Int.J. Behav. Med. (2014) 21 (Suppl 1):S1–S216 DOI 10.1007/s12529-014-9418-2
Abstracts from the ICBM 2014 Meeting
DESIGN AND CONDUCT OF RANDOMIZED BEHAVIORAL CLINICAL TRIALS – SESSION 1 Peter G. Kaufmann, Ph.D.1, Lynda H. Powell, Ph.D.2, Kenneth E. Freedland, Ph.D.3 1 National Heart, Lung and Blood Institute, Bethesda, Maryland 2 Rush University, Chicago, Illinois 3 Washington University, St. Louis, Missouri
USING N-OF-1 DESIGNS IN BEHAVIOURAL MEDICINE Prof Derek Johnston and Prof Marie Johnston Aberdeen University, Scotland
Introduction: Randomized controlled trials are the standard objective method for evaluating efficacy and effectiveness of interventions. Their implementation in behavioral medicine poses specific challenges that warrant careful consideration. Speakers will draw on their substantial experience in conducting, reviewing, and monitoring clinical trials involving behavioral interventions to provide solutions for commonly encountered issues. Objectives: this workshop is designed to provide a basic overview of the most salient principles that underlie the conduct of valid randomized behavioral clinical trials. Material will include a discussion of equipoise and blinding, efficacy and effectiveness, pragmatic trials, large simple trials, multisite trials, relationship of pilot studies to outcomes in the main trial, a consideration of Phases of trials, applicability of “Good Clinical Practices” as promulgated by regulatory agencies, issues in analysis including intent-to-treat, responder, and per-protocol analyses, primary and secondary endpoints, ancillary studies, and the structure and function of data and safety monitoring committees. Recognizing the diversity of issues in clinical trials, faculty will endeavor to integrate answers to specific questions or requests submitted to [email protected]
not later than two weeks before the workshop. Altogether, this session will present the principal challenges associated with the design of clinical trials involving behavioral interventions, encourage questions from participants and encourage questions regarding any of the presented material. Workshop activities: The workshop will consist primarily of lectures, drawing on the contemporary clinical trials literature in behavioral medicine and related fields. Power point slides and selected readings will be distributed. We encourage questions submitted in advance of the workshop. The faculty will be available for consultation after the workshop. Description of the intended participants: The session assumes no particular level of familiarity with clinical trials involving behavioral interventions. It should be of interest to everyone with an interest in improving the quality of clinical research. Presenters: All three presenters have been involved in numerous single- and multi-site behavioral clinical trials involving individual or group-randomized designs, and have served on research grant review committees, data and safety monitoring boards, and taught clinical trials methods for more than a decade.
Introduction; N-of-1 studies (sometimes called single case studies) have been used for some time in clinical psychology, are increasingly used in medicine and have been advocated by the Medical Research Council in the UK as an important initial step developing and evaluating complex interventions. They are a critical aspect of testing that psychological theory applies to individuals. However n-of-1 studies are not common in behavioural medicine or health psychology perhaps because few researchers in these fields have been trained in the design, operationalisation and analysis n-of-1 studies. This workshop aims to modestly increase interested researchers’ and clinicians’ knowledge about n-of-1 and greatly increase their confidence that they can and should conduct n-of-1 research. Objectives; the objectives of this workshop are to consider: The importance of conducting n-of-1 studies in (a) the development and testing of theory, (b) the initial stages of treatment development and evaluation and (c) in clinical practice. The problems of establishing causality in n-of-1 studies and describe the main nof-1 designs that attempt to deal with this.The types of measures that can be used in n-of-1 studies including ecological momentary assessment/ experience sampling methods on PDAs, smart phones and similar devices. The main data analytic problems when analysing the time series data typical of n-of-1 studies in behavioural medicine. Current methods for understanding and analysing typical small sample n-of-1 data. Workshop activities; The workshop will include lectures, group discussion and demonstration of measurement and analytic procedures. Participants will be encouraged to describe their experience of n-of-1 methods and/or their future plans for n-of-1 studies. Description of the intended participants; The workshop is open to all with an interest in conducting n-of-1 studies. No previous experience of n-of-1 methods is required but some experience would be helpful. People with great expertise in n-of-1 methods might not gain much from the workshop, but we would surely gain from their attendance. Brief information on the presenters/facilitators Derek Johnston researches occupational stress, behavioural aspects of cardiovascular disease and physical activity. He has a particular interest in real time measurement of behaviour and physiological functioning and n-of-1 methodology. Marie Johnston conducts research on disability (theory, measurement and intervention) and on behaviour change in health and healthcare contexts using all appropriate methods including n-of-1 studies. Both are at
Workshop #3 SELF REGULATION INTERVENTIONS AND A PROBLEM SOLVING IMPLEMENTATION IN HEALTH CARE PRACTICE Hennie Koelewijn & Nynke Kuipers PCC Health Promotion, The Netherlands Introduction.Self regulation can be defined as a circular process of human behavior, in which individuals give direction to their thoughts and feelings by means of self-reflection, in order to attain self set behavioral goals (Maes & Gebhardt, 2000; Maes & Karoly, 2005). The problem solving approach, as implementation framework of self regulation interventions, consists of four practical steps: 1) goal setting, 2) creating a plan of action, 3) feedback, process evaluation and control procedures and 4) goal evaluation and reformulation of (realistic) goals (Koelewijn, 2013). Research on self regulation interventions shows promising results in improving well-being of patients with chronic illnesses (Huisman et al., 2009; Janssen, 2012). Furthermore, pilot studies in health care practice settings also show that a problem solving approach with self regulation interventions is effective in improving wellbeing (depression, anxiety and burnout) for individual clients that participate in short-term care programs (Koelewijn, Kuipers & Van Mourik, 2012). Based on these research findings, we advice that health care providers receive more training to implement self regulation interventions. Objectives This interactive workshop will allow a venue for participants to exchange experiences applying self regulation interventions and a problem solving approach in short term care programs. In this workshop the following topics will be covered: Firstly, we will present an overview of the literature on interventions in experimental and clinical settings. Secondly, we will elaborate on thirteen intervention principles and the four implementation steps. Followed by a discussion on the opportunities and challenges in the application of self regulation and problem solving in practice. Workshop activities; the workshop will include an oral presentation on self regulation interventions and a problem solving implementation. Additionally, interactive exercises, case studies and discussions are facilitated.Description of the intended participants The workshop is at introductory level and is intended for participants to improve their implementation skills of self regulation interventions. Brief information on the presenters/facilitators: Last May Hennie Koelewijn received her doctorate after fifteen years of practicing and researching the problem solving implementation approach in health care settings. Furthermore, as director of four psychology practices she is an innovator in training and educating young health psychologists and other healthcare workers. Nynke Kuipers is currently Head Academy of PCC Health Promotion. She educates young health psychologists in learning to implement (selfregulation) intervention programs. She also teaches all kind of health care workers multidisciplinary and communication skills. Furthermore, she is a registered organizational and occupational psychologist and coaches individual clients, managers and teams in improving well-being, quality of work and personal development.
