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BACKGROUND AND OBJECTIVES Several approaches are currently under study to contribute to efforts to allow men who have sex with men (MSM) to donate blood. One of these approaches involves implementing a programme of plasma donation for fractionation, with a quarantine period. The goal of this article is to identify the determinants of intention to participate in the plasma donation programme among MSM in Montreal, Canada. MATERIALS AND METHODS Based on the theory of planned behaviour, a questionnaire was developed to measure MSM's intention to donate plasma and identify influencing factors. A multiple linear regression analysis was conducted to identify the determinants of intention to donate plasma. RESULTS Respondents' (N = 933) intention to donate plasma in the next six months was moderate. The multiple linear regression model explained 55% (P

AIMS AND OBJECTIVES The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). BACKGROUND Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. DESIGN Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. METHODS The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157). RESULTS Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. CONCLUSION Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. RELEVANCE TO CLINICAL PRACTICE The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

Experience has a paradoxical effect on intention-behavior consistency. In some studies greater experience is associated with weaker intention-behavior relations (due to habit formation), whereas in other studies experience strengthens the relationship between intention and behavior (by stabilizing intentions). The present research tests the idea that both of these findings are possible—because experience produces a quadratic relationship between intentions and behavior. Findings from a longitudinal study of blood donors (N = 2,389) indicated that the intention-behavior relation exhibited the predicted inverted U-shaped curve as a function of lifetime donation experience. Greater experience of donation enhanced the predictive validity of intention up to a point; thereafter, increasing experience was associated with weaker prediction of donation behavior by intention. These findings are consistent with the idea that experience both strengthens and weakens the intention-behavior relation and helps to...

Background and objectives In Canada, Hema-Quebec is considering the possibility of allowing men who have sex with men (MSM) to donate plasma for fractionation combined with a mandatory quarantine period. This study aims to assess the acceptability and operational feasibility of the programme in the targeted population. Materials and methods Seven focus groups with MSM (N = 47) were conducted in Montreal, regarding their beliefs underlying attitudes, subjective norms and perceived behavioural control relating to intention to participate in a programme of plasma donation for fractionation. A theoretical thematic content analysis was realized. Results Participants brought up benefits of the programme. Some are altruistic (help others, save lives, contribute as citizens), while others are linked to what it could bring to their community (progress, opportunity to include MSM in blood donation programmes, acknowledgement of MSM's contributions to the well-being of others). However, even if the programme is in accordance with their altruistic values, it clashes with their values of equality and social justice. Many disadvantages were raised (discrimination and stigmatization of MSM, the fact that their blood is presented as being not as good as the blood of others). Facilitating factors and barriers to participation were put forward in terms of programme characteristics and sites where donations would be made. Conclusion The findings suggest some interest in the programme of plasma donation for fractionation, but this is significantly tempered by the fact that differential treatment for MSM would continue and that their demands regarding access to whole blood donation are still unmet.

BACKGROUND Recruiting new donors is a challenging experience for most blood collection agencies. A modest proportion of the population is eligible to give blood and few of these individuals volunteer. The goal of this study was to examine the effects of brief behavioral interventions on nondonors’ intention to give blood, by addressing some commonly reported obstacles. STUDY DESIGN AND METHODS A total of 244 young adults who were eligible to give blood but had never done so participated in the study. They were assigned randomly to an applied tension (AT) instruction condition, a relaxation instruction condition, a Web browsing condition, or a no-treatment control condition. After the 20-minute experimental intervention, half watched three short injection and blood draw videos and the others sat quietly. Intention to give blood and different cognitive constructs associated with blood donation were measured using a Theory of Planned Behavior questionnaire. RESULTS Participants in all three active conditions had significantly greater increases in intention to donate blood compared to controls, although those who learned AT had greater increases than Web browsing. Bootstrapping tests of mediation indicated particular importance of increased perceived behavioral control in AT and relaxation treatment effects. Follow-up analyses revealed a significant association between degree of within-session increase in intention and subsequent blood clinic attendance. CONCLUSION These results suggest that simple interventions can be effective in increasing nondonors’ intention to donate blood and, perhaps, actual attendance. The mediational analyses suggest that interventions can selectively target different barriers associated with blood donation.

This study provides evidence of construct validity for the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), a 1-item instrument used among 236 participants referred for cardiopulmonary exercise testing. The Baecke Habitual Physical Activity Questionnaire (Baecke-HPA) was used to evaluate convergent and divergent validity. The self-reported measure of walking (QCAF) evaluated the convergent validity. Cardiorespiratory fitness assessed convergent validity by the Veterans Specific Activity Questionnaire (VSAQ), peak measured (VO2peak) and maximum predicted (VO2pred) oxygen uptake. Partial adjusted correlation coefficients between the GSLTPAQ, Baecke-HPA, QCAF, VO2pred and VSAQ provided evidence for convergent validity; while divergent validity was supported by the absence of correlations between the GSLTPAQ and the Occupational Physical Activity domain (Baecke-HPA). The GSLTPAQ presents level 3 of evidence of construct validity and may be useful to assess leisure-time physical activity among patients with cardiovascular disease and healthy individuals.

Excessive salt intake has been directly associated with cardiovascular diseases, especially hypertension, and non-cardiovascular diseases. Despite the current recommendations, salt intake remains high, indicating the need to develop theory-based interventions aimed at reducing this intake.The purpose of this study was to test the impact of a theory-based intervention - the SALdável Program - to promote the use of less than 4 g of salt/day during cooking.This was a two-arm parallel-group randomized study. A total of 92 hypertensive women were randomly assigned to an intervention or control group. The intervention was aimed at motivating participants to reduce salt addition by increasing self-efficacy and counteracting the negative influence of habit. Primary outcomes were the behavioral question of salt addition and total salt addition, secondary outcomes were overall salt intake, provided by 24-hour urinary sodium excretion, and psychosocial variables (intention, self-efficacy, and habit).At three-month follow-up, the intervention group improved significantly more than the control group regarding salt addition measures (p-values between 0.05 and 0.001) and psychosocial variables (all p-values ⩽0.001). The reduction in 24-hour urinary sodium excretion was not significant.The findings showed that this theory-based intervention was effective to motivate and change the behavior of hypertensive women regarding daily salt use in cooking meals. This was accomplished by means of improvements in intention and self-efficacy and reduction of the habit of using more than 4 g of salt/day during cooking.

Background: Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. Research objective: The purpose of this study was to identify the psychosocial determinants of nurses’ intention to practise euthanasia in palliative care if it were legalised. Research design: A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. Participants and research context: A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. Ethical considerations: The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. Findings: The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1–7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50–6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58–5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Discussion: Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses’ moral norm was related to beneficence, an ethical principle. Conclusion: To our knowledge, this is the first study to identify nurses’ motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses’ moral norm and intention.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Our main goal is to provide knowledge about the effectiveness and adoption factors of ICT interventions on SRH promotion and HIV/AIDS prevention among adolescents and young adults. Primary objective: To assess the effectiveness of ICT interventions for SRH promotion including HIV/AIDS prevention among adolescents and young adults. Interventions of interest are the behavioral ones, aimed at SRH promotion and primary prevention of HIV in heterosexual adolescents and young adults. Three comparisons are then planned: 1‐ ICT intervention versus no intervention; 2‐ ICT intervention versus other interventions not using ICT; 3‐ ICT intervention versus another ICT intervention. To assess the influence of specific factors across studies, subgroup comparisons will be conducted with respect to the characteristics of technology, intervention and recipients. The following characteristics provide potential categories for grouping studies, but the number of subgroup comparisons will depend on the characteristics of the studies included in the review. Characteristics of technology: internet (internet‐based, web‐based and online intervention), computer, cell phone, Personal Digital Assistance, CD‐Rom, interactive video, telemedicine/telehealth, etc. Characteristics of interventions: clinic‐based, school‐based, population‐based, community‐based, peer‐support, tailored, targeted, theory‐based, etc. Characteristics of recipients: gender (male, female), age (adolescents, young adults), place of residence (urban, rural). Secondary objective: To identify factors of applicability of ICT interventions in SRH promotion and HIV/AIDS prevention among adolescents and young adults. We will develop the discussion on the limitations and opportunities of ICT approaches (access, cost, ease of use, confidentiality/privacy, etc.).

This study tested the efficacy of interventions to recruit new plasma donors among whole blood donors. A sample of 924 donors was randomized to one of three conditions: control; information only by nurse; and information plus self-positive image message by nurse (SPI). Participants in the control condition only received a leaflet describing the plasma donation procedure. In the two experimental conditions the leaflet was explained face-to-face by a nurse. The dependent variables were the proportion of new plasma donors and the number of donations at six months. Overall, 141 (15.3%) new plasma donors were recruited at six months. There were higher proportions of new plasma donors in the two experimental conditions compared to the control condition (P<.001); the two experimental conditions did not differ. Also, compared to the control condition, those in the experimental conditions (all Ps<.001) gave plasma more often (information only by nurse: d=.26; SPI: d=.32); the SPI intervention significantly outperformed (P<.05) the information only by nurse condition. The results suggest that references to feelings of SPI such as feeling good and being proud and that giving plasma is a rewarding personal experience favor a higher frequency of plasma donation.

OBJECTIVE: This study tested key variations in the question-behavior effect against a control condition or an implementation intention condition on returning to give blood among lapsed donors (individuals who had not given blood in the past 2 years). DESIGN: At baseline, 7,000 lapsed donors were randomized to 1 of 6 experimental conditions or to a control condition. Participants in the experimental conditions were asked to complete a 6-item postal questionnaire assessing intentions only, interrogative intention, moral norm plus intention, anticipated regret plus intention, positive self-image plus intention, or implementation intentions. OBJECTIVE measures of behavior were obtained 6 and 15 months later. The frequency of registrations to give blood over the next 6 and 15 months was measured. RESULTS: Intention-to-treat analysis of the frequency of registrations (GENMOD procedure, Poisson distribution) indicated main effects for condition (experimental vs. control) at both 6 months, χ²(1) = 4.64, p < .05, and 15 months, χ²(1) = 5.88, p < .05. Positive self-image and implementation intention interventions outperformed the control condition at 6 months. At 15 months, standard intention, interrogative intention, and regret plus intention conditions showed more frequent registrations compared with control and were just as effective as implementation intention formation. Moderation analysis showed that the moral norm and positive self-image conditions were significant for first-time (1 previous donation) but not repeat (2 or more previous donations) donors. CONCLUSION: The question-behavior effect can be used to reinvigorate blood donation among lapsed donors, and can be as effective as forming implementation intentions.

The purpose of this study was to provide three construct validity evidence for using fitness center attendance electronic records to objectively assess the frequency of leisure-time physical activity among adults. One hundred members of a fitness center (45 women and 55 men; aged 18 to 64 years) completed a self-report leisure-time physical activity questionnaire. The theory of planned behavior constructs (e.g., intention and perceived behavioral control), VO2max, and % BF were assessed. Fitness center attendance electronic records were expressed as the weekly mean number of mandatory check-in records retrieved from the fitness center's electronic database over a 12-week period prior to participant's physical fitness evaluation. A continuous (frequency) and categorical (“adherent” versus “non-adherent”) scores were computed. Results indicated that perceived behavioral control was associated with fitness center attendance electronic records and mediated the fitness center attendance electronic records–inte...

Background The aim of the study was to predict a first lifetime plasma donation among whole blood donors. Study Design and Methods A sample of 252 whole blood donors, who never donated plasma, completed the study questionnaire assessing intention, attitudes, subjective norm, and perceived behavioral control toward giving plasma. The dependent variables were intention to give plasma and first lifetime plasma donation within 6 months. Results At 6 months, 57 individuals had made 98 plasma donations. First lifetime plasma donation was predicted by intention (p

