Impact Of Behavioral Interventions Research Articles

Interventions for cold homes: a rapid review of the health impacts.

Cold homes are associated with an increased risk of adverse health outcomes for older people. To mitigate this risk, homes need to be heated to an appropriate temperature. This review aims to identify interventions designed to improve heating and temperatures within homes and summarize its impact on health, health service utilization and cost effectiveness. A rapid review was conducted. Studies assessing the effects of structural, financial, or behavioural interventions designed to improve home temperatures of residents aged 18+ years were eligible. Searches were carried out in four databases. A search for grey literature, and backward and forward citation searching were performed. Data were summarized in a narrative synthesis and mapped using EPPI-Reviewer and EPPI-Mapper software. Eighteen studies reported across 19 publications were included. Structural interventions were associated with better mental health and quality of life, a reduction in health service utilization, and improvements in satisfaction with internal home temperature, social interactions and financial difficulties. The impact on physical health outcomes varied by age, gender and long-term conditions. Evidence about the impact of behavioural interventions was inconsistent. Structural improvements to increase home temperatures may offer the potential to improve some aspects of health. However, the impact on physical health, including which groups are most likely to benefit, is unclear. Key gaps include the lack of evidence about the impact of financial interventions, and the impact of all types of interventions, on quality of life, mortality and costs.

An Update on Apraxia of Speech.

Apraxia of speech (AOS) is a motor speech disorder that has long been recognized to occur secondary to acute neurologic insults and, more recently, to neurodegenerative diseases as a harbinger for progressive supranuclear palsy and corticobasal syndrome. This article reviews recent findings regarding the clinic phenotypes of AOS, neuroimaging correlates, and the underlying disease processes. Two clinical subtypes of AOS map onto two underlying 4-repeat tauopathies. New imaging techniques have recently been applied to the study of progressive AOS. There is no data on the impact of behavioral intervention, although studies of nonfluent/agrammatic primary progressive aphasia that include patients with AOS suggest some benefit in speech intelligibility and maintenance. While recent findings suggest subtypes of AOS exist that are linked to molecular pathology and have important implications for disease progression, further research is needed to assess outcome of behavioral and other types of intervention.

Impact of Behavioral Interventions on Patient Activation in Adults with Hypertension: A Systematic Review and Meta-Analysis.

Introduction: Behavioral interventions assist patients in maintaining optimal self-management of their health, especially in those at risk of certain conditions. Little is known about the effects of self-management interventions on patient activation in adults with hypertension. Therefore, this systematic review and meta-analysis aimed to evaluate how self-management strategies affect changes in activation levels in adults with hypertension. Methods: We searched online databases: PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between January 2004 and May 2021. We included randomized controlled trials that assessed the effects of self-management interventions on patient activation in adults with hypertension and reported patient activation using the patient activation measure (PAM). Results: 4 Four studies (N = 1415 participants) met the inclusion criteria. In adults with hypertension, self-management interventions improved patient activation with moderate strength of evidence. A community-based self-management program, motivational interviewing strategies, and home-based patient-activated care were associated with better PAM scores than usual care. Conclusion: Our findings reinforce the need for healthcare providers to incorporate these interventions into primary care to support the adoption of recommended hypertension self-management behaviors. Future studies must focus on tailoring support to the patient’s level of activation in hypertension self-management.

Comparison of two simulators for individual based models in HIV epidemiology in a population with HSV 2 in Yaound\xe9 (Cameroon)

Model comparisons have been widely used to guide intervention strategies to control infectious diseases. Agreement between different models is crucial for providing robust evidence for policy-makers because differences in model properties can influence their predictions. In this study, we compared models implemented by two individual-based model simulators for HIV epidemiology in a heterosexual population with Herpes simplex virus type-2 (HSV-2). For each model simulator, we constructed four models, starting from a simplified basic model and stepwise including more model complexity. For the resulting eight models, the predictions of the impact of behavioural interventions on the HIV epidemic in Yaoundé-Cameroon were compared. The results show that differences in model assumptions and model complexity can influence the size of the predicted impact of the intervention, as well as the predicted qualitative behaviour of the HIV epidemic after the intervention. These differences in predictions of an intervention were also observed for two models that agreed in their predictions of the HIV epidemic in the absence of that intervention. Without additional data, it is impossible to determine which of these two models is the most reliable. These findings highlight the importance of making more data available for the calibration and validation of epidemiological models.

