Publications by category
Journal articles
van Beurden SB, Smith JR, Lawrence NS, Abraham C, Greaves CJ (In Press). Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults (Preprint).
Abstract:
Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults (Preprint)
. BACKGROUND
. ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss.
.
.
. OBJECTIVE
. The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal.
.
.
. METHODS
. We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback.
.
.
. RESULTS
. We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies.
.
.
. CONCLUSIONS
. The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants.
.
.
. CLINICALTRIAL
. International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
.
Abstract.
Withers TM, Garner NJ, Thorley CS, Kellett J, Price L, Auckland S, Sheldon J, Howe A, Pascale M, Smith JR, et al (2023). Intervention fidelity assessment: a sub-study of the Norfolk Diabetes Prevention Study (NDPS).
Br J Health PsycholAbstract:
Intervention fidelity assessment: a sub-study of the Norfolk Diabetes Prevention Study (NDPS).
BACKGROUND: Previous research has shown that lifestyle modification can delay or prevent the onset of type 2 diabetes in high-risk individuals. The Norfolk Diabetes Prevention Study (NDPS) was a parallel, three-arm, randomized controlled trial with up to 46 months follow-up that tested a group-delivered, theory-based lifestyle intervention to reduce the incidence of type 2 diabetes in high-risk groups. The current study aimed to evaluate if the NDPS intervention was delivered to an acceptable standard and if any part(s) of the delivery required improvement. METHODS: a sub-sample of 30, 25 for inter-rater reliability and audio-recordings of the NDPS intervention education sessions were assessed independently by two reviewers (CT, TW) using a 12-item checklist. Each item was scored on a 0-5 scale, with a score of 3 being defined as 'adequate delivery'. Inter-rater reliability was assessed. Analysis of covariance (ANCOVA) was used to assess changes in intervention fidelity as the facilitators gained experience. RESULTS: Inter-rater agreement was acceptable (86%). A mean score of 3.47 (SD = .38) was achieved across all items of the fidelity checklist and across all intervention facilitators (n = 6). There was an apparent trend for intervention fidelity scores to decrease with experience; however, this trend was non-significant (p > .05) across all domains in this small sample. CONCLUSION: the NDPS was delivered to an acceptable standard by all Diabetes Prevention Facilitators. Further research is needed to better understand how the intervention's delivery characteristics can be optimized and how they might vary over time.
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Author URL.
Garner NJ, Smith JR, Sampson MJ, Greaves CJ (2022). Quantity and specificity of action-plans as predictors of weight loss: analysis of data from the Norfolk Diabetes Prevention Study (NDPS). Psychology & Health, 1-26.
Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, et al (2021). Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial.
BMC Med,
19(1).
Abstract:
Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial.
BACKGROUND: the purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes. METHODS: We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months. RESULTS: We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants
Abstract.
Author URL.
van Beurden SB, Greaves CJ, Abraham C, Lawrence NS, Smith JR (2021). ImpulsePal: the systematic development of a smartphone app to manage food temptations using intervention mapping.
DIGITAL HEALTH,
7 Author URL.
Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, et al (2021). Lifestyle Intervention with or Without Lay Volunteers to Prevent Type 2 Diabetes in People with Impaired Fasting Glucose and/or Nondiabetic Hyperglycemia. JAMA Internal Medicine, 181(2), 168-168.
Daniels R, Harding A, Smith JR, Gomez-Cano M (2020). Development and validation of a tool to measure belongingness as a proxy for participation in undergraduate clinical learning. Education for Primary Care, 31(5), 311-317.
Borek AJ, Smith JR, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Abraham SCS (2019). Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study.
Efficacy and Mechanism Evaluation,
6(3), 1-162.
Abstract:
Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study
Background
Theories and meta-analyses have elucidated individual-level mechanisms of action in behaviour change interventions. Although group-based interventions are commonly used to support health-related behaviour change, such interventions rarely consider theory and research (e.g. from social psychology) on how group-level mechanisms can also influence personal change.
Objectives
The aim was to enhance understanding of mechanisms of action in group-based behaviour change interventions. The objectives were to (1) develop a potentially generalisable framework of change processes in groups, (2) test the framework by analysing group session recordings to identify examples illustrating group processes and facilitation techniques and (3) explore links between group-level mechanisms and outcomes.
Data sources
In this mixed-methods study, the research team reviewed literature, conducted consultations and analysed secondary data (i.e. delivery materials and 46 audio-recordings of group sessions) from three group-based weight loss interventions targeting diet and physical activity: ‘Living Well Taking Control’ (LWTC), ‘Skills for weight loss Maintenance’ and ‘Waste the Waist’. Quantitative LWTC programme data on participant characteristics, attendance and outcomes (primarily weight loss) were also used.
Methods
Objectives were addressed in three stages. In stage 1, a framework of change processes in groups was developed by reviewing literature on groups (including theories, taxonomies of types of change techniques, qualitative studies and measures of group processes), analysing transcripts of 10 diverse group sessions and consulting with four group participants, four facilitators and 31 researchers. In stage 2, the framework was applied in analysing 28 further group sessions. In stage 3, group-level descriptive analyses of available quantitative data from 67 groups and in-depth qualitative analyses of two groups for which comprehensive quantitative and qualitative data were available were conducted to illustrate mixed-methods approaches for exploring links between group processes and outcomes.
Results
Stage 1 resulted in development of the ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework and definitions, encompassing group intervention design features, facilitation techniques, group dynamic and development processes, interpersonal change processes, selective intrapersonal change processes operating in groups, and contextual factors. In stage 2, a coding schema was developed, refined and applied to identify examples of framework components in group sessions, confirming the content validity of the framework for weight loss interventions. Stage 3 demonstrated considerable variability in group characteristics and outcomes and illustrated how the framework could be applied in integrating group-level qualitative and quantitative data to generate and test hypotheses about links between group mechanisms and outcomes (e.g. to identify features of more or less successful groups).
Limitations
The framework and examples were primarily derived from research on weight loss interventions, and may require adaptations/additions to ensure applicability to other types of groups. The mixed-methods analyses were limited by the availability and quality of the secondary data.
Conclusions
This study identified, defined, categorised into a framework and provided examples of group-level mechanisms that may influence behaviour change.
Future work
The framework and mixed-methods approaches developed provide a resource for designers, facilitators and evaluators to underpin future research on, and delivery of, group-based interventions.
Funding
This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.
Abstract.
Van Beurden S, Smith JR, Lawrence N, Abraham SCS, Greaves C (2019). Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults.
JMIR Formative Research,
3(2), e11586-e11586.
Abstract:
Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults
Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss.
Objective: the aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal.
Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback.
Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies.
Conclusions: the evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants.
Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
Abstract.
Borek AJ, Abraham SCS, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Smith JR (2019). Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework.
Health Psychology ReviewAbstract:
Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants’ experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.
Abstract.
Garner NJ, Pascale M, France K, Ferns C, Clark A, Auckland S, Sampson M, NDPS Group (2019). Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS).
BMJ Open Diabetes Res Care,
7(1).
Abstract:
Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS).
OBJECTIVE: Intensive lifestyle interventions reduce the risk of type 2 diabetes in populations at highest risk, but staffing levels are usually unable to meet the challenge of delivering effective prevention strategies to a very large at-risk population. Training volunteers with existing type 2 diabetes to support healthcare professionals deliver lifestyle interventions is an attractive option. METHODS: We identified 141 973 people at highest risk of diabetes in the East of England, screened 12 778, and randomized 1764 into a suite of type 2 diabetes prevention and screen detected type 2 diabetes management trials. A key element of the program tested the value of volunteers with type 2 diabetes, trained to act as diabetes prevention mentors (DPM) when added to an intervention arm delivered by healthcare professionals trained to support participant lifestyle change. RESULTS: We invited 9951 people with type 2 diabetes to become DPM and 427 responded (4.3%). of these, 356 (83.3%) were interviewed by phone, and of these 131 (36.8%) were interviewed in person. We then appointed 104 of these 131 interviewed applicants (79%) to the role (mean age 62 years, 55% (n=57) male). All DPMs volunteered for a total of 2895 months, and made 6879 telephone calls to 461 randomized participants. Seventy-six (73%) DPMs volunteered for at least 6 months and 66 (73%) for at least 1 year. DISCUSSION: Individuals with type 2 diabetes can be recruited, trained and retained as DPM in large numbers to support a group-based diabetes prevention program delivered by healthcare professionals. This volunteer model is low cost, and accesses the large type 2 diabetes population that shares a lifestyle experience with the target population. This is an attractive model for supporting diabetes prevention efforts.
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Smith JR, Greaves CJ, Thompson JL, Taylor RS, Jones M, Armstrong R, Moorlock S, Griffin A, Solomon-Moore E, Biddle MSY, et al (2019). The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme.
International Journal of Behavioral Nutrition and Physical Activity,
16(1).
Abstract:
The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme
Abstract
Objective
This two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months.
Methods
Adults aged 18–75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants’ homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype “Living Well, Taking Control” (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded.
Results
The target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (− 1.7 kg, 95% CI − 2.59 to − 0.85). Higher attendance was associated with greater weight loss (− 3.0 kg, 95% CI − 4.5 to − 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI − 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm.
Conclusions
This voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors.
Trial registration
Trial registration number: ISRCTN70221670, 5 September 2014
Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM.
Abstract.
Smith JR, Musgrave S, Payerne E, Noble M, Sims EJ, Clark AB, Barton G, Pinnock H, Sheikh A, Wilson AM, et al (2018). At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): Study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations.
Trials,
19(1).
Abstract:
At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): Study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations
Background: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. Methods: We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asthma' identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients' records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4weeks and a reminder video at 6weeks and 6months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted. Discussion: This study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes.
Abstract.
Kok MSY, Jones M, Solomon-Moore E, Smith JR (2018). Implementation fidelity of a voluntary sector-led diabetes education programme.