Workshop #4 APPLICATIONS OF LATENT VARIABLE MODELS IN BEHAVIORAL MEDICINE RESEARCH Maria M. Llabre, Ph.D., William Arguelles, PhD Department of Psychology and the Behavioral Medicine Research Center at the University of Miami, USA Latent variable models (LVM) are broad and flexible statistical models that specify the relations among a set of observed or manifest variables and their underlying unobservable constructs, the latent variables. Latent variables can be categorical or continuous, as is also the case with their resulting observed variables. Depending on the type of variable combination, these models are recognized by different names. For example, confirmatory factor analysis (CFA) is a LVM with continuous observed
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and latent variables, whereas item response theory (IRT) models work with categorical indicators but continuous latent variables. Mixture models are those with categorical latent variables. Latent growth models (LGM) examine change across repeated measures by specifying parameters of change as latent variables. These models are useful in behavioral medicine research because they can accommodate measurement error, can reduce the number of observed variables, can facilitate the handling of some types of missing data, and can facilitate testing theoretical predictions. However, their application needs to consider the assumptions made. This workshop will introduce the basic concepts of LVM and illustrate the potential these models bring to different questions in behavioral medicine research. The concepts will be illustrated with several examples including both a CFA and a mixture model of metabolic syndrome, and applications of LGM to cardiovascular reactivity. Activities will include specification of the models and interpretation of results. This workshop is at an intermediate level. Participants should be familiar with linear models (regression analysis) and have a general notion of factor analysis. Maria M. Llabre is Professor of Psychology and teaches graduate statistics courses. William Arguelles is a Postdoctoral Fellow in Cardiovascular Behavioral Medicine.
Workshop #5 DESIGNING AND PROMOTING INTERVENTIONS IN PSYCHOSOCIAL CANCER CARE Barbara L. Andersen1, Robert T. Croyle2, Joost Dekker3, Michael A. Diefenbach4, Judith B. Prins5, Annette L. Stanton6 1 Professor of Psychology; Director, Livestrong Survivorship Center of Excellence; Ohio State University, USA 2 Director of the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA 3 Professor Allied Health Care, Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands 4 Director of Research, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA 5 Chair of the Department Medical Psychology, Radboud 190 UniversityMedical Centre,Nijmegen, theNetherlands 6 Professor, Psychology & Psychiatry/Biobehavioral Sciences; Member, 192 Jonsson Comprehensive Cancer Center; Senior Research Scientist, Cousins 193 Center for Psychoneuroimmunology; UCLA, USA. Introduction ; this interactive workshop will address important challenges in designing and promoting effective interventions in psychosocial cancer care. World-leading experts in the field of psychosocial cancer care will present the state of the science and discuss the future development of the field. We welcome active participation of the audience, in a collaborative effort to improve psychosocial cancer care. The workshop is a collaborative activity of APA Division 38 (Health Psychology), Society of Behavioral Medicine (Cancer SIG), and International Society of Behavioral Medicine. Objectives; to present the state of the science of designing and promoting effective interventions in psychosocial cancer care. To involve the audience in a discussion, in a collaborative effort to improve psychosocial cancer care. Workshop activities; the state of the science is introduced in the following lectures: Designing, testing and implementing BREATH: a web-based self-management intervention for breast cancer patients, Judith B. Prins. Psychosocial cancer interventions on the internet: Are our patients ready?, Michael A. Diefenbach. Building Tests of Mechanisms into PsychoOncology Intervention Trials, Annette L. Stanton. Disseminating empirically supported psychological treatments for cancer patients, Barbara L. Andersen. Psychosocial Aspects of Quality Cancer Care, Robert T. Croyle. In the discussion following each lecture, the audience is invited to contribute their opinion and experience. Description of the intended participants; Health professionals, clinicians, researchers and policy makers involved in psychosocial cancer care.
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Wednesday 20 August 2014 ICBM Satellite Forum 09.00 – 16.00
FROM RESEARCH TO REALITY: LESSONS FROM DISSEMINATION AND IMPLEMENTATION RESEARCH ACROSS THE GLOBE Proposed by: Brian Oldenburg, Carina Chan (Chair, ISBM Early Career Network - INSPIRE) and K. Viswanath (Chair, Organizational Liaison)
Historically, researchers and policy makers have focused most of their attention on developing and testing empirically supported interventions. Much less attention has been paid to what is needed to implement and sustain these in a range of real-world settings. Many empirically supported interventions are less effective and/or fail to reach their target audiences when implemented within existing service structures and systems, and few are sustained over the long term. Clearly, if effective public health programs are not widely adopted and implemented, their potential to improve people’s health is significantly impaired. This challenge is exacerbated by the different values and perspectives that exist between practitioners, program implementers, policy makers and researchers. Practitioners often find evidencebased interventions difficult to conduct in community settings especially when there is such limited information about how to adapt programs to the local context. Furthermore, public health decision makers and program implementers are often reluctant to consider ‘new’ interventions when effectiveness has not been demonstrated in their particular setting or country. By contrast, researchers are usually more concerned with the internal validity of their programs rather than generalizability and external validity. “Dissemination” refers to the targeted distribution of information and intervention materials to a specific public health or clinical practice audience with the intent being to spread knowledge and the associated evidence-based interventions. “Implementation” refers to the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. “Translation” refers to applying or adapting research findings or evidence to different community or population settings. This also includes ‘translation’ to other countries or cultures from where the original program was developed and evaluated. While there is a growing recognition of the importance of Dissemination and Implementation Research and a fast developing body of work, significant gaps remain. These gaps include a lack of case studies and evidence-base from low and middle income countries, continuing and vexing methodological challenges especially with study designs and measures, and more critical a lack of sustained dialogue between researchers and end-users on mechanisms of translation. The 2nd Satellite Forum of ICBM 2014 aims to follow on the conversations began at ICBM 2012 to address these gaps by bringing together key stakeholders from academy, policy and practice communities to continue the dialogue. This forum aims to draw on the knowledge and experience of speakers and participants from around the world:
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To learn about experiences from practice, policy and research communities on studying and implementing D&I research across the globe. To assess the state of the science in regard to theoretical models, research designs and measures on D&I research. To identify ways of working together in the future to further advance the evidence base for better implementation and translation of behavioural medicine interventions globally. To showcase exemplar D& I research studies from across the globe.