Dealing with Misselling: Impact of Behavioural Interventions on Insurance Agents

This case study is about misselling of insurance policies and associated ethical challenges in a leading insurance company. Pro-organisational ethical violations mostly remain unnoticed and are often protected by implausible explanations. In the long run, persistent rationalisation makes malpractices a norm. The present work describes the interventions applied by a consulting firm to bring behavioural integrity. The consulting firm found that socialisation, rationalisation and institutionalisation considerably influenced people’s behaviour at the workplace and normalised unethical behaviour of insurance agents. It architected the behaviour of salespeople by specifically designed interventions through self-control mechanism and nudges. These interventions developed integrity in employees and reduced the number of cautions, warnings and terminations.

Abstract 14772: Effects of Reallocating Time in Different Physical Activity Intensities and Sleep on Cardiovascular Disease Risk Factors in Asian American Women: A Cross Sectional Modeling Study

Introduction: Physical activity (PA), sedentary behavior (SB) and sleep form the finite 24-hour day; changes to one behavior result in changes to the others. Little is known about how shifting the balance of time spent in these behaviors affects cardiovascular (CV) risk factors. The purpose of this study is to model the effects of changes in PA, SB and sleep on body mass index (BMI), waist circumference (WC) and blood pressure (BP) in Asian American women, who have elevated CV risk. Methods: Normotensive middle-aged Asian American women completed 7 days of hip and wrist actigraphy monitoring (Actigraph, GT3X and GT9X) to assess 24-hour activity. Total sleep time was identified using the Cole-Kripke algorithm with sleep diaries, and moderate-to-vigorous PA (MVPA), light PA and SB were classified by Freedson’s cut-points from wake time. Isotemporal substitution models were used to test effects of replacing 30 mins of each behavior with the others on BMI, WC and BP adjusting for age, education and comorbidity. Results: Data from 75 women were included (age=61.4±8.0, 57% college educated, median comorbidities=1[IQR=0-2]). On average, their days were composed of 0.5 hrs MVPA, 6.2 hrs light PA, 10 hrs SB and 5.3 hrs sleep (2.1 hrs non-wear time). In partition models, where all behaviors were entered simultaneously, more MVPA and sleep were associated with lower BMI and WC. In isotemporal substitution models that held total wear time constant (Table 1), replacing 30 mins SB with an equal amount of MVPA or sleep decreased BMI by 1.7 and 0.6 and WC by 4.1 and 1.2 cm. Replacing 30 mins light PA with MVPA or sleep decreased BMI by 1.9 and 0.9 and WC by 4.5 and 1.6 cm. None of the modeled behavior changes affected BP. Conclusion: These findings suggest that substituting 30 mins of SB or light PA with MVPA or sleep could significantly reduce Asian American women’s BMI and WC. Future studies should test the impact of behavioral interventions that promote these changes on CV risk in Asian American women.

Effect of behavioral intervention on scratching behavior in patients with senile pruritus

Objective To explore the impact of behavioral intervention on scratching behavior of patients with senile pruritus. Methods One hundred cases of senile pruritus were randomly divided into observation group (n=50) and control group (n=50). All subjects received oral antihistamine.The observation group received behavioral intervention based on the trans-theoretical model, and the control group received routine health education.Visual analogue scale (VAS), Pittsburgh sleep quality index (PSQI) and dermatology life quality index (DLQI) were used to compare the itching symptoms, sleep quality and quality of life of senile pruritus patients in the two groups. Results After 6 months intervention, the change of scratching behavior in the observation group((1.96±1.54), (8.83±2.05), (10.46±2.24)) was significantly better than those in the control group((4.68±1.48), (12.89±2.02), (14.62±2.12)), and the differences were statistically significant (all P<0.01). Conclusion Health intervention based on trans-theoretical model can effectively change scratching behavior, relieve itching symptoms, improve sleep quality and the quality of life of senile pruritus patients. Key words: Senile pruritus; Scratching behavior; Trans-theoretical model; Quality of life