Health Education,
118(1), 62-81.
Abstract:
Implementation fidelity of a voluntary sector-led diabetes education programme
Purpose: the quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes. Design/methodology/approach: This fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence. Findings: Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings. Originality/value: an appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.
Abstract.
Bardus M, van Beurden SB, Smith JR, Abraham C (2016). A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management.
Int J Behav Nutr Phys Act,
13Abstract:
A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management.
BACKGROUND: There are thousands of apps promoting dietary improvement, increased physical activity (PA) and weight management. Despite a growing number of reviews in this area, popular apps have not been comprehensively analysed in terms of features related to engagement, functionality, aesthetics, information quality, and content, including the types of change techniques employed. METHODS: the databases containing information about all Health and Fitness apps on GP and iTunes (7,954 and 25,491 apps) were downloaded in April 2015. Database filters were applied to select the most popular apps available in both stores. Two researchers screened the descriptions selecting only weight management apps. Features, app quality and content were independently assessed using the Mobile App Rating Scale (MARS) and previously-defined categories of techniques relevant to behaviour change. Inter-coder reliabilities were calculated, and correlations between features explored. RESULTS: of the 23 popular apps included in the review 16 were free (70%), 15 (65%) addressed weight control, diet and PA combined; 19 (83%) allowed behavioural tracking. On 5-point MARS scales, apps were of average quality (Md = 3.2, IQR = 1.4); "functionality" (Md = 4.0, IQR = 1.1) was the highest and "information quality" (Md = 2.0, IQR = 1.1) was the lowest domain. On average, 10 techniques were identified per app (range: 1-17) and of the 34 categories applied, goal setting and self-monitoring techniques were most frequently identified. App quality was positively correlated with number of techniques included (rho = .58, p
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Bardus M, Smith JR, Samaha L, Abraham C (2016). Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality.
Eur J Public Health,
26(4), 602-610.
Abstract:
Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality.
BACKGROUND: the use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. METHODS: Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. RESULTS: Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. CONCLUSIONS: Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base.
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White R, Abraham C, Smith JR, White M, Staiger PK (2016). Recovery under sail: Rehabilitation clients' experience of a sail training voyage. Addiction Research & Theory, 24(5), 355-365.
van Beurden SB, Greaves CJ, Smith JR, Abraham C (2016). Techniques for modifying impulsive processes associated with unhealthy eating: a systematic review.
Health Psychol,
35(8), 793-806.
Abstract:
Techniques for modifying impulsive processes associated with unhealthy eating: a systematic review.
OBJECTIVE: This systematic review aimed to (a) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior, (b) describe the mechanisms targeted by such techniques, and (c) summarize available evidence on the effectiveness of these techniques. METHOD: Searches of 5 bibliographic databases identified studies, published in English since 1993, that evaluated at least 1 technique to modify impulsive processes affecting eating in adults. Data were systematically extracted on study characteristics, population, study quality, intervention techniques, proposed mechanisms of action, and outcomes. Effectiveness evidence was systematically collated and described without meta-analysis. RESULTS: Ninety-two studies evaluated 17 distinct impulse management techniques. They were categorized according to whether they aimed to (a) modify the strength of impulses or (b) engage the reflective system or other resources in identifying, suppressing, or otherwise managing impulses. Although higher quality evidence is needed to draw definitive conclusions, promising changes in unhealthy food consumption and food cravings were observed for visuospatial loading, physical activity, and if-then planning, typically for up to 1-day follow-up. CONCLUSIONS: a wide range of techniques have been evaluated and some show promise for use in weight management interventions. However, larger-scale, more methodologically robust, community-based studies with longer follow-up times are needed to establish whether such techniques can have a long-term impact on eating patterns. (PsycINFO Database Record
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Borek AJ, Abraham C, Smith JR, Greaves CJ, Tarrant M (2015). A checklist to improve reporting of group-based behaviour-change interventions.
BMC Public Health,
15Abstract:
A checklist to improve reporting of group-based behaviour-change interventions.
BACKGROUND: Published descriptions of group-based behaviour-change interventions (GB-BCIs) often omit design and delivery features specific to the group setting. This impedes the ability to compare behaviour-change interventions, synthesise evidence on their effectiveness and replicate effective interventions. The aim of this study was to develop a checklist of elements that should be described to ensure adequate reporting of GB-BCIs. METHODS: a range of characteristics needed to replicate GB-BCIs were extracted from the literature and precisely defined. An abbreviated checklist and a coder manual were developed, pilot tested and refined. The final checklist and coder manual were used to identify the presence or absence of specified reporting elements in 30 published descriptions of GB-BCIs by two independent coders. Reliability of coding was assessed. RESULTS: the checklist comprises 26 essential reporting elements, covering intervention design, intervention content, participant characteristics, and facilitator characteristics. Inter-rater reliability for identification of reporting elements was high (95% agreement, Mean AC1 = 0.89). CONCLUSION: the checklist is a practical tool that can be used, alongside other reporting guidelines, to ensure comprehensive description and to assess reporting quality of GB-BCIs. It can also be helpful for designing group-based health interventions.
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Bardus M, Smith JR, Samaha L, Abraham C (2015). Mobile Phone and Web 2.0 Technologies for Weight Management: a Systematic Scoping Review.
Journal of medical Internet research,
17(11).
Abstract:
Mobile Phone and Web 2.0 Technologies for Weight Management: a Systematic Scoping Review.
BackgroundWidespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management.ObjectiveTo provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc).MethodsA systematic scoping review of the literature was conducted based on a published protocol (registered atProsperoCRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized.ResultsWe identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%).ConclusionsThere is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions.
Abstract.
Isa A, Loke YK, Smith JR, Papageorgiou A, Hunter PR (2013). Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.
PLoS Negl Trop Dis,
7(9).
Abstract:
Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.
BACKGROUND: Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. METHODS AND FINDINGS: We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. CONCLUSIONS: to control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.
Abstract.
Author URL.
Murdoch J, Salter C, Cross J, Smith JR, Poland F (2013). Resisting medications: moral discourses and performances in illness narratives. Sociology of Health and Illness: a journal of medical sociology, 35(3), 449-464.
Noble MJ, Harrison BDW, Windley J, Smith JR, Wilson AM, Price GM, Price D (2012). Asthma at-risk registers--can be effective if carefully constructed and correctly implemented.
Prim Care Respir J,
21(2), 135-136.
Author URL.
Smith JR, Noble MJ, Musgrave S, Murdoch J, Price GM, Barton GR, Windley J, Holland R, Harrison BD, Howe A, et al (2012). The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care.
Thorax,
67(12), 1052-1060.
Abstract:
The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care.
BACKGROUND: Patients at risk of severe exacerbations contribute disproportionally to asthma mortality, morbidity and costs. We evaluated the effectiveness and costs of using 'asthma risk registers' for these patients in primary care. METHODS: in a cluster-randomised trial, 29 primary care practices identified 911 at-risk asthma patients using British asthma guideline criteria (severe asthma plus adverse psychosocial characteristics). Intervention practices added electronic alerts to identified patients' records to flag their at-risk status and received practice-based training about using the alerts to improve patient access and opportunistic management. Control practices continued routine care. Numbers of patients experiencing the primary outcome of a moderate-severe exacerbation (resulting in death, hospitalisation, accident and emergency attendance, out-of-hours contact, or a course/boost in oral prednisolone for asthma), other healthcare and medication usage, and costs over 1 year were derived from practice-based records. RESULTS: There was no significant effect on exacerbations (control: 46.5%; intervention: 53.6%, OR, 95% CI 1.30, 0.93 to 1.80). However, this composite outcome masked relative reductions in intervention patients experiencing hospitalisations (OR 0.50, 95% CI 0.26 to 0.94), accident and emergency (OR 0.74, 95% CI 0.42 to 1.31) and out-of-hours contacts (OR 0.79, 95% CI 0.45 to 1.37); and a relative increase in prednisolone prescription for exacerbations (OR 1.31, 95% CI 0.92 to 1.85). Furthermore, prescription of nebulised short-acting β-agonists reduced and long-acting β-agonists increased for intervention relative to control patients. The adjusted mean per patient healthcare cost was £138.21 lower (p=0.837) among intervention practices. CONCLUSION: Using asthma risk registers in primary care did not reduce treated exacerbations, but reduced hospitalisations and increased prescriptions of recommended preventative therapies without increasing costs.
Abstract.
Author URL.
Ramjeet J, Smith JR, Adams M (2008). The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review. J Clin Nurs, 17, 418-428.
Smith JR, Mugford M, Holland R, Noble MJ, Harrison BDW (2007). Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.
J Asthma,
44(3), 219-241.
Abstract:
Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.
Research highlights psychosocial factors associated with adverse asthma events. This systematic review therefore examined whether psycho-educational interventions improve health and self-management outcomes in adults with severe or difficult asthma. Seventeen controlled studies were included. Characteristics and content of interventions varied even within broad types. Study quality was generally poor and several studies were small. Any positive effects observed from qualitative and quantitative syntheses were mainly short term and, in planned subgroup analyses (involving < 5 trials), effects on hospitalizations, quality of life, and psychological morbidity in patients with severe asthma did not extend to those in whom multiple factors complicate management.
Abstract.
Author URL.
Noble MJ, Smith JR, Windley J (2006). A controlled retrospective pilot study of an 'at-risk asthma register' in primary care.
Prim Care Respir J,
15(2), 116-124.
Abstract:
A controlled retrospective pilot study of an 'at-risk asthma register' in primary care.
