health clinics and 47.6% had tested for HIV more than once in the past year.ConclusionsChemsex in London MSM remained stable but high, particularly among HIV-positive men. Irrespective of HIV status, chemsex was associated with engagement in HIV/STI risk behaviours. Frequency of HIV testing in the past year among HIV-negative/unknown-status men was below national recommendations. Promoting combination prevention strategies, including three monthly HIV/STI testing, access to pre-exposure prophylaxis/antiretroviral treatment and behavioural interventions among MSM reporting chemsex, remains vital to address sexual health inequalities in MSM.

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

Funding Information: The research conducted by D.M.H. and N.H. in this study was funded by the Fonds Wetenschappelijk Onder-zoek—Vlaanderen (Research Foundation—Flanders; FWO, http://www.fwo.be/en/) (Grant Agreements G0E8416N and G0B2317N). The research done by J.D.S. and A.M.V. in this study has been supported in part by Grants G.0692.14 and G0B2317N, funded by the FWO, Belgium. P.J.K.L. was supported By a PhD Grant of the FWO (1S31916N), and is currently funded via a post-doctoral fellowship (1242021N) of the FWO. WD was supported by a postdoctoral fellowship from FWO (12L5816N). Research done by V.M. in this study has been completed as part of the ELTE Thematic Excellence Programme 2020 supported by the National Research, Development and Innovation Office (TKP2020-IKA-05). The authors gratefully acknowledge support from the FWO Scientific Research Community on Network Statistics for Sexually Transmitted Diseases Epidemiology. The computational resources and services used in this work were provided by the VSC (Flemish Supercomputer Center), funded by the Research Foundation—Flanders (FWO) and the Flemish Government—department EWI. Publisher Copyright: © 2021, The Author(s). Model comparisons have been widely used to guide intervention strategies to control infectious diseases. Agreement between different models is crucial for providing robust evidence for policy-makers because differences in model properties can influence their predictions. In this study, we compared models implemented by two individual-based model simulators for HIV epidemiology in a heterosexual population with Herpes simplex virus type-2 (HSV-2). For each model simulator, we constructed four models, starting from a simplified basic model and stepwise including more model complexity. For the resulting eight models, the predictions of the impact of behavioural interventions on the HIV epidemic in Yaoundé-Cameroon were compared. The results show that differences in model assumptions and model complexity can influence the size of the predicted impact of the intervention, as well as the predicted qualitative behaviour of the HIV epidemic after the intervention. These differences in predictions of an intervention were also observed for two models that agreed in their predictions of the HIV epidemic in the absence of that intervention. Without additional data, it is impossible to determine which of these two models is the most reliable. These findings highlight the importance of making more data available for the calibration and validation of epidemiological models. publishersversion published

Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I2 = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.

This study reports on integrating community perspectives to adapt a family-focused, culturally appropriate behavioural intervention program to prevent diabetes among Aboriginal children (6–11 years) in Central Australia. A participatory action research approach was used to engage a range of service providers, cultural advisors, and family groups. Appropriateness, acceptability, content, and delivery of a prevention program within the Central Australian context were discussed through a series of workshops with twenty-five service providers and seven family groups separately. The data obtained were deductively coded for thematic analysis. Main findings included: (i) the strong need for a diabetes prevention program that is community owned, (ii) a flexible and culturally appropriate program delivered by upskilling community members as program facilitators, and (iii) consideration of social and environmental factors when implementing the program. It is recommended that a trial of the adapted prevention program for effectiveness and implementation is led by an Aboriginal community-controlled health service.

Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder. Lay abstract Interventions which are delivered in natural contexts and use both developmental and behavioural techniques may be helpful for children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation (JASPER) is a type of intervention, which falls under this category. Although several studies have examined the effects of JASPER, this has not yet been summarised in a review. This systematic literature review examined the effects of JASPER intervention, and the techniques that make up JASPER, on child, parent and educator outcomes. We screened 96 articles and, of these, 19 were included in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills, and language skills compared to children who did not receive JASPER intervention. Parents and educators were mostly able to use the JASPER techniques. There were no consistent child, parent, teacher or treatment characteristics that influenced the effects of the JASPER intervention. None of the studies met all of the indicators of being a good quality study outlined by the Council of Exceptional Children. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.

