Publications by authors named "A Chater"

59 Publications

Can Physical Activity Support Grief Outcomes in Individuals Who Have Been Bereaved? A Systematic Review.

Sports Med Open 2021 Apr 8;7(1):26. Epub 2021 Apr 8.

Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA, UK.

Background: In 2018, there were 616,014 registered deaths in the United Kingdom (UK). Grief is a natural consequence. Many mental health concerns, which can be identified as grief outcomes (e.g. anxiety and depression) in those who have experienced a bereavement, can be improved through physical activity. The objective of this review was to identify from the existing literature if physical activity can benefit grief outcomes in individuals who have been bereaved.

Methods: A systematic review of nine databases was performed. Included studies (qualitative and quantitative) explored physical activity to help individuals (of any age) who had experienced a human bereavement (excluding national loss).

Results: From 1299 studies screened, 25 met the inclusion criteria, detailing eight types of bereavement (parental (n = 5), spousal (n = 6), patient (n = 4), pre-natal (n = 3), later life (n = 1), caregiver (n = 1), multiple (n = 4) and non-defined (n = 1). Activities including yoga, running, walking and martial arts were noted as beneficial. Physical activity allowed a sense of freedom, to express emotions, provided a distraction and an escape from grief, whilst enhancing social support.

Conclusion: There is some evidence that physical activity may provide benefit for the physical health and psychological wellbeing of those who have been bereaved, including when the loss has happened at a young age. This review is timely, given the wide-scale national loss of life due to COVID-19 and extends knowledge in this area. More research is needed to explore the benefits of physical activity for those who have been bereaved. In particular, there is a need for well-designed interventions which are tailored to specific activities, populations and grief outcomes.
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http://dx.doi.org/10.1186/s40798-021-00311-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028581PMC
April 2021

The impact of COVID-19 on health behaviour, well-being, and long-term physical health.

Br J Health Psychol 2021 Mar 31. Epub 2021 Mar 31.

Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.

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http://dx.doi.org/10.1111/bjhp.12520DOI Listing
March 2021

Understanding physician behaviour in the 6-8 weeks hip check in primary care: a qualitative study using the COM-B.

BMJ Open 2021 Mar 19;11(3):e044114. Epub 2021 Mar 19.

Institute of Child Health, University College London, London, UK

Objectives: A compulsory hip check is performed on an infant at 6-8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective.

Design: Qualitative study with in-depth semistructured interviews of 6-8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment.

Setting: Primary care.

Participants: 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed.

Results: Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6-8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis.

Conclusion: Aspects of capability, opportunity and motivation affect GPs' diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.
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http://dx.doi.org/10.1136/bmjopen-2020-044114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986785PMC
March 2021

A randomised-controlled feasibility study of the REgulate your SItting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: study protocol.

Pilot Feasibility Stud 2021 Mar 19;7(1):76. Epub 2021 Mar 19.

Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK.

Background: People with type 2 diabetes mellitus (T2DM) generally spend a large amount of time sitting. This increases their risk of cardiovascular disease, premature mortality, diabetes-related complications and mental health problems. There is a paucity of research that has evaluated interventions aimed at reducing and breaking up sitting in people with T2DM. The primary aim of this study is to assess the feasibility of delivering and evaluating a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM.

Methods: This is a mixed-methods randomised controlled feasibility trial. Participants (n=70) with T2DM aged 18-85 years who sit ≥7 h/day and are able to ambulate independently will be randomly allocated to receive the REgulate your SItting Time (RESIT) intervention or usual care (control group) for 24 weeks. RESIT is a person-focused intervention that delivers a standardised set of behaviour change techniques to the participants, but the mode through which they are delivered can vary depending on the tools selected by each participant. The intervention includes an online education programme, health coach support, and a range of self-selected tools (smartphone apps, computer-prompt software, and wearable devices) that deliver behaviour change techniques such as self-monitoring of sitting and providing prompts to break up sitting. Measures will be taken at baseline, 12 and 24 weeks. Eligibility, recruitment, retention and data completion rates will be used to assess trial feasibility. Sitting, standing and stepping will be measured using a thigh-worn activity monitor. Cardiometabolic health, physical function, psychological well-being, sleep and musculoskeletal symptoms will also be assessed. A process evaluation will be conducted including evaluation of intervention acceptability and fidelity.

Discussion: This study will identify the feasibility of delivering a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM and evaluating it through a randomised controlled trial (RCT) design. The findings will inform a fully powered RCT to evaluate the effectiveness of the intervention.

Trial Registration: ISRCTN, ISRCTN14832389 ; Registered 6 August 2020.
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http://dx.doi.org/10.1186/s40814-021-00816-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977248PMC
March 2021

The impact of neurological disability and sensory loss on mindfulness practice.

Disabil Rehabil 2021 Feb 23:1-9. Epub 2021 Feb 23.