BACKGROUND: There are few reports of primary care initiatives designed to improve management of asthma patients who are at risk of adverse outcomes. AIM: to assess the impact on emergency treatments, service use, and costs, of introducing an at-risk asthma register in a general practice surgery. METHODS: Asthma patients demonstrating characteristics associated with adverse outcomes were added to an at-risk register. Tags were placed in patients' records and practice staff were trained to ensure their appropriate recognition and management. Data were retrospectively extracted from the notes of 26 identified at-risk patients, as well as 26 age-, sex-, and treatment-matched controls with asthma, for one year before and after the introduction of the register. Implementation and service use costs were estimated. RESULTS: Before introduction of the register, more 'at-risk' than control patients were hospitalised (3 vs. 0), attended the accident and emergency (A&E) department (1 vs. 0), and were nebulised (4 vs. 0), for asthma. Significantly higher numbers also used out-of-hours services, received oral steroids, attended their general practitioner (GP), and failed to attend scheduled clinics for asthma (all p
Abstract.
Author URL.
Holland R, Battersby J, Harvey I, Lenaghan E, Smith JR, Hay L (2005). A systematic review of multi-disciplinary interventions in heart failure. Heart, 91, 899-906.
Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BDW, Koutantji M, Upton C, Harvey I (2005). A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.
Health Technol Assess,
9(23), iii-167.
Abstract:
A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.
OBJECTIVES: Prior research has highlighted the importance of psychosocial factors in 'difficult' asthma. This study aimed to review the content, effectiveness and cost-effectiveness of psycho-educational interventions designed to address these factors in patients with severe and difficult asthma. DATA SOURCES: Thirty-two electronic databases and other sources were searched for studies of educational, self-management, psychosocial and multifaceted interventions. REVIEW METHODS: Abstracts were screened in duplicate, against prior definitions, to identify eligible interventions targeted to patients with forms of or risk factors for difficult asthma. Studies were classified by patient group (child, adult) and graded along two dimensions related to study design and relevance in terms of the degree to which they were judged to have targeted difficult asthma. Detailed data were extracted from studies meeting a minimum design and relevance threshold. Characteristics of studies were tabulated and results qualitatively synthesised. Where sufficiently similar studies reported adequate data about comparable outcomes, quantitative syntheses of results were undertaken using a random effects approach to calculate pooled relative risks (RR) or standardised mean differences (SMD), with 95% confidence intervals (CI). RESULTS: Searches identified over 23,000 citations. After initial screening and removal of duplicates, 4240 possibly relevant abstracts were assessed. Papers associated with 188 studies were initially obtained and classified. Fifty-seven studies including control groups and those that were judged to have at least 'possible' targeting of difficult asthma (35 in children, 21 in adults, 1 in both) were selected for in-depth review. The delivery, setting, timing and content of interventions varied considerably even within broad types. Reporting of interventions and methodological quality was often poor, but studies demonstrated some success in targeting and following up at-risk patients. Studies reporting data suitable for calculation of summary statistics were of higher quality than those that did not. There was evidence from these that, compared to usual or non-psycho-educational care, psycho-educational interventions reduced admissions when data from the latest follow-ups reported were pooled across nine studies in children (RR = 0.64, CI = 0.46-0.89) and six studies with possible targeting of difficult asthma in adults (RR = 0.57, CI = 0.34-0.93). In children, the greatest and only significant effects were confined to individual studies with limited targeting of difficult asthma and no long-term follow-up. Limited data in adults also suggested effects may not extend to those most at risk. There was no evidence of pooled effects of psycho-educational interventions on emergency attendances from eight studies in children (RR = 0.97, CI = 0.78-1.21) and four in adults (RR = 1.03, CI = 0.82-1.29). There were overall significant reductions in symptoms, similar in different sub-groups of difficult asthma, across four paediatric studies that could be combined (SMD = -0.45, CI = -0.68 to -0.22), but mixed results across individual adult studies. A few individual studies in children showed mainly positive effects on measures of self-care behaviour, but with respect to all other outcomes in adults and children, studies showed mixed results or suggested limited effectiveness of psycho-educational interventions. No studies of psychosocial interventions were included in any quantitative syntheses and it was not possible to draw clear conclusions regarding the relative effectiveness of educational, self-management and multifaceted programmes. Data on costs were very limited. of the two well-designed economic evaluations identified, both of multifaceted interventions, one in children suggested an additional cost of achieving health gain in terms of symptom-free days. Provisional data from the other study suggested that in adults the significantly increased costs of providing an intervention were not offset by any short-term savings in use of healthcare resources or associated with improvements in health outcomes. CONCLUSIONS: There was some evidence of overall positive effects of psycho-educational interventions on hospital admissions in adults and children, and on symptoms in children, but limited evidence of effects on other outcomes. The majority of research and greatest effects, especially in adults, were confined to patients with severe disease but who lacked other characteristics indicative of difficult asthma or likely to put them at risk. A lack of good-quality research limited conclusions about cost-effectiveness. Although psycho-educational interventions may be of some benefit to patients with severe disease, there is currently a lack of evidence to warrant significant changes in clinical practice with regard to the care of patients with more difficult asthma. Further research is needed to: (1) standardise reporting of complex interventions; (2) extend and update this review; (3) improve identification of patients at risk from their asthma; (4) develop and test appropriate outcome measures for this group; and (5) design and evaluate, via the conduct of high-quality pragmatic RCTs, more powerful psycho-educational interventions that are conceptualised in terms of the ways in which psychosocial factors and asthma interact.
Abstract.
Author URL.
Smith JR, Mildenhall S, Noble M, Mugford M, Shepstone L, Harrison BDW (2005). Clinician-assessed poor compliance identifies adults with severe asthma who are at risk of adverse outcomes.
J Asthma,
42(6), 437-445.
Abstract:
Clinician-assessed poor compliance identifies adults with severe asthma who are at risk of adverse outcomes.
Our aim was to determine whether clinician-identified poor compliance is useful in identifying, from among adults with severe asthma, patients with characteristics likely to put them at risk of adverse outcomes. Patients with severe asthma (previous hospital admissions and/or prescribed step 4-5 treatment according to British Thoracic Society guidelines) considered by clinicians to be either compliant (C, N = 41) or poorly compliant (PC, N = 92) with aspects of their recommended management (attendance at appointments, taking medication, and monitoring asthma) provided data on symptoms, health service use, medication, self-management practices, physical and psychological comorbidities, and sociodemographic/socioeconomic characteristics. Cross-sectional univariate analyses were used to examine whether the groups differed with respect to self-reported indicators of asthma morbidity and self-management. Logistic regressions were additionally used to explore psychosocial factors independently associated with patients being identified as PC. Compared with C patients, PC patients had significantly poorer self-reported asthma control in terms of medication use, symptoms, time off work, asthma-specific quality of life, primary care visits, emergency attendances, and hospital admissions. This was coupled with poorer self-management practices. Patients identified as PC also had higher levels of physical and psychological comorbidities, were younger, and faced more difficult social and economic circumstances. We identified significant psychological (anxiety) and social (younger age, not working, number of benefits, adverse family circumstances) factors independently associated with patients being identified as PC. Among adults with severe asthma, clinician-assessed poor compliance was useful in distinguishing between two groups that differed significantly in terms of asthma morbidity indicators, self-management practices, and psychosocial characteristics, which have been previously shown to be associated with hospital admissions, near-fatal attacks, and fatal asthma. We conclude that clinician-assessed poor compliance is a useful marker for identifying patients at risk of these adverse outcomes.
Abstract.
Author URL.
Smith JR, Mildenhall S, Noble MJ, Shepstone L, Koutantji M, Mugford M, Harrison BDW (2005). The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes.
Thorax,
60(12), 1003-1011.
Abstract:
The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes.
BACKGROUND: Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes. METHODS: a pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4-5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status. RESULTS: at the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores (differences (with 95% CI) -0.35 (-1.83 to 1.13), 3.10 (-11.42 to 17.63), 0.42 (-10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e.g. adjusted difference at 12 months 0.13 (95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses. CONCLUSIONS: a home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes.
Abstract.
Author URL.
Chapters
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2019). Health behaviour change interventions. In (Ed) Cambridge Handbook of Psychology, Health and Medicine: Third Edition, 270-273.
Tsekleves E, Cooper R, Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours. In (Ed) Design for Health, 58-71.
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours: Behaviour-change interventions for public health. In (Ed)
Design for Health, 58-71.
Abstract:
Behaviours: Behaviour-change interventions for public health
Abstract.
Denford S, Abraham C, Smith J, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In Spotswood F (Ed)
Beyond behaviour change Key issues, interdisciplinary approaches and future directions, Bristol: Policy Press, 49-70.
Abstract:
Intervention design and evaluation: behaviour change imperatives
Abstract.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Denford S, Abraham C, Smith J, Lloyd J, White M, Tarrant M, Wyatt K, Greaves C, Dean S (2015). Designing and evaluating behavior change interventions to promote health. In Reynolds KJ, Branscombe NR (Eds.) The Psychology of Change: Life Contexts, Experiences, and Identities, New York: Psychology Press, Taylor & Francis, 151-169.
Abraham C, Denford S, Dean S, Greaves C, Lloyd J, Tarrant M, White M, Wyatt K (2015). Designing interventions to change health-related behaviour. In Richards D, Hallberg IR (Eds.) Complex Interventions in Health: an overview of research methods, Routledge, 103-110.
Smith JR, Cleland J (2011). The interaction of psychological factors with illness, disease and treatment. In Cleland J, Cotton P, van Teiljlingen E (Eds.) Health, Behaviour and Society: Clinical Medicine in Context, Exeter: Learning Matters, 44-60.
Cleland J, Smith JR (2011). Using psychology to help your medical practice. In Cleland J, Cotton P (Eds.) Health, Behaviour and Society: Clinical Medicine in Context, Exeter: Learning Matters, 25-43.
Smith JR (2008). Asthma. In Newman S, Steed E, Mulligan K (Eds.) Chronic Physical Illness: Self-Management and Behavioural Interventions, Oxford: Open University Press, 204-223.
Smith JR, Harrison B (2007). Psychosocial factors in severe asthma in adults. In Johnston SL, O'Byrne PM (Eds.) Exacerbations of Asthma, Abgindon: Informa Healthcare, 321-340.