Topics to be covered in the 1-day forum will include:
What are some of studies that best exemplify challenges and opportunities of D& I research across the globe? What are some of the needs of and challenges faced by policy makers to using research to promote changes in policies related to behavioural medicine?
What are the barriers to and preferences of practice communities in adopting, customizing and localizing effective interventions to their practice settings? What are some of the significant theoretical models and approaches being used? What is the state of evidence to support the models? What types of methods have been used for dissemination, implementation? What has been the experience in using these methods? What capacity, infrastructure and funding models are needed for more ‘scaled up’ dissemination and implementation program delivery and research?
These topics will be illustrated by case studies from different countries and settings. The speakers/discussants for the 1-day program will include ICBM attendees from both developed and developing countries who have expertise in research, policy and/or practice related to the dissemination and/ or implementation of behavioural medicine programs. A number of these individuals have already indicated their interest in being involved.
Workshop #6 DESIGN AND CONDUCT OF RANDOMIZED BEHAVIORAL CLINICAL TRIALS – SESSION 2 Peter G. Kaufmann, Ph.D.1, Lynda H. Powell, Ph.D.2, Kenneth E. Freedland, Ph.D.3 1 National Heart, Lung and Blood Institute, Bethesda, Maryland 2 Rush University, Chicago, Illinois 3 Washington University, St. Louis, Missouri Introduction: Randomized controlled trials are the standard objective method for evaluating efficacy and effectiveness of interventions. Their implementation in behavioral medicine poses specific challenges that warrant careful consideration. Speakers will draw on their substantial experience in conducting, reviewing, and monitoring clinical trials involving behavioral interventions to provide solutions for commonly encountered issues. Objectives: This workshop will address additional methodological issues associated with the design and execution of clinical trials involving behavioral interventions. These include: consideration of interventions dosage and its relationship to effect size; selection of appropriate control group options consistent with the objectives of the clinical trial in the context of existing literature; effect of inclusion and exclusion criteria on detecting a valid outcome; and, selection of appropriate primary and secondary outcome measures when the interventions can affect multiple targets or influence the expression of several symptoms. The presentations will address potential confounding of results by methods used to foster retention or with follow-up assessments themselves. Finally, the presentation will discuss effective publication of clinical trials. Workshop activities: The workshop will consist primarily of lectures, drawing on the contemporary clinical trials literature in behavioral medicine and related fields. Power point slides and selected readings will be distributed. We encourage questions submitted in advance of the workshop to [email protected]
The faculty will be available for consultation after the workshop. Description of the intended participants: The session assumes no particular level of familiarity with clinical trials involving behavioral interventions as it should be of interest to individuals with a wide range of experience in clinical research. The selected topics build on those presented in Session 1. Maximum number of participants: There is no limitation on the number of participants. Presenters: All three presenters have been involved in numerous singleand multi-site behavioral clinical trials involving individual or grouprandomized designs, and have served on research grant review committees, data and safety monitoring boards, and taught clinical trials methods for more than a decade.
Workshop #7 SPECIFYING THE CONTENT OF COMPLEX INTERVENTIONS TO IMPROVE HEALTH: USING A TAXONOMY OF BEHAVIOUR CHANGE TECHNIQUES (BCTS). Dr Wendy Hardeman (University of Cambridge) and Prof Marie Johnston (University of Aberdeen). Introduction; To date, there has been no shared language for describing the content, especially the ‘active ingredients’ of behaviour change interventions; by contrast, biomedical interventions are precisely specified. This limits the possibility of replicating effective interventions, synthesising evidence, and understanding the causal mechanisms underlying behaviour change. With the guidance of a multidisciplinary International Advisory Board of leaders in the field of behaviour change, we have developed a reliable method of specifying behaviour change techniques (BCTs), with consensually agreed labels and definitions (see www.ucl.ac.uk/health-psychology/BCTtaxonomy). Objectives; To familiarise participants with the need for the BCT Taxonomy, its method of development and its application. To give hands-on experience of using the BCT Taxonomy V1 to identify the active content of behaviour change interventions and write intervention descriptions. To encourage discussion between participants about their experiences of using BCT labels and definitions and future uses of the taxonomy. Workshop activities; Training tasks will teach participants a structured method for identifying the active content of behaviour change interventions and writing clear, replicable descriptions of intervention content using BCT labels and definitions in the taxonomy. The workshop will combine brief presentations, hands-on practice (individually and in groups) and structured discussion. Participants completing the workshop will be invited to join the Network of collaborators which will facilitate contact with others using and continuing to develop this resource. Description of the intended participants; The workshop is open to all participants with an interest in investigating, reviewing, designing or delivering behavioural interventions. No previous knowledge or experience of BCT taxonomies is required. Brief information on the presenters/facilitators; Wendy Hardeman and Marie Johnston are core members of the BCT Taxonomy V1 team. Wendy has developed and evaluated a range of behavioural interventions, with specification of interventions, fidelity, and process evaluation as key interests. Marie has also conducted RCTs of behavioural interventions with a focus on theory, measurement of outcomes and improving specification of the active ingredients. Acknowledgement: This workshop has arisen from initial findings of a UK MRC-funded study “Strengthening evaluation and implementation by specifying components of behaviour change interventions”, aka the BCT Taxonomy Project (Grant holders: Susan Michie, Charles Abraham, Martin Eccles, Jill Francis, Wendy Hardeman and Marie Johnston).
Workshop #8 TALK AND TEXT: QUALITYAND INNOVATION IN QUALITATIVE RESEARCH FOR BEHAVIOURAL MEDICINE Sally Sargeant Assistant Professor in Behavioural Sciences in the School of Medicine at Bond University, Australia Introduction; Qualitative research continues to enjoy increasing interest and use within a range of disciplines. In line with this increase, there are more demands to ensure that the quality of qualitative research is high. This means ensuring that such research is theoretically and conceptually supported; that analysis is thorough; and that it is well documented and disseminated appropriately. This workshop will focus on strengthening skills in qualitative research for behavioural medicine, for beginners and those who have some experience. In particular the focus will be on assessing the quality of
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qualitative research and how to design effective studies that are matched to an appropriate research question. Attention is also paid to the process of analysis and how best to articulate this in written reports. Objectives
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To establish when it is appropriate to use qualitative methodology To understand data collection methods and analytic techniques and relevant distinctions between them To describe and critique writing qualitative reports To explain how to maximise quality in qualitative research
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Designing and practising interview questions Practising qualitative analysis Documenting methods Personal reflections
Description of the intended participants; The workshop is suitable for participants who are new to qualitative research and those who wish to enhance their existing skills or learn about a new analytic technique. Brief information on the presenters/facilitators; Sally Sargeant is an Assistant Professor in Behavioural Sciences in the School of Medicine at Bond University, Australia. She has advised on many qualitative projects which have led to successful grant applications. She is an editorial board member of Qualitative Health Research and is committed to promoting good practice in qualitative data analysis.