Estimating Local Intervention Impact with Individual Level National Data by Using GBD Studies to Guide Models

Background: Non-communicable diseases account for the majority of the global burden of disease. Interventions, such as exercise and healthy diet, have the potential to decrease the prevalence and burden of diseases. While global academic studies represent the domain knowledge and provide the marginal effect of risk factors, individual level observational data reflects the joint distribution of local behaviors and socioeconomics, and their local impact on disease prevalence. Methods: We developed a method to evaluate the potential impact of a public health intervention by guiding individual level disease prevalence models of local observational data with the published meta-analysis results of Global Burden of Disease (GBD) studies. We use a Hierarchical Bayes framework to ensure that the model parameters are in agreement with the qualitative patterns in the meta-analysis results. The method provides impact estimates with uncertainty intervals at the population or any targetable subpopulation level. The intervention impact accounts for the burden due to multiple diseases without double counting and controls for demographics, socioeconomics and behaviors. We evaluate the potential impact of behavioral interventions involving smoking, physical exercise and diet on prevalence and disability adjusted life years (DALY) due to Ischemic Heart Disease (IHD) and Diabetes in the Turkish adult population. Findings: As expected, eliminating smoking and secondhand smoking and encouraging exercise have the potential to reduce DALYs associated with IHD and Diabetes by 10% (8% to 12%) and 8% (7% to 10%), respectively in the overall population. Somewhat surprisingly, increasing fruit and vegetable consumption would increase the expected DALYs for about one in five individuals due to its adverse effect on Diabetes, while bringing about a 2% (1% to 3%) reduction at the population level DALYs. Interpretation: The findings are in line with the qualitative patterns of GBD meta-analysis results, but differ quantitatively for some risk factors and demographic groups. Beyond evaluating the potential impact at the national level, the method allows the decision maker to see the heterogeneity of the intervention impact due to joint distribution of behaviors and other socioeconomic/ lifestyle factors in addition to different relative risk estimates by age and gender. Funding Statement: The authors are employees of Koc University and there was no additional funding from other sources for this research. Declaration of Interests: The authors do not have any competing interest. Ethics Approval Statement: We received a waiver from the Koc University Ethics Committee. We also got approval from the Turkish Statistical Institute for the study to be able to use the micro-level data.

The impact of behavioral interventions on co-infection dynamics: An exploration of the effects of home isolation

Behavioral epidemiology, the field aiming to determine the impact of individual behavior on the spread of an epidemic, has gained increased recognition during the last few decades. Behavioral changes due to the development of symptoms have been studied in mono-infections. However, in reality, multiple infections are circulating within the same time period and behavioral changes resulting from contraction of one of the diseases affect the dynamics of the other.The present study aims at assessing the effect of home isolation on the joint dynamics of two infectious diseases, including co-infection, assuming that the two diseases do not confer cross-immunity. We use an age- and time- structured co-infection model based on partial differential equations. Social contact matrices, describing different mixing patterns of symptomatic and asymptomatic individuals are incorporated into the calculation of the age- and time-specific marginal forces of infection.Two scenarios are simulated, assuming that one of the diseases has more severe symptoms than the other. In the first scenario, people stay only at home when having symptoms of the most severe disease. In the second scenario, twice as many people stay at home when having symptoms of the most severe disease than when having symptoms of the other disease.The results show that the impact of home isolation on the joint dynamics of two infectious diseases depends on the epidemiological parameters and properties of the diseases (e.g., basic reproduction number, symptom severity). In case both diseases have a low to moderate basic reproduction number, and there is no home isolation for the less severe disease, the final size of the less severe disease increases with the proportion of symptomatic cases of the most severe disease staying at home, after an initial decrease. This counterintuitive result could be explained by a shift in the peak time of infection of the disease with the most severe symptoms, resulting in a smaller number of people with less contacts at the peak time of the other infection. When twice as many people stay at home when having symptoms of the most severe disease than when having symptoms of the other disease, increasing the proportion staying at home always reduces the final size of both diseases, and the number of co-infections.In conclusion, when providing advise if people should stay at home in the context of two or more co-circulating diseases, one has to take into account epidemiological parameters and symptom severity.