School of Sport Science and Physical Activity, University of Bedfordshire, Luton, UK.

Objectives: Mindfulness-based approaches are increasingly recommended in the management of medical conditions associated with sensory loss and absence, such as Spinal Cord Injury (SCI), Multiple Sclerosis (MS) and Functional Neurological Disorder (FND). Yet the implications of undertaking practices such as body scanning when living with sensory loss have not been considered. This study aimed to explore the impact of sensory loss on the practice and experience of mindfulness in qualified mindfulness teachers with SCI/FND/MS.

Methods: Eight mindfulness teachers (5 females, 3 males) with SCI/FND/MS, sensory loss and wheelchair use were recruited from mindfulness teacher databases. In-depth, semi-structured interviews were undertaken, lasting between 50 and 93 min. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Idiographic analyses for descriptive, linguistic and conceptual themes were completed before cross-case analyses.

Results: Analyses resulted in two superordinate themes: (1) Adopting your Body; and (2) Sensation without Loss. These themes reflected the challenge of overcoming initial resistance to areas of the body with sensory disruption, building a relationship with the whole body, such that sensory awareness could be visualised and experienced without proprioception.

Conclusions: Mindfulness offers a unique approach to accepting and working with the body after paralysis or sensory loss. Fundamental to the use of mindfulness with such populations, is the prioritisation of inclusive sensory language and exploring sensory absence as well as sensory presence. The cognitive and emotional outcomes of body scanning may be uniquely elevated in populations with neurophysiological disorders, highlighting the benefits of mindfulness for adaptive and protective self-management.IMPLICATIONS FOR REHABILITATIONMindfulness-based practices which focus on the body and sensation are accessible to people with neurological limitations.Mindfulness techniques can be extended through the use of visualisation strategies to encourage (non-proprioceptive) awareness of paralysed limbs or areas of the body with sensory loss.The language used in mindfulness-based interventions may need adapted by practitioners so that it remains inclusive for people with sensory loss as well as sensory presence.Additional care needs to be taken when using body scans during mindfulness as they have the potential to exacerbate psychological distress in people with reduced sensory awareness.
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http://dx.doi.org/10.1080/09638288.2021.1887946DOI Listing
February 2021

Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework.

Ophthalmic Physiol Opt 2021 Mar 20;41(2):301-315. Epub 2021 Feb 20.

School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.

Purpose: Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour-change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers.

Methods: Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM-B.

Results: Sixteen participants (9 male, 7 female; median age 45 years, range 28-65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity).

Conclusions: Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.
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http://dx.doi.org/10.1111/opo.12782DOI Listing
March 2021

A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic.

Vaccines (Basel) 2021 Jan 20;9(2). Epub 2021 Jan 20.

Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK.

Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza ( = 11; 31%) or H1N1 ( = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.
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http://dx.doi.org/10.3390/vaccines9020072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909419PMC
January 2021

A randomised controlled trial of energetic activity for depression in young people (READY): a multi-site feasibility trial protocol.

Pilot Feasibility Stud 2021 Jan 4;7(1). Epub 2021 Jan 4.

Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, UK.

Background: Prevalence of depression is increasing in young people, and there is a need to develop and evaluate behavioural interventions which may provide benefits equal to or greater than talking therapies or pharmacological alternatives. Exercise could be beneficial for young people living with depression, but robust, large-scale trials of effectiveness and the impact of exercise intensity are lacking. This study aims to test whether a randomised controlled trial (RCT) of an intervention targeting young people living with depression is feasible by determining whether it is possible to recruit and retain young people, develop and deliver the intervention as planned, and evaluate training and delivery.

Methods: The design is a three-arm cluster randomised controlled feasibility trial with embedded process evaluation. Participants will be help-seeking young people, aged 13-17 years experiencing mild to moderate low mood or depression, referred from three counties in England. The intervention will be delivered by registered exercise professionals, supported by mental health support workers, twice a week for 12 weeks. The three arms will be high-intensity exercise, low-intensity exercise, and a social activity control. All arms will receive a 'healthy living' behaviour change session prior to each exercise session and the two exercise groups are energy matched. The outcomes are referral, recruitment, and retention rates; attendance at exercise sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data; adverse events, all measured at baseline, 3, and 6 months; resource use; and reach and representativeness.

Discussion: UK National Health Service (NHS) policy is to provide young people with advice about using exercise to help depression but there is no evidence-based exercise intervention to either complement or as an alternative to medication or talking therapies. UK National Institute for Health and Care Excellence (NICE) guidelines suggest that exercise can be an effective treatment, but the evidence base is relatively weak. This feasibility trial will provide evidence about whether it is feasible to recruit and retain young people to a full RCT to assess the effectiveness and cost-effectiveness of an exercise intervention for depression.

Trial Registration: ISRCTN, ISRCTN66452702 . Registered 9 April 2020.
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http://dx.doi.org/10.1186/s40814-020-00734-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779325PMC
January 2021

Study protocol for evaluation of aid to diagnosis for developmental dysplasia of the hip in general practice: controlled trial randomised by practice.

BMJ Open 2020 12 2;10(12):e041837. Epub 2020 Dec 2.

Research Department of Primary Care and Population Health, UCL, London, UK.

Introduction: In the UK, a compulsory '6-week hip check' is performed in primary care for the detection of developmental dysplasia of the hip (DDH). However, missed diagnoses and infants incorrectly labelled with DDH remain a problem, potentially leading to adverse consequences for infants, their families and the National Health Service. National policy states that infants should be referred to hospital if the 6-week check suggests DDH, though there is no available tool to aid examination or offer guidelines for referral. We developed standardised diagnostic criteria for DDH, based on international Delphi consensus, and a 9-item checklist that has the potential to enable non-experts to diagnose DDH in a manner approaching that of experts.

Methods And Analysis: We will conduct a controlled trial randomised by practice that will compare a diagnostic aid against standard care for the hip check. The primary objective is to determine whether an aid to the diagnosis of DDH reduces the number of clinically insignificant referrals from primary care to hospital and the number of late diagnosed DDH. The trial will include a qualitative process evaluation, an assessment of professional behavioural change and a full health economic evaluation. We will recruit 152 general practitioner practices in England. These will be randomised to conduct the hip checks with use of the study diagnostic aid and/or as per usual practice. The total number of infants seen during a 15-month recruitment period will be 110 per practice. Two years after the 6-week hip check, we will measure the number of referred infants that are (1) clinically insignificant for DDH and (2) those that constitute appropriate referrals.

Ethics And Dissemination: This study has approval from the Health Research Authority (16/1/2020) and the Confidentiality Advisory Group (18/2/2020). Results will be published in peer-reviewed academic journals, disseminated to patient organisations and the media.

Trial Registration Number: NCT04101903; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-041837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713187PMC
December 2020

Parents' expectations and experiences of the 6-week baby check: a qualitative study in primary care.

BJGP Open 2020 Dec 15;4(5). Epub 2020 Dec 15.

Department of Population Health Sciences, King's College London, London, UK.

Background: The Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6-8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs.

Aim:  To explore the expectations and experiences of parents attending their GP for a baby check.

Design & Setting: A qualitative study was undertaken in primary care in London.

Method: Content analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby.

Results: Despite the availability of plentiful sources of general advice on infants' health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby's normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety.

Conclusion: The baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.
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http://dx.doi.org/10.3399/bjgpopen20X101110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880180PMC
December 2020

The vital role of health psychology in the response to COVID-19.

Br J Health Psychol 2020 11;25(4):831-838

Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.

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http://dx.doi.org/10.1111/bjhp.12484DOI Listing
November 2020

Does intentional asphyxiation by strangulation have addictive properties?

Addiction 2021 04 1;116(4):718-724. Epub 2020 Oct 1.

Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK.

Background And Aims: Intentional asphyxiation leads to cerebral hypoxia, starving the brain of oxygen and inducing hypoxic euphoria, but carries a serious risk of accidental death, especially if practised alone. This article raises the question as to whether it could usefully be regarded as having addictive properties.

Methods And Results: A review of the literature, together with eight case study vignettes, are presented. Intentional asphyxiation can occur with or without sexual activity. Initiation often occurs in adolescence, with development in some cases of an entrenched behaviour pattern, driven by a strong euphoriant effect, without adequate safeguarding from serious harm, and being undertaken by people with comorbidities. There does not appear to be strong evidence of seeking support for cessation of the practice.

Conclusions: Intentional asphyxiation behaviours may have addictive properties, and understanding this aspect of the problem may be fruitful in guiding research and interventions aimed at addressing it.
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http://dx.doi.org/10.1111/add.15247DOI Listing
April 2021

Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework.

J Antimicrob Chemother 2020 12;75(12):3458-3470

Cardiff University, Cardiff CF24 OAB, UK.

Background: The need to conserve antibiotic efficacy, through the management of respiratory tract infections (RTIs) without recourse to antibiotics, is a global priority. A key target for interventions is the antibiotic prescribing behaviour of healthcare professionals including non-medical prescribers (NMPs: nurses, pharmacists, paramedics, physiotherapists) who manage these infections.

Objectives: To identify what evidence exists regarding the influences on NMPs' antimicrobial prescribing behaviour and analyse the operationalization of the identified drivers of behaviour using the Theoretical Domains Framework (TDF).

Methods: The search strategy was applied across six electronic bibliographic databases (eligibility criteria included: original studies; written in English and published before July 2019; non-medical prescribers as participants; and looked at influences on prescribing patterns of antibiotics for RTIs). Study characteristics, influences on appropriate antibiotic prescribing and intervention content to enhance appropriate antibiotic prescribing were independently extracted and mapped to the TDF.

