Blurring the boundaries between synthesis and evaluation. A customized realist evaluative synthesis into adolescent risk behavior prevention

Realist methodologies have been increasingly advocated for the investigation of complex social issues. Public health programs, such as those designed to prevent adolescent risk behavior, are typically considered complex. In conducting a realist review of the empirical literature relating to such programs, we encountered several challenges, including (a) an overabundance of empirical evidence, (b) a problematic level of heterogeneity within and between methodological approaches, (c) discrepancies between theoretical underpinnings and program operationalization, (d) homogeneity of program outcomes, with very little variation in program effectiveness, and (d) a paucity of description relating to content and process. To overcome these challenges, we developed a customized approach to realist evidence synthesis, drawing on the VICTORE (Volition, Implementation, Contexts, Time, Outcomes, Rivalry, and Emergence) complexity checklist and incorporating stakeholder engagement as primary data to achieve greater depth of understanding relating to contextual and mechanistic factors, and the complex interactions between them. Here we discuss the benefits of this adapted methodology alongside an overview of the research through which the methodology was developed. A key finding from this research was that combining the complexity checklist with primary data from stakeholder engagement enabled us to systematically interrogate the data across data sources, uncovering and evidencing mechanisms which may otherwise have remained hidden, giving greater ontological depth to our research findings. This paper builds on key methodological developments in realist research, demonstrating how realist methodologies can be customized to overcome challenges in developing and refining program theory from the literature, and contributes to the broader literature of innovative approaches to realist research

The identification of salient beliefs concerning university students’ decision to participate in sport

The aim of this study was to identify salient beliefs toward university-provided recreational sport in first-year undergraduate students. A purposive sample of 76 students (36 males, 40 females; mean age: 19.2 ± 1.7 years) undertaking various degree subjects at a higher education institution in the North of England, United Kingdom, was used in the study. The instrument was a theory-based open-ended questionnaire informed by the Theory of Planned Behavior, addressing behavioral, normative, and control beliefs. Thematic content analysis and coding was conducted on 30 randomly selected questionnaires followed by a frequency count to identify the modal salient beliefs. The modal set revealed 17 beliefs from a possible 53: six behavioral, five normative, and six control. These beliefs were related to health benefits, enjoyment, friendships, time constraints, study workloads, awareness, and the perception of family, friends, and academics. The results highlight the factors that should be targeted for intervention and provide data to be utilized for a second main quantitative study which will identify more specific belief targets. Due to equivocal intervention success, this formative research can serve to help increase the number of students participating in university recreational spor

Hypertrophic and Fibrotic Human PKD Hearts are Associated with Macrophage Infiltration and Abnormal TGF-β1 Signaling

Autosomal dominant polycystic kidney disease (PKD) is a hereditary kidney disorder which can affect cardiovascular system. Cardiac hypertrophy and cardiomyopathy in PKD have been reported by echocardiography analyses, but histopathology analyses of human PKD hearts have never been examined. The current studies evaluated human heart tissues from five subjects without PKD (non-PKD) and five subjects with PKD. Our histopathology data of human PKD hearts showed an increased extracellular matrix associated with cardiac hypertrophy and fibrosis. Hypertrophy- and fibrosis-associated pathways involving abnormal cardiac structure were next analyzed. We found that human PKD myocardium was infiltrated by inflammatory macrophage M1 and M2; expression of transforming growth factor (TGF-β1) and its receptor were upregulated with overexpression of pSmad3 and β-catenin. Because patients with PKD have an abnormal kidney function that could potentially affect heart structure, we used a heart-specific PKD mouse model to validate that cardiac hypertrophy and fibrosis were independent from polycystic kidney. In summary, our data show that hearts from human PKD were characterized by hypertrophy, interstitial fibrosis, perivascular fibrosis, and conduction system fibrosis with upregulated TGF-β1 and its receptor. We suggest that such structural abnormalities may predispose to systolic and diastolic cardiac dysfunction in the PKD myocardium

The role of brand loyalty and social media in e-commerce interfaces: survey results and implications for user interfaces

This paper explores the role of brand loyalty and social media in e-commerce interfaces. A survey consisting of 118 respondents was contacted to address the questions relating to online shopping and brand loyalty. Link between the frequency of access and time spent on an e-commerce user interface, and brand loyalty, gender and age profile differences, and the role of social media to branding and on-line shopping was analyzed. It was found that online loyalty differs from offline loyalty and loyalty also differed across genders, showing men were more loyal than women when shopping online. Information shared about products on social media by friends and family played an important role in purchase decision making. Website interface and ease of navigation were also key aspects for online shopping. The research concluded with recommendations to create multimodal websites which are more interactive and targeted so customer experience is enhanced and loyalty is achieved through the use of interactivity and social media

Comparative analysis between condom use clusters and risk behaviours among portuguese university students

