Complex Behavioural Intervention Research Articles

Challenge of evaluating a national HIV prevention programme: the case of loveLife, South Africa

Although 50% of all new global HIV infections occur among young people, our knowledge to date of the impact of adolescent HIV prevention interventions in developing country settings is limited....

Prevención y adherencia: Dos claves para el enfrentamiento de las enfermedades crónicas

Over 50% of adults in Chile have a high cardiovascular risk. Thus, non communicable chronic diseases may surpass the capacity of the health systems. Therefore the prevention and treatment of their risk factors is urgent. Unfortunately, the low patient's compliance with prescribed treatment, reduces their efficacy. The best interventions to improve compliance with chronic treatment programs are: to simplify daily doses of medications and to do complex behavioral interventions. Risk factor prevention is a highly recommended action that has obtained promising results in Chile with the program "Mírame". To modify health behavior is also necessary to give people more power in their own care and to increase behavioral and social science contents into medical curricula.

Interventions to improve adherence to lipid lowering medication.

Lipid lowering drugs are still widely underused, despite compelling evidence about their effectiveness in the treatment and prevention of cardiovascular disease. Poor patient adherence to medication regimen is a major factor in the lack of success in treating hyperlipidaemia. In this review we focus on interventions, which encourage patients at risk of heart disease or stroke to take lipid lowering medication regularly. To assess the effect of interventions aiming at improved adherence to lipid lowering drugs, focusing on measures of adherence and clinical outcomes. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycInfo and CINAHL. Date of most recent search was in February 2003. No language restrictions were applied. Randomised controlled trials of adherence-enhancing interventions to lipid lowering medication in adults for both primary and secondary prevention of cardiovascular disease in an ambulatory setting. Two reviewers extracted data independently and assessed studies according to criteria outlined by the Cochrane Reviewers' Handbook. The eight studies found contained data on 5943 patients. Interventions could be stratified into four categories : 1. simplification of drug regimen, 2. patient information/education, 3. intensified patient care such as reminding and 4. complex behavioural interventions such as group sessions. Change in adherence ranged from -3% to 25% (decrease in adherence by 3% to increase in adherence by 25%). Three studies reported significantly improved adherence through simplification of drug regimen (category 1), improved patient information/education (category 2) and reminding (category 3). The fact that the successful interventions were evenly spread across the categories, does not suggest any advantage of one particular type of intervention. The methodological and analytical quality was generally low and results have to be considered with caution. Combining data was not appropriate due to the substantial heterogeneity between included randomised controlled trials (RCTs). At this stage, no specific intervention aimed at improving adherence to lipid lowering drugs can be recommended. The lack of a gold standard method of measuring adherence is one major barrier in adherence research. More reliable data might be achieved by newer methods of measurement, more consistency in adherence assessment and longer duration of follow-up. Increased patient-centredness with emphasis on the patient's perspective and shared-decision-making might lead to more conclusive answers when searching for tools to encourage patients to take lipid lowering medication.

Treating Nocturnal Enuresis in Children

Childhood nocturnal enuresis (bedwetting) affects many families. Although it has a high rate of spontaneous remission, bedwetting may bring social and emotional stigma, stress, and inconvenience to both the child with enuresis and his or her family. Summary of systematic reviews of treatment for nocturnal enuresis in children, published in the Cochrane Library, using evidence only from randomized and quasi-randomized trials to compare interventions. Interventions included behavioral, alarm, and pharmacologic treatments. Six Cochrane Reviews contributed evidence to this review: simple behavioral interventions, alarms, complex behavioral or educational interventions, desmopressin, tricyclics and related drugs, and other drugs. The participants were children (usually up to the age of 16). Much of the available evidence was of poor quality, and there were few direct comparisons between different types of intervention. Simple behavioral Interventions, such as reward systems, are widely used as standard first-line treatment, but they require a high level of parental involvement. There is currently little evidence to show that these interventions work, but they may be worth trying because they have only a few adverse effects. The use of an alarm intervention reduced nighttime bed wetting in a majority of children both during and after treatment. Overlearning or dry-bed training may reduce the relapse rate. Before embarking on alarm treatment, families need to be made aware of both the time and the high level of parental involvement necessary to attain success. Drug therapy, such as desmopressin and tricyclics, reduced the number of wet nights per week compared with placebo but only while the drug was used. Patients and their families need to be warned about possible side effects of some of the drugs. Alarms are the most effective treatment for nocturnal enuresis in children, but desmopressin may be considered for temporary relief.