Results: The search retrieved 490 original articles. Eight papers met the review criteria. Key issues centred around strategies for managing challenges experienced during consultations, managing patient concerns, peer support and wider public awareness of antimicrobial resistance. The two most common TDF domains highlighted as influences on prescribing behaviour, represented in all studies, were social influences and beliefs about consequences.

Conclusions: The core domains highlighted as influential to appropriate antibiotic prescribing should be considered when developing future interventions. Focus should be given to overcoming social influences (patients, other clinicians) and reassurance in relation to beliefs about negative consequences (missing something that could lead to a negative outcome).
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http://dx.doi.org/10.1093/jac/dkaa335DOI Listing
December 2020

Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods.

BMJ Open 2020 06 30;10(6):e036181. Epub 2020 Jun 30.

Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Luton, UK.

Objectives: To assess the acceptability and feasibility of using a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers for patients presenting with common, acute, uncomplicated self-limiting respiratory tract infections (RTIs).

Design: Experimental with mixed methods; preintervention and postintervention online surveys and semistructured interviews.

Setting: Primary care settings across the UK.

Participants: 11 nurse and 4 pharmacist prescribers.

Intervention: A theory-based brief interactive animation electronic learning activity comprised a consultation scenario by a prescriber with an adult presenting with a common, acute, uncomplicated self-limiting RTI to support a 'no antibiotic prescribing strategy'.

Outcome Measures: Recruitment, response and attrition rates were assessed. The overall usefulness of the intervention was assessed by analysing prescribers' self-reported confidence and knowledge in treating patients with RTIs before and after undertaking the intervention, and views on the relevance of the intervention to their work. Acceptability of the intervention was assessed in semistructured interviews. The feasibility of data collection methods was assessed by recording the number of study components completed by prescribers.

Results: 15 prescribers (maximum sample size) consented and completed all four stages of the study. Prescribers reported high to very high levels of confidence and knowledge preintervention and postintervention, with slight postintervention increases in communicating with patients and a slight reduction in building rapport. Qualitative findings supported quantitative findings; prescribers were reassured of their own practice which in turn increased their confidence and knowledge in consultations. The information in the intervention was not new to prescribers but was applicable and useful to consolidate learning and enable self-reflection. Completing the e-learning intervention was acceptable to prescribers.

Conclusions: It was feasible to conduct the study. The intervention was acceptable and useful to prescribers. Future work will add complex clinical content in the intervention before conducting a full trial.
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http://dx.doi.org/10.1136/bmjopen-2019-036181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328741PMC
June 2020

Randomised Controlled Feasibility Study of the MyHealthAvatar-Diabetes Smartphone App for Reducing Prolonged Sitting Time in Type 2 Diabetes Mellitus.

Int J Environ Res Public Health 2020 06 19;17(12). Epub 2020 Jun 19.

Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Polhill Avenue, Bedford MK41 9EA, UK.

This study evaluated the feasibility and acceptability of a self-regulation smartphone app for reducing prolonged sitting in people with Type 2 diabetes mellitus (T2DM). This was a two-arm, randomised, controlled feasibility trial. The intervention group used the MyHealthAvatar-Diabetes smartphone app for 8 weeks. The app uses a number of behaviour change techniques aimed at reducing and breaking up sitting time. Eligibility, recruitment, retention, and completion rates for the outcomes (sitting, standing, stepping, and health-related measures) assessed trial feasibility. Interviews with participants explored intervention acceptability. Participants with T2DM were randomised to the control ( = 10) and intervention groups ( = 10). Recruitment and retention rates were 71% and 90%, respectively. The remaining participants provided 100% of data for the study measures. The MyHealthAvatar-Diabetes app was viewed as acceptable for reducing and breaking up sitting time. There were preliminary improvements in the number of breaks in sitting per day, body fat %, glucose tolerance, attitude, intention, planning, wellbeing, and positive and negative affect in favour of the intervention group. In conclusion, the findings indicate that it would be feasible to deliver and evaluate the efficacy of the MyHealthAvatar-Diabetes app for breaking up sitting time and improving health outcomes in a full trial.
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http://dx.doi.org/10.3390/ijerph17124414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345154PMC
June 2020

Determinants of weekly sitting time: construct validation of an initial COM-B model and comparison of its predictive validity with the Theory of Planned Behaviour.

Psychol Health 2021 Jan 14;36(1):96-114. Epub 2020 May 14.

Department of Psychology and Sport Sciences, University of Hertfordshire, Herts, UK.

Objective: In relation to sitting behaviour, to investigate which theoretical domains best formed the Capability, Opportunity, and Motivation constructs of the COM-B, and compare the predictive validity to the Theory of Planned Behaviour (TPB), taking habit strength into consideration.

Design: Using a prospective design, 186 adults completed measures capturing domains from the Theoretical Domains Framework for the three COM-B constructs, and habit strength, which were examined using a formative measurement model. Predictive validity was then compared to the TPB.

