The study of theoretical support of psycho-behavioral health interventions on the example of smoking cessation

Contexte : De nombreux auteurs et guides spécialisés recommandent l'utilisation d'interventions comportementales en santé fondées sur un modèle théorique en avançant des arguments comme (1) l'aide dans la sélection pertinente de techniques psycho-comportementales associées à une théorie, (2) les liens de causalité entre les concepts utilisés dans une théorie, (3) le suivi des bénéficiaires lors des différentes phases de l'intervention et (4) l'interprétation des résultats positifs ou négatifs associés à l'intervention. La thèse interroge ce fondement des interventions non médicamenteuses sur un modèle théorique de changement comportemental à partir des données d'études cliniques comparatives ciblées sur l'arrêt du tabac. Méthode : La première étude a été conduite selon le format d'une revue exploratoire des essais randomisés contrôlés disponibles dans la littérature. Cette revue a évalué la fréquence d'utilisation d'une intervention théoriquement ancrée et décrite de changement de comportement dans 396 interventions psychologiques visant l'arrêt de tabac. La deuxième étude a comparé l'efficacité des interventions théoriques et des interventions a-théoriques sur la base de 411 interventions comportementales visant l'arrêt du tabac évaluées dans les derniers essais randomisés contrôlés. Les analyses ont été réalisées à l'aide du logiciel R par des modèles linéaires généralisés. Résultats : La première étude montre que parmi les 396 interventions identifiées, seules 48.5% (n=192) étaient basées sur un modèle théorique de changement de comportement, dont 140 mono-théoriques et 52 multi-théoriques. La théorie la plus utilisée avec 59% des cas (n=113) était le Modèle Transthéorique de Prochaska et DiClemente (1983). La deuxième étude montre que les interventions adossées à au moins une théorie ne sont pas plus efficaces que les interventions a-théoriques pour l'arrêt du tabac mesuré par un marqueur biologiqu e et sont moins efficaces par mesure auto-rapportée. Le nombre de théories employées dans une intervention comportementale n'influe pas de manière significative sur l'efficacité de l'intervention. L'effet de la théorisation de l'intervention et de sa mention explicite dans la publication sur l'arrêt de tabac n'est pas modifié par l'ajout d'un traitement médicamenteux (e.g., substitut nicotinique, bupropion), sauf pour l'arrêt biologiquement rapporté en post-intervention, où l'effet de l'ancrage théorique est augmenté par le traitement médicamenteux. Conclusion : La thèse montre, contrairement à un postulat souvent admis, que l'adossement théorique des interventions psychologiques visant l'arrêt du tabac à travers des études cliniques pragmatiques n'amène pas d'efficacité significativement supérieure aux interventions a-théorique. La thèse propose des pistes explicatives de ces résultats contre-intuitifs et des recommandations sur l'élaboration et la description des interventions dans le domaine des interventions non-médicamenteuses.Context : Authors and expert guides recommend the use of theoretical model-based health behavioural interventions by advancing arguments such as (1) assistance in choice of relevant psycho-behavioural techniques associated with a theory; (2) the establishment of casual links between theoretical concepts used in a theory; (3) screening and follow-up of beneficiaries during the different phases of an intervention and (4) interpretation of positive or negative results of an intervention in relation to the theoretical basis. The thesis questions the foundation of non-pharmacological interventions on theoretical models of behaviour change based on the data from comparative clinical studies focused on behavioural interventions for smoking cessation. Methods : The first study was conducted in the format of a scoping review of randomized controlled trials available in the literature. This review assessed the frequency of use of theory-based and described behavior change interventions in 396 psychological interventions aimed at smoking cessation. The second study compared the effectiveness between theory-based and non-theory-based interventions based on 411 behavioural interventions targeting smoking cessation evaluated in randomized controlled trials. Statistical analyses were conducted within the R-studio software using generalized linear model estimations. Result : The results obtained in the first study showed that out of 396 interventions, only 48.5% (n=192) were based on at least one theoretical model of behavioral change, of which 140 interventions were mono-theoretical and 52 interventions poly-theoretical. The transtheoretical model of behavioral change by Prochaska and DiClemente (1983) was the most used theory present in 113 theoretical interventions out of 192 (59%). The results of the second study showed, that theory-based interventions were not more effective than a-theoretical interventions for smoking cessation for biologically validated abstinence, and were less effective for self-reported smoking abstinence. The number of theories employed in a behavioral intervention did not significantly influence the effectiveness of an intervention. The effect of intervention theorization and its explicit mention in the publication on smoking cessation was not moderated by the addition of pharmacological support (e.g., nicotine replacement therapy, medications), except for post-interventional biologically reported abstinence, where the effect of theorization was significantly increased by drug therapy. Conclusion : The thesis shows, that contrary to an often accepted postulate, the presence of theoretical basis in psycho-behavioural interventions for smoking cessation evaluated in pragmatic clinical studies, does not lead to a significantly higher effectiveness of interventions than the absence of theory

Rôle des interventions non-médicamenteuses pour vieillir en bonne santé

International audienceL’offre en interventions non médicamenteuses (INM) s’élargit continuellement pour les personnes de plus de 60 ans, aussi bien en prévention qu’en thérapeutique. Sélectionnées de manière empirique depuis des siècles ou apparues récemment à grand renfort d’études épigénétiques, d’essais cliniques et d’innovations technologiques, l’essor des INM s’amplifie et se diversifie dans le monde. Des questions résiduelles concernent 1) leur périmètre qui semble se recouper avec celui des médecines alternatives ; 2) leur évaluation qui semble impossible selon certains chercheurs ; et 3) leur mise en œuvre chez les personnes âgées qui semble trop contraignante. L’article répond à ces trois questions et présente ensuite des outils numériques développés par la Plateforme universitaire CEPS facilitant l’évaluation des INM dans le domaine du bien-vieillir. La mutation du système de santé, devenue nécessaire pour répondre aux besoins des baby-boomers, va élargir l’arsenal des solutions pertinentes pour la santé, leur combinaison dans une médecine et une approche de santé devenues personnalisées, compréhensives et intégratives. Les INM vont y jouer un rôle majeur au cours du siècle. Ces pratiques se distinguent des médecines alternatives, des messages généraux de santé publique et des offres socioculturelles par une recherche continue, une démarche qualité et une traçabilité des usages. Les INM constituent aujourd’hui un écosystème complémentaire des traitements biomédicaux dont la consolidation économique et juridique est croissante

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis - implications for public health communications in Australia

Objective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19). Main outcome measures Primary outcome: responses to question € If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions. Results Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine. Conclusions Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates

How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses

: COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study ( www.icarestudy.com ). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study (www.icarestudy.com). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended