Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

The hoarding dimension of OCD: psychological comorbidity and the five-factor personality model

Although hoarding has been associated with several psychological disorders, it is most frequently linked to obsessive-compulsive disorder (OCD). The present study assessed hoarding obsessions and compulsions in 204 individuals with OCD, and evaluated how hoarding was related to obsessive-compulsive symptom severity, psychological comorbidity, and personality as measured by the five-factor model. Results indicated that hoarding in OCD is a dimensional variable that is positively associated with dysphoria, total number of lifetime Axis I disorders, and lifetime histories of bipolar I, PTSD, and body dysmorphic disorder. Hoarding was negatively correlated with the NEO-Personality Inventory-Revised (NEO-PI-R) factor of Conscientiousness and positively associated with the NEO-PI-R factor of Neuroticism. When all personality and psychopathology variables were entered into a regression equation, dysphoria, bipolar II disorder, Conscientiousness, age, and Extraversion emerged as significant predictors of hoarding severity. Recommendations are made for clinicians and for future research.     

Balance between volunteer work and family roles: Testing a theoretical model of work‐family conflict in the volunteer emergency services

Trends indicate overall declines in numbers of volunteer emergency service workers and suggest negative organisational factors impacting adversely on volunteers and organisations. Conflict between emergency service work and family is implicated in falling volunteer numbers, and there is thus a need for research on difficulties experienced in balancing volunteer work and family. The current study tested an adaptation of the work‐family conflict (WFC) model originally proposed by Frone, Russell, and Cooper, in a sample of 102 couples in which one partner was an Australian emergency service volunteer. Results supported a model in which volunteer work‐related antecedents, including time invested in on‐call emergency activities and post‐traumatic stress symptoms, had indirect links with outcomes, including volunteer burnout and their partners' support for the volunteer work role, through the effects of WFC. These results add to research using theoretical models of paid work processes to better understand the problems faced by volunteer workers, and identify specific antecedents and outcomes of WFC in the volunteer emergency services. Implications for future research and organisations reliant on volunteer workers are discussed.     

Mimicking disliked others: Effects of a priori liking on the mimicry‐liking link

The sharing of bodily states elicits in mimicker and mimickee corresponding conceptualisations, which facilitates liking. There are many studies showing the relatedness of mimicry and liking. However, the mimicry‐liking link has not been investigated under conditions in which the mimickee is liked or disliked a priori. In two studies, we examined moderating effects of a priori liking on the mimicry‐liking link. Liking was measured via self‐report measures (Studies 1 and 2) and behavioural measures using a virtual environment technology (Study 2). Results showed that when participants intentionally mimicked a disliked person, liking for that person was not improved, whereas when participants mimicked a liked person, liking for that person increased. These effects were shown to be mediated by affiliation. These studies not only provided further evidence of a link between mimicry and liking, but also demonstrated that this relationship is moderated by a priori liking. Copyright © 2009 John Wiley & Sons, Ltd.     

Field and observer viewpoint in remember-know memories of personal childhood events

This experiment examined the viewpoint and other phenomenal characteristics of childhood memories based on both personal recollections and self-knowledge. Participants were asked to provide examples of remember, know, and uncertain memories, and to rate each memory on a number of dimensions. Remembered events were generally viewed from a field perspective, while known-about events were generally viewed from an observer perspective. In line with earlier research, remembered events received the highest ratings for sensory and contextual detail, emotional content, and memory accuracy, while known-about events were given the lowest ratings. The results are discussed with reference to their possible implications for memory recovery or enhancement techniques that ask people to adopt a different viewpoint. Consideration is given as to whether a switch to a field perspective might encourage the acceptance of suggested details or events.     

Library Instruction,Intervention and Immersion: A 5-Year Study of Religion and the Arts

A religion faculty member approached the author after he gave a presentation to the faculty at Waldorf College on integrated library instruction. She expressed disappointment at her students’ scholarly performance on a major research paper she assigns every semester. The ensuing discussion resulted in a campus collaboration among the author, the faculty member, the campus writing center, and the academic achievement center. This article reports on the results of a five-year study on intervention and immersion of library instruction for the class Religion and the Arts at a small liberal arts college.     

Comparación entre dos escalas de medida subjetiva: Thurstone y Anderson

RESUMEN

La autora comienza exponiendo una síntesis de los modelos de Thurstone y Anderson -Ley del Juicio Comparativo y Teoría de la Integración de la Información, respectivamente- los cuales, desde supuestos distintos, permiten establecer una escala de intervalos en la medición de estímulos subjetivos. En esta investigación el objetivo es descubrir la existencia de una transformación admisible para la escala de intervalos que permita pasar de la escala de medida proporcionada por un modelo a la proporcionada por el otro, utilizando los mismos estímulos y los mismos sujetos. El trabajo concluye considerando que los resultados son esperanzadores aunque se sugiere aceptarlos con cierta cautela ya que se utilizaron pocas categorías de estímulos.     

Sport-Based Group Therapy Program for Boys with ADHD or with Other Behavioral Disorders

A group of children with Attention Deficit Hyperactivity Disorder (ADHD) was compared to children with other behavior and emotional problems. All the participants participated together in 20 weekly sessions for 1 academic year. The participants were assessed with three questionnaires on three different occasions: before the beginning of the group, at the completion of the group, and 1 year after the completion of the group. The results showed that the children indicated improvement in two behavior domains while their parents indicated improvement in the children's behavior in five domains. The most striking improvement was reduction of anxiety.