Main Outcome Measures: Self-reported sitting behaviour.

Results: Self-monitoring (behavioural regulation domain) formed Capability; subjective norm (social influences domain) formed Opportunity; intention (intentions domain), positive affect (emotion domain), and perceived behavioural control (beliefs about capabilities domain), formed Motivation. The COM-B strongly predicted sitting behaviour (27% variance explained), with Capability, Opportunity, and habit strength as key drivers. The TPB explained a large amount of variance (23%) in sitting behaviour, with intention and habit strength as key drivers.

Conclusions: The behavioural regulation domain of Capability, the social influences domain of Opportunity, and habit strength were important drivers of sitting behaviour, with comparable variance predicted in the COM-B and TPB. Future research should consider this approach to conceptualise the COM-B for specific populations and behaviours.
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http://dx.doi.org/10.1080/08870446.2020.1763994DOI Listing
January 2021

Personalised Adherence Support for Maintenance Treatment of Inflammatory Bowel Disease: A Tailored Digital Intervention to Change Adherence-related Beliefs and Barriers.

J Crohns Colitis 2020 Oct;14(10):1394-1404

UCL School of Pharmacy, Centre for Behavioural Medicine, London, UK.

Background And Aims: Interventions to improve adherence to medication may be more effective if tailored to the individual, addressing adherence-related beliefs about treatment and overcoming practical barriers to daily use. We evaluated whether an algorithm, tailoring support to address perceptual and practical barriers to adherence, reduced barriers and was acceptable to patients with inflammatory bowel disease [IBD].

Methods: Participants with IBD, prescribed azathioprine and/or mesalazine, were recruited via patient groups, social media, and hospital clinics and allocated to Intervention or Control Groups. The online intervention comprised messages tailored to address beliefs about IBD and maintenance treatment and to provide advice on overcoming practical difficulties with taking regular medication. The content was personalised to address specific perceptual and practical barriers identified by a pre-screening tool. Validated questionnaires assessed barriers to adherence and related secondary outcomes at baseline and at 1 and 3 months of follow-up.

Results: A total of 329 participants were allocated to the Intervention [n = 153] and Control [n = 176] Groups; just under half [46.2%] completed follow-up. At 1 and 3 months, the Intervention Group had significantly fewer concerns about IBD medication [p ≤0.01]; and at three months, fewer doubts about treatment necessity, fewer reported practical barriers, and higher reported adherence [p <0.05]. Relative to controls at follow-up, the Intervention Group were more satisfied with information about IBD medicines, and viewed pharmaceuticals in general more positively. Questionnaires, interviews, and intervention usage indicated that the intervention was acceptable.

Conclusions: Personalised adherence support using a digital algorithm can help patients overcome perceptual barriers [doubts about treatment necessity and medication concerns] and practical barriers to adherence.
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http://dx.doi.org/10.1093/ecco-jcc/jjz034DOI Listing
October 2020

An oral history of health psychology in the UK.

Br J Health Psychol 2020 09 20;25(3):502-518. Epub 2020 Apr 20.

School of Psychology, Bangor University, UK.

Purpose An oral history of the development of health psychology in the United Kingdom. Methods Standard oral history methods produced interviews with 53 UK health psychologists, averaging 92 min in length. All interviewees entered the field from the 1970s to the 2000s, representing all four countries in the United Kingdom. A reconstructive mode of analysis, along with the few existing sources, was used to create a narrative of the history of health psychology in the United Kingdom. Audio recordings and transcripts will be archived for use by future researchers. Findings In the 1970s, medical schools in London recruited psychologists to teach, while also conducting pragmatic research on issues in healthcare. At the same time, some clinical psychologists began to work with physical health conditions in general hospitals. Partly influenced by developments in the United States and Europe, an identity of 'health psychology' developed and spread to researchers and practitioners doing work in psychology and health. In the 1980s, the field continued to attract researchers, including social psychologists working with health behaviours and outcomes, and clinical psychologists working in health care settings. During this time, it became formalized as a scientific field with the creation of the BPS Health Psychology Section, courses, and journals. In the 1990s, the field moved towards professional practice, which was controversial with other BPS divisions. However, it continued to grow and develop through the 2000s and 2010s. Conclusion Reflections on the development of UK health psychology represent the first historical narrative produced from oral testimony of those who were present at the time. Statement of Contribution What is already known on this subject? Health psychology emerged in the 1970s, initially in the United States following an APA Task Force report. It developed from a range of precursor movements including psychosomatic medicine, while in the United Kingdom medical psychology was an additional precursor. The development of health psychology has been discussed for a range of countries including the United States and others, but historical scholarship relating to the United Kingdom has been limited. What does this study add? From an oral history project, a narrative of UK health psychology's development is built up. Influences included opportunities at medical schools from the 1970s onward. Growing interest in health behaviours as a test of social psychology theory was important. The experiences of clinical psychologists working in health care settings are demonstrated. Multidisciplinary influences on the emergence and shaping of health psychology are evident.
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http://dx.doi.org/10.1111/bjhp.12418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497242PMC
September 2020

Evidence-based policy making for health promotion to reduce the burden of non-communicable diseases in Moldova.