OBJETIVO: Realizar adaptação cultural para versão brasileira do questionário de atividade física no tempo de lazer e avaliar a validade de conteúdo, praticabilidade, aceitabilidade e confiabilidade.MÉTODOS: Foram realizadas as etapas de tradução, síntese, retrotradução, avaliação por comitê de especialistas e pré-teste, seguidos pela avaliação da praticabilidade, aceitabilidade e confiabilidade (teste-reteste). Os juízes avaliaram as equivalências semântico-idiomática, conceitual, cultural e metabólica. A versão adaptada foi submetida ao pré-teste (n = 20) e teste-reteste (n = 80) em indivíduos saudáveis e pacientes com doenças cardiovasculares, em Limeira, SP, entre 2010 e 2011. A proporção de concordância do comitê de juízes foi quantificada por meio do Índice de Validade de Conteúdo. A confiabilidade foi avaliada segundo critério de estabilidade, com intervalo de 15 dias entre as aplicações, a praticabilidade pelo tempo gasto na entrevista e a aceitabilidade pelo percentual de itens não respondidos e proporção de pacientes que responderam a todos os itens.RESULTADOS: A versão traduzida do questionário apresentou equivalências semântico-idiomática, conceitual, cultural e metabólica adequadas, com substituição de algumas atividades físicas mais adequadas para a população brasileira. A análise da praticabilidade evidenciou curto tempo de aplicação do instrumento (média de 3,0 min). Quanto à aceitabilidade, todos os pacientes responderam a 100% dos itens. A análise do teste-reteste sugeriu estabilidade temporal do instrumento (Índice de Correlação Intraclasse = 0,84).CONCLUSÕES: A versão brasileira do questionário apresentou propriedades de medida satisfatórias. Recomenda-se sua aplicação a populações diversas em estudos futuros, a fim de disponibilizar propriedades de medida robustas. OBJETIVO: Realizar adaptación cultural para la versión brasileña del cuestionario de actividad física en el tiempo de descanso y evaluar la validez del contenido, factibilidad, aceptabilidad y confiabilidad.MÉTODOS: Se realizaron las etapas de traducción, síntesis, retro-traducción, evaluación por comité de especialistas y pre-prueba, seguidos por la evaluación de la factibilidad, aceptabilidad y confiabilidad (prueba- re-prueba). Los árbitros evaluaron las equivalencias semántico-idiomática, conceptual, cultural y metabólica. La versión adaptada fue sometida a la pre-prueba (n=20) y prueba-re-prueba (n=80) en individuos saludables y pacientes con enfermedades cardiovasculares, en Limeira, SP, Brasil, entre 2010 y 2011. La proporción de concordancia del comité de árbitros fue cuantificada por medio de índice de validez de contenido. La confiabilidad fue evaluada según criterio de estabilidad, con intervalo de 15 días entre las aplicaciones, la factibilidad por el tiempo de gasto en la entrevista y la aceptabilidad por el porcentaje de ítems no respondidos y proporción de pacientes que respondieron a todos los ítems.RESULTADOS: Las versión traducida del cuestionario presentó equivalencias semántico-idiomática, conceptual, cultural y metabólica adecuadas, con sustitución de algunas actividades físicas más adecuadas para la población brasileña. El análisis de la factibilidad presentó corto tiempo de aplicación del instrumento (promedio de 3,0 min). Con relación a la aceptabilidad, todos los pacientes respondieron a 100% de los itens. El análisis de la prueba-re-prueba sugirió estabilidad temporal del instrumento (índice de correlación intraclase = 0,84).CONCLUSIONES: La versión brasileña del cuestionario presentó propiedades de medida satisfactorias. Se recomienda su aplicación a poblaciones diversas en estudios futuros, a fin de dejar disponibles las propiedades de medida robustas. OBJECTIVE: To conduct the cultural adaptation of the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and to assess its content validity, practicability, acceptability and reliability.METHODS: The stages of translation, synthesis, back translation, expert committee review and pre-test were carried out, followed by the evaluation of the practicability, acceptability and reliability (test-retest). The judges assessed its semantic, idiomatic, conceptual, cultural and metabolic equivalences. The adapted version was submitted to the pre-test (n = 20), and test-retest (n = 80), in healthy individuals and in those suffering from cardiovascular disease in Limeira, SP, Southeastern Brazil, between 2010 and 2011. The proportion of agreement of the committee of judges was assessed using the Content Validity Index. Reliability was assessed by the criterion of stability, with 15 days between applications. Practicability was evaluated by the time spent interviewing and acceptability was estimated as the percentage of unanswered items and the proportion of patients who responded to all items.RESULTS: The translated version of the questionnaire showed evidence of appropriate semantic-idiomatic, conceptual, cultural and metabolic equivalence, with substitutions of several physical activities more appropriate to the Brazilian population. The practicability analysis showed short time needed for the application of the instrument (mean 3.0 minutes). As for acceptability, all patients answered 100% of the items. The test-retest analysis suggested that stability was good (Intraclass Correlation Coefficient value of 0.84).CONCLUSIONS: The Brazilian version of the questionnaire showed satisfactory measures of the qualities in question. Its application to diverse populations in future studies is recommended in order to provide robust measures of these qualities.