Conferences
Smith JR, Noble MJ, Winder R, Poltawski L, Ashford PA, Musgrave S, Stirling S, Morgan-Trimmer S, Caress AL, Wilson AM, et al (2019). INITIAL PROCESS EVALUATION FINDINGS FROM THE AT-RISK REGISTERS INTEGRATED INTO PRIMARY CARE TO STOP ASTHMA CRISES IN THE UK (ARRISA-UK) TRIAL: PRACTICE CHARACTERISTICS, ENGAGEMENT AND EARLY EXPERIENCES OF THE INTERVENTION.
Author URL.
Borek AJ, Smith JR, Abraham C, Greaves CJ, Morgan-Trimmer S, Gillison F, Jones M, Tarrant M, McCabe R (2017). MECHANISMS OF ACTION IN GROUP-BASED INTERVENTIONS (MAGI) STUDY: a FRAMEWORK OF CHANGE PROCESSES IN GROUP-BASED HEALTH INTERVENTIONS.
Author URL.
van Beurden SB, Greaves CJ, Smith JR, Abraham C, Lawrence N (2016). FACILITATING WEIGHT LOSS WITH THE IMPULSEPAL APP': a FEASIBILITY STUDY.
Author URL.
Borek A, Abraham C, Greaves C, Tarrant M, Smith JR (2016). HOW DO DIABETES PREVENTION GROUPS GENERATE INDIVIDUAL CHANGE?.
Author URL.
Smith JR, Borek A, Abraham C, Greaves C, Morgan-Trimmer S, Gillison F, Jones M, Keable J, Tarrant M, McCabe R, et al (2016). MECHANISMS OF ACTION IN GROUP INTERVENTIONS (MAGI) STUDY: INITIAL FINDINGS AND a CONCEPTUAL FRAMEWORK.
Author URL.
Sharpe R, Smith JR, Orr N, Phoenix C, Bethel A, Goodwin V, Lang I, Garside R (2016). PHYSICAL ACTIVITY INTERVENTIONS IN OLDER ADULTS: a SYSTEMATIC REVIEW OF REVIEWS.
Author URL.
van Beurden SB, Greaves CJ, Smith JR, Abraham C (2016). TECHNIQUES FOR MODIFYING IMPULSIVE PROCESSES ASSOCIATED WITH UNHEALTHY EATING: a SYSTEMATIC REVIEW.
Author URL.
Smith JR, Greaves C, Abraham C, Thompson JL, Taylor R, Jones M, Kok M, Armstrong R, Coleman S, Solomon-Moores E, et al (2016). THE COMMUNITY-BASED PREVENTION OF DIABETES (COMPOD) TRIAL OF THE VOLUNTARY SECTOR-LED LIVING WELL, TAKING CONTROL (LWTC) DIABETES PREVENTION PROGRAMME.
Author URL.
Abraham C, Onya H, Aarø L, Smith JR, Devine-Wright H, Wubs A, Ramatsea S, Themane M, Mashamba J (2015). Evaluation of a culturally-situated, research-based HIV-prevention program in South African Schools (symposium presentation). European Health Psychology Society Conference.
Van Beurden S, Greaves CJ, Smith JR, Abraham S (2015). Identifying techniques for modifying impulsive influences on eating behaviour: a systematic review (oral presentation). European Health Psychology Conference.
Smith JR, Murray NJ, Greaves CJ, Abraham S, Hooper L (2014). A systematic review of intervention studies using Health Action Process Approach (HAPA) model components to target behaviours for preventing and managing chronic diseases (oral presentation). European Health Psychology Conference.
Borek A, Abraham S, Smith JR, Tarrant M, Greaves C (2014). Reporting of group-based behavioural interventions: a checklist and tool for assessing the quality of descriptions (oral presentation). European Health Psychology Society Conference.
Watson S, Bhattacharya D, Wood J, Smith JR, Adams M, Song F (2012). The impact of treatment side-effects upon medication adherence (oral presentation). Health Services Research and Pharmacy Practice Conference.
Watson S, Bhattacharya D, Wood J, Smith JR, Adams M, Song F (2011). Systematic review and meta-analysis shows stress is negatively associated with adherence to medication (poster presentation). Health Services Research and Pharmacy Practice Conference.
Smith JR, et al (2010). Cross-sectional and longitudinal relationships of self-management behaviours and other psychological factors with outcomes in patients with severe asthma. British Thoracic Society Winter Meeting.
Smith JR, Noble MJ, Harrison BDW, Adams M (2010). P175 Cross-sectional and longitudinal relationships of self-management behaviours and other psychological factors with outcomes in patients with severe asthma.
Smith JR, Noble M, Musgrave S, Murdoch J, Price G, Windley J, Holland R, Harrison BDW, Howe A, Price D, et al (2010). The At-Risk Registers in Severe Asthma (ARRISA) study: a cluster-randomised controlled trial in primary care (oral presentation). British Thoracic Society Winter Meeting.
Nicol AAM, Smith RD, Smith JR, Mills KS, Somerville M, Adams M, Reynolds S (2006). What do patients with rheumatoid arthritis think of shared clinical decision-making? a qualitative observational study of anti-TNF treatment in clinical practice. European League Against Rheumatism congress.
Author URL.
Koutantji M, Smith JR, Adams M, Brooksby A, Somerville M, Scott DGI (2004). OBSERVATIONAL STUDY OF THE ROUTINE USE OF ANTI-TNF DRUGS IN THE TREATMENT OF RHEUMATOID ARTHRITIS IN a UK SETTING: IMPACTS ON QUALITY OF LIFE AND MOOD.
Author URL.
Smith JR, Mildenhall S, Noble M, Harrison BDW (2003). Poor compliance is a marker for those at-risk of adverse outcomes in adults with severe asthma.
Author URL.
Smith JR, Mugford M, Holland R, Noble M, Harrison BDW, Koutantji M (2003). Systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in difficult asthma.
Author URL.
Smith JR, Mildenhall S, Noble M, Mugford M, Harrison BDW (2003). The coping with asthma study: a randomised controlled trial and economic evaluation of a home-based intervention for at-risk asthmatics.
Author URL.
Smith JR, Koutantji M, Mildenhall S, Harrison BDW, Noble M (2002). Psychosocial factors in adults at risk of adverse asthma outcomes: Relationships with symptom control and quality of life.
Author URL.
Publications by year
In Press
van Beurden SB, Smith JR, Lawrence NS, Abraham C, Greaves CJ (In Press). Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults (Preprint).
Abstract:
Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults (Preprint)
. BACKGROUND
. ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss.
.
.
. OBJECTIVE
. The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal.
.
.
. METHODS
. We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback.
.
.
. RESULTS
. We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies.
.
.
. CONCLUSIONS
. The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants.
.
.
. CLINICALTRIAL
. International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
.
Abstract.
van Beurden SB, Greaves CJ, Lawrence NS, Abraham C, Smith JR (In Press). ImpulsePal: Developing a Smartphone App to Manage Food Temptations using Intervention Mapping. (Preprint).
Abstract:
ImpulsePal: Developing a Smartphone App to Manage Food Temptations using Intervention Mapping. (Preprint)
. BACKGROUND
. Impulsive processes driving eating behaviour can often undermine peoples’ attempts to lose weight and maintain weight loss.
.
.
. OBJECTIVE
. To develop an impulse management intervention to support weight loss in adults.
.
.
. METHODS
. Intervention Mapping (IM) was used to systematically develop the “ImpulsePal” intervention. The development involved: 1) a needs assessment including a qualitative study, service user workshops, a systematic review of impulse modification techniques, and consultations with intervention design and delivery experts; 2) specification of performance objectives, determinants, and change objectives; 3) selection of intervention strategies (mapping of taxonomy-related change techniques to the determinants of change); 4) creation of programme materials; 5) specification of adoption and implementation plans; 6) devising an evaluation plan.
.
.
. RESULTS
. Application of the IM Protocol resulted in a smartphone app-based intervention aimed at reducing unhealthy snacking, overeating, and alcoholic and sugary drink consumption. The app includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity as a craving-management technique, and context-specific reminders. An “Emergency Button” was also included to provide access to in-the-moment support when temptation is strong.
.
.
. CONCLUSIONS
. ImpulsePal is a novel, theory- and evidence-informed, person-centred app to improve impulse management and promote healthier eating. Intervention Mapping ensured that all app components are practical operationalisations of change techniques that target our specific change objectives and their associated theoretical determinants. Using this approach enhances transparency, provides a clear framework for analysis and increases replicability as well as the potential of the intervention to accomplish the desired outcome of supporting weight loss.
.
Abstract.
2023
Withers TM, Garner NJ, Thorley CS, Kellett J, Price L, Auckland S, Sheldon J, Howe A, Pascale M, Smith JR, et al (2023). Intervention fidelity assessment: a sub-study of the Norfolk Diabetes Prevention Study (NDPS).
Br J Health PsycholAbstract:
Intervention fidelity assessment: a sub-study of the Norfolk Diabetes Prevention Study (NDPS).
BACKGROUND: Previous research has shown that lifestyle modification can delay or prevent the onset of type 2 diabetes in high-risk individuals. The Norfolk Diabetes Prevention Study (NDPS) was a parallel, three-arm, randomized controlled trial with up to 46 months follow-up that tested a group-delivered, theory-based lifestyle intervention to reduce the incidence of type 2 diabetes in high-risk groups. The current study aimed to evaluate if the NDPS intervention was delivered to an acceptable standard and if any part(s) of the delivery required improvement. METHODS: a sub-sample of 30, 25 for inter-rater reliability and audio-recordings of the NDPS intervention education sessions were assessed independently by two reviewers (CT, TW) using a 12-item checklist. Each item was scored on a 0-5 scale, with a score of 3 being defined as 'adequate delivery'. Inter-rater reliability was assessed. Analysis of covariance (ANCOVA) was used to assess changes in intervention fidelity as the facilitators gained experience. RESULTS: Inter-rater agreement was acceptable (86%). A mean score of 3.47 (SD = .38) was achieved across all items of the fidelity checklist and across all intervention facilitators (n = 6). There was an apparent trend for intervention fidelity scores to decrease with experience; however, this trend was non-significant (p > .05) across all domains in this small sample. CONCLUSION: the NDPS was delivered to an acceptable standard by all Diabetes Prevention Facilitators. Further research is needed to better understand how the intervention's delivery characteristics can be optimized and how they might vary over time.
