Developing the content of two behavioural interventions : using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Background: Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics. Method: Interventions were developed using a systematic, empirically informed approach in which we: selected theoretical frameworks; identified modifiable behavioural antecedents that predicted GPs intended and actual management of URTI; mapped these target antecedents on to evidence-based behaviour change techniques; and operationalised intervention components in a format suitable for delivery by postal questionnaire. Results: We identified two psychological constructs that predicted GP management of URTI: "Self-efficacy," representing belief in one's capabilities, and "Anticipated consequences," representing beliefs about the consequences of one's actions. Behavioural techniques known to be effective in changing these beliefs were used in the design of two paper-based, interactive interventions. Intervention 1 targeted self-efficacy and required GPs to consider progressively more difficult situations in a "graded task" and to develop an "action plan" of what to do when next presented with one of these situations. Intervention 2 targeted anticipated consequences and required GPs to respond to a "persuasive communication" containing a series of pictures representing the consequences of managing URTI with and without antibiotics. Conclusion: It is feasible to systematically develop theoretically-based interventions to change professional practice. Two interventions were designed that differentially target generalisable constructs predictive of GP management of URTI. Our detailed and scientific rationale for the choice and design of our interventions will provide a basis for understanding any effects identified in their evaluation. Trial registration: Clinicaltrials.gov NCT00376142This study is funded by the European Commission Research Directorate as part of a multi-partner program: Research Based Education and Quality Improvement (ReBEQI): A Framework and tools to develop effective quality improvement programs in European healthcare. (Proposal No: QLRT-2001-00657)

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Development and exploratory cluster-randomised opportunistic trial of a theory-based intervention to enhance physical activity among adolescents

Peer reviewedPostprin

A methodology to engineer graded BDI agents

In this work we present a methodological framework to engineer graded BDI agent-based systems. The graded BDI agent model allows to specify an agent’s architecture able to deal with the environment uncertainty and with graded mental attitudes. We work up previous approaches on software engineering process, adapting and extending them, in order to develop agents with a more complex internal architecture.VII Workshop de Agentes y Sistemas Inteligentes (WASI)Red de Universidades con Carreras en Informática (RedUNCI

Explaining the Conversion to Organic Farming of Farmers of the Obwalden Canton, Switzerland - Extension of the Theory of Planned Behavior within a Structural Equation Modeling Approach

Farmers' decisions about conversion to organic farming are analyzed with a structural equation model. The Theory of Planned Behavior (ToPB), one of the prominent theories in the social psychology, is used as the theoretical basis of this study. Though ToPB is a well-defined theory, it is static rather than procedural and cannot model the individual decision-making as a process. Therefore, we first examine the general applicability of ToPB in an agricultural context and explain the variance in intentions of farmers to convert to organic farming. Second, we extend the ToPB to make it more procedural. For this purpose, research findings from the Diffusion Theory are included as part of the behavioral model. The empirical results indicate that, overall, the model has an acceptable fit to the data. The effects of the additional variables "Goal" and "Communication" are highly significant. This illustrates the importance of forming personal goals in the behavior domain and that people act in a goal-directed, rational way. Moreover, it gives empirical evidence that communication through personal channels has a great impact on individual decision-making. Altogether, this study shows that the extended ToPB provides an appropriate approach to investigate individual decision-making processes in agriculture.behavior research, conversion to particularly animal friendly stabling system, theory of planned behavior, diffusion theory, structural equation modelling, Farm Management, C8, D1, Q12, Z13,

Explaining the conversion to particularly animal-friendly stabling system of farmers of the Obwalden Canton, Switzerland - Extension of the Theory of Planned Behavior within a Structural Equation Modeling Approach.

Farmers' intentions about conversion to particularly animal-friendly stabling system (PAFS) are analyzed with a structural equation model. The Theory of Planned Behavior (ToPB, Ajzen 1985) is used as the theoretical basis of this study. Though ToPB is a well-defined theory, it is static rather than procedural and cannot model the individual decision-making as a process. Therefore, we first examine the general applicability of ToPB in an agricultural context and explain the variance in intentions of farmers to convert to PAFS. Second, we extend the ToPB to make it more procedural. For this purpose, research findings from the Diffusion Theory are included as part of the behavioral model. The empirical results indicate that the model has a good fit to the data. The effects of the additional variables "Goal" and "Communication" are highly significant. This illustrates the importance of forming personal goals in the behavior domain and that people act in a goal-directed, rational way. Moreover, it gives empirical evidence that communication through personal channels has a great impact on individual decision-making. Altogether, this study shows that the extended ToPB provides an appropriate approach to investigate individual decision-making processes in agriculture.Farm Management,

Using the Medical Research Council framework for the development and evaluation of complex interventions in a theory-based infant feeding intervention to prevent childhood obesity:The baby milk intervention and trial

Introduction. We describe our experience of using the Medical Research Council framework on complex interventions to guide the development and evaluation of an intervention to prevent obesity by modifying infant feeding behaviours. Methods. We reviewed the epidemiological evidence on early life risk factors for obesity and interventions to prevent obesity in this age group. The review suggested prevention of excess weight gain in bottle-fed babies and appropriate weaning as intervention targets; hence we undertook systematic reviews to further our understanding of these behaviours. We chose theory and behaviour change techniques that demonstrated evidence of effectiveness in altering dietary behaviours. We subsequently developed intervention materials and evaluation tools and conducted qualitative studies with mothers (intervention recipients) and healthcare professionals (intervention deliverers) to refine them. We developed a questionnaire to assess maternal attitudes and feeding practices to understand the mechanism of any intervention effects. Conclusions. In addition to informing development of our specific intervention and evaluation materials, use of the Medical Research Council framework has helped to build a generalisable evidence base for early life nutritional interventions. However, the process is resource intensive and prolonged, and this should be taken into account by public health research funders. This trial is registered with ISRTCN: 20814693 Baby Milk Trial

Reputation-based decisions for logic-based cognitive agents

Computational trust and reputation models have been recognized as one of the key technologies required to design and implement agent systems. These models manage and aggregate the information needed by agents to efficiently perform partner selection in uncertain situations. For simple applications, a game theoretical approach similar to that used in most models can suffice. However, if we want to undertake problems found in socially complex virtual societies, we need more sophisticated trust and reputation systems. In this context, reputation-based decisions that agents make take on special relevance and can be as important as the reputation model itself. In this paper, we propose a possible integration of a cognitive reputation model, Repage, into a cognitive BDI agent. First, we specify a belief logic capable to capture the semantics of Repage information, which encodes probabilities. This logic is defined by means of a two first-order languages hierarchy, allowing the specification of axioms as first-order theories. The belief logic integrates the information coming from Repage in terms if image and reputation, and combines them, defining a typology of agents depending of such combination. We use this logic to build a complete graded BDI model specified as a multi-context system where beliefs, desires, intentions and plans interact among each other to perform a BDI reasoning. We conclude the paper with an example and a related work section that compares our approach with current state-of-the-art models. © 2010 The Author(s).This work was supported by the projects AEI (TIN2006-15662-C02-01), AT (CONSOLIDER CSD20070022, INGENIO 2010), LiquidPub (STREP FP7-213360), RepBDI (Intramural 200850I136) and by the Generalitat de Catalunya under the grant 2005-SGR-00093.Peer Reviewe