The aim of this study was to identify the psychosocial and socio-demographic determinants of physical activity maintenance (PAM) among adults by examining baseline differences between individuals who did and did not maintain physical activity participation over time (Part-I) and by examining how well combinations of psychosocial constructs and socio-demographic characteristics predict PAM (Part-II). Longitudinal and experimental studies (sample mean age 18–64 years) published between 1980 and 2010 were included. Independent data extraction was performed by two reviewers. All pooled effect sizes were calculated with the inverse-variance method under the random-effects model assumption. A total of 31 and 22 studies met all inclusion criteria and were included in Part-I and Part-II meta-analysis, respectively. Maintainers had higher [standard mean difference (95%CI)] self-efficacy (0.62 [0.49, 0.76]) and intention (0.65 [0.52, 0.79]) compared with relapsers. Health status directly affected PAM and m...

Implementation intentions are a powerful strategy to promote health-related behaviours, but mixed results are observed regarding physical activity. The primary aim of this study was to systematically and quantitatively review the literature on the effectiveness of implementation intentions on physical activity. The second aim was to identify conditions under which effectiveness is optimal. A literature search was performed in several databases for published and non-published reports. The inverse variance method with random effect model was used for the meta-analysis of results. Effect sizes were reported as standard mean differences. Twenty-six independent studies were included in the systematic review. The overall effect size of implementation intentions was 0.31, 95% confidence intervals (CI) [0.11, 0.51] at post-intervention and 0.24, 95% CI [0.13, 0.35] at follow-up. The duration of follow-up had no significant effect on effect size (F(1, 18) = 0.21, p=0.66. This strategy was more effective a...

The consumption of omega-3 (n-3) fatty acids (FA), namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been linked to reduced cardiovascular disease (CVD) risk. The objective of this study was to examine the relation between n-3 FA in plasma phospholipid (PL) levels and CVD risk factors. n-3 FA levels in plasma PL were determined using gas chromatography in 100 obese (body mass index (BMI), ≥30 kg·m−2) and 100 nonobese selected individuals from the Quebec City metropolitan area. The CVD risk factors analysed were BMI, blood pressure, plasma lipids levels, and fasting plasma glucose. Significantly higher levels of alpha-linolenic acid (ALA) and docosapentaenoic acid (DPA) were observed in obese subjects, whereas significantly higher levels of DHA were observed in nonobese subjects. For CVD risk factors, ALA levels were positively correlated with plasma triglyceride concentrations and negatively associated with diastolic blood pressure. None of the CVD risk factors studied was linked to EPA levels. In addition, DPA was negatively related to high-density lipoprotein cholesterol (HDL-C) and positively correlated with the total cholesterol/HDL-C ratio. DHA levels were negatively correlated with BMI, waist circumference, and plasma triglyceride levels, whereas a positive association was observed with HDL-C levels. Total n-3 FA percentages were negatively correlated with BMI. In conclusion, higher DHA percentages in plasma PL are associated with a more favourable CVD risk profile, whereas higher DPA percentages in plasma PL are associated with a more deteriorated CVD risk profile.