Abstract.
Author URL.
2022
Garner NJ, Smith JR, Sampson MJ, Greaves CJ (2022). Quantity and specificity of action-plans as predictors of weight loss: analysis of data from the Norfolk Diabetes Prevention Study (NDPS). Psychology & Health, 1-26.
2021
Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, et al (2021). Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial.
BMC Med,
19(1).
Abstract:
Effects of the Norfolk diabetes prevention lifestyle intervention (NDPS) on glycaemic control in screen-detected type 2 diabetes: a randomised controlled trial.
BACKGROUND: the purpose of this trial was to test if the Norfolk Diabetes Prevention Study (NDPS) lifestyle intervention, recently shown to reduce the incidence of type 2 diabetes in high-risk groups, also improved glycaemic control in people with newly diagnosed screen-detected type 2 diabetes. METHODS: We screened 12,778 participants at high risk of type 2 diabetes using a fasting plasma glucose and glycosylated haemoglobin (HbA1c). People with screen-detected type 2 diabetes were randomised in a parallel, three-arm, controlled trial with up to 46 months of follow-up, with a control arm (CON), a group-based lifestyle intervention of 6 core and up to 15 maintenance sessions (INT), or the same intervention with additional support from volunteers with type 2 diabetes trained to co-deliver the lifestyle intervention (INT-DPM). The pre-specified primary end point was mean HbA1c compared between groups at 12 months. RESULTS: We randomised 432 participants (CON 149; INT 142; INT-DPM 141) with a mean (SD) age of 63.5 (10.0) years, body mass index (BMI) of 32.4 (6.4) kg/m2, and HbA1c of 52.5 (10.2) mmol/mol. The primary outcome of mean HbA1c at 12 months (CON 48.5 (9.1) mmol/mol, INT 46.5 (8.1) mmol/mol, and INT-DPM 45.6 (6.0) mmol/mol) was significantly lower in the INT-DPM arm compared to CON (adjusted difference -2.57 mmol/mol; 95% CI -4.5, -0.6; p = 0.007) but not significantly different between the INT-DPM and INT arms (-0.55 mmol/mol; 95% CI -2.46, 1.35; p = 0.57), or INT vs CON arms (-2.14 mmol/mol; 95% CI -4.33, 0.05; p = 0.07). Subgroup analyses showed the intervention had greater effect in participants
Abstract.
Author URL.
van Beurden SB, Greaves CJ, Abraham C, Lawrence NS, Smith JR (2021). ImpulsePal: the systematic development of a smartphone app to manage food temptations using intervention mapping.
DIGITAL HEALTH,
7 Author URL.
Sampson M, Clark A, Bachmann M, Garner N, Irvine L, Howe A, Greaves C, Auckland S, Smith J, Turner J, et al (2021). Lifestyle Intervention with or Without Lay Volunteers to Prevent Type 2 Diabetes in People with Impaired Fasting Glucose and/or Nondiabetic Hyperglycemia. JAMA Internal Medicine, 181(2), 168-168.
2020
Daniels R, Harding A, Smith JR, Gomez-Cano M (2020). Development and validation of a tool to measure belongingness as a proxy for participation in undergraduate clinical learning. Education for Primary Care, 31(5), 311-317.
2019
Borek AJ, Smith JR, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Abraham SCS (2019). Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study.
Efficacy and Mechanism Evaluation,
6(3), 1-162.
Abstract:
Developing and applying a framework to understand mechanisms of action in group-based, behaviour change interventions: the MAGI mixed-methods study
Background
Theories and meta-analyses have elucidated individual-level mechanisms of action in behaviour change interventions. Although group-based interventions are commonly used to support health-related behaviour change, such interventions rarely consider theory and research (e.g. from social psychology) on how group-level mechanisms can also influence personal change.
Objectives
The aim was to enhance understanding of mechanisms of action in group-based behaviour change interventions. The objectives were to (1) develop a potentially generalisable framework of change processes in groups, (2) test the framework by analysing group session recordings to identify examples illustrating group processes and facilitation techniques and (3) explore links between group-level mechanisms and outcomes.
Data sources
In this mixed-methods study, the research team reviewed literature, conducted consultations and analysed secondary data (i.e. delivery materials and 46 audio-recordings of group sessions) from three group-based weight loss interventions targeting diet and physical activity: ‘Living Well Taking Control’ (LWTC), ‘Skills for weight loss Maintenance’ and ‘Waste the Waist’. Quantitative LWTC programme data on participant characteristics, attendance and outcomes (primarily weight loss) were also used.
Methods
Objectives were addressed in three stages. In stage 1, a framework of change processes in groups was developed by reviewing literature on groups (including theories, taxonomies of types of change techniques, qualitative studies and measures of group processes), analysing transcripts of 10 diverse group sessions and consulting with four group participants, four facilitators and 31 researchers. In stage 2, the framework was applied in analysing 28 further group sessions. In stage 3, group-level descriptive analyses of available quantitative data from 67 groups and in-depth qualitative analyses of two groups for which comprehensive quantitative and qualitative data were available were conducted to illustrate mixed-methods approaches for exploring links between group processes and outcomes.
Results
Stage 1 resulted in development of the ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework and definitions, encompassing group intervention design features, facilitation techniques, group dynamic and development processes, interpersonal change processes, selective intrapersonal change processes operating in groups, and contextual factors. In stage 2, a coding schema was developed, refined and applied to identify examples of framework components in group sessions, confirming the content validity of the framework for weight loss interventions. Stage 3 demonstrated considerable variability in group characteristics and outcomes and illustrated how the framework could be applied in integrating group-level qualitative and quantitative data to generate and test hypotheses about links between group mechanisms and outcomes (e.g. to identify features of more or less successful groups).
Limitations
The framework and examples were primarily derived from research on weight loss interventions, and may require adaptations/additions to ensure applicability to other types of groups. The mixed-methods analyses were limited by the availability and quality of the secondary data.
Conclusions
This study identified, defined, categorised into a framework and provided examples of group-level mechanisms that may influence behaviour change.
Future work
The framework and mixed-methods approaches developed provide a resource for designers, facilitators and evaluators to underpin future research on, and delivery of, group-based interventions.
Funding
This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research partnership.
Abstract.
Van Beurden S, Smith JR, Lawrence N, Abraham SCS, Greaves C (2019). Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults.
JMIR Formative Research,
3(2), e11586-e11586.
Abstract:
Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults
Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss.
Objective: the aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal.
Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback.
Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies.
Conclusions: the evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants.
Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51)
Abstract.
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2019). Health behaviour change interventions. In (Ed) Cambridge Handbook of Psychology, Health and Medicine: Third Edition, 270-273.
Smith JR, Noble MJ, Winder R, Poltawski L, Ashford PA, Musgrave S, Stirling S, Morgan-Trimmer S, Caress AL, Wilson AM, et al (2019). INITIAL PROCESS EVALUATION FINDINGS FROM THE AT-RISK REGISTERS INTEGRATED INTO PRIMARY CARE TO STOP ASTHMA CRISES IN THE UK (ARRISA-UK) TRIAL: PRACTICE CHARACTERISTICS, ENGAGEMENT AND EARLY EXPERIENCES OF THE INTERVENTION.
Author URL.
Borek AJ, Abraham SCS, Greaves CJ, Gillison F, Tarrant M, Morgan-Trimmer SA, McCabe R, Smith JR (2019). Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework.
Health Psychology ReviewAbstract:
Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants’ experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting ‘Mechanisms of Action in Group-based Interventions’ (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research.
Abstract.
Garner NJ, Pascale M, France K, Ferns C, Clark A, Auckland S, Sampson M, NDPS Group (2019). Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS).
BMJ Open Diabetes Res Care,
7(1).
Abstract:
Recruitment, retention, and training of people with type 2 diabetes as diabetes prevention mentors (DPM) to support a healthcare professional-delivered diabetes prevention program: the Norfolk Diabetes Prevention Study (NDPS).
OBJECTIVE: Intensive lifestyle interventions reduce the risk of type 2 diabetes in populations at highest risk, but staffing levels are usually unable to meet the challenge of delivering effective prevention strategies to a very large at-risk population. Training volunteers with existing type 2 diabetes to support healthcare professionals deliver lifestyle interventions is an attractive option. METHODS: We identified 141 973 people at highest risk of diabetes in the East of England, screened 12 778, and randomized 1764 into a suite of type 2 diabetes prevention and screen detected type 2 diabetes management trials. A key element of the program tested the value of volunteers with type 2 diabetes, trained to act as diabetes prevention mentors (DPM) when added to an intervention arm delivered by healthcare professionals trained to support participant lifestyle change. RESULTS: We invited 9951 people with type 2 diabetes to become DPM and 427 responded (4.3%). of these, 356 (83.3%) were interviewed by phone, and of these 131 (36.8%) were interviewed in person. We then appointed 104 of these 131 interviewed applicants (79%) to the role (mean age 62 years, 55% (n=57) male). All DPMs volunteered for a total of 2895 months, and made 6879 telephone calls to 461 randomized participants. Seventy-six (73%) DPMs volunteered for at least 6 months and 66 (73%) for at least 1 year. DISCUSSION: Individuals with type 2 diabetes can be recruited, trained and retained as DPM in large numbers to support a group-based diabetes prevention program delivered by healthcare professionals. This volunteer model is low cost, and accesses the large type 2 diabetes population that shares a lifestyle experience with the target population. This is an attractive model for supporting diabetes prevention efforts.