Complexity as an opportunity and challenge for behavioural public policy

AbstractThis paper is a response to Sanders, Snijders and Hallsworth (2018). The challenges and opportunities of behavioural public policy Sanders, Snijders and Hallsworth discuss highlight a conundrum for the field: the impact of behavioural interventions is difficult to measure accurately in complex situations, and yet complexity is inherent in the very areas in most need of impact. Behavioural interventions will be only one tool of many to work towards broader organisational, systems and social change. As a field, we should be looking to other disciplines, inviting them into the fold of discussions on how to achieve these changes. Finally, while the mantra of nudge for good is a useful beacon, intentions are only part of the equation, and a number of questions should be asked when considering a behavioural policy intervention.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to generate a list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to inform the research agenda of the IBTN and to make recommendations for future research.

Measuring sexual behaviour in Malawi: a triangulation of three data collection instruments

BackgroundThere is a need for valid approaches to measure sexual interactions to assess the impact of behavioural interventions and to predict the impact of behaviour changes. Different methods of asking about sexual behaviour often yield conflicting answers and men often report higher levels of heterosexual activity than women. To better understand self-reported sexual behaviour data and how best to collect it, we analyzed data collected as part of a larger project (ST IMPACTS) on the social and behavioural impact of introducing community-level HIV self-testing (HIVST) with counseling (semi-supervised with pre- and generic post-test counseling provided on delivery or collection of test kits) in an urban Malawian setting.MethodsInformation on sexual behaviour was collected from HIV self-testers over a three-month period. Three different methods were used: retrospective face-to-face interviews (FTFI); audio computer assisted self-interviews (ACASI) and a prospective coital diary. Both retrospective instruments were used before and after the three-month study period. Frequency and cross-tabulation, as well as scatterplots, were used for exploratory analyses. Chi-square tests were used to test for differences in proportions. Spearman’s correlation coefficient was used to explore associations between both continuous and ordinal variables and Wilcoxon’s paired sample and Mann-Whitney test was used to test for differences in such variables or between variables.ResultsThere was reasonable agreement between the two retrospective methods although both yielded inconsistent answers e.g. with lower reported numbers of life-time sexual partners at the end than at the beginning of the study period. The diary method elicited higher reported levels of sex with multiple partners than both retrospective instruments which may be due to inadequate recall. Over the study period 37.4% of men and 19.7% of women reported multiple sexual partners using the diary. There was no clear relationship between reported sexual behaviour and HIV status (prevalence 9.6%).ConclusionsDiaries may therefore have higher validity for sensitive behaviour reporting and thus be the preferred method in similar African contexts in measuring sexual behaviours.

An international, Delphi consensus study to identify priorities for methodological research in behavioural trials: A study protocol

Background: Effective behaviour change interventions are needed to impact important health outcomes, including morbidity and mortality. However, the uptake and impact of behavioural interventions have been limited by methodological challenges. The International Behavioural Trials Network (IBTN) was established in 2013 to facilitate global improvement in methodological quality of behavioural trials. There has been no formal process, within the network or in the broader literature, to define the most important research priorities to achieve this aim. In this project, we will conduct an international, Delphi consensus study to identify and achieve consensus on priorities for methodological research in behavioural trials among IBTN members. Methods: Fifteen core members of IBTN, who are experts in the field of behavioural intervention research, will be invited to brainstorm a complete list of all items they consider priority areas for methodological research in trials of behavioural interventions. The IBTN Research Prioritisation team (the authors) will review all items generated, removing duplicates and merging similar topics, and generate a ‘long-list’ of items. This long-list will be sent to the 15 IBTN core members for approval. We will then administer two online Delphi surveys to all IBTN members. In the first survey, respondents will be asked to rate the importance of each item on a nine-point scale and rank their top five priorities. In the second survey, respondents will receive feedback on others’ responses and a reminder of their own responses in survey 1, and will be asked to re-rate items and re-select their ‘top five’. Discussion: Findings from the project will be used to develop the research agenda of the IBTN and to make recommendations for future research.

