Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs.

Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team.

Results: In complex interventions, effects are produced not only by the intervention, but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies.

Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.     

How Transitional Justice Processes and Official Apologies Influence Reconciliation: The Case of the Chilean ‘Truth and Reconciliation’ and ‘Political Imprisonment and Torture’ Commissions

Perceptions of the ‘Truth and Reconciliation’ and ‘Political Imprisonment and Torture’ commissions and related beliefs, emotions and socio‐emotional climate were analysed in people affected and unaffected by past political violence in Chile (N = 1278). People directly affected regard institutional apologies as less sincere and effective, and they were more critical of the commissions. Those who have a positive appraisal of the commissions, compared with people who disagree with the commissions activities, are less prone to forget past collective violence; report higher levels of negative emotions, such as shame, and positive ones, such as pride and hope, about the collective past; and consider that the commissions contributed to knowing the truth about what happened to victims and helped bring human rights violators to justice. Those appraising the commissions in a positive fashion also perceive a more positive emotional climate and inter‐group trust, have more confidence in institutions and report more universalistic values. A multiple‐regression analysis suggests that commissions play a relatively successful role as transitional justice rituals, reinforcing reconciliation. Copyright © 2015 John Wiley & Sons, Ltd.     

‘Do-It-Yourself’ Healthcare? Quality of Health and Healthcare Through Wearable Sensors

Wearable sensors are an integral part of the new telemedicine concept supporting the idea that Information Technologies will improve the quality and efficiency of healthcare. The use of sensors in diagnosis, treatment and monitoring of patients not only potentially changes medical practice but also one’s relationship with one’s body and mind, as well as the role and responsibilities of patients and healthcare professionals. In this paper, we focus on knowledge assessment of the online communities of Fitbit (a commercial wearable device) and the Quantified Self movement. Through their online forums, we investigate how users’ knowledge claims, shared experiences and imaginations about wearable sensors interrogate or confirm the narratives through which they are introduced to the publics. Citizen initiatives like the Quantified Self movement claim the right to ‘own’ the sensor generated data. But how these data can be used through traditional healthcare systems is an open question. More importantly, wearable sensors trigger a social function that is transformative of the current idea of care and healthcare, focused on sharing, socialising and collectively reflecting about individual problems. Whether this is aligned with current policy making about healthcare, whose central narrative is focused on efficiency and productivity, is to be seen.     

The specificity of the neural response to speech at birth

In this work we ask whether at birth, the human brain responds uniquely to speech, or if similar activation also occurs to a non‐speech surrogate ‘language’. We compare neural activation in newborn infants to the language heard in utero (English), to an unfamiliar language (Spanish), and to a whistled surrogate language (Silbo Gomero) that, while used by humans to communicate, is not speech. Anterior temporal areas of the neonate cortex are activated in response to both familiar and unfamiliar spoken language, but these classic language areas are not activated to the whistled surrogate form. These results suggest that at the time human infants emerge from the womb, the neural preparation for language is specialized to speech.