Abstract.
Author URL.
Smith JR, Greaves CJ, Thompson JL, Taylor RS, Jones M, Armstrong R, Moorlock S, Griffin A, Solomon-Moore E, Biddle MSY, et al (2019). The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme.
International Journal of Behavioral Nutrition and Physical Activity,
16(1).
Abstract:
The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme
Abstract
Objective
This two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months.
Methods
Adults aged 18–75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants’ homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype “Living Well, Taking Control” (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded.
Results
The target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (− 1.7 kg, 95% CI − 2.59 to − 0.85). Higher attendance was associated with greater weight loss (− 3.0 kg, 95% CI − 4.5 to − 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI − 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm.
Conclusions
This voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors.
Trial registration
Trial registration number: ISRCTN70221670, 5 September 2014
Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM.
Abstract.
2018
Smith JR, Musgrave S, Payerne E, Noble M, Sims EJ, Clark AB, Barton G, Pinnock H, Sheikh A, Wilson AM, et al (2018). At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): Study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations.
Trials,
19(1).
Abstract:
At-risk registers integrated into primary care to stop asthma crises in the UK (ARRISA-UK): Study protocol for a pragmatic, cluster randomised trial with nested health economic and process evaluations
Background: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma patients in primary care. ARRISA involved identifying individuals at risk of adverse asthma events, flagging their electronic health records, training practice staff to develop and implement practice-wide processes of care when alerted by the flag, plus motivational reminders. We now seek to determine the effectiveness and cost-effectiveness of ARRISA in reducing asthma-related crisis events. Methods: We are undertaking a pragmatic, two-arm, multicentre, cluster randomised controlled trial, plus health economic and process evaluation. We will randomise 270 primary care practices from throughout the UK covering over 10,000 registered patients with 'at-risk asthma' identified according to a validated algorithm. Staff in practices randomised to the intervention will complete two 45-min eLearning modules (an individually completed module giving background to ARRISA and a group-completed module to develop practice-wide pathways of care) plus a 30-min webinar with other practices. On completion of training at-risk patients' records will be coded so that a flag appears whenever their record is accessed. Practices will receive a phone call at 4weeks and a reminder video at 6weeks and 6months. Control practices will continue to provide usual care. We will extract anonymised routine patient data from primary care records (with linkage to secondary care data) to determine the percentage of at-risk patients with an asthma-related crisis event (accident and emergency attendances, hospitalisations and deaths) after 12months (primary outcome). We will also capture the time to crisis event, all-cause hospitalisations, asthma control and any changes in practice asthma management for at-risk and all patients with asthma. Cost-effectiveness analysis and mixed-methods process evaluations will also be conducted. Discussion: This study is novel in terms of using a practice-wide intervention to target and engage with patients at risk from their asthma and is innovative in the use of routinely captured data with record linkage to obtain trial outcomes.
Abstract.
Kok MSY, Jones M, Solomon-Moore E, Smith JR (2018). Implementation fidelity of a voluntary sector-led diabetes education programme.
Health Education,
118(1), 62-81.
Abstract:
Implementation fidelity of a voluntary sector-led diabetes education programme
Purpose: the quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes. Design/methodology/approach: This fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence. Findings: Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings. Originality/value: an appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.
Abstract.
2017
Tsekleves E, Cooper R, Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours. In (Ed) Design for Health, 58-71.
Denford S, Abraham C, Van Beurden S, Smith JR, Morgan-Trimmer S (2017). Behaviours: Behaviour-change interventions for public health. In (Ed)
Design for Health, 58-71.
Abstract:
Behaviours: Behaviour-change interventions for public health
Abstract.
Borek AJ, Smith JR, Abraham C, Greaves CJ, Morgan-Trimmer S, Gillison F, Jones M, Tarrant M, McCabe R (2017). MECHANISMS OF ACTION IN GROUP-BASED INTERVENTIONS (MAGI) STUDY: a FRAMEWORK OF CHANGE PROCESSES IN GROUP-BASED HEALTH INTERVENTIONS.
Author URL.
2016
Bardus M, van Beurden SB, Smith JR, Abraham C (2016). A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management.
Int J Behav Nutr Phys Act,
13Abstract:
A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management.
BACKGROUND: There are thousands of apps promoting dietary improvement, increased physical activity (PA) and weight management. Despite a growing number of reviews in this area, popular apps have not been comprehensively analysed in terms of features related to engagement, functionality, aesthetics, information quality, and content, including the types of change techniques employed. METHODS: the databases containing information about all Health and Fitness apps on GP and iTunes (7,954 and 25,491 apps) were downloaded in April 2015. Database filters were applied to select the most popular apps available in both stores. Two researchers screened the descriptions selecting only weight management apps. Features, app quality and content were independently assessed using the Mobile App Rating Scale (MARS) and previously-defined categories of techniques relevant to behaviour change. Inter-coder reliabilities were calculated, and correlations between features explored. RESULTS: of the 23 popular apps included in the review 16 were free (70%), 15 (65%) addressed weight control, diet and PA combined; 19 (83%) allowed behavioural tracking. On 5-point MARS scales, apps were of average quality (Md = 3.2, IQR = 1.4); "functionality" (Md = 4.0, IQR = 1.1) was the highest and "information quality" (Md = 2.0, IQR = 1.1) was the lowest domain. On average, 10 techniques were identified per app (range: 1-17) and of the 34 categories applied, goal setting and self-monitoring techniques were most frequently identified. App quality was positively correlated with number of techniques included (rho = .58, p
Abstract.
Author URL.
van Beurden SB, Greaves CJ, Smith JR, Abraham C, Lawrence N (2016). FACILITATING WEIGHT LOSS WITH THE IMPULSEPAL APP': a FEASIBILITY STUDY.
Author URL.
Borek A, Abraham C, Greaves C, Tarrant M, Smith JR (2016). HOW DO DIABETES PREVENTION GROUPS GENERATE INDIVIDUAL CHANGE?.
Author URL.
Denford S, Abraham C, Smith J, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In Spotswood F (Ed)
Beyond behaviour change Key issues, interdisciplinary approaches and future directions, Bristol: Policy Press, 49-70.
Abstract:
Intervention design and evaluation: behaviour change imperatives
Abstract.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Denford S, Abraham C, Smith JR, Morgan-Trimmer S, Lloyd J, Wyatt K (2016). Intervention design and evaluation: behaviour change imperatives. In (Ed) Beyond Behaviour Change, 49-70.
Smith JR, Borek A, Abraham C, Greaves C, Morgan-Trimmer S, Gillison F, Jones M, Keable J, Tarrant M, McCabe R, et al (2016). MECHANISMS OF ACTION IN GROUP INTERVENTIONS (MAGI) STUDY: INITIAL FINDINGS AND a CONCEPTUAL FRAMEWORK.
Author URL.
Bardus M, Smith JR, Samaha L, Abraham C (2016). Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality.
Eur J Public Health,
26(4), 602-610.
Abstract:
Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality.
BACKGROUND: the use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. METHODS: Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. RESULTS: Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. CONCLUSIONS: Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base.
Abstract.
Author URL.
Sharpe R, Smith JR, Orr N, Phoenix C, Bethel A, Goodwin V, Lang I, Garside R (2016). PHYSICAL ACTIVITY INTERVENTIONS IN OLDER ADULTS: a SYSTEMATIC REVIEW OF REVIEWS.
Author URL.
White R, Abraham C, Smith JR, White M, Staiger PK (2016). Recovery under sail: Rehabilitation clients' experience of a sail training voyage. Addiction Research & Theory, 24(5), 355-365.
van Beurden SB, Greaves CJ, Smith JR, Abraham C (2016). TECHNIQUES FOR MODIFYING IMPULSIVE PROCESSES ASSOCIATED WITH UNHEALTHY EATING: a SYSTEMATIC REVIEW.
Author URL.
Smith JR, Greaves C, Abraham C, Thompson JL, Taylor R, Jones M, Kok M, Armstrong R, Coleman S, Solomon-Moores E, et al (2016). THE COMMUNITY-BASED PREVENTION OF DIABETES (COMPOD) TRIAL OF THE VOLUNTARY SECTOR-LED LIVING WELL, TAKING CONTROL (LWTC) DIABETES PREVENTION PROGRAMME.
Author URL.
van Beurden SB, Greaves CJ, Smith JR, Abraham C (2016). Techniques for modifying impulsive processes associated with unhealthy eating: a systematic review.
Health Psychol,
35(8), 793-806.
Abstract:
Techniques for modifying impulsive processes associated with unhealthy eating: a systematic review.
OBJECTIVE: This systematic review aimed to (a) identify and categorize techniques used to modify or manage impulsive processes associated with unhealthy eating behavior, (b) describe the mechanisms targeted by such techniques, and (c) summarize available evidence on the effectiveness of these techniques. METHOD: Searches of 5 bibliographic databases identified studies, published in English since 1993, that evaluated at least 1 technique to modify impulsive processes affecting eating in adults. Data were systematically extracted on study characteristics, population, study quality, intervention techniques, proposed mechanisms of action, and outcomes. Effectiveness evidence was systematically collated and described without meta-analysis. RESULTS: Ninety-two studies evaluated 17 distinct impulse management techniques. They were categorized according to whether they aimed to (a) modify the strength of impulses or (b) engage the reflective system or other resources in identifying, suppressing, or otherwise managing impulses. Although higher quality evidence is needed to draw definitive conclusions, promising changes in unhealthy food consumption and food cravings were observed for visuospatial loading, physical activity, and if-then planning, typically for up to 1-day follow-up. CONCLUSIONS: a wide range of techniques have been evaluated and some show promise for use in weight management interventions. However, larger-scale, more methodologically robust, community-based studies with longer follow-up times are needed to establish whether such techniques can have a long-term impact on eating patterns. (PsycINFO Database Record
Abstract.