Workshop #9 HOW TO IMPROVE EHEALTH INTERVENTIONS IN HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE? Dr J van Gemert-Pijnen, Dr S Kelders Introduction: eHealth is gaining more and more ground in health psychology and behavioural medicine to support wellbeing, a healthier lifestyle or adherence to medications. Despite the large number of eHealth projects to date, the actual use of eHealth interventions is lower than expected. Many projects in Health fail to survive beyond the pilot phase and studies that investigate the effectiveness of eHealth applications most often do not show long-term effects. The ongoing concern in academic literature about these shortcomings situates eHealth as an immature research domain not capable to follow the golden standards of high quality research in health psychology and behavioral medicine. On the other side, in lifestyle or mental health interventions positive results with internet-based interventions can be observed and patients favor internet interventions. Therefore, we will discuss how to make eHealth interventions more enjoyable, feasible, and cost-effective. Objectives: In this workshop we demonstrate how eHealth interventions can be improved, using technology as a driver for adherence and behavior change. In our workshop we introduce a new approach to guide the development of eHealth interventions. The approach is based on an integration of theories form behavioural sciences and persuasive technology. The purpose of the workshop is first, to provide new opportunities to develop eHealth interventions that are user centred and that are implementable in practice, second to discuss an agenda for future research in eHealth for health psychology and behavioral medicine-interventions. Learning outcomes are insight in how to use technology to develop eHealth interventions that work, help and are cost effective, and knowledge about how to evaluate the effects of eHealth interventions on adherence and outcomes. Workshop activities: The workshop starts with a demonstration of examples of eHealth interventions to support self-care and safe-care. Interventions we focus on are blended therapy for depression, self-management applications to support patients with chronic diseases, and applications to
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support medical professionals to increase safety at work. The examples will be discussed alongside the new approach for development and implementation to improve eHealth interventions. Persuasive Technology will be highlighted as a strategy to increase the adherence to eHealth interventions. The effects of persuasive technology on adherence and its’ consequences for design will be discussed with participants. Participants will evaluate the persuasiveness and user friendliness of eHealth interventions using the eHealthwiki.org (toolkit) and a persuasive model for system and content design. Finally, the workshop synthesizes views on innovative research methods to improve the uptake and impact of eHealth interventions. For the workshop we use our book, Improving eHealth(www.elevenpub.com). Description of the intended participants: participants with interest in design, implementation, evaluation of eHealth interventions. Brief information on the presenters/facilitators: Lisette van Gemert-Pijnen is associate professor at the University of Twente, at the University Medical Center Groningen, and adjunct professor at the University of Waterloo in Canada. Lisette founded and is the director of the first Center for eHealth Research and Disease Management (www.ehealthresearchcenter.nl). Her research group’s program focusses on persuasive designs (people-driven) and business modeling (valuedriven) for interactive eHealth interventions, in particular on how persuasive designs can increase trust, engagement, and adherence to eHealth interventions aimed at safe care and self- care. Lisette is the chief editor of the book Improving eHealth, which provides mixed methods for developing and implementing eHealth interventions aimed at behavior change. Saskia Kelders is assistant professor at the University of Twente. In 2012 she defended her PhD-thesis ‘Understanding adherence to web-based interventions’. Currently she teaches eHealth and eMental Health to Master students in psychology. She is involved in research projects about positive technology to change attitudes and behaviors in mental health. Her focus is on the development and evaluation of these technologies, with a special interest in persuasive technology, adherence and log-data.
Workshop #10 BEHAVIORAL MEDICINE IN CHINA: CHALLENGES AND OPPORTUNITIES Organizers: Bo Bai (Chair), Joost Dekker (Co-chair), Chengxuan Qiu (Coordinator), Feng Ji (Coordinator) Presenters: Qingshan Geng, Joseph Tak-Fai Lau, Peiyuan Lu. Discussants: Qihua Tan, Chengxuan Qiu Introduction/background; In the last three decades, along with rapid economic growth and improvement in living standards in China, there have been considerable changes in diets (e.g., meat consumption), lifestyle behaviors (e.g., smoking, alcohol consumption, sedentary lifestyle, and sexual behavior), and social environment, which significantly contribute to the epidemic of chronic non-communicable diseases (e.g., cancer, ischemic heart disease, and stroke) and sexually transmitted diseases (e.g., HIV) as well. In addition, health problems of rural-urban migrant workers have become increasingly important due to rapid urbanization. Research in the field of behavioral medicine will help to deal with the tremendous threats owing to these major public health issues and thus, contribute to the sustainable development of economy and society in China. Objectives; To present and discuss research on several relevant topics related to behavioral medicine in China. To promote collaboration and exchange on research in behavioral medicine between China and other nations. Workshop activities; Welcome speech (5 min): Prof Bo Bai, President of Chinese Society of Behavioral Medicine (CSBM), Chinese Medical Association, China. Scientific session (20 min/talk plus 10 min break): Prof Qingshan Geng, "Sexually transmitted diseases and education-based intervention in China" Prof Joseph Tak-Fai Lau, "Health of migrant workers from rural to urban areas in China"
Prof Peiyuan Lu, "Stroke and vascular cognitive impairment in China" Dr Qihua Tan, “Metabolic factors, lifestyle behaviors, and health”. Dr Chengxuan Qiu, “Prevention of vascular cognitive impairment: an international perspective”. Concluding remarks (5 min): Prof Joost Dekker, President of International Society of Behavioral Medicine (ISBM), The Netherlands. Description of the intended participants; The intended participants of this workshop include (1) researchers from China and other Asian-Pacific countries, and (2) people who have traditional collaboration with China or who are interested in developing new collaboration with researchers in China. Brief information on the presenters/facilitators Prof Bo Bai, President of CSBM, and President of Jining Medical University, Shandong, China. Prof Joost Dekker, President of ISBM, and Professor of VU University Medical Centre, Amsterdam, The Netherlands. Prof Qingshan Geng, Deputy Head of Health Department of Guangdong Province, China. Prof Joseph Tak-Fai Lau, President of the Hong Kong Society of Behavioral Health and Director of the Centre of Health Behaviors Research, School of Public Health and Primary Care, Chinese University of Hong Kong, China. Prof Lau serves as a HIV consultant of several Provincial Centres for Disease Control and Prevention in China. Prof Peiyuan Lu, Dean of Department of Neurology, and Vice President of Hebei General Hospital, Hebei, China. Dr Qihua Tan, Associate Professor at Institute of Public Health, University of Southern Denmark, Denmark. Dr Tan’s research focuses on epigenetic epidemiology of cancer and aging phenotypes as well as genetic and environmental factors of metabolic disorders in eastern and western populations. Dr Chengxuan Qiu, Associate Professor at the Aging Research Centre, Karolinska Institutet, Sweden and Visiting Professor of Jining Medical University, China. Dr Qiu’s research focuses on epidemiology and prevention of dementia and vascular mechanisms of brain aging, cognitive, and physical dysfunction.