Complex behavioural and educational interventions for nocturnal enuresis in children.

Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. To assess the effects of complex behavioural and educational interventions on nocturnal enuresis in children, and to compare them with other interventions. We searched the Cochrane Incontinence Group trials register (December 2002) and the reference lists of relevant articles. Date of the most recent searches: December 2002. All randomised or quasi-randomised trials of complex behavioural or educational interventions for nocturnal enuresis in children were included, except those focused solely on daytime wetting. Comparison interventions included no treatment, simple and physical behavioural methods, alarms, desmopressin, tricyclics, and miscellaneous other interventions. Two reviewers independently assessed the quality of the eligible trials, and extracted data. Sixteen trials involving 1081 children were identified which included a complex or educational intervention for nocturnal enuresis. The trials were mostly small and some had methodological problems including the use of a quasi-randomised method of concealment of allocation in three trials and baseline differences between the groups in another three.A complex intervention (such as dry bed training (DBT) or full spectrum home training (FSHT)) including an alarm was better than no-treatment control groups (eg RR for failure or relapse after stopping DBT 0.25; 95% CI 0.16 to 0.39) but there was not enough evidence about the effects of complex interventions alone if an alarm was not used. A complex intervention on its own was not as good as an alarm on its own or the intervention supplemented by an alarm (eg RR for failure or relapse after DBT alone versus DBT plus alarm 2.81; 95% CI 1.80 to 4.38). On the other hand, a complex intervention supplemented by a bed alarm might reduce the relapse rate compared with the alarm on its own (eg RR for failure or relapse after DBT plus alarm versus alarm alone 0.5; 95% CI 0.31 to 0.80).There was not enough evidence to judge whether providing educational information about enuresis was effective, irrespective of method of delivery. There was some evidence that direct contact between families and therapists enhanced the effect of a complex intervention, and that increased contact and support enhanced a package of simple behavioural interventions, but these were addressed only in single trials and the results would need to be confirmed by further randomised controlled trials, in particular the effect on use of resources. Although DBT and FSHT were better than no treatment when used in combination with an alarm, there was insufficient evidence to support their use without an alarm. An alarm on its own was also better than DBT on its own, but there was some evidence that combining an alarm with DBT was better than an alarm on its own, suggesting that DBT may augment the effect of an alarm. There was also some evidence that direct contact with a therapist might enhance the effects of an intervention.

Evaluating interventions for HIV prevention in Africa

Rigorous evaluation of promising interventions should be encouraged early on when HIV incidence is rising and high-risk groups are readily identifiable. It is vital to know which approaches actually work and which do not. The evaluation of complex behavioural interventions is challenging but expertise in this area is accumulating. The development piloting and full-scale evaluation of promising interventions is essential to the success of HIV prevention and should receive greater priority. (excerpt)

A methodology for describing and decomposing complex psychosocial and behavioral interventions.

This article presents a comprehensive conceptual framework and methodology for characterizing multidimensional psychosocial and behavioral interventions for family caregivers of people with Alzheimer's disease. The methodology involved conducting a detailed task analysis of the interventions, and the application of the analytical hierarchy process. The authors were able to achieve high levels of consistency and reliability using this methodology to decompose and describe the interventions according to a complex conceptual framework comprising 3 dimensions: target domain, functional domain, and delivery system characteristics. Application of this methodology will enhance the ability to describe and measure interventions consistently, make comparisons across studies, isolate causal factors that achieve desired outcomes, and more generally elevate the science of psychosocial intervention research.