BMC Proc 2020 6;14(Suppl 1). Epub 2020 Mar 6.

1Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland.

The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of the on 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.
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http://dx.doi.org/10.1186/s12919-020-0183-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059653PMC
March 2020

Preparing pharmacy students to communicate effectively with adolescents.

Int J Pharm Pract 2020 Apr 1;28(2):134-141. Epub 2019 Oct 1.

Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.

Objectives: To develop an elective workshop designed to equip pharmacy students with skills to effectively communicate with adolescents. To conduct preliminary evaluation of the workshop to assess its impact on pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.

Methods: Academics from three universities in three countries collaborated on the workshop development and evaluation. The workshop structure was designed upon the foundations of communication best practices and established techniques, and it consisted of two online modules and an in-person tutorial. Pharmacy students undertaking a 4-year Bachelor, Master or Doctor of Pharmacy degree from all three participating universities evaluated the workshop via pre- and post-questionnaires.

Key Findings: A total of 81 pharmacy students volunteered to attend and evaluate the workshop. Of these 81 students, 31 completed paired pre- and post-questionnaires, 44 students completed unpaired questionnaires and six students were lost to follow-up. Of the paired pre- and post-questionnaires, students were mostly female (67.7%) with an average age of 24.9 years (standard deviation, SD = 5.6) and were in the first (32.3%), second (16.1%) or third (51.6%) year of their pharmacy programme. Over 80% of students somewhat or strongly agreed that the workshop made them feel more comfortable speaking with young people in pharmacy settings. Mean (SD) perceived confidence (pre = 21.7 (4.0) and post = 24.9 (4.5)) and knowledge scores (pre = 5.2 (1.5) and post = 6.6 (1.6)) significantly improved after undertaking the workshop.

Conclusions: The workshop increased pharmacy student perceived confidence and knowledge relating to the importance of adolescent counselling and counselling techniques.
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http://dx.doi.org/10.1111/ijpp.12581DOI Listing
April 2020

The Effectiveness of Sedentary Behaviour Reduction Workplace Interventions on Cardiometabolic Risk Markers: A Systematic Review.

Sports Med 2019 Nov;49(11):1739-1767

Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK.

Background: Sedentary behaviour is a risk factor for type 2 diabetes and cardiovascular disease.

Objectives: The aims of this work were to systematically review the effects of workplace sedentary behaviour reduction interventions on cardiometabolic risk markers (primary aim) and identify the active behaviour change techniques (BCTs) by which these interventions work (secondary aim).

Methods: A systematic search of 11 databases for articles published up to 12 April 2019 yielded a total of 4255 unique titles, with 29 articles being identified for inclusion. Interventions were rated as very promising, quite promising or non-promising based on their effects on cardiometabolic risk markers compared with baseline and/or a comparison arm. Interventions were coded for BCTs used. To assess the relative effectiveness of BCTs, a promise ratio was calculated as the frequency of a BCT appearing in all promising interventions divided by its frequency of appearance in all non-promising interventions.

Results: A narrative synthesis included 29 published studies of varying study design and comprised of 30 interventions. Risk of bias was high for blinding and allocation concealment, moderate for random sequence generation, and low for outcome assessment. Nine interventions were very promising, 11 were quite promising, 10 were non-promising, and 10 active control groups did not experience cardiometabolic changes. Significant sedentary behaviour reductions were present in all but five studies where cardiometabolic risk markers improved. The BCTs of social comparison, problem solving, demonstration of the behaviour, goal setting (behaviour), behaviour substitution, and habit reversal, demonstrated moderate to high promise ratios.

Conclusions: Workplace interventions show promise for improving cardiometabolic risk markers. The BCTs with the greatest promise of cardiometabolic risk marker improvements included social comparison, those related to individual habits, and behaviour goals.

Registration: This systematic review was prospectively registered in PROSPERO (CRD42017072427).
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http://dx.doi.org/10.1007/s40279-019-01168-9DOI Listing
November 2019

Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurses and pharmacists: intervention development and feasibility study protocol.

BMJ Open 2019 08 18;9(8):e028326. Epub 2019 Aug 18.

University of Bedfordshire, Centre for Health, Wellbeing and Behaviour Change, Bedford, UK.