Workshop #11 USING SOCIAL MEDIA TO WRITE AND PROMOTE YOUR SCIENTIFIC PAPERS James C Coyne PhD Introduction; Social media provide a powerful set of tools for organizing research teams, conducting research, crowd sourcing expertise, and obtaining preliminary peer review of your scientific papers. Social media also provide powerful ways to publicize and disseminate newly published papers to a broad audience. Writing groups organized on the Internet increasingly publish papers in JAMA, PNAS and BMJ, as well as open access journals. Individual authors often develop their ideas in tweets, short and long read blog posts, and then solicit feedback on drafts. Authors and universities increasingly engage in social media campaigns to publicize and discuss recently published papers. High impact journals undertake their own such efforts. Powerful tools such as PubMed Commons provide increasingly respected post publication peer review. Altmetrics now quantify such activities. This workshop provides exposure and hands-on experience in use of these tools at all stages of writing and promoting scientific work. Objectives
1. Familiarize participants with tools such as Twitter, blogs, Rebel 2. 3.
Mouse, and Facebook to develop research and promote it after publication. Provide concrete case examples of successful application of these tools to both the knowledge production and dissemination. Engage participants in utilizing these tools with the projects they bring to the workshop.
Workshop activities; Didactic presentation of tools and concrete examples of their application will be followed by a highly interactive session in
which participants will be invited to develop their ideas for organizing paper writing and subsequent promotion using social media. Description of the intended participants; The workshop will be of greatest interest to junior and senior researchers who are actively writing papers. Participants will be encouraged to bring ideas and works in progress. If they have forthcoming papers, they may use the workshop to construct social media strategies for promoting and disseminating their work. Brief information on the presenters/facilitators; The presenter has written hundreds of articles. His blog posts at PLOS Mind the Brain and Science Based Medicine each receive thousands of hits. A few years ago he turned to writing collectives organized on the Internet that have produced numerous high impact and award-winning articles. He has yet to meet all authors on some of these papers. He can present a number of personal examples of the progression of tweets to published papers to post publication promotion.
Poster Session A P1 PLANNING, TIMING AND QUIT SUCCESS: A RANDOMISED CONTROLLED TRIAL J.B. Balmford, Ron Borland, Elena Swift Cancer Council Victoria, MELBOURNE, Australia Introduction: Recent research has led to debate over the benefit of delaying the implementation of a decision to quit smoking in order to plan the attempt, and the role of planning. However, timing and planning need not be linked: planning can occur before a commitment to quit is made, after it is implemented, and in between. Method: 2x2 factorial RCT. Smokers (n=1,602) were recruited from Australian QuitCoach users who were open to the possibility of quitting, but not committed to quit within 2 days. In one arm participants were encouraged to implement a quit attempt without delay (Timing arm) and in the other were encouraged to use a set of planning resources added to the basic QuitCoach (Planning arm). Process measures of intervention uptake and short term outcomes were collected at 1 month, and 6-month sustained abstinence at 7 months. Results: 1-month follow-up data was obtained from 49% (n=789), of whom 42.8% had quit. There were significant positive main effects for timing and planning (both OR's 1.49, 95% CI 1.00-2.24) but no evidence for an interaction (OR 0.71, 95% CI 0.41-1.27). In the Timing arm, only 35.6% agreed to quit immediately. In the Planning arm, 52.9% used at least one of the planning tools. Results for 6-month sustained abstinence are being collected and will be reported at the meeting. Conclusions: Preliminary findings indicate that encouraging immediate implementation of a quit attempt, and the availability of planning resources, are associated with modest increases in abstinence. CORRESPONDING AUTHOR: Dr JB Balmford, Cancer Council, Victoria Australia, [email protected]
P2 DRUG CONSUMPTION ATTITUDES AT PENINSULA MUSIC FESTIVAL Z Abram University of Medicine and Pharmacy Tirgu Mures, TIRGU MURES, Romania Introduction. The study of drug consumption and health attitude among the youth makes it possible to know the risk factors that show correlation between health, general condition and drug use. Method. During a festival called Peninsula Music Festival Tîrgu Mureş we examined smoking, alcohol consumption and drug usage habits of
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young participants using a questionnaire method. The collected data were compared with data obtained during other surveys. Results. The changes of both legal and illegal drug use habits led us to conclude that the same happens in our country as in the western EU countries. The frequency of drug trials grows among the youth, the habits of drug use change, cannabis derivatives and ethnobotanical drugs dominate while the proportion of opiate users is decreasing. The statistics are alarming among music festival participants: 83% of them are smokers, 64% have been drunk more than 10 times and the majority have tried at least one drug, about 10% of them being frequent users. Conclusions. Our study emphasises the importance of drug-prevention strategies and concludes with the importance of making more effort in order to involve the younger generation in health education programmes. CORRESPONDING AUTHOR: Prof Z. Abram, University of Medicine and Pharmacy, Tirgu Mures Romania, [email protected]
P3 MOBILE PHONE ADDICTION: A SOCIO-COGNITIVE PERSPECTIVE ON EXCESSIVE MOBILE PHONE USE H. Allahverdipour, Sara Poorrazavi, Mohammad Asgharijafarabadi Tabriz university of Medical Sciences, TABRIZ, Iran Introduction: The study examined the predictive ability of selected demographic and socio-psychological characteristics to explain excessive mobile phone use (EMPU) behavior and problematic use, in a sample of university students, on the basis of the social cognitive theory. Methods: The sample consisted of 476 randomly selected university students in Tabriz, Iran. The study was cross-sectional in nature. A researcher-designed questionnaire was used for the purpose of data collection. No causal inferences were drawn due to non-experimental nature of the study. Results: It was found that having boyfriend/girlfriend increases the likelihood of EMPU while self-efficacy to avoid EMPU decreases it. Selfefficacy to avoid EMPU, self-regulation, observational learning, selfcontrol, and attitude toward EMPU were predictors of mobile phone problematic use. The results provided a proper fit for a conceptual model of reciprocal determinism. Conclusion: Although social cognitive constructs may predict mobile phone problematic use, they are not useful in predicting the behavior of EMPU. CORRESPONDING AUTHOR: Prof. H Allahverdipour, Tabriz university of Medical Sciences, Iran, [email protected]