Author URL.
2015
Borek AJ, Abraham C, Smith JR, Greaves CJ, Tarrant M (2015). A checklist to improve reporting of group-based behaviour-change interventions.
BMC Public Health,
15Abstract:
A checklist to improve reporting of group-based behaviour-change interventions.
BACKGROUND: Published descriptions of group-based behaviour-change interventions (GB-BCIs) often omit design and delivery features specific to the group setting. This impedes the ability to compare behaviour-change interventions, synthesise evidence on their effectiveness and replicate effective interventions. The aim of this study was to develop a checklist of elements that should be described to ensure adequate reporting of GB-BCIs. METHODS: a range of characteristics needed to replicate GB-BCIs were extracted from the literature and precisely defined. An abbreviated checklist and a coder manual were developed, pilot tested and refined. The final checklist and coder manual were used to identify the presence or absence of specified reporting elements in 30 published descriptions of GB-BCIs by two independent coders. Reliability of coding was assessed. RESULTS: the checklist comprises 26 essential reporting elements, covering intervention design, intervention content, participant characteristics, and facilitator characteristics. Inter-rater reliability for identification of reporting elements was high (95% agreement, Mean AC1 = 0.89). CONCLUSION: the checklist is a practical tool that can be used, alongside other reporting guidelines, to ensure comprehensive description and to assess reporting quality of GB-BCIs. It can also be helpful for designing group-based health interventions.
Abstract.
Author URL.
Denford S, Abraham C, Smith J, Lloyd J, White M, Tarrant M, Wyatt K, Greaves C, Dean S (2015). Designing and evaluating behavior change interventions to promote health. In Reynolds KJ, Branscombe NR (Eds.) The Psychology of Change: Life Contexts, Experiences, and Identities, New York: Psychology Press, Taylor & Francis, 151-169.
Abraham C, Denford S, Dean S, Greaves C, Lloyd J, Tarrant M, White M, Wyatt K (2015). Designing interventions to change health-related behaviour. In Richards D, Hallberg IR (Eds.) Complex Interventions in Health: an overview of research methods, Routledge, 103-110.
Abraham C, Onya H, Aarø L, Smith JR, Devine-Wright H, Wubs A, Ramatsea S, Themane M, Mashamba J (2015). Evaluation of a culturally-situated, research-based HIV-prevention program in South African Schools (symposium presentation). European Health Psychology Society Conference.
Van Beurden S, Greaves CJ, Smith JR, Abraham S (2015). Identifying techniques for modifying impulsive influences on eating behaviour: a systematic review (oral presentation). European Health Psychology Conference.
Bardus M, Smith JR, Samaha L, Abraham C (2015). Mobile Phone and Web 2.0 Technologies for Weight Management: a Systematic Scoping Review.
Journal of medical Internet research,
17(11).
Abstract:
Mobile Phone and Web 2.0 Technologies for Weight Management: a Systematic Scoping Review.
BackgroundWidespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management.ObjectiveTo provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc).MethodsA systematic scoping review of the literature was conducted based on a published protocol (registered atProsperoCRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized.ResultsWe identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%).ConclusionsThere is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions.
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2014
Smith JR, Murray NJ, Greaves CJ, Abraham S, Hooper L (2014). A systematic review of intervention studies using Health Action Process Approach (HAPA) model components to target behaviours for preventing and managing chronic diseases (oral presentation). European Health Psychology Conference.
Borek A, Abraham S, Smith JR, Tarrant M, Greaves C (2014). Reporting of group-based behavioural interventions: a checklist and tool for assessing the quality of descriptions (oral presentation). European Health Psychology Society Conference.
2013
Isa A, Loke YK, Smith JR, Papageorgiou A, Hunter PR (2013). Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.
PLoS Negl Trop Dis,
7(9).
Abstract:
Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.
BACKGROUND: Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. METHODS AND FINDINGS: We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. CONCLUSIONS: to control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.
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Murdoch J, Salter C, Cross J, Smith JR, Poland F (2013). Resisting medications: moral discourses and performances in illness narratives. Sociology of Health and Illness: a journal of medical sociology, 35(3), 449-464.
2012
Noble MJ, Harrison BDW, Windley J, Smith JR, Wilson AM, Price GM, Price D (2012). Asthma at-risk registers--can be effective if carefully constructed and correctly implemented.
Prim Care Respir J,
21(2), 135-136.
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Smith JR, Noble MJ, Musgrave S, Murdoch J, Price GM, Barton GR, Windley J, Holland R, Harrison BD, Howe A, et al (2012). The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care.
Thorax,
67(12), 1052-1060.
Abstract:
The at-risk registers in severe asthma (ARRISA) study: a cluster-randomised controlled trial examining effectiveness and costs in primary care.
BACKGROUND: Patients at risk of severe exacerbations contribute disproportionally to asthma mortality, morbidity and costs. We evaluated the effectiveness and costs of using 'asthma risk registers' for these patients in primary care. METHODS: in a cluster-randomised trial, 29 primary care practices identified 911 at-risk asthma patients using British asthma guideline criteria (severe asthma plus adverse psychosocial characteristics). Intervention practices added electronic alerts to identified patients' records to flag their at-risk status and received practice-based training about using the alerts to improve patient access and opportunistic management. Control practices continued routine care. Numbers of patients experiencing the primary outcome of a moderate-severe exacerbation (resulting in death, hospitalisation, accident and emergency attendance, out-of-hours contact, or a course/boost in oral prednisolone for asthma), other healthcare and medication usage, and costs over 1 year were derived from practice-based records. RESULTS: There was no significant effect on exacerbations (control: 46.5%; intervention: 53.6%, OR, 95% CI 1.30, 0.93 to 1.80). However, this composite outcome masked relative reductions in intervention patients experiencing hospitalisations (OR 0.50, 95% CI 0.26 to 0.94), accident and emergency (OR 0.74, 95% CI 0.42 to 1.31) and out-of-hours contacts (OR 0.79, 95% CI 0.45 to 1.37); and a relative increase in prednisolone prescription for exacerbations (OR 1.31, 95% CI 0.92 to 1.85). Furthermore, prescription of nebulised short-acting β-agonists reduced and long-acting β-agonists increased for intervention relative to control patients. The adjusted mean per patient healthcare cost was £138.21 lower (p=0.837) among intervention practices. CONCLUSION: Using asthma risk registers in primary care did not reduce treated exacerbations, but reduced hospitalisations and increased prescriptions of recommended preventative therapies without increasing costs.
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Watson S, Bhattacharya D, Wood J, Smith JR, Adams M, Song F (2012). The impact of treatment side-effects upon medication adherence (oral presentation). Health Services Research and Pharmacy Practice Conference.
2011
Watson S, Bhattacharya D, Wood J, Smith JR, Adams M, Song F (2011). Systematic review and meta-analysis shows stress is negatively associated with adherence to medication (poster presentation). Health Services Research and Pharmacy Practice Conference.
Smith JR, Cleland J (2011). The interaction of psychological factors with illness, disease and treatment. In Cleland J, Cotton P, van Teiljlingen E (Eds.) Health, Behaviour and Society: Clinical Medicine in Context, Exeter: Learning Matters, 44-60.
Cleland J, Smith JR (2011). Using psychology to help your medical practice. In Cleland J, Cotton P (Eds.) Health, Behaviour and Society: Clinical Medicine in Context, Exeter: Learning Matters, 25-43.
2010
Smith JR, et al (2010). Cross-sectional and longitudinal relationships of self-management behaviours and other psychological factors with outcomes in patients with severe asthma. British Thoracic Society Winter Meeting.
Smith JR, Noble MJ, Harrison BDW, Adams M (2010). P175 Cross-sectional and longitudinal relationships of self-management behaviours and other psychological factors with outcomes in patients with severe asthma.
Smith JR, Noble M, Musgrave S, Murdoch J, Price G, Windley J, Holland R, Harrison BDW, Howe A, Price D, et al (2010). The At-Risk Registers in Severe Asthma (ARRISA) study: a cluster-randomised controlled trial in primary care (oral presentation). British Thoracic Society Winter Meeting.
2008
Smith JR (2008). Asthma. In Newman S, Steed E, Mulligan K (Eds.) Chronic Physical Illness: Self-Management and Behavioural Interventions, Oxford: Open University Press, 204-223.
Ramjeet J, Smith JR, Adams M (2008). The relationship between coping and psychological and physical adjustment in rheumatoid arthritis: a literature review. J Clin Nurs, 17, 418-428.
2007
Smith JR, Mugford M, Holland R, Noble MJ, Harrison BDW (2007). Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.
J Asthma,
44(3), 219-241.
Abstract:
Psycho-educational interventions for adults with severe or difficult asthma: a systematic review.
Research highlights psychosocial factors associated with adverse asthma events. This systematic review therefore examined whether psycho-educational interventions improve health and self-management outcomes in adults with severe or difficult asthma. Seventeen controlled studies were included. Characteristics and content of interventions varied even within broad types. Study quality was generally poor and several studies were small. Any positive effects observed from qualitative and quantitative syntheses were mainly short term and, in planned subgroup analyses (involving < 5 trials), effects on hospitalizations, quality of life, and psychological morbidity in patients with severe asthma did not extend to those in whom multiple factors complicate management.
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Smith JR, Harrison B (2007). Psychosocial factors in severe asthma in adults. In Johnston SL, O'Byrne PM (Eds.) Exacerbations of Asthma, Abgindon: Informa Healthcare, 321-340.
2006
Noble MJ, Smith JR, Windley J (2006). A controlled retrospective pilot study of an 'at-risk asthma register' in primary care.
Prim Care Respir J,
15(2), 116-124.
Abstract:
A controlled retrospective pilot study of an 'at-risk asthma register' in primary care.
