Using the theoretical domains framework and the behavioural change wheel in an overarching synthesis of systematic reviews

OBJECTIVE: Synthesis that can filter the evidence from multiple sources to inform the choice of intervention components is highly desirable yet, at present, there are few examples of systematic reviews that explicitly define this type of synthesis using behaviour change frameworks. Here, we demonstrate how using the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) made it possible to bring together the findings from a series of three interconnected systematic reviews on the self-care of minor ailments (MAs) to inform the choice of intervention components. METHOD: The TDF and the capability, opportunity, motivation model of behaviour at the hub of the BCW were used to synthesise the findings from the three reviews, including syntheses of service-user views in interviews (review 1, 20 studies) and surveys (review 2, 13 studies), and evaluations of a range of interventions and services (review 3, 21 studies). RESULTS: The TDF and BCW approach provided a systematic, structured and replicable methodology for retrospectively integrating different types of evidence within a series of systematic reviews. Several intervention strategies, grounded in theory and discussed with key stakeholders, were suggested, which can be implemented and tested. CONCLUSIONS: This novel application of the TDF/BCW approach illustrates how it can be used to bring together quantitative and qualitative evidence to better understand self-care behaviour for MAs within a systematic review context. The TDF/BCW approach facilitated exploration of the contradictions and gaps between the separate review syntheses, and supported the identification of possible intervention strategies, grounded in theory. The ongoing development and refinement of this method is supported. PROSPERO REGISTRATION NUMBER: CRD42017071515

Pornography use and sexting amongst children and young people : a systematic overview of reviews

BACKGROUND: Young people's use of pornography and participation in sexting are commonly viewed as harmful behaviours. This paper reports findings from a 'review of reviews', which aimed to systematically identify and synthesise the evidence on pornography and sexting amongst young people. Here, we focus specifically on the evidence relating to young people's use of pornography; involvement in sexting; and their beliefs, attitudes, behaviours and wellbeing to better understand potential harms and benefits, and identify where future research is required. METHODS: We searched five health and social science databases; searches for grey literature were also performed. Review quality was assessed and findings synthesised narratively. RESULTS: Eleven reviews of quantitative and/or qualitative studies were included. A relationship was identified between pornography use and more permissive sexual attitudes. An association between pornography use and stronger gender-stereotypical sexual beliefs was also reported, but not consistently. Similarly, inconsistent evidence of an association between pornography use and sexting and sexual behaviour was identified. Pornography use has been associated with various forms of sexual violence, aggression and harassment, but the relationship appears complex. Girls, in particular, may experience coercion and pressure to engage in sexting and suffer more negative consequences than boys if sexts become public. Positive aspects to sexting were reported, particularly in relation to young people's personal relationships. CONCLUSIONS: We identified evidence from reviews of varying quality that linked pornography use and sexting amongst young people to specific beliefs, attitudes and behaviours. However, evidence was often inconsistent and mostly derived from observational studies using a cross-sectional design, which precludes establishing any causal relationship. Other methodological limitations and evidence gaps were identified. More rigorous quantitative studies and greater use of qualitative methods are required

Consumption and effects of caffeinated energy drinks in young people : an overview of systematic reviews and secondary analysis of UK data to inform policy

BACKGROUND: This overview and analysis of UK datasets was commissioned by the UK government to address concerns about children's consumption of caffeinated energy drinks and their effects on health and behaviour. METHODS: We searched nine databases for systematic reviews, published between 2013 and July 2021, in English, assessing caffeinated energy drink consumption by people under 18 years old (children). Two reviewers rated or checked risk of bias using AMSTAR2, and extracted and synthesised findings. We searched the UK Data Service for country-representative datasets, reporting children's energy-drink consumption, and conducted bivariate or latent class analyses. RESULTS: For the overview, we included 15 systematic reviews; six reported drinking prevalence and 14 reported associations between drinking and health or behaviour. AMSTAR2 ratings were low or critically low. Worldwide, across reviews, from 13% to 67% of children had consumed energy drinks in the past year. Only two of the 74 studies in the reviews were UK-based. For the dataset analysis, we identified and included five UK cross-sectional datasets, and found that 3% to 32% of children, across UK countries, consumed energy drinks weekly, with no difference by ethnicity. Frequent drinking (5 or more days per week) was associated with low psychological, physical, educational and overall well-being. Evidence from reviews and datasets suggested that boys drank more than girls, and drinking was associated with more headaches, sleep problems, alcohol use, smoking, irritability, and school exclusion. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment suggests that the evidence is weak. CONCLUSIONS: Weak evidence suggests that up to a third of children in the UK consume caffeinated energy drinks weekly; and drinking 5 or more days per week is associated with some health and behaviour problems. Most of the evidence is from surveys, making it impossible to distinguish cause from effect. Randomised controlled trials are unlikely to be ethical; longitudinal studies could provide stronger evidence. PROSPERO REGISTRATIONS: CRD42018096292 - no deviations. CRD42018110498 - one deviation - a latent class analysis was conducted