P4 BRIEF INTERVENTION PRACTICES AMONGST NURSES WORKING WITH PREGNANT WOMEN OR PARENTS IN NORTH-NORWAY S.C. Wangberg1, 2 22 1 Narvik University College, NARVIK, Norway 2 Regional Centre of Substance Abuse, University Hospital of North Norway, NARVIK, Norway Introduction: Brief interventions are an effective way of reducing risk use of alcohol use amonst pregnant women and parents. A training program is currently being implemented in Norway for nurses working with pregnant women or parents of pre-school children. This study assessed the current practices and attitudes amongst these nurses in North-Norway. Methods: A survey was conducted amongst all 385 nurses working with pregnant women or parents in North-Norway. Of these, 105 community nurses and 35 midwives responded (36%). Results: Most of the midwives (91%) ask the pregnant women about their alcohol use at their first consultation. Twenty-seven per cent of the community nurses do the same. Fathers are asked less. While the nurses
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agreed that screening tools are useful, they are not always using them and they stated a need for more training. When risk use of alcohol is detected, 49% of the midwives and 34% of the community nurses follow up with an intervention of their own. Referring to the parent’s GP was even more common. Motivational Interviewing was well known and frequently used. Time constraints and lack of cooperation with other professionals were mentioned as barriers for brief interventions in response to an open question. Conclusion: Response rate limits conclusions to be drawn, but it seems that the nurses find brief interventions for alcohol use to be an important part of their job, but could use more training in the screening tools, and more time for following up parents. CORRESPONDING AUTHOR: Dr. SC Wangberg Narvik, University College, Norway, [email protected]
P5 PERSONAL AND PERCEIVED PEER USE OF TOBACCO AMONG UNIVERSITY STUDENTS IN SEVEN EUROPEAN COUNTRIES C.R. Pischke1, SM Helmer1, G Van Hal2, B Vriesacker2, R Dempsey3, J McAlaney4, BM Bewick5, YAkvardar6, F Guillén-Grima7, O Orosova8, F Salonna9, O Kalina8, C Stock10, H Zeeb1, R Mikolajczyk11 1 Leibniz-Institute for Prevention Research and Epidemiology - BIPS, BREMEN, Germany 2 Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium, ANTWERP, Belgium 3 Staffordshire University, STAFFORDSHIRE, United Kingdom 4 Bradford University, BRADFORD, United Kingdom 5 University of Leeds, LEEDS, United Kingdom 6 Marmara University, ISTANBUL, Turkey 7 Public University of Navarra, NAVARRA, Spain 8 PJ Safaric University, KOSICE, Slovak Republic 9 Palacky Univesity Olomouc, OLOMOUC, Czech Republic 10 University of Southern Denmark, ESBJERG, Denmark 11 Helmholtz Centre for Infection Research, BRAUNSCHWEIG, Germany Background: Previous research suggests that students tend to overestimate peer tobacco use. However, except for one Dutch study, the majority of studies on social norms regarding tobacco consumption were conducted in North America. The Social Norms Intervention for the prevention of Polydrug usE (SNIPE) study aims to assess rates of tobacco use and perceptions of peer tobacco use among European students. Methods: The SNIPE study was EU-funded and conducted in 7 European countries (Belgium, Denmark, Germany, Slovak Republic, Spain, United Kingdom, Turkey). In total 4,439 students (71% female) answered questions about their personal tobacco use and their perceptions on tobacco consumption rates in the majority of their peers at baseline. Results: Overall, the majority of male (60.8%) and female (72.5%) students were non-tobacco users (never use and no use in the past 2 months) at baseline. Tobacco use was least common in Belgium, where only 18.2% of students had used tobacco two or more times a week in the last two months, compared to higher rates of tobacco consumption in Turkey (43.3%) and Germany (40.6%). Across all countries, students reported higher rates of perceived tobacco consumption for their peers than for themselves. For example, more than 50% of students in each country perceived that the majority of peers of their own gender (>51%) consumed tobacco at least twice or more often a week. Conclusions: The SNIPE-study represents the first cross-national European collaboration indicating significant variations in tobacco use by country. Consistent with previous research, European students overestimated peer tobacco use. CORRESPONDING AUTHOR: Dr. Pischke, Leibniz-Institute for Prev e n t i o n R e s e a r c h a n d E p i d e m i o l o g y - B I P S , G e r m a n y, [email protected]
P6 OVER 12 YEARS FOLLOW UP OF QUIT SMOKING PROGRAM PARTICIPANTS Y.T. Takahashi1, Hideshi Miura2 1 Nara Women's University, NARA, Japan 2 Quit Smoking Marathon, AGEO, Japan Introduction: Although achieving lifelong tobacco abstinence is an important issue, few studies have evaluated the long term effectiveness of the internetmediated programs. In 1997, the first internet-mediated smoking cessation program was provided in Japan named Quit Smoking Marathon (QSM). The program was composed of two step programs: step1 program is to start quitting (1 month) and step2 program is to continue lifelong abstinence. This is the first report of over 12 years follow up of QSM participants. Methods: A questionnaire asking the present status of smoking, duration of abstinence and participation of the step2 program of QSM was sent by e-mail to 1127 members participated the QSM in 1997-2001 (over 12 years since participated). Biochemical methods for determination of smoking status, such as expired carbon monoxide, were not adopted. Results: 108 e-mails were not delivered because of the e-mail address failure. 118 members answered to the questionnaire. 108 members quit at the end of step1 program and 82 of 108 (76.0%) had continued absolute abstinance. Of 118 members, 58 still join the step2 program (55 quitters and 3 failures). 56 retired the program (45 quitters and 11 failures). Significant difference was found between the quitting rate in step2 program members and in those who had left (p 20 msec) survived on average more than double the days (133.5) than those with low HRV (64.0). In a cox regression, higher initial HRV significantly predicted lower risk of death, independent of confounders. This relationship was mediated by CRP levels. In patients who lived only up to one month from diagnosis, HRV was unrelated to CRP, while in patients surviving longer, HRV was significantly inversely related to CRP (r = -0.20, p < 0.05). Conclusions: These results are in line with vagal nerve protection in a fatal cancer, and propose that the mechanism may involve neuroimmunomodulation. Future studies must test whether vagal nerve activation (behaviorally or electrically) may help patients with advanced cancers. CORRESPONDING AUTHOR: Prof. Y.G. Gidron, Free University of Brussels (VUB), Belgium, [email protected]
