A method for assessing fidelity of delivery of telephone behavioral support for smoking cessation

Objectives: Behavioral support for smoking cessation is delivered through different modalities, often guided by treatment manuals. Recently developed methods for assessing fidelity of delivery have shown that face-to-face behavioral support is often not delivered as specified in the service treatment manual. This study aimed to extend this method to evaluate fidelity of telephone-delivered behavioral support. Method: A treatment manual and transcripts of 75 audio-recorded behavioral support sessions were obtained from the United Kingdom's national Quitline service and coded into component behavior change techniques (BCTs) using a taxonomy of 45 smoking cessation BCTs. Interrater reliability was assessed using percentage agreement. Fidelity was assessed by comparing the number of BCTs identified in the manual with those delivered in telephone sessions by 4 counselors. Fidelity was assessed according to session type, duration, counselor, and BCT. Differences between self-reported and actual BCT use were examined. Results: Average coding reliability was high (81%). On average, 41.8% of manual-specified BCTs were delivered per session (SD = 16.2), with fidelity varying by counselor from 32% to 49%. Fidelity was highest in pre-quit sessions (46%) and for BCT "give options for additional support" (95%). Fidelity was lowest for quit-day sessions (35%) and BCT "set graded tasks" (0%). Session duration was positively correlated with fidelity (r = .585; p < .01). Significantly fewer BCTs were used than were reported as being used, t(15) = -5.52, p < .001. Conclusions: The content of telephone-delivered behavioral support can be reliably coded in terms of BCTs. This can be used to assess fidelity to treatment manuals and to in turn identify training needs. The observed low fidelity underlines the need to establish routine procedures for monitoring delivery of behavioral support. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target

The formation of ultra-compact dwarf galaxies and nucleated dwarf galaxies

Ultra compact dwarf galaxies (UCDs) have similar properties as massive globular clusters or the nuclei of nucleated galaxies. Recent observations suggesting a high dark matter content and a steep spatial distribution within groups and clusters provide new clues as to their origins. We perform high-resolution N-body / smoothed particle hydrodynamics simulations designed to elucidate two possible formation mechanisms for these systems: the merging of globular clusters in the centre of a dark matter halo, or the massively stripped remnant of a nucleated galaxy. Both models produce density profiles as well as the half light radii that can fit the observational constraints. However, we show that the first scenario results to UCDs that are underluminous and contain no dark matter. This is because the sinking process ejects most of the dark matter particles from the halo centre. Stripped nuclei give a more promising explanation, especially if the nuclei form via the sinking of gas, funneled down inner galactic bars, since this process enhances the central dark matter content. Even when the entire disk is tidally stripped away, the nucleus stays intact and can remain dark matter dominated even after severe stripping. Total galaxy disruption beyond the nuclei only occurs on certain orbits and depends on the amount of dissipation during nuclei formation. By comparing the total disruption of CDM subhaloes in a cluster potential we demonstrate that this model also leads to the observed spatial distribution of UCDs which can be tested in more detail with larger data sets.Comment: 8 pages, 8 figures, final version accepted for publication in MNRA

How do hospitals respond to feedback about blood transfusion practice? A multiple case study investigation

National clinical audits play key roles in improving care and driving system-wide change. However, effects of audit and feedback depend upon both reach (e.g. relevant staff receiving the feedback) and response (e.g. staff regulating their behaviour accordingly). This study aimed to investigate which hospital staff initially receive feedback and formulate a response, how feedback is disseminated within hospitals, and how responses are enacted (including barriers and enablers to enactment). Using a multiple case study approach, we purposively sampled four UK hospitals for variation in infrastructure and resources. We conducted semi-structured interviews with staff from transfusion-related roles and observed Hospital Transfusion Committee meetings. Interviews and analysis were based on the Theoretical Domains Framework of behaviour change. We coded interview transcripts into theoretical domains, then inductively identified themes within each domain to identify barriers and enablers. We also analysed data to identify which staff currently receive feedback and how dissemination is managed within the hospital. Members of the hospital’s transfusion team initially received feedback in all cases, and were primarily responsible for disseminating and responding, facilitated through the Hospital Transfusion Committee. At each hospital, key individuals involved in prescribing transfusions reported never having received feedback from a national audit. Whether audits were discussed and actions explicitly agreed in Committee meetings varied between hospitals. Key enablers of action across all cases included clear lines of responsibility and strategies to remind staff about recommendations. Barriers included difficulties disseminating to relevant staff and needing to amend feedback to make it appropriate for local use. Appropriate responses by hospital staff to feedback about blood transfusion practice depend upon supportive infrastructures and role clarity. Hospitals could benefit from support to disseminate feedback systematically, particularly to frontline staff involved in the behaviours being audited, and practical tools to support strategic decision-making (e.g. action-planning around local response to feedback)

the transformational potential of health promotion

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Normative misperceptions about alcohol use in the general population of drinkers: a cross-sectional survey.

Underestimating one's own alcohol consumption relative to others ('normative misperception') has been documented in some college student and heavy-alcohol using samples, and may contribute to excessive drinking. This study aimed to assess how far this phenomenon extends to alcohol users more generally in four English-speaking countries and if associations with socio-demographic and drinking variables exist

Healthier central England or North-South divide? Analysis of national survey data on smoking and high-risk drinking.

OBJECTIVES: This paper compares patterns of smoking and high-risk alcohol use across regions in England, and assesses the impact on these of adjusting for sociodemographic characteristics. DESIGN: Population survey of 53 922 adults in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies. MEASURES: Participants answered questions regarding their socioeconomic status (SES), gender, age, ethnicity, Government Office Region, smoking status and completed the Alcohol Use Disorders Identification Test (AUDIT). High-risk drinkers were defined as those with a score of 8 or more (7 or more for women) on the AUDIT. RESULTS: In unadjusted analyses, relative to the South West, those in the North of England were more likely to smoke, while those from the East of England, South East and London were less likely. After adjustment for sociodemographics, smoking prevalence was no higher in North East (RR 0.97, p>0.05), North West (RR 0.98, p>0.05) or Yorkshire and the Humber (RR 1.03, p>0.05) but was less common in the East and West Midlands (RR 0.86, p0.05) CONCLUSIONS: In adjusted analyses, smoking and high-risk drinking appear less common in 'central England' than in the rest of the country. Regional differences in smoking, but not those in high-risk drinking, appear to be explained to some extent by sociodemographic disparities

Anisotropic static solutions in modelling highly compact bodies

Einstein field equations for anisotropic spheres are solved and exact interior solutions obtained. This paper extends earlier treatments to include anisotropic models which accommodate a wider variety of physically viable energy densities. Two classes of solutions are possible. The first class contains the limiting case $\mu\propto r^{-2}$ for the energy density which arises in many astrophysical applications. In the second class the singularity at the center of the star is not present in the energy density. The models presented in this paper allow for increasing and decreasing profiles in the behavior of the energy density.Comment: 9 pages, to appear in Pramana - J. Phy

Metal flux from dissolution of iron oxide grain coatings in sandstones

Acknowledgements Sandstone samples were kindly contributed by the Geological Survey of Northern Ireland, D. Halbert, R. Starkey, and L. Bullock. This work was partly supported by NERC grant NE/M010953/1. Electron Microscopy was performed with the help of J. Still in the ACEMAC Facility at the University of Aberdeen.Peer reviewedPublisher PD