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.     

Interventions in everyday lives: How clients use psychotherapy outside their sessions

The purpose of psychotherapy is to help clients address and overcome problems troubling them in their everyday lives. Therapy can therefore only work if clients include it in their ongoing lives to deal with their problems. Detailed, systematic research is needed on how clients do so in their everyday lives outside their sessions. A design of exploratory case studies on this topic is presented in this article. The main outcomes of such a case study on family therapy are then laid out in general terms. They highlight how treatment practices and clients’ ordinary everyday practices interact when clients change their everyday lives to overcome their troubles. They also highlight what it involves for clients to accomplish this. It is concluded that we need more research on how to understand intervention; on the interaction between interventions and clients’ conduct of their everyday life; on sessions as a particular, secluded part of clients’ ongoing everyday lives, and on how to consider therapists’ procedures and conduct of sessions accordingly.     

Fostering networking behavior,career planning and optimism,and subjective career success: An intervention study

The present study evaluated personal resource-oriented interventions supporting the career development of young academics, working at German universities within the STEM fields. The study sought to foster subjective career success by improving networking behavior, career planning, and career optimism. The study involved a quasi-experimental pre-post intervention with two intervention and two control groups (N = 81 research associates). Participants of the first intervention group received networking training; participants of the second intervention group received the same networking training plus individual career coaching. Participants of both intervention groups were female. Participants of the control groups (i.e., male vs. female group) did not participate in any intervention. As expected, path analyses, based on mean differences from pre-test to post-test, revealed an increase in career planning and career optimism within the networking plus career coaching intervention group, that was indirectly positively related to changes in subjective career success. Contrary to our expectations, the networking group training alone and in combination with the career coaching showed no effectiveness in fostering networking behavior. Results are discussed in the context of career counseling and intervention effectiveness studies.     

Development and Initial Validation of a Scale Measuring the Beliefs of Educators Regarding Response to Intervention

This article presents information on the development and initial validation of the 16-item Response to Intervention (RTI) Beliefs Scale. The scale is designed to measure the extent to which educators working in schools hold beliefs consistent with the tenets of RTI. The authors administered the instrument to 2,430 educators in 62 elementary schools in the fall of 2007 and 2,443 educators in 68 elementary schools in the spring of 2008. Exploratory, single-level confirmatory, and multilevel confirmatory factor analysis procedures were used to examine construct validity. Results supported a correlated 3-factor model (Academic Abilities and Performance of Students with Disabilities, Data-Based Decision Making, and Functions of Core and Supplemental Instruction) at both the school and educator levels of analysis. Furthermore, the factor scores derived from the model demonstrated significant, positive relations to RTI implementation. Reliability estimates for two of the three factor scores exceeded.70. Implications for research on educator beliefs and implementation of RTI as well as implications for school psychologists supporting RTI implementation are discussed.     

A Comparison of Taped-Problem Interventions to Increase Math Fact Fluency: Does the Length of Time Delay Affect Student Learning Rates?

An alternating treatments design with a control condition was used to evaluate and compare the effects of two taped-problem interventions on addition fact fluency. Both taped-problem interventions were identical with the exception of the time delay between the auditory cue of the problem and the answer. One condition used a 2-s delay and the other condition used no delay. Results showed that both taped-problem conditions showed growth in student digits correct per minute scores and that the no-delay condition was slightly more efficient as the taped-problem no-delay procedure took approximately 33% less time. Discussion focuses on using comparative intervention designs to detect nuances in procedures to improve our understanding of math fact interventions that result in the highest learning rates.     

What is the Accordion Effect?

In "Action and Responsibility,' Joel Feinberg pointed to an important idea to which he gave the label "the accordion effect.' Feinberg's discussion of this idea is of interest on its own, but it is also of interest because of its interaction with his critique, in his "Causing Voluntary Actions,' of a much discussed view of H. L. A. Hart and A. M. Honoré that Feinberg labels the "voluntary intervention principle.' In this essay I reflect on what the accordion effect is supposed by Feinberg to be, on differences between Feinberg's understanding of this idea and that of Donald Davidson, and on the interaction between Feinberg's discussion of the accordion effect and his critique of the voluntary intervention principle.     

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18-22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group (n = 42), individuals assigned to the workshop group (n = 43) would experience a significant decrease in obsessive-compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive-compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.     

Two Theories of Just War

As it is traditionally conceived, Just War Theory is not well suited for dealing with nation vs non-nation wars. It thus makes sense to create a second Just War Theory to deal with these wars. This article explores the differences and similarities between the two theories.