The impact of behavioural risk-reduction interventions on willingness to pay to avoid sexually transmitted infections: a stated preference study of justice-involved youth

ABSTRACTRisky health behaviours, such as smoking, drinking and risky sex, are substantial contributors to the U.S. morbidity rates and healthcare costs. While economic models typically regard preferences as stable, a growing literature suggests that information, including how it interacts with intentions and attitudes, plays an important role in unhealthy behaviours. Relatedly, a large health literature demonstrates that theory-based behavioural interventions can successfully change risky behaviour. This study uses the contingent valuation (CV) survey method to investigate the impact of behavioural interventions on a novel outcome measure: the willingness to pay (WTP) to avoid the consequences associated with risky behaviour. Using novel pre- and post-intervention data from Project MARS (Motivating Adolescents to Reduce Sexual Risk), this study estimates the impact of the intervention on elicited WTP to avoid sexually transmitted infections (STIs). It is found that after the intervention, participants’ elicited WTP to avoid STIs were significantly higher, and more sensitive to differences in infection severity. These results suggest that the intervention may affect risky sexual behaviour by changing the perceived value of avoiding the consequences of risky sexual behaviour. Additionally, these findings contribute to an ongoing debate regarding the construct validity of CV studies in health economics.

Projecting the impact of hypothetical early life interventions on adiposity in children living in low-income households.

It is difficult to evaluate the effectiveness of interventions aimed at reducing early childhood obesity using randomized trials. Objective To illustrate how observational data can be analysed using causal inference methods to estimate the potential impact of behavioural 'interventions' on early childhood adiposity. Methods We used longitudinal data from 1054 children 1-5 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children and followed (WIC) from 2008 to 2010 for a mean duration of 23 months. The data came from a random sample of WIC families living in Los Angeles County in 2008. We used the parametric g-formula to estimate the impact of various hypothetical behavioural interventions. Results Adjusted mean weight-for-height Z score at the end of follow-up was 0.73 (95% CI 0.65, 0.81) under no intervention and 0.63 (95% CI 0.38, 0.87) for all interventions given jointly. Exclusive breastfeeding for 6 months or longer was the most effective intervention [population mean difference = -0.11 (95% CI -0.22, 0.01)]. Other interventions had little or no effect. Conclusions Compared with interventions promoting healthy eating and physical activity behaviours, breastfeeding was more effective in reducing obesity risk in children aged 1-5 years. When carefully applied, causal inference methods may offer viable alternatives to randomized trials in etiologic and evaluation research.

Behavioral Therapies for Treatment-Seeking Cannabis Users

Narrative reviews conclude that behavioral therapies (BTs) produce better outcomes than control conditions for cannabis use disorders (CUDs). However, the strength and consistency of this effect has not been directly empirically examined. The present meta-analysis combined multiple well-controlled studies to help clarify the overall impact of behavioral interventions in the treatment of CUDs. A comprehensive literature search produced 10 randomized controlled trials (RCTs; n = 2,027) that were included in the final analyses. Analyses indicated an effect of BTs (including contingency management, relapse prevention, and motivational interviewing, and combinations of these strategies with cognitive behavioral therapy) over control conditions (including waitlist [WL], psychological placebo, and treatment as usual) across pooled outcomes and time points (Hedges' g = 0.44). These results suggest that the average patient receiving a behavioral intervention fared better than 66% of those in the control conditions. BT also outperformed control conditions when examining primary outcomes alone (frequency and severity of use) and secondary outcomes alone (psychosocial functioning). Effect sizes were not moderated by inclusion of a diagnosis (RCTs including treatment-seeking cannabis users who were not assessed for abuse or dependence vs. RCTs including individuals diagnosed as dependent), dose (number of treatment sessions), treatment format (either group vs. individual treatment or in-person vs. non-in-person treatment), sample size, or publication year. Effect sizes were significantly larger for studies that included a WL control comparison versus those including active control comparisons, such that BT significantly outperformed WL controls but not active control comparisons.