Funder: Mason Medical Research Foundation, Testing asymptomatic people for SARS-CoV-2 aims to reduce COVID-19 transmission. Screening programmes' effectiveness depends upon testing strategy, sample handling logistics, test sensitivity and individual behaviour, in addition to dynamics of viral transmission. The interaction between these factors is not fully characterized. We investigated the interaction between these factors to determine how to optimize reduction of transmission. We estimate that under idealistic assumptions 70% of transmission may be averted, but under realistic assumptions only 7% may be averted. We show that programmes that overwhelm laboratory capacity or reduce isolation of those with minor symptoms have increased transmission compared with those that do not: programmes need to be designed to avoid these issues, or they will be ineffective or even counter-productive. Our model allows optimal selection of whom to test, quantifies the balance between accuracy and timeliness, and quantifies potential impacts of behavioural interventions. We anticipate our model can be used to understand optimal screening strategies for other infectious diseases with substantially different dynamics.

BACKGROUND: Scant data exist on weight loss interventions for youth with intellectual disabilities (ID). OBJECTIVE: To compare weight loss among youth with ID randomized to a 6-month, family-based behavioural intervention (FBBI) or a waitlist and to compare weight loss among youth who completed a 6-month maintenance (FBBI-M) intervention to a control group (FBBI-C). METHODS: Youth with ID and overweight/obesity, aged 14–22 years, were randomized to the FBBI or to a waitlist and subsequently randomized to a maintenance intervention or a control group. Sessions were held weekly during the FBBI and biweekly during the FBBI-M. Using an intention-to-treat approach, we used linear mixed models to test differences in the change in weight and in BMI from the start of FBBI. RESULTS: The 24 participants who received the FBBI lost, on average (SE), 5.1 (1.1) kg (P < .001) over 6 months. The 13 participants who were waitlisted gained, on average (SE), 1.2 (1.6) kg over the 6-month waiting period. At 12 months, those who received FBBI-M lost, on average (SE), 4.4 (1.7) kg more than those who received FBBI-C (−7.6 vs −3.2 kg, P-value = .008). CONCLUSION: Participation in an intensive FBBI for weight loss with ID was efficacious, and continued participation in a maintenance intervention yielded additional weight loss.

Background Fidelity in complex behavioural interventions is underexplored and few comprehensive or detailed fidelity studies report on specific procedures for monitoring fidelity. Using Bellg’s popular Treatment Fidelity model, this paper aims to increase understanding of how to practically and comprehensively assess fidelity in complex, group-level, interventions. Approach and lessons learned Drawing on our experience using a mixed methods approach to assess fidelity in the INFORM study (Improving Nursing home care through Feedback On perfoRMance data—INFORM), we report on challenges and adaptations experienced with our fidelity assessment approach and lessons learned. Six fidelity assessment challenges were identified: (1) the need to develop succinct tools to measure fidelity given tools tend to be intervention specific, (2) determining which components of fidelity (delivery, receipt, enactment) to emphasize, (3) unit of analysis considerations in group-level interventions, (4) missing data problems, (5) how to respond to and treat fidelity ‘failures’ and ‘deviations’ and lack of an overall fidelity assessment scheme, and (6) ensuring fidelity assessment doesn’t threaten internal validity. Recommendations and conclusions Six guidelines, primarily applicable to group-level studies of complex interventions, are described to help address conceptual, methodological, and practical challenges with fidelity assessment in pragmatic trials. The current study offers guidance to researchers regarding key practical, methodological, and conceptual challenges associated with assessing fidelity in pragmatic trials. Greater attention to fidelity assessment and publication of fidelity results through detailed studies such as this one is critical for improving the quality of fidelity studies and, ultimately, the utility of published trials. Trial registration ClinicalTrials.gov NCT02695836. Registered on February 24, 2016