Objective The present research assessed the simultaneous effects of four attitude variables (cognitive attitudes, affective attitudes, anticipated negative affective reactions, and anticipated positive affective reactions) in the context of the theory of planned behavior (TPB) on blood-donation intentions and behavior. Methods Experienced blood donors (N = 1108) completed questionnaires measuring attitude variables plus components of the TPB and a measure of attitudinal ambivalence in relation to giving blood again in the next six months. Records were used to assess whether participants subsequently donated blood again in the six months after completing the questionnaire. The main outcome measures were objectively assessed blood donation and intentions to make an additional donation of blood. Results Confirmatory factor analysis supported a distinction between cognitive attitudes about giving blood, affective attitudes about giving blood, anticipated negative affective reactions about not giving blood, and anticipated positive affective reactions about giving blood. Multiple regression analyses indicated that perceived behavioral control, anticipated negative affective reactions, cognitive attitude, anticipated positive affective reactions and subjective norms were significant simultaneous predictors of intentions to donate blood. Logistic regression analyses indicated that intentions, perceived behavioral control, and anticipated positive affective reactions were significant, simultaneous predictors of blood donation. Attitudinal ambivalence significantly moderated the effects of cognitive attitudes on intentions, and the effects of anticipated negative affective reactions on both intentions and donation behavior. Conclusion The findings point to the value of considering different types of attitudes, and anticipated negative affective reaction in particular, for predicting health behaviors.

Background Approximately 12% to 15% of blood donors are temporarily deferred from giving blood because they fail relevant medical criteria. Temporary deferral has a profound negative impact on subsequent donation. To our knowledge, an implementation intentions intervention has never been tested among temporarily deferred donors. We hypothesized that return rates would be higher among participants exposed to an implementation intentions intervention compared to those in a control condition that is mere measurement of related cognitions. Study Design and Methods Participants were assigned to implementation intentions or mere measurement conditions; whether or not participants received a temporary interdiction on giving blood was measured. A total of 956 novice donors were temporarily deferred (n = 490, in the implementation intentions condition; n = 466, in the mere measurement condition). Participants in the implementation intentions condition formed if–then plans to overcome three common barriers to blood donation: forgetting to attend, fitting the opportunity to give blood into one's schedule, and organizing transportation to the donation venue. Participants in the mere measurement condition did not form plans. Results Participants in the implementation intentions condition had a 19% greater chance of returning to give blood again within the 4 years after their first lifetime donation compared to participants in the mere measurement condition (p = 0.04) when controlling for sex and attempt at which participants were deferred. Conclusion The results of this study indicate that implementation intentions could be a useful strategy for promoting donor return among temporarily deferred novice blood donors.

The question-behaviour effect (QBE) refers to the finding that survey questions about a behaviour can change that behaviour. However, little research has tested how the QBE can be maximized in behavioural medicine settings. The present research tested manipulations of cognitive targets (questions about anticipated regret or beneficence) and survey return rates (presence vs. absence of a sticky note requesting completion of the questionnaire) on the magnitude of the QBE for influenza vaccination in older adults.Participants (N = 13,803) were recruited from general practice and randomly allocated to one of eight conditions: control 1 (no questionnaire); control 2 (demographics questionnaire); intention and attitude questionnaire (with or without a sticky note); intention and attitude plus anticipated regret questionnaire (with or without a sticky note); intention and attitude plus beneficence questionnaire (with or without a sticky note). Objective records of subsequent influenza vaccination from general practice records formed the dependent variable.Intention-to-treat analyses indicated that receiving an influenza vaccination questionnaire significantly increased vaccination rates compared to the no questionnaire, OR = 1.17, 95% CI = 1.01, 1.36 and combined control conditions, OR = 1.13, 95% CI = 1.01, 1.25. Including the sticky note significantly increased questionnaire return rates, OR = 1.25, 95% CI = 1.04, 1.50. However, there were no differences in vaccination rates between questionnaires containing different cognitive targets, a sticky note or not, and no interactions. There were no significant differences in the per-protocol analyses, i.e. among respondents who completed and returned the questionnaires.The QBE is a simple, low-cost intervention to increase influenza vaccination rates. Increasing questionnaire return rates or asking anticipated regret or beneficence questions in addition to intention and attitude questions did not enhance the QBE.