Introduction: Nurse and pharmacist independent prescribers manage patients with respiratory tract infections and are responsible for around 8% of all primary care antibiotic prescriptions. A range of factors influence the prescribing behaviour of these professionals, however, there are no interventions available specifically to support appropriate antibiotic prescribing behaviour by these groups. The aims of this paper are to describe (1) the development of an intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers and (2) an acceptability and feasibility study designed to test its implementation with these prescribers. METHOD AND ANALYSIS: a three-stage, eight-step method was used to identify relevant determinants of behaviour change and intervention components based on the Behaviour Change Wheel. The intervention is an online resource comprising underpinning knowledge and an interactive animation with a variety of open and closed questions to assess understanding. nurse and pharmacist prescribers (n=12-15) will use the intervention. Evaluation includes semi-structured interviews to capture information about how the user reacts to the design, delivery and content of the intervention and influences on understanding and engagement, and a pre-post survey to assess participants' perceptions of the impact of the intervention on knowledge, confidence and usefulness in terms of application to practice. Taking an initial inductive approach, data from interview transcripts will be coded and then analysed to derive themes. These themes will then be deductively mapped to the Capability, Opportunity, Motivation-Behaviour model. Descriptive statistics will be used to analyse the survey data, and trends identified.

Ethics And Dissemination: Ethical approval for the study has been provided by the School of Healthcare Sciences Research Governance and Ethics Committee, Cardiff University. The findings will be disseminated via publication in peer-reviewed journals and through conference presentations.
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http://dx.doi.org/10.1136/bmjopen-2018-028326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701627PMC
August 2019

The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM-B.

J Adv Nurs 2019 Nov 3;75(11):2952-2968. Epub 2019 Sep 3.

Cardiff University, Cardiff, UK.

Aim: With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour.

Design: A qualitative research design.

Methods: Semi-structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March-July 2018 and continued until data saturation was reached.

Results: Nine themes inductively explained prescribing behaviour: 1) 'Knowledge and experience'; 2) 'Consultation and communication skills'; 3) 'Professional confidence and identity'; 4) 'Wanting the best outcome'; 5) 'NHS versus patient cost'; 6) 'Emotion-led decisions'; 7) 'Time allocation'; 8) 'Formulary access' and 9) 'Supporting environment for patient-centred care'. Themes were then deductively mapped to the TDF and COM-B.

Conclusion: There is an ongoing need to support community practitioner nurse prescribers' 'Capability' to prescribe in terms of knowledge and aquired skills; 'Opportunity' to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and 'Motivation' to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non-adherence.

Impact: Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient-centred care and the best outcome should be supported, this may mean increasing time allocated to consultations.
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http://dx.doi.org/10.1111/jan.14170DOI Listing
November 2019

Breaking barriers: using the behavior change wheel to develop a tailored intervention to overcome workplace inhibitors to breaking up sitting time.

BMC Public Health 2019 Aug 16;19(1):1126. Epub 2019 Aug 16.

Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Polhill Avenue, Bedford, Bedfordshire, MK41 9EA, UK.

Background: The workplace is a prominent domain for excessive sitting. The consequences of increased sitting time include adverse health outcomes such as cardiovascular disease and poor mental wellbeing. There is evidence that breaking up sitting could improve health, however, any such intervention in the workplace would need to be informed by a theoretical evidence-based framework. The aim of this study was to use the Behaviour Change Wheel (BCW) to develop a tailored intervention to break up and reduce workplace sitting in desk-based workers.

Methods: The BCW guide was followed for this qualitative, pre-intervention development study. Semi-structured interviews were conducted with 25 office workers (26-59 years, mean age 40.9 [SD = 10.8] years; 68% female) who were purposively recruited from local council offices and a university in the East of England region. The interview questions were developed using the Theoretical Domains Framework (TDF). Transcripts were deductively analysed using the COM-B (Capability, Opportunity, Motivation - Behaviour) model of behaviour. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate change in sitting behaviour of office workers in a future intervention.

Results: Qualitative analysis using COM-B identified that participants felt that they had the physical Capability to break up their sitting time, however, some lacked the psychological Capability in relation to the knowledge of both guidelines for sitting time and the consequences of excess sitting. Social and physical Opportunity was identified as important, such as a supportive organisational culture (social) and the need for environmental resources (physical). Motivation was highlighted as a core target for intervention, both reflective Motivation, such as beliefs about capability and intention and automatic in terms of overcoming habit through reinforcement. Seven intervention functions and three policy categories from the BCW were identified as relevant. Finally, 39 behaviour change techniques (BCTs) were identified as potential active components for an intervention to break up sitting time in the workplace.

Conclusions: The TDF, COM-B model and BCW can be successfully applied through a systematic process to understand the drivers of behaviour of office workers to develop a co-created intervention that can be used to break up and decrease sitting in the workplace. Intervention designers should consider the identified BCW factors and BCTs when developing interventions to reduce and break up workplace sitting.
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http://dx.doi.org/10.1186/s12889-019-7468-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697980PMC
August 2019

Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B.

Int J Environ Res Public Health 2019 08 14;16(16). Epub 2019 Aug 14.

Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Polhill Avenue, Bedford MK41 9EA, Bedfordshire, UK.