The purpose of the pilot MOVE-C study was to examine the effects of a 12-week high-intensity interval training (HIIT) plus lifestyle education program on quality of life (QoL), behavioural and psychosocial outcomes among inactive adults with coeliac disease.This study used a 3 (time: baseline, immediately post and three months post) × 2 (group: experimental versus waitlist control) mixed design. After completing baseline testing, 41 participants were randomised to one of two groups: HIIT + or waitlist control (WLC). The HIIT + intervention involved twice-weekly HIIT, during which participants progressed to 14 × 30 s intervals (90% heart rate max; HRmax), with 2-minute recovery (50% HRmax). The HIIT + intervention also included six bi-weekly education sessions.Participants in HIIT + reported significant improvements in QoL and exercise behaviour immediately post-intervention, and this was sustained three months post-intervention, whereas no changes in QoL nor exercise behaviour were reported in WLC. Improvements were also reported among HIIT + immediately after the intervention for gastrointestinal symptoms and self-compassion. All participants reported significant improvements in adherence to a GFD immediately post-intervention.Findings from this pilot study provide preliminary evidence that a tailored exercise and lifestyle intervention can lead to improved QoL, exercise behaviour, gastrointestinal symptoms and self-compassion among inactive adults with coeliac disease.

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

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

Background: Oral disease is one of the most prevalent chronic health conditions affecting children. Twice-daily toothbrushing is recommended to promote good oral health; however, a large proportion of Australian families are not meeting this recommendation. Aim: This study aimed to identify important barriers to regular toothbrushing for young children. Design: In this study, 239 parents of 0- to 4-year-old children completed an online survey that investigated child, family, and parent factors associated with child toothbrushing. Hierarchical linear regression was used to identify predictors of toothbrushing frequency in children and perceived difficulty of the task by parents. Results: We found that parent factors, specifically oral health knowledge, were the most significant predictors of toothbrushing frequency. Conversely, parent factors did not contribute significantly to the prediction of perceived difficulty of toothbrushing once family and child factors were taken into account. Oral health knowledge and use of routines were identified as the most important predictors of toothbrushing frequency, whereas resistant child behaviour and household organisation were found to be the most important predictors of perceived difficulty of regular toothbrushing. Conclusions: The findings of the study have implications for behavioural interventions to support parents, as well as directions for future research.

Objective The objective of this study was to explore factors influencing patients with hypertension to participating in a hypertension self-management education (HSME) programme and challenges of sustaining the learnt self-care practices. Study design This was a qualitative study with focus group discussions. Methods Focus group discussions using a semistructured moderator guide were conducted among participants who had attended the HSME programme. Data were audio recorded, transcribed verbatim and analysed using a thematic analysis approach. Results Three focus groups involving 19 participants were conducted. Four major themes emerged from the data collected. Most participants enjoyed the group-based HSME sessions because sharing experiences with those having similar health problems can reduce their sense of isolation. However, the participants highlighted the difficulty in sustaining self-care practices in the presence of friends and family influences. Conclusion A number of patient-, family- and community-level motivators and barriers to patients' hypertension self-management have been identified. Efforts to tailor behavioural interventions to sustain daily self-care activities during social and cultural events are imperative.

Vertigo is associated with a wide range of vestibular pathologies. It increasingly affects the elderly, with a high cost to society. Solutions include vestibular suppressants and vestibular rehabilitation, which form the mainstay of therapy. Antihistamines represent the largest class of agents used to combat vestibular vertigo symptoms. Agents targeting the H(1) and H(3) receptors have been in clinical use for several decades as single agents. Nonetheless, effective management of vertigo proves elusive as many treatments largely address only associated symptoms, and with questionable efficacy. Additionally, the primary and limiting side effect of sedation is counterproductive to normal functioning and the natural recovery process occurring via central compensation. To address these issues, the timing of administration of betahistine, the mainstay H(3) antihistamine, can be fine‐tuned, while bioavailability is also being improved. Other approaches include antihistamine combination studies, devices, physical therapy and behavioural interventions. Recently demonstrated expression of H(4) receptors in the peripheral vestibular system represents a new potential drug target for treating vestibular disorders. A number of novel selective H(4) antagonists are active in vestibular models in vivo. The preclinical potential of SENS‐111 (Seliforant), an oral first‐in‐class selective H(4) antagonist is the only such molecule to date to be translated into the clinical setting. With an excellent safety profile and notable absence of sedation, encouraging outcomes in an induced vertigo model in healthy volunteers have led to ongoing clinical studies in acute unilateral vestibulopathy, with the hope that H(4) antagonists will offer new effective therapeutic options to patients suffering from vertigo.