O156 IDENTIFICATION OF DISTINCT TRAJECTORIES OF BENEFIT FINDING AND PSYCHOLOGICAL SYMPTOMS IN CANCER PATIENTS L. Zhu1, A.V. Ranchor2, M. Van der Lee3, B. Garssen3, R.E. Stewart4, V.S. Helgeson5, R. Sanderman2, M.J. Schroevers2 1 Dept. of Health Psychology, University Medical Center Groningen, Netherlands, GRONINGEN, Nederland 2 Department of Health Psychology, University Medical Center Groningen, GRONINGEN, Nederland 3 Helen Dowling Institute, Centre for Psycho-Oncology, BILTHOVEN, Nederland 4 Department of Public Health, University Medical Center Groningen, GRONINGEN, Nederland 5 Department of Psychology, Carnegie Mellon University, PITTSBURGH, United States of America Introduction: This study aims to (1) identify distinct trajectories of benefit finding among cancer patients receiving psychological care; (2) examine whether socio-demographic, medical, and psychological care characteristics could differentiate these trajectories; (3) examine the associations of trajectories of benefit finding with psychological symptoms. Method: Participants were 241 cancer patients who were receiving psychological care at seven psycho-oncology institutions in the Netherlands. Data were collected before the start of psychological care, and 3 months and 9 months thereafter. A Latent Class Growth Modelling was applied to examine research questions in Mplus 7.1. Results: Five trajectories of benefit finding were identified: “high”(8%), “moderate”(29%), “low-large improvement”(8%), “low-small improvement”(39%), “very low”(16%). Socio-demographic, medical, and psychological care characteristics could not distinguish those trajectories. Distinct benefit finding trajectories had differential courses of depressive symptoms but not anxiety symptoms. Conclusions: Around half of cancer patients were able to maintain a high level of benefit finding or experience improvements on benefit finding during psychological care. Yet, there were still half of patients who remained low on benefit finding. Those who are able to improve or maintain a high level of benefit finding are more likely to improve depressive symptoms. This study suggests that there might be a vulnerable group of cancer patients, who were having difficulties in searching benefits from cancer and improving their psychological symptoms. Special attention should be given to this group in future psychological care. CORRESPONDING AUTHOR: L. Zhu, Dept. of Health Psychology, University Medical Center Groningen, Netherlands Nederland [email protected]
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O157 POSTTRAUMATIC GROWTH AND BENEFIT-FINDING IN LUNG CANCER (LC) SURVIVORS: THE BENEFIT OF RURAL RESIDENCE? M. Andrykowski1, R. F. Steffens2 1 University of Kentucky, LEXINGTON, United States of America 2 Purdue University - North Central, WESTVILLE, United States of America Purpose: Prior research suggests cancer survivors residing in rural areas are at greater risk for experiencing distress compared to survivors residing in urban areas. Trauma theory suggests positive mental health outcomes (posttraumatic growth (PTG), benefit-finding (BF)) can follow traumatic or threatening events. No research, however, has examined whether rural residence is linked to reports of PTG and BF in cancer survivors. Methods: A population-based sample of 193 LC survivors (M=15 months post-diagnosis, range 11-22 months) was recruited using a statewide SEER cancer registry. Survivors completed a telephone interview and questionnaire packet consisting of measures of physical comorbidity and positive mental health outcomes (Posttraumatic Growth Inventory (PTGI), Benefit-Finding Questionnaire (BFQ)). Survivors were categorized into Rural (n-117) and Urban (n=76) groups based on county of residence using US Department of Agriculture Rural-Urban continuum codes. Results: Compared to Urban cancer survivors, Rural cancer survivors reported more growth on all 5 PTGI subscales with significant differences evident for the PTGI total score (p 0.70). Factor analysis replicated the theoretical structure of the ERI construct (Goodness-of-Fit Index > 0.90). In this sample Chinese adolescents, 10.86 % students reported suicidal ideation during the last 6 months, which was found to be significantly related to both effort and reward. Remarkably, effort-reward imbalance was associated with elevated risk of suicidal ideation (odds ratio = 1.77, 95 % confidence interval = 1.34-2.35). Conclusions: The Effort-Reward Imbalance Questionnaire - School Version is a valid instrument for identifying sources of stressful experience among Chinese adolescents, which is observed to be associated with suicidal ideation. Further studies with prospective design and in other cultural settings are called for. CORRESPONDING AUTHOR: J.L. Li, University of Düsseldorf, Germany, [email protected]
O253 ADOLESCENT SCHOOL ABSENTEEISM AND SERVICE USE IN A POPULATION-BASED STUDY K. Gärtner1, K. M. Stormark2, S. Haugland2, T. Bøe2, M. Hysing2 1 Norwegian Institute of Public Health, BERGEN, Norway 2 Centre for Child and Adolescent Mental Health and Welfare, West, Uni health, BERGEN, Norway Introduction.School absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. Therefore, it is important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use in adolescents with high absenteeism, both rate and type of contact in comparison to their peers. Methods. The study is based on data from a population-based study targeting all pupils in upper secondary education in Hordaland County, Norway (the [email protected]
study) in 2012. 10 220 adolescents between the ages of 16 and 18 participated in the study. Information on service use was based on adolescents’ self-report and data on absence came from an administrative registry provided by Hordaland County Council. Results. A total of 1819 participants (17.7%) had high absence (defined as being absent 15% or more). Compared to participants with no absence, those with high absence were more likely to be in contact with all services, such as specialist mental health care (OR 3.2), public health center for youth (OR 2.3) and their GP (OR 1.9). Further, contact with several services was significantly more common among adolescents with high absence and the contacts were more frequent. Conclusion. Adolescents with high absence had increased service use and were more frequently in contact with services. This finding suggests a potential for these services to address school absenteeism and play a role in preventing school dropout and associated adverse consequences. CORRESPONDING AUTHOR: K. Gärtner, Norwegian Institute of Public Health, Norway, [email protected]
O254 INJURY AND SOCIAL CORRELATES AMONG IN-SCHOOL ADOLESCENTS IN THE CARIBBEAN K.F. Peltzer, S. Pengpid Mahidol University, SALAYA, Thailand Introduction, The aim of this study was to determine estimates of the prevalence and social correlates of injury among adolescents in Caribbean countries. Methods, Cross-sectional national data from the Global School-based Health Survey (GSHS) included 11571 students primarily at the ages from 13 to 16 years from 7 Caribbean countries chosen by a two-stage cluster sample design to represent all students in grades 6-10 in each country. Results, The percentage of adolescents reporting one or more serious injuries within the past 12 months was 54.3% for all countries, ranging from 43.1% in Dominica to 59.5% in Jamaica. By major activity of all survey participants, “fall”(11.4%) was the leading external cause of injury, followed by fighting with someone (5.0%), “something fell on me or hit me”(4.9%), vehicle accident (4.3%), and attacked or assaulted or abused by someone (1.9%). The injury sustained by most students of all surveyed involved a cut, puncture, stab wound (9.5%), followed by broken bone/dislocated joint (7.8%), concussion/head injury (2.7%), burn injury (1.5%) and had a gunshot wound (1.4%). In multivariate regression analysis it was found that being male, having hunger (as an indicator for low socioeconomic status), substance use (smoking and alcohol use), psychological distress (anxiety or worried and suicide ideation) and truancy were found to be associated with annual injury prevalence rates. Conclusion, A high prevalence of injury was observed. Risk factors identified should be considered in an integrated approach to injury