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: and These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.
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http://dx.doi.org/10.3390/ijerph16162903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720704PMC
August 2019

Community nursing and antibiotic stewardship: the importance of communication and training.

Br J Community Nurs 2019 Jul;24(7):338-342

Professor, School of Healthcare Sciences, Cardiff University, Cardiff.

Antimicrobial stewardship (using antimicrobials responsibly) can reduce the risk of antimicrobial resistance (AMR). Many health professionals identify themselves as 'antibiotic guardians', but patient expectations, time constraints, and a lack of confidence or underdeveloped communication skills can influence decisions to prescribe. Nurse prescribers have an important role to play in antibiotic stewardship, and their numbers continue to grow. While nurse prescribers welcome this extension to their traditional role, they are often faced with barriers to antibiotic stewardship activities. These barriers may relate to their Capability (knowledge/skill), Opportunity (norms of practice, influence of patients, environmental factors), and Motivation (attitudes and beliefs, concern over outcome, emotion and habit) [COM-B]. Education, training and enablement can help to overcome these barriers, and the development of knowledge, confidence and effective communication skills should be of priority. Further, communication skills can help nurse prescribers understand patient expectations, with the use of open-ended questions, active listening and creation of a patient-centred consultation that leads to a mutually agreed end goal and way forward.
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http://dx.doi.org/10.12968/bjcn.2019.24.7.338DOI Listing
July 2019

Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B.

BMJ Open 2019 06 19;9(6):e029177. Epub 2019 Jun 19.

Department of Sport Science and Physical, University of Bedfordshire, Luton, UK.

Objectives: Respiratory tract infections are frequently managed by nurse and pharmacist prescribers, and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing among these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to: (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections and (2) identify the behaviour change techniques (BCTs) that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour.

Design: Qualitative design comprising semistructured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour.

Setting: Primary care.

Participants: Twenty one prescribers (4 pharmacists and 17 nurses).

Results: A range of factors across 12 domains of the TDF were found to influence prescriber behaviour, and 40 BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting and information about health consequences) were identified as supporting prescribers in managing these expectations.

Conclusion: With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups.
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http://dx.doi.org/10.1136/bmjopen-2019-029177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588983PMC
June 2019

Academic performance of third-year medical students learning in rural settings.

Aust J Rural Health 2018 Apr 6. Epub 2018 Apr 6.

Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, Queensland, Australia.

Objective: Investigate the academic performance of medical students in rural and remote discipline rotations by rurality of placement.

Design: A retrospective cohort study.

Setting: Rural and remote clinical placement locations in Queensland, Australia.

Participants: University of Queensland third-year medical students.

Main Outcome Measures: In this study, student results for a range of assessments are the main outcome measures with rural area of student placement locations as categorised by the Australian Standard Geographical Classification - Remoteness Areas system the independent variable of interest.

Results: There was a significant effect of Australian Standard Geographical Classification - Remoteness Areas of placement on the health project, clinical case presentation, clinical participation assessment and overall grade, after controlling for the potential confounding impact of sex, age, students who attended the rural clinical school, cohort year, rotation during the year and type of health service where students were placed. No significant effect of rural placement level was identified for the written examination, poster or journal of achievement assessments.

Conclusion: Medical students' academic achievement is associated with many factors, but this study shows that being placed in remote areas is one factor that either does not impede or can positively influence the learning and academic performance of medical students.
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http://dx.doi.org/10.1111/ajr.12414DOI Listing
April 2018

Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis.

Transl Behav Med 2019 01;9(1):147-157

Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK.

Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.
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http://dx.doi.org/10.1093/tbm/iby010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305562PMC
January 2019

The Impact of Active Workstations on Workplace Productivity and Performance: A Systematic Review.

Int J Environ Res Public Health 2018 02 27;15(3). Epub 2018 Feb 27.

Institute for Health Research, University of Bedfordshire, Luton LU1 3JU, UK.

Active workstations have been recommended for reducing sedentary behavior in the workplace. It is important to understand if the use of these workstations has an impact on worker productivity. The aim of this systematic review was to examine the effect of active workstations on workplace productivity and performance. A total of 3303 articles were initially identified by a systematic search and seven articles met eligibility criteria for inclusion. A quality appraisal was conducted to assess risk of bias, confounding, internal and external validity, and reporting. Most of the studies reported cognitive performance as opposed to productivity. Five studies assessed cognitive performance during use of an active workstation, usually in a single session. Sit-stand desks had no detrimental effect on performance, however, some studies with treadmill and cycling workstations identified potential decreases in performance. Many of the studies lacked the power required to achieve statistical significance. Three studies assessed workplace productivity after prolonged use of an active workstation for between 12 and 52 weeks. These studies reported no significant effect on productivity. Active workstations do not appear to decrease workplace performance.
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http://dx.doi.org/10.3390/ijerph15030417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876962PMC
February 2018