What health policy makers need to know about mismatches between public perceptions of disease risk, prevalence and severity: a national survey

Objectives: The aim of this study was to assess people’s perceptions of their personal risk, population prevalence and perceived severity in relation to three key health conditions (cancer, heart disease and hearing loss), gauge the size of any misperceptions, and identify correlates of such misperceptions. / Design: This study was a cross-sectional survey. / Study sample: A total of 10,401 adults representative of the UK population were participated in the study. / Results: Clear majorities of people incorrectly believe that they are at greater personal risk of cancer (>75%), that cancer is more prevalent in the population (>50%) and that cancer is more disabling (>65%), than either heart disease or hearing loss. In turn, people consistently regard their personal risk of hearing loss, the population prevalence of hearing loss and the severity of hearing loss as lower than either cancer or heart disease. Multiple regression analyses showed inconsistent patterns of relationships between people’s beliefs, sociodemographic characteristics and their health behaviours. / Conclusions: Accuracy in beliefs about cancer, heart disease and hearing loss is low, and the relationships between these beliefs, their potential antecedents and consequences are complex. Policy makers should ensure close adherence to evidence or risk-making decisions that are costly both in financial terms and in terms of suboptimal population subjective well-being

Beyond “planning”: A meta-analysis of implementation intentions to support smoking cessation

Objective: Implementation intentions support behavior change by encouraging people to link critical situations with appropriate responses. Overall effectiveness for smoking cessation is unknown. This systematic review and meta-analysis aimed to evaluate the effectiveness of implementation intentions for smoking cessation. Method: Using PRISMA guidelines, 6 electronic databases were searched (updated February 2018) using key terms. Data were pooled for smoking cessation (categorical variable; yes/no) and entered into random effects models. Analyses assessed: (a) effectiveness as a single intervention, and (b) effectiveness when included as one of multiple intervention components. Results: Twelve studies were identified. Implementation intentions were effective for smoking cessation at follow up, OR = 1.70, CI [1.32, 2.20], p < .001, average 10.7% quit rate for intervention participants (4.9% in controls). Implementation intentions as a single intervention were effective for smoking cessation, OR = 5.69, 95% CI [1.39, 23.25], p = .02 (average quit rate 14.3% in intervention participants vs. 3.6% in controls) and as part of multicomponent interventions, OR = 1.67, 95% CI [1.29, 1.66], p < .001 (average quit rate 8.2% in intervention participants vs. 5.8% in controls). Conclusions: Implementation intentions are effective at helping smokers quit although the review reported substantial heterogeneity across the limited number of included studies. The present review sets the agenda for future research in this area including longer term objectively verified abstinence and identification of potential moderators of effectiveness including population characteristics

Determinants of adults' intention to vaccinate against pandemic swine flu

This article has been made available through the Brunel Open Access Publishing Fund.This article has been made available through the Brunel Open Access Publishing Fund.Background: Vaccination is one of the cornerstones of controlling an influenza pandemic. To optimise vaccination rates in the general population, ways of identifying determinants that influence decisions to have or not to have a vaccination need to be understood. Therefore, this study aimed to predict intention to have a swine influenza vaccination in an adult population in the UK. An extension of the Theory of Planned Behaviour provided the theoretical framework for the study. Methods: Three hundred and sixty two adults from the UK, who were not in vaccination priority groups, completed either an online (n = 306) or pen and paper (n = 56) questionnaire. Data were collected from 30th October 2009, just after swine flu vaccination became available in the UK, and concluded on 31st December 2009. The main outcome of interest was future swine flu vaccination intentions. Results: The extended Theory of Planned Behaviour predicted 60% of adults’ intention to have a swine flu vaccination with attitude, subjective norm, perceived control, anticipating feelings of regret (the impact of missing a vaccination opportunity), intention to have a seasonal vaccine this year, one perceived barrier: “I cannot be bothered to get a swine flu vaccination” and two perceived benefits: “vaccination decreases my chance of getting swine flu or its complications” and “if I get vaccinated for swine flu, I will decrease the frequency of having to consult my doctor,” being significant predictors of intention. Black British were less likely to intend to have a vaccination compared to Asian or White respondents. Conclusions: Theoretical frameworks which identify determinants that influence decisions to have a pandemic influenza vaccination are useful. The implications of this research are discussed with a view to maximising any future pandemic influenza vaccination uptake using theoretically-driven applications.This article is available through the Brunel Open Access Publishing Fund

What maximizes the effectiveness and implementation of technology-based interventions to support healthcare professional practice? A systematic literature review