Background Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians’ guideline-recommended prescription of thiazide diuretics. The trial found no intervention effect. Using the theory of planned behaviour (TPB), we hypothesised that changes in thiazide prescribing would be reflected in changes in intention, consistent with changes in attitude and subjective norm, with no change to their perceived behavioural control (PBC), and tested this alongside the RCT. Methods We developed and sent TPB postal questionnaires to a random sub-sample of family physicians in each trial arm 2 months before and 6 months after dissemination of the PEMs. We used analysis of covariance to test for group differences using a 2 × 3 factorial design. We content-analysed an open-ended question about perceived barriers to thiazide prescription. Using control group data, we tested whether baseline measures of TPB constructs predicted self-reported thiazide prescribing at follow-up. Results Four hundred twenty-six physicians completed pre- and post-intervention questionnaires. Baseline scores on measures of TPB constructs were high: intention mean = 5.9 out of 7 (SD = 1.4), attitude mean = 5.8 (SD = 1.1), subjective norm mean = 5.8 (SD = 1.1) and PBC mean = 6.2 (SD = 1.0). The arms did not significantly differ post-intervention on any of the theory-based constructs, suggesting a possible ceiling effect. Content analysis of perceived barriers suggested post-intentional barriers to prescribing thiazides most often focused on specific patient clinical characteristics and potential side effects. Baseline intention (β = 0.63, p

Background Continuing professional development (CPD) activities are one way that new knowledge can be translated into changes in practice. However, few tools are available for evaluating the extent to which these activities change health professionals’ behavior. We developed a questionnaire called CPD-Reaction for assessing the impact of CPD activities on health professionals’ clinical behavioral intentions. We evaluated its responsiveness to change in behavioral intention and verified its acceptability among stakeholders. Methods and findings We enrolled 376 health professionals who completed CPD-Reaction before and immediately after attending a CPD activity. We contacted them three months later and asked them to self-report on any behavior change. We compared the mean rankings on each CPD-Reaction construct before and immediately after CPD activities. To estimate its predictive validity, we compared the median behavioral intention score (post-activity) of health professionals reporting a behavior change three months later with the median behavioral intention score of physicians who reported no change. We explored stakeholders’ views on CPD-Reaction in semi-structured interviews. Participants were mostly family physicians (62.2%), with an average of 19 years of clinical practice. Post-activity, we observed an increase in intention-related scores for all constructs (P < 0.001) with the most appreciable for the construct beliefs about capabilities. A total of 313 participants agreed to be contacted at follow up, and of these only 69 (22%) reported back. Of these, 43 (62%) self-reported a behavior change. We observed no statistically significant difference in intention between health professionals who later reported a behavior change and those who reported no change (P = 0.30). Overall, CPD stakeholders found the CPD-Reaction questionnaire of interest and suggested potential solutions to perceived barriers to its implementation. Conclusion The CPD-Reaction questionnaire seems responsive to change in behavioral intention. Although CPD stakeholders found it interesting, future implementation will require addressing barriers they identified.

The aim of the study was to test the relative efficacy of action planning and reward distribution to promote retention of whole blood donors.A sample of 7,399 donors was randomised to one of three interventions: "action planning" (n=2,585); "reward" (n=2,397); and "thank you" (n=2,417). Participants in the action planning condition were invited to write the date of their next donation on a post-it note before taking it home at the end of the donation process. Participants in the "reward" condition were given an anti-theft credit card sleeve at the end of the donation process. The "thank you" intervention is the usual condition at the end of the process; it was considered the control condition. The dependent variable was the proportion of donors who registered to give blood at six months.Overall, 4,444 (60.06%) donors registered to give blood at six months. There were no differences between the three interventions in the proportions of donors who registered to give blood (d.f. 2, chi-square=3.72, p0.15). However, gender modified the effect of the intervention (d.f. 2, chi-square=6.57, p0.0375); more women registered in the "thank you" condition than in the other two.The results suggest that action planning and the distribution of a reward have no motivational effect on the return to give blood. Nonetheless, women appear to respond more negatively to these interventions at the end of the donation process.