BACKGROUND: There are few reports of primary care initiatives designed to improve management of asthma patients who are at risk of adverse outcomes. AIM: to assess the impact on emergency treatments, service use, and costs, of introducing an at-risk asthma register in a general practice surgery. METHODS: Asthma patients demonstrating characteristics associated with adverse outcomes were added to an at-risk register. Tags were placed in patients' records and practice staff were trained to ensure their appropriate recognition and management. Data were retrospectively extracted from the notes of 26 identified at-risk patients, as well as 26 age-, sex-, and treatment-matched controls with asthma, for one year before and after the introduction of the register. Implementation and service use costs were estimated. RESULTS: Before introduction of the register, more 'at-risk' than control patients were hospitalised (3 vs. 0), attended the accident and emergency (A&E) department (1 vs. 0), and were nebulised (4 vs. 0), for asthma. Significantly higher numbers also used out-of-hours services, received oral steroids, attended their general practitioner (GP), and failed to attend scheduled clinics for asthma (all p
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Nicol AAM, Smith RD, Smith JR, Mills KS, Somerville M, Adams M, Reynolds S (2006). What do patients with rheumatoid arthritis think of shared clinical decision-making? a qualitative observational study of anti-TNF treatment in clinical practice. European League Against Rheumatism congress.
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2005
Holland R, Battersby J, Harvey I, Lenaghan E, Smith JR, Hay L (2005). A systematic review of multi-disciplinary interventions in heart failure. Heart, 91, 899-906.
Smith JR, Mugford M, Holland R, Candy B, Noble MJ, Harrison BDW, Koutantji M, Upton C, Harvey I (2005). A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.
Health Technol Assess,
9(23), iii-167.
Abstract:
A systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in adults and children with difficult asthma.
OBJECTIVES: Prior research has highlighted the importance of psychosocial factors in 'difficult' asthma. This study aimed to review the content, effectiveness and cost-effectiveness of psycho-educational interventions designed to address these factors in patients with severe and difficult asthma. DATA SOURCES: Thirty-two electronic databases and other sources were searched for studies of educational, self-management, psychosocial and multifaceted interventions. REVIEW METHODS: Abstracts were screened in duplicate, against prior definitions, to identify eligible interventions targeted to patients with forms of or risk factors for difficult asthma. Studies were classified by patient group (child, adult) and graded along two dimensions related to study design and relevance in terms of the degree to which they were judged to have targeted difficult asthma. Detailed data were extracted from studies meeting a minimum design and relevance threshold. Characteristics of studies were tabulated and results qualitatively synthesised. Where sufficiently similar studies reported adequate data about comparable outcomes, quantitative syntheses of results were undertaken using a random effects approach to calculate pooled relative risks (RR) or standardised mean differences (SMD), with 95% confidence intervals (CI). RESULTS: Searches identified over 23,000 citations. After initial screening and removal of duplicates, 4240 possibly relevant abstracts were assessed. Papers associated with 188 studies were initially obtained and classified. Fifty-seven studies including control groups and those that were judged to have at least 'possible' targeting of difficult asthma (35 in children, 21 in adults, 1 in both) were selected for in-depth review. The delivery, setting, timing and content of interventions varied considerably even within broad types. Reporting of interventions and methodological quality was often poor, but studies demonstrated some success in targeting and following up at-risk patients. Studies reporting data suitable for calculation of summary statistics were of higher quality than those that did not. There was evidence from these that, compared to usual or non-psycho-educational care, psycho-educational interventions reduced admissions when data from the latest follow-ups reported were pooled across nine studies in children (RR = 0.64, CI = 0.46-0.89) and six studies with possible targeting of difficult asthma in adults (RR = 0.57, CI = 0.34-0.93). In children, the greatest and only significant effects were confined to individual studies with limited targeting of difficult asthma and no long-term follow-up. Limited data in adults also suggested effects may not extend to those most at risk. There was no evidence of pooled effects of psycho-educational interventions on emergency attendances from eight studies in children (RR = 0.97, CI = 0.78-1.21) and four in adults (RR = 1.03, CI = 0.82-1.29). There were overall significant reductions in symptoms, similar in different sub-groups of difficult asthma, across four paediatric studies that could be combined (SMD = -0.45, CI = -0.68 to -0.22), but mixed results across individual adult studies. A few individual studies in children showed mainly positive effects on measures of self-care behaviour, but with respect to all other outcomes in adults and children, studies showed mixed results or suggested limited effectiveness of psycho-educational interventions. No studies of psychosocial interventions were included in any quantitative syntheses and it was not possible to draw clear conclusions regarding the relative effectiveness of educational, self-management and multifaceted programmes. Data on costs were very limited. of the two well-designed economic evaluations identified, both of multifaceted interventions, one in children suggested an additional cost of achieving health gain in terms of symptom-free days. Provisional data from the other study suggested that in adults the significantly increased costs of providing an intervention were not offset by any short-term savings in use of healthcare resources or associated with improvements in health outcomes. CONCLUSIONS: There was some evidence of overall positive effects of psycho-educational interventions on hospital admissions in adults and children, and on symptoms in children, but limited evidence of effects on other outcomes. The majority of research and greatest effects, especially in adults, were confined to patients with severe disease but who lacked other characteristics indicative of difficult asthma or likely to put them at risk. A lack of good-quality research limited conclusions about cost-effectiveness. Although psycho-educational interventions may be of some benefit to patients with severe disease, there is currently a lack of evidence to warrant significant changes in clinical practice with regard to the care of patients with more difficult asthma. Further research is needed to: (1) standardise reporting of complex interventions; (2) extend and update this review; (3) improve identification of patients at risk from their asthma; (4) develop and test appropriate outcome measures for this group; and (5) design and evaluate, via the conduct of high-quality pragmatic RCTs, more powerful psycho-educational interventions that are conceptualised in terms of the ways in which psychosocial factors and asthma interact.
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Smith JR, Mildenhall S, Noble M, Mugford M, Shepstone L, Harrison BDW (2005). Clinician-assessed poor compliance identifies adults with severe asthma who are at risk of adverse outcomes.
J Asthma,
42(6), 437-445.
Abstract:
Clinician-assessed poor compliance identifies adults with severe asthma who are at risk of adverse outcomes.
Our aim was to determine whether clinician-identified poor compliance is useful in identifying, from among adults with severe asthma, patients with characteristics likely to put them at risk of adverse outcomes. Patients with severe asthma (previous hospital admissions and/or prescribed step 4-5 treatment according to British Thoracic Society guidelines) considered by clinicians to be either compliant (C, N = 41) or poorly compliant (PC, N = 92) with aspects of their recommended management (attendance at appointments, taking medication, and monitoring asthma) provided data on symptoms, health service use, medication, self-management practices, physical and psychological comorbidities, and sociodemographic/socioeconomic characteristics. Cross-sectional univariate analyses were used to examine whether the groups differed with respect to self-reported indicators of asthma morbidity and self-management. Logistic regressions were additionally used to explore psychosocial factors independently associated with patients being identified as PC. Compared with C patients, PC patients had significantly poorer self-reported asthma control in terms of medication use, symptoms, time off work, asthma-specific quality of life, primary care visits, emergency attendances, and hospital admissions. This was coupled with poorer self-management practices. Patients identified as PC also had higher levels of physical and psychological comorbidities, were younger, and faced more difficult social and economic circumstances. We identified significant psychological (anxiety) and social (younger age, not working, number of benefits, adverse family circumstances) factors independently associated with patients being identified as PC. Among adults with severe asthma, clinician-assessed poor compliance was useful in distinguishing between two groups that differed significantly in terms of asthma morbidity indicators, self-management practices, and psychosocial characteristics, which have been previously shown to be associated with hospital admissions, near-fatal attacks, and fatal asthma. We conclude that clinician-assessed poor compliance is a useful marker for identifying patients at risk of these adverse outcomes.
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Smith JR, Mildenhall S, Noble MJ, Shepstone L, Koutantji M, Mugford M, Harrison BDW (2005). The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes.
Thorax,
60(12), 1003-1011.
Abstract:
The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes.
BACKGROUND: Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes. A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes. METHODS: a pragmatic randomised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics. All had previous hospital admissions and/or were on British Thoracic Society step 4-5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management. Patients were visited in their homes for assessment and, where appropriate, intervention. The main outcomes measured were symptom control, asthma specific quality of life, and generic health status. RESULTS: at the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control, physical functioning, or mental health scores (differences (with 95% CI) -0.35 (-1.83 to 1.13), 3.10 (-11.42 to 17.63), 0.42 (-10.22 to 11.07), respectively). Small effects on asthma specific quality of life up to 12 months (e.g. adjusted difference at 12 months 0.13 (95% CI 0.02 to 0.25)) and short term effects on generic health status, which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention, were apparent only from fully adjusted analyses. CONCLUSIONS: a home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes.
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2004
Koutantji M, Smith JR, Adams M, Brooksby A, Somerville M, Scott DGI (2004). OBSERVATIONAL STUDY OF THE ROUTINE USE OF ANTI-TNF DRUGS IN THE TREATMENT OF RHEUMATOID ARTHRITIS IN a UK SETTING: IMPACTS ON QUALITY OF LIFE AND MOOD.
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2003
Smith JR, Mildenhall S, Noble M, Harrison BDW (2003). Poor compliance is a marker for those at-risk of adverse outcomes in adults with severe asthma.
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Smith JR, Mugford M, Holland R, Noble M, Harrison BDW, Koutantji M (2003). Systematic review to examine the impact of psycho-educational interventions on health outcomes and costs in difficult asthma.
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Smith JR, Mildenhall S, Noble M, Mugford M, Harrison BDW (2003). The coping with asthma study: a randomised controlled trial and economic evaluation of a home-based intervention for at-risk asthmatics.
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2002
Smith JR, Koutantji M, Mildenhall S, Harrison BDW, Noble M (2002). Psychosocial factors in adults at risk of adverse asthma outcomes: Relationships with symptom control and quality of life.
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