Aging and immunity – Impact of behavioral intervention

Immune responses to pathogens to which they were not previously exposed are commonly less effective in elderly people than in young adults, whereas those to agents previously encountered and overcome in earlier life may be amplified. This is reflected in the robust finding in many studies that the proportions and numbers of naïve B and T cells are lower and memory cells higher in the elderly. In addition to the "extrinsic" effects of pathogen exposure, "intrinsic" events such as age-associated differences in haematopoeitic stem cells and their niches in the bone marrow associated with differences in cell maturation and output to the periphery are also observed. In the case of T cells, the "intrinsic" process of thymic involution, beginning before puberty, further contributes to reducing the production of naïve T cells. Like memory T cell populations, innate immune cells may be increased in number but decreased in efficacy on a per-cell basis. Thus, superimposed on chronological age alone, remodelling of immunity as a result of interactions with the environment over the life course is instrumental in shaping immune status in later life. In addition to interactions with pathogens, host microbiome and nutrition, exercise and stress, and many other extrinsic factors are crucial modulators of this "immunosenescence" process. In this review, we briefly outline the observed immune differences between younger and older people, and discuss the possible impacts of behavioral variations thereon.

Impact of Behavioral Interventions in the Management of Adults with Type 2 Diabetes Mellitus

Research on the role of behavior change as an efficacious intervention for adults with type 2 diabetes is evolving. Searching PubMed and Ovid Medline, we identified and reviewed primarily randomized controlled trials from 2010 to 2013 of adults managing type 2 diabetes without insulin. All studies are evaluated in terms of the rigor of their design and their impact on glycosylated hemoglobin. The most efficacious interventions appear to be low-carbohydrate/glycemic load diets, combined aerobic and resistance training, and self-monitoring of blood glucose, which educates patients about the impact of their food selections and physical activity on their blood glucose.

The Impact of Behavioral Intervention on Obesity Mediated Declines in Mobility Function: Implications for Longevity

A primary focus of longevity research is to identify prognostic risk factors that can be mediated by early treatment efforts. To date, much of this work has focused on understanding the biological processes that may contribute to aging process and age-related disease conditions. Although such processes are undoubtedly important, no current biological intervention aimed at increasing health and lifespan exists. Interestingly, a close relationship between mobility performance and the aging process has been documented in older adults. For example, recent studies have identified functional status, as assessed by walking speed, as a strong predictor of major health outcomes, including mortality, in older adults. This paper aims to describe the relationship between the comorbidities related to decreased health and lifespan and mobility function in obese, older adults. Concurrently, lifestyle interventions, including diet and exercise, are described as a means to improve mobility function and thereby limit the functional limitations associated with increased mortality.

The Impact of Behavioral Intervention on Family Interactions at Mealtime in Pediatric Cystic Fibrosis

The current study evaluated the impact of a behavioral intervention (Be In Charge!), targeting caloric intake and weight gain in children with CF, on family interactions at mealtime. Forty-five families of children with cystic fibrosis (CF), ages 4 to 12 years, were randomized to Be In Charge! or nutrition education and assessed using the McMaster Mealtime Family Interaction Coding System. No differences were found in family functioning between the two interventions pre- to posttreatment or 1-year follow-up, except for Affect Management. A significantly greater percentage of families receiving Be In Charge! demonstrated improvement in Affect Management from pretreatment to 1-year follow-up. Implications for developing the next generation of behavioral interventions are discussed.