Background Technological support may be crucial in optimizing healthcare professional practice and improving patient outcomes. A focus on electronic health records has left other technological supports relatively neglected. Additionally, there has been no comparison between different types of technology-based interventions, and the importance of delivery setting on the implementation of technology-based interventions to change professional practice. Consequently, there is a need to synthesise and examine intervention characteristics using a methodology suited to identifying important features of effective interventions, and the barriers and facilitators to implementation. Three aims were addressed: to identify interventions with a technological component that are successful at changing professional practice, to determine if and how such interventions are theory-based, and to examine barriers and facilitators to successful implementation. Methods A literature review informed by realist review methods was conducted involving a systematic search of studies reporting either: (1) behavior change interventions that included technology to support professional practice change; or (2) barriers and facilitators to implementation of technological interventions. Extracted data was quantitative and qualitative, and included setting, target professionals, and use of Behaviour Change Techniques (BCTs). The primary outcome was a change in professional practice. A thematic analysis was conducted on studies reporting barriers and facilitators of implementation. Results Sixty-nine studies met the inclusion criteria; 48 (27 randomized controlled trials) reported behavior change interventions and 21 reported practicalities of implementation. The most successful technological intervention was decision support providing healthcare professionals with knowledge and/or person-specific information to assist with patient management. Successful technologies were more likely to operationalise BCTs, particularly “instruction on how to perform the behavior”. Facilitators of implementation included aligning studies with organisational initiatives, ensuring senior peer endorsement, and integration into clinical workload. Barriers included organisational challenges, and design, content and technical issues of technology-based interventions. Conclusions Technological interventions must focus on providing decision support for clinical practice using recognized behavior change techniques. Interventions must consider organizational context, clinical workload, and have clearly defined benefits for improving practice and patient outcomes

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010.

OBJECTIVE: To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals. RESULTS: Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. CONCLUSIONS: Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease

Do Self-Incentives and Self-Rewards Change Behavior? A Systematic Review and Meta-Analysis

Encouraging people to self-incentivize (i.e., to reward themselves in the future if they are successful in changing their behavior) or self-reward (i.e., prompt people to reward themselves once they have successfully changed their behavior) are techniques that are frequently embedded within complex behavior change interventions. However, it is not clear whether self-incentives or self-rewards per se are effective at bringing about behavior change. Nine databases were searched alongside manual searching of systematic reviews and online research registers. One thousand four hundred papers were retrieved, spanning a range of behaviors, though the majority of included papers were in the domain of “health psychology”. Ten studies matched the inclusion criteria for self-incentive but no studies were retrieved for self-reward. The present systematic review and meta-analysis is therefore the first to evaluate the unique effect of self-incentives on behavior change. Effect sizes were retrieved from seven of the ten studies. Analysis of the seven studies produced a very small pooled effect size for self-incentives (k=7; N=1,161), which was statistically significant, d+=0.17, CI=0.06 to 0.29. The weak effect size and dearth of studies raises the question of why self-incentivizing is such a widely employed component of behavior change interventions. The present research opens up a new field of inquiry to establish: (a) whether or not self-incentivizing and self-rewarding are effective behavior change techniques, (b) if self-incentives and self-rewards need to be deployed alongside other behavior change techniques, and (c) when and for whom self-incentives and self-rewards could support effective behavior change

Designing theoretically-informed implementation interventions

Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care. However, the transfer of research findings into practice is unpredictable and can be a slow and haphazard process. Ideally, the choice of implementation strategies would be based upon evidence from randomised controlled trials or systematic reviews of a given implementation strategy. Unfortunately, reviews of implementation strategies consistently report effectiveness some, but not all of the time; possible causes of this variation are seldom reported or measured by the investigators in the original studies. Thus, any attempts to extrapolate from study settings to the real world are hampered by a lack of understanding of the effects of key elements of individuals, interventions, and the settings in which they were trialled. The explicit use of theory offers a way of addressing these issues and has a number of advantages, such as providing: a generalisable framework within which to represent the dimensions that implementation studies address, a process by which to inform the development and delivery of interventions, a guide when evaluating, and a way to allow for an exploration of potential causal mechanisms. However, the use of theory in designing implementation interventions is methodologically challenging for a number of reasons, including choosing between theories and faithfully translating theoretical constructs into interventions. The explicit use of theory offers potential advantages in terms of facilitating a better understanding of the generalisability and replicability of implementation interventions. However, this is a relatively unexplored methodological area

Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies : A case study from UK primary care

Peer reviewedPublisher PD

Investigating Which Behaviour Change Techniques Work for Whom in Which Contexts Delivered by What Means: Proposal for an International Collaboratory of Centres for Understanding Behaviour Change (CUBiC)

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

A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

<div><p>Background</p><p>One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.</p><p>Methodology/Principal Findings</p><p>A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.</p><p>Conclusions</p><p>The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.</p></div