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The Handbook of Behavior Change is the first wide-ranging compendium of theory- and evidence-based research and practice on behavior change. It provides scientists, students, and practitioners with the current evidence on behavior change and expert advice on how to develop, evaluate, and implement behavior change interventions. The handbook also sets an agenda for future research on behavior change theory and practice across multiple behaviors, contexts, and populations. This chapter outlines emerging issues and future research directions arising from the handbook. The chapter stresses the importance of theory development, including the need for greater emphasis on ecological and social theories; clearer descriptions and operationalizations of behavior change theories; and increased application of interdisciplinary approaches. Future research on intervention development should conduct more comprehensive intervention fidelity assessments; adopt novel means to improve the translation, feasibility, and optimization of interventions; ensure consideration of ethical issues in behavior change research; routinely evaluate mechanisms of action in behavior change interventions; and apply complex systems approaches to behavior change. “Best-practice” guidance on behavior change should consider emerging methods and approaches to behavior change; implement trials to evaluate the long-term maintenance of behavior change; and develop core curricula on behavior change to educate the next generation of scientists and practitioners.
A preponderance of theories have been adopted to identify the determinants of behavior. Despite claims of generalizability, research applying these theories has identified gaps or boundary conditions that delimit their application. Theory integration provides one means to address these gaps. This chapter outlines the contribution of integrated theories to advancing knowledge of behavior change. Four approaches to theory integration are identified and summarized: additional constructs, core constructs, expert consensus, and utility-based approaches. Theory integration is often motivated by the need to reduce redundancy in constructs across existing theories and improve their predictive power to arrive at optimally comprehensive, parsimonious, explanations of behavior. Examples of integrated theories are provided and how they have contributed to theory development outlined. Behavior change interventions based on integrated theory comprise multiple techniques that target change in the constructs that set the integrated theory apart from its constituent theories. While some interventions based on integrated theories have demonstrated efficacy in changing behavior, future research on integrated theories needs to adopt factorial designs that independently target change in integrated theory constructs. Such research will demonstrate the independent and interactive effects of techniques based on the integrated theory on behavior and on measures of the targeted theory construct.
Social problems in many domains, including health, education, social relationships, and the workplace, have their origins in human behavior. The documented links between behavior and social problems have sparked interest in governments and organizations to develop effective interventions to promote behavior change. The Handbook of Behavior Change provides comprehensive coverage of contemporary theory, research, and practice on behavior change. The handbook incorporates theory- and evidence-based approaches to behavior change with chapters from leading theorists, researchers, and practitioners from multiple disciplines, including psychology, sociology, behavioral science, economics, and implementation science. Chapters are organized into three parts: (1) Theory and Behavior Change; (2) Methods and Processes of Behavior Change: Intervention Development, Application, and Translation; and (3) Behavior Change Interventions: Practical Guides to Behavior Change. This chapter provides an overview of the theory- and evidence-based approaches of the handbook, introduces the content of the handbook, and provides suggestions on how the handbook may be used by different readers. The handbook aims to provide all interested in behavior change, including researchers and students, practitioners, and policy makers, with up-to-date knowledge on behavior change and guidance on how to develop effective interventions to change behavior in different populations and contexts.
Social problems in many domains, including health, education, social relationships, and the workplace, have their origins in human behavior. The documented links between behavior and social problems have compelled governments and organizations to prioritize and mobilize efforts to develop effective, evidence-based means to promote adaptive behavior change. In recognition of this impetus, The Handbook of Behavior Change provides comprehensive coverage of contemporary theory, research, and practice on behavior change. It summarizes current evidence-based approaches to behavior change in chapters authored by leading theorists, researchers, and practitioners from multiple disciplines, including psychology, sociology, behavioral science, economics, philosophy, and implementation science. It is the go-to resource for researchers, students, practitioners, and policy makers looking for current knowledge on behavior change and guidance on how to develop effective interventions to change behavior.
Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.
We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.
Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.
Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
Left ventricular non-compaction is an architectural abnormality of the myocardium, associated with heart failure, systemic thromboembolism, and arrhythmia. We sought to assess the prevalence of left ventricular non-compaction in patients with single ventricle heart disease and its effects on ventricular function.
Cardiac MRI of 93 patients with single ventricle heart disease (mean age 24 ± 8 years; 55% male) from three tertiary congenital centres was retrospectively reviewed; 65 of these had left ventricular morphology and are the subject of this report. The presence of left ventricular non-compaction was defined as having a non-compacted:compacted (NC:C) myocardial thickness ratio >2.3:1. The distribution of left ventricular non-compaction, ventricular volumes, and function was correlated with clinical data.
The prevalence of left ventricular non-compaction was 37% (24 of 65 patients) with a mean of 4 ± 2 affected segments. The distribution was apical in 100%, mid-ventricular in 29%, and basal in 17% of patients. Patients with left ventricular non-compaction had significantly higher end-diastolic (128 ± 44 versus 104 ± 46 mL/m2, p = 0.047) and end-systolic left ventricular volumes (74 ± 35 versus 56 ± 35 mL/m2, p = 0.039) with lower left ventricular ejection fraction (44 ± 11 versus 50 ± 9%, p = 0.039) compared to those with normal compaction. The number of segments involved did not correlate with ventricular function (p = 0.71).
Left ventricular non-compaction is frequently observed in patients with left ventricle-type univentricular hearts, with predominantly apical and mid-ventricular involvement. The presence of non-compaction is associated with increased indexed end-diastolic volumes and impaired systolic function.
Thermal infrared data collected by the Thermal Emission Spectrometer (TES) and Thermal Emission Imaging System (THEMIS) instruments have significantly impacted the understanding of martian surface mineralogy. Spatial/temporal variations in igneous lithologies; the discovery of quartz, carbonates, and chlorides; and the widespread identification of amorphous, silica-enriched materials reveal a planet that has experienced a diversity of primary and secondary geo-logic processes including igneous crustal evolution, regional sedimentation, aqueous alteration, and glacial/periglacial activity.
In the autumn of 1306 a group of twenty-two knights deserted the king's army in Scotland in order to pursue their martial interests elsewhere by participating in tournaments in France. Their impulsive behaviour can perhaps be understood, as, for all intents and purposes, the campaign for 1306 had come to an end and the aged king lay infirm at Lanercost, which he had only reached at Michaelmas. The Prince of Wales had himself departed Scotland in early autumn, travelling south in a leisurely fashion by way of Langley, Dover and Canterbury, and eventually spending Christmas with his two young halfbrothers at Northampton Castle. Nevertheless, despite the absence of the royal commanders and the lack of military activity, the dereliction of their duty by these knights would not be overlooked. Indeed, as if in anticipation of this very development, in the previous spring, on 6 April at Wolvesey, Edward I – himself an avid tournament knight in his youth4 – had issued a prohibition on tournaments, urging men instead to ‘prepare themselves to set out with the king for the parts of Scotland in as much strength as they can for the repression of the rebellion there’. This injunction was followed in the autumn by an order of 24 September to all the sheriffs in England further forbidding ‘tournaments, tiltings, jousts, or other deeds of arms, … until the king's war in Scotland be finished and until the king shall cause other ordinance to be made as to this’. The impetus for this further injunction, we are told, was that the king himself ‘understands that certain of his subjects make and propose to make tournaments … to the delay and hindrance of the king's affairs of Scotland’. Such individuals were to be considered ‘as his enemies and traitors and as hinderers of the expedition of his affairs’. Nonetheless, within three weeks of this supplementary order, the desertions had taken place.
When word of these desertions reached the king his reaction was both immediate and predictably severe. On 18 October 1306 orders went out to sheriffs across England to seize the lands and goods as well as the persons of the deserters.