Introduction In recent years, prescription drug misuse has become a common issue among adolescents and young adults in many countries, with, for example, a lifetime prevalence of 12% among individuals aged 12-17 in 2017 in United States. Purpose of review To summarize recently published studies about prescription drug misuse among adolescent and young adults. Recent findings Prescription drug misuse has many definitions, one being any medication taken in a way other than prescribed, whether related to dosage or manner of usage. Among adolescents, it has a relationship with illicit drug use, decline in academic performance, future delinquency, and mental problems. Individual predisposing factors include identity crisis and role confusion, and there are also environmental influences. Preventive approaches include the use of monitoring systems. Management involves initial assessment and treatment, which largely focuses on behavioural interventions. Summary Further understanding of risk and protective factors, co-occurring issues, and treatment can help prevent and reduce the prevalence of prescription drug misuse. Collaboration among government, clinicians, and patients is urged to combat this growing issue.

Aims This review aimed at investigating fruit, vegetable and legume consumption, salt/sodium intake, and the adherence to the Mediterranean dietary pattern in adolescents, three key aspects towards the adoption of a healthy diet. Data synthesis Three separate searches were carried out on PubMed and Scopus, using the same procedure, searching for studies published in the previous decade with data on fruit and/or vegetable or legume consumption, salt or sodium intake, and adherence to the Mediterranean Diet assessed using the KIDMED questionnaire. The review included a total of 58 papers, which describe original investigations on healthy adolescents (10–19 years old) living in North America, Europe or Oceania, with a sample size >150 participants. The average fruit and vegetable consumption has been found strongly below the recommended values of 400 grams or 5 portions per day in almost all the examined populations. Very little is known about adolescents' legume consumption. Few available data have been found also for sodium intake and, for the majority of the screened populations, levels were far above the recommended 5 grams per day. Lastly, a medium–low adherence to the Mediterranean Diet has been found for adolescents living in Mediterranean Countries. Conclusions Adolescents living in North America, Europe or Oceania are far from being compliant with the nutritional recommendations for fruit, vegetables, legumes, and sodium, and they do not follow the principles of the Mediterranean Diet. Educational and behavioural interventions are required to improve adolescents' dietary patterns.

Background Depression is common among chronic heart failure (CHF) patients, and it is associated with significant re-hospitalization and mortality as well as lower quality of life. While psychotherapy is efficacious treatment for depression, the effect for depression among CHF is uncertain. And barriers preclude widely utility of psychotherapy among the elderly. Telephone-delivered psycho-behavioural intervention specifically focuses on depression among the elderly with CHF, and could be a promising alternative to conventional treatment. The present study was designed to prospectively investigate the effect of a telephone-delivered psycho-behavioural intervention on depression in the elderly with chronic heart failure (CHF). Method/design In this prospective, multicentre, parallel, randomized, and controlled trial, 236 participants with depression associated with CHF (New York Heart Association classes II and III) will be enrolled. The study will consist of a 12-week intensive intervention and a 24-week maintenance intervention. Eligible participants will be randomized to either the intervention arm or the control arm. During the intensive phase, participants will receive either a guided telephone psycho-behavioural intervention or regular telephone contacts from the counsellors weekly. During the maintenance phase, participants will receive either psychological behavioural support or regular telephone contacts monthly from counsellors. Depressive symptoms, cardiac outcome and quality of life will be assessed at baseline and weeks 1, 2, 4, 8, 12, 24 and 36. Participants will undergo echocardiography and the plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) tested at baseline, weeks 12 and 36. The primary outcome is the response rate of depression, from baseline to week 12. The second outcomes include the change in cardiac function, quality of life and severity of depressive symptoms during the trial. Discussion To our knowledge, this study is the first prospective randomized trial to test the effective of the telephone-delivered psycho-behavioural intervention on depression in the elderly with CHF. The findings are expected to provide a new and evidence-based approach for depression among the elderly with CHF. Trial registration The trial was registered at www.clinicaltrials.gov (identification number: NCT03233451) on 28 July 2017 and updated on 18 August 2017.