Reviews on Long COVID: a scope of the literature. : Update October 2022

Summary • For this update, we identified 29 published reviews; two completed reviews that are yet to be published; and 63 new protocols for ongoing reviews on Long COVID. • Most published reviews were focused on the frequency or risk of persistent symptoms/effects, which has been a consistent finding in all our reports. • We identified more published and ongoing reviews with a focus on treatment/rehabilitation compared to our last update

Treatment and rehabilitation of Long COVID: a scope of the literature. : Update October 2022

Summary • We identified 11 randomised controlled trials published since June 2022 that were focused on Long COVID treatment or rehabilitation. Across two reports, we have now identified and assessed 25 trials published in 2022. • A majority of trials focused on evaluating treatments for people with persistent problems with their sense of smell (olfactory dysfunction). • Trial quality varied and inadequate reporting of methods often prevented a full assessment of the risk of bias. However, six trials were rated positively for at least 11 out of the 13 criteria that we assessed

Reviews on Long COVID: A scope of the literature. : Update July 2022

This report is the second quarterly update of the rapid scope of published and ongoing systematic reviews related to Long COVID that was originally conducted for the Department of Health and Social Care in England in November 2021.1 The first update covered the period November 2021 to the end of March 2022.2 For the current update, we identified systematic reviews and review protocols focused on Long COVID that were published between the start of April and the end of June 2022. Long COVID was conceptualised broadly as any symptoms or effects that persist or develop after acute COVID-19 infection

Treatment and rehabilitation of Long COVID: a scope of the RCT literature : July 2022

Summary • We identified 14 randomised controlled trials published in the last six months, which examined the effectiveness of a range of interventions focused on Long COVID treatment or rehabilitation. • Across trials, the post COVID period ranged widely from a few weeks after symptom onset or diagnosis to several months post recovery from active infection or hospital discharge. • Trial quality varied and inadequate reporting of methods frequently precluded a full assessment of the risk of bias. However, six trials were rated positively for at least 75% of the domains we assessed

Treatment and rehabilitation of Long COVID: A scope of the literature. : Update April 2023

Summary • We identified 18 randomised controlled trials published since December 2022 that were focused on Long COVID treatment or rehabilitation. Across our four reports produced to date, we have identified and assessed 55 trials published between January 2022 and March 2023. • A third of the trials included in this update had a primary focus on treating persistent problems with respiratory function and physical fitness (n=6). Other trials focused on olfactory dysfunction (n=5); long-term fatigue (n=2); headaches (n=1) and cognitive impairment, physical and mental fatigue and neuropsychiatric issues (n=1). Three trials evaluated interventions for treating non-specific Long COVID symptoms, all of which were focused on improving physical fitness. • Five trials were rated positively for at least 11 out of the 13 criteria that we assessed. Four trials met 10 criteria and nine gained a positive rating for between five and nine criteria

Reviews on Long COVID: a scope of the literature. : Update April 2023

Summary • For this update, we identified 37 published reviews and 73 new protocols for ongoing reviews on Long COVID. The number of published reviews is lower than in our last quarterly report in January (n=50), but higher than in our October report (n=29), all of which used the same databases and search strategy. • Most published reviews were focused on symptoms or effects, which is consistent with the earlier reports. • We identified fewer published reviews with a primary focus on Long COVID risk factors (3/37) than in January (10/50). • Most of the protocols for ongoing reviews focused on Long COVID treatment or rehabilitation (30/73), as was the case in the January report (33/56). • Most of the other protocols focused on symptoms or effects (21/73), or risk factors (13/73)