The research on condom use has been focused on high-risk individuals, paying less attention to those who have moderate risk or safe sexual conducts. In order to design accurate interventions, potential differences among the condom use behavior groups must be considered. The goal was to assess possible differences in individuals presenting different types of risk behavior. 140 heterosexual university students answered a self-reported questionnaire about their sexual history, condom use habits, sexual self-esteem, sexual satisfaction, sexual control, attitudes towards condoms, self-efficacy to condom use, and emotions and feelings during sexual intercourse. A cluster analysis was conducted using the results about condom use and risk behaviors. Three groups with different risk levels emerged, presenting differences over sexual self-efficacy, attitudes towards condoms, socio-demographic variables, and sexual history. The results suggest the condom use inconsistency is highly associated with other risk behaviors but the contrary does not necessarily happens. Condom use consistent users also presented risk behaviors as smoking and drinking. The group differences suggest the risks were more affected by the combination of lack of skills with a negative attitude toward condoms than by contextual or personal variables. These differences sustain the need of an intervention adjusted to the individual's risk levels, since they differ on skills and beliefs that may hinder or promote the adoption of health behaviors.Foundation for Science and Technology/Fundacao para a Ciencia e Tecnologia (Portugal)info:eu-repo/semantics/publishedVersio

Intention of preserving forest remnants among landowners in the Atlantic Forest: The role of the ecological context via ecosystem services

Unravelling the psychological processes determining landowners' support towards forest conservation is crucial, particularly in rural areas of the tropics, where most forest remnants are within private lands. As human–nature connections are known to shape pro‐environmental behaviours, the intention of preserving forest remnants should ultimately be determined by the ecological context people live in. Here, we investigate the pathways through which the ecological context (forest cover), via direct contact with forests and ecosystem services and disservices, influence the psychological antecedents of conservation behaviour (beliefs, attitude and intention of preserving forest remnants). We conceptualized a model based on the Reasoned Action Approach, using the ecological context and these three forest experiences as background factors, and tested the model using Piecewise Structural Equation Modelling. Data were collected through an interview‐based protocol applied to 106 landowners across 13 landscapes varying in forest cover in a consolidated rural region in the Brazilian Atlantic Forest. Our results indicate that: (a) ecosystem services are more important than disservices for shaping intention of preserving forests, particularly non‐provisioning services; (b) contact with forest has an indirect effect on intention, by positively influencing the frequency of receiving ecosystem services; (c) people living in more forested ecological contexts have more contact with forests, receive ecosystem services more frequently and, ultimately, have stronger intention of preserving forests. Hence, our study suggests a dangerous positive feedback loop between deforestation, the extinction of forest experiences and impairment of human–nature connections. Local demands across the full range of ecosystem services, the balance between services and disservices and the ecological context people live in should be considered when developing conservation initiatives in tropical rural areas

Antimicrobial resistance: a biopsychosocial problem requiring innovative interdisciplinary and imaginative interventions

To date, antimicrobials have been understood through largely biomedical perspectives. There has been a tendency to focus upon the effectiveness of pharmaceuticals within individual bodies. However, the growing threat of antimicrobial resistance demands we reconsider how we think about antimicrobials and their effects. Rather than understanding them primarily within bodies, it is increasingly important to consider their effects between bodies, between species and across environments. We need to reduce the drivers of antimicrobial resistance (AMR) at a global level, focusing on the connections between prescribing in one country and resistance mechanisms in another. We need to engage with the ways antimicrobials within the food chain will impact upon human healthcare. Moreover, we need to realise what happens within the ward will impact upon the environment (through waste water). In the future, imaginative interventions will be required that must make the most of biomedicine but draw equally across a wider range of disciplines (e.g. engineering, ecologists) and include an ever-increasing set of professionals (e.g. nurses, veterinarians and farmers). Such collective action demands a shift to working in new interdisciplinary, inter-professional ways. Mutual respect and understanding is required to enable each perspective to be combined to yield synergistic effects

A model of caregiver paediatric HIV disclosure decision-making

Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one’s status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers, and maximise available support. Yet deciding whether, what, how, and when to tell HIV-positive children about their condition, is challenging for caregivers. We systematically review HIV disclosure theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention stage, integrates individual and contextual determinants. It aims to be situationally-specific, broadly applicable, and consistent with the empirical literature. Research and practice implications are discussed

Thrilled to have “bagged a bargain” or “bitter” and “very frustrating”? Exploring consumer attitudes to value and deals in tourism

Similar to most global tourism markets, UK consumers adjusted their behavior during the global financial crisis, emphasizing value for money in travel choices. However, there is little evidence concerning consumers’ value-seeking behavior and especially how deals, discounts, and other sales promotions influence tourist decision making. This project explores concepts of value consciousness and deal proneness to shed light on attitudes toward monetary value in travel purchases. Using focus groups, the study found that deals and discounts frequently underpin some tourist choices, but that value consciousness is related to deal proneness, and interactions between the two could result in negative, positive, or mixed emotions. This relationship was captured through a dynamic categorization of tourists’ attitudes and behavior into four approaches to deals and value, namely, deals (1) as a way of life, (2) as a bonus, (3) as a problem, and (4) as toxic. The categories were dynamic in that individuals could move across them. The implications for tourism marketers are outlined