Whilst self-care programme involving comprehensive lifestyle plans including physical and behavioural interventions have reported positive outcomes for the aged suffering from urinary incontinence (UI), very few programmes have been implemented amongst Iranian nursing home residents, particularly in men.The aim of this study was to examine the effect of a self-care programme on UI and self-esteem in elderly men dwelling in nursing homes in Iran.Sixty-one elderly men (aged 60-75 years of age), at two different sites and living in nursing homes in the west of Iran, suffering from urinary incontinence were included in this study. Participants were selected using convenience sampling based on selected and randomized criteria in experimental and control groups. Data collection tools included Mini-Mental State Examination (MMSE), Rosenberg Self-Esteem Scale Questionnaire (RSES), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and demographic information form. Data were analysed using SPSS vesion18 (SPSS Inc., Chicago, IL).A significant decrease in the mean scores of ICIQ-SF in the experimental group compared with the control group following intervention (The study findings demonstrate that the self-care programme significantly reduced UI in elderly men living in nursing homes, and that this in turn contributed to boosting their self-esteem. Implementing such an intervention has shown to be useful in managing both UI and improving self-esteem in this patient population.

AIMS: Using an 18-month, multisite randomized control trial as an exemplar, the aim of this study was to identify themes related to adolescent and parental feasibility and acceptability for participation in large behavioural trials designed to improve adolescents’ Type 1 diabetes self-management. METHODS: Thematic analysis methodology was used to develop themes describing factors related to acceptability and feasibility. RESULTS: Based on a sample of interviews (N = 72), factors contributing to intervention acceptability and feasibility were identified. Aspects of acceptability included: a framework for goal-setting, the coach as a non-judgemental listener, perception of an ongoing benefit to participation and the delivery mode. Aspects of feasibility included: participants’ altruism to help adolescents with Type 1 diabetes; pre-enrolment preparation for intervention content and duration; and the option of remote intervention delivery via telephone or video, which minimized travel time and costs. In addition, participants described positive outcomes including improvements in behaviour, Type 1 diabetes self-management behaviours and parent–adolescent communication, and emotion–attitude changes. Participants also described potential revisions that may inform future trials. CONCLUSIONS: Acceptability and feasibility of behavioural interventions with adolescents with chronic illness have multifactorial dimensions. While empowering adolescent self-management, parental support is also an under-appreciated aspect to consider. Potential revisions were identified for subsequent behavioural trials.

Background Community based providers are well place to deliver behavioural interventions to improve health. Good project management and reliable outcome data are needed to efficiently deliver and evaluate such interventions, and Management information systems (MIS) can facilitate these processes. We explored stakeholders perspectives on the use of MIS in community based behavioural interventions. Methods Stakeholders, purposively selected to provide a range of MIS experience in the delivery of community based behavioural interventions to improve health (public health commissioners, intervention service managers, project officers, health researchers and MIS designers), were invited to participate in individual semi-structured interviews. We used a topic guide and encouraged stakeholders to reflect on their experiences.: Interviews were recorded, transcribed and analysed using five steps of Framework analysis. We applied an agreed coding framework and completed the interviews when no new themes emerged. Results We interviewed 15 stakeholders. Key themes identified were: (i) MIS access; (ii) data and its function; (iii) MIS development and updating. Within these themes the different experiences, needs, use, training and expertise of stakeholders and the variation and potential of MIS were evidenced. Interviews advised the need to involve stakeholders in MIS design and development, build-in flexibility to accommodate MIS refinement and build on effective MIS. Conclusions Findings advised involving stakeholders, early in the design process. Designs should build on existing MIS of proven utility and ensure flexibility in the design, to incorporate adaptations and ongoing system development in response to early MIS use and evolving stakeholder needs. Electronic supplementary material The online version of this article (10.1186/s12889-018-6363-z) contains supplementary material, which is available to authorized users.