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.     

Presence,Content, and Characteristics of Memories of Individuals with Dental Phobia

Knowledge about memories of distressing events underlying fears and specific phobias is limited. This study assessed (1) the presence, content, and characteristics of memories of events that initiated or exacerbated dental anxiety levels; and (2) the relationship between dental trait anxiety and some key features of these memories. This study used a semi‐structured interview and included dental phobics (n = 42), subthreshold dental phobics (n = 41), and normal controls (n = 70). Dental phobics were more likely to report a memory underlying their anxiety than the normal controls. Moreover, dental phobics' memories were reported as more vivid, disturbing, and more intensely relived than the memories of the normal controls. Greater severity of dental trait anxiety was significantly associated with greater disturbance of patients' memories. The results suggest that memories of distressing events play a significant role in the development of dental phobia and that their characteristics are associated with severity of dental trait anxiety. Copyright © 2015 John Wiley & Sons, Ltd.     

Internetbasierte Gesundheitsinterventionen

Background

Internet-based health interventions can serve as a useful supplement to regular face-to-face therapy only if they are accepted by the clients.

Objective

This aim of the current study was to examine the attitudes and opinions of potential users on internet-based health interventions in Germany. This information could make a useful contribution to the development and promotion of measures which target their requirements.

Material and methods

To address this issue psychotherapy patients and persons on a waiting list for outpatient psychotherapy were interviewed about their attitudes towards internet-based interventions and compared with the results from a matched control group.

Results

Compared with the control group, waiting list candidates in particular declared a reduced interest in engaging in internet-based interventions and both patient groups perceived few advantages. All groups appreciated the enhanced flexibility associated with internet-based interventions, but both patient groups thought that the increased anonymity and reduced inhibition threshold for seeking treatment were less advantageous than the control group. Compared to the controls, both patient groups worried more about privacy issues and a possible misinterpretation of their written statements. Both patient groups considered internet-based psychotherapy as conceivable for the treatment of fewer kinds of psychopathological symptoms than the control group. Patients considered that internet-based treatment of panic disorder, posttraumatic stress disorder, depression and generalized anxiety disorder was least imaginable although, to date, relatively many internet-based options are available for these disorders. There appears to be interest in the treatment of sexual dysfunctions through the internet.

Conclusion

To address the reservations concerning privacy protection, paper and pencil registration procedures could be provided. In addition, by clearly emphasizing that there is the possibility of establishing personal contact to a therapist either face to face or by video conference, internet-based services could also be more useful in satisfying patient needs.

     

What Goes Up Apparently Needn't Come Down: Asymmetric Predictions of Ascent and Descent in Rankings

In eight studies, we document an upward mobility bias, or a tendency to predict that a rise in rankings is more likely than a decline. This asymmetry was observed in predictions of classroom performance, NBA and NFL standings, business school rankings, and employee performance rankings. The bias was found for entities people care about and want to see improve their standing, as well as entities in which people are not invested. It appears to result from people's tendency to give considerable weight to a focal agent's intentions and motivation, but to give less weight to the intentions of competitors and other factors that would thwart the focal agent's improvement. We show that this bias is most pronounced for implicit incremental theorists, who believe that performance is malleable (and hence assign more weight to intentions and effort). We discuss implications of this asymmetry for decision making and for an understanding of the underdog bias. Copyright © 2015 John Wiley & Sons, Ltd.     

Individual Differences in Diving: Intelligence,Personality, and Underwater Adaptation

Diving is an activity that is carried out in an extreme environment with extraordinary psychophysical demands. It requires the divers to undergo an adaptive process in order to survive, to be able to take advantage of their capabilities, and to achieve an efficient performance. In this ex post facto study, data from a sample of military personnel participating in scuba diving courses (N = 649) were analyzed. Our aim was to verify the role of individual differences in the adaptation to an extreme and hostile environment. The results indicate the existence of psychological variables that differentiate between divers and the general population, those who pass or fail the diving course, and between groups of divers who obtain differential levels of performance in underwater tasks. These findings support that dispositional characteristics have utility for the identification of suitable personnel for professional diving.     

Keeping It Going: Evidence of Long-Term Improvements After Implementation of the 1-2-3 Magic Parenting Program

This study builds upon a pilot evaluation of the 1-2-3 Magic Program (Bailey, van der Zwan, Phelan, &; Brooks, 2012 Bailey, E. L., van der Zwan, R., Phelan, T. W., &; Brooks, A. (2012). The 1–2-3 Magic Program: Implementation outcomes of an Australian pilot evaluation with school-aged children. Child &; Family Behavior Therapy, 34(1), 53–69. doi:10.1080/07317107.2012.654455[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]), by investigating its long-term efficacy as a brief parenting intervention for families with a school-aged child. Twelve Australian families participated in a randomized controlled trial, assigned either to a wait-listed control group or to one that received immediate training. Consistent with the pilot evaluation, only families who had received training reported significant improvement in child and parenting behavior at an 8-week follow-up assessment. These improvements were maintained for 12-month posttraining, supporting the long-term efficacy of the 1-2-3 Magic Program for Australian families.