etiology in planning injury prevention and safety promotion activities among school children. CORRESPONDING AUTHOR: K.F. Peltzer, Mahidol University, Thailand, [email protected]
O255 SWEDISH CHILDREN OF PRISONERS' MENTAL HEALTH AND QUALITY OF LIFE IN COMPARISON TO POPULATION NORMS A.H. Berman1, B. Liu1, M. Löfgren2, N. Koivumaa2, K. Engström1 1 Karolinska Institutet, STOCKHOLM, Sweden 2 Bryggan, STOCKHOLM, Sweden Introduction: Children are exposed to significant life stressors when a parent is sentenced to prison. This study investigated mental health and quality of life status for Swedish children of prisoners who participated in the FP7 EU COPING study, in comparison to recently established population norms. Method: Children of prisoners aged 7-17 (n=50) responded to a survey about having a parent in prison, including the Strengths and Difficulties Questionnaire (SDQ) and the KIDSCREEN-27. Parental assessments were available for children 14 and younger (n=36). Parents answered the WHOQOL-BREF regarding their own quality of life. Population norms were available from a random population sample of children 1116 years old (n=201) and their parents (n=202), who responded to the SDQ and KIDSCREEN-27 in self-report and parental versions. Sociodemographic variables were included. Results: Children of prisoners showed significantly worse mental health in comparison to the population sample, regarding hyperactivity, emotional symptoms, conduct problems, peer problems and Total difficulties (p”0.02). Quality of life was significantly lower regarding physical and psychological wellbeing, autonomy and parent relations, school environment and total raw score (p”0.05). Boys differed to a greater extent than girls from population respondents. Conclusions: Despite sampling limitations, Swedish children of prisoners generally can be said to have lower mental health and quality of life status than their randomly selected peers. Although Sweden is regarded as a country with extensive support resources for children with social deficits, these services do not appear to compensate for the negative effects of coping with a parent in prison. CORRESPONDING AUTHOR: Associate Prof. H. Berman, Karolinska Institutet, Sweden, [email protected]
O256 POPULATION-BASED PRECONCEPTION CARRIER SCREENING: ATTITUDES AND INTENTIONS OF POTENTIAL USERS M. Plantinga, A. Buitenhuis, E. Birnie, M.A. Verkerk, K. Abbott, I.M. Van Langen, A.V. Ranchor UMCG, GRONINGEN, Nederland Background The UMCG (Groningen, NL) has developed a next-generation sequencing (NGS) test for Preconception Carrier Screening (PCS). This is the first population-based PCS test to be offered to prospective couples in the Netherlands. It covers approximately 60 severe, autosomal recessive diseases simultaneously. So far, little is known about how potential users view a population-based PCS test covering several diseases simultaneously. Before the PCS test will be offered in a pilot trial, it is important to investigate potential users’ attitudes and intentions. This study aims to receive a better understanding of the intentions of potential users towards PCS, which factors influence this intention, and to what extent different ways of formulating information influence people’s intentions. Methods Data is collected by means of an online survey among 600 potential users (300 couples). Based on the Theory of Planned Behaviour (TPB) (Ajzen, 1991) we examined potential users’ intentions to undergo the test and the factors that influence their intentions. Included determinants are: attitudes towards the offer of PCS, towards having a sick child
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and towards terminating pregnancy; subjective norms; response efficacy; perceived barriers and perceived benefits. Information about PCS will be manipulated in a 2*2 design (positive/negative and factual/emotional). Results The data will be collected in three phases by recruitment company SSI in February. Each participant will receive a questionnaire, including the items specified above, before manipulation of information, after manipulation of information, and finally, after couples have had a discussion about the PCS test. The results will be available in April. CORRESPONDING AUTHOR: M. Plantinga, UMCG, Nederland, [email protected]
O257 ANTICIPATED PRESENTATION TO HEALTH PROFESSIONALS WITH OVARIAN CANCER SYMPTOMS IN GENETIC RISK VERSUS POPULATION SAMPLES S. Smits1, J. Boivin1, U. Menon2, K. Brain1 1 Cardiff University, CARDIFF, United Kingdom 2 UCL, LONDON, United Kingdom Background: In the absence of an ovarian cancer (OC) screening programme, symptom awareness is a potential route to earlier symptomatic presentation. However, materials to support this strategy may need to be tailored according to risk. The current study explored this using the Health Belief Model. Methods: Surveys were completed by 283 women at increased genetic risk of OC and 1,043 women drawn from the general population via the International Cancer Benchmarking Partnership. Questions covered symptom awareness, anticipated presentation, health beliefs and OC worry. Structural equation modelling (SEM) was used to identify determinants of anticipated presentation in the two risk groups. Results: SEM revealed a latent construct ‘perceived threat’ that determined perceived risk (r=.35***) and OC worry (r=.98***) in women at increased risk, but only perceived risk (r=.64*) in the general population sample. High perceived threat was associated with earlier anticipated presentation for those at increased risk (-.18**), but not in the general population (r=-.03). Endorsing more benefits than barriers to presentation was associated with earlier presentation in both increased risk (r=-.34***) and general population (r=.17***) samples. Discussion: The nature and mechanism of action of health beliefs differs according to disease risk. Perceived threat comprised both affective (worry) and cognitive (susceptibility) aspects in women at risk, but only cognitive aspects in the general population sample. In those at increased genetic risk, the affective component of risk perception predominated and may override cognitive aspects of help seeking behaviour. Information materials should be tailored to minimise worry and avoid inappropriate help seeking behaviour. CORRESPONDING AUTHOR: Miss E. Smits, Cardiff University, United Kingdom, [email protected]
O258 HOW DO HEALTH PROFESSIONALS COMMUNICATE RISK D U R I N G C A R D I O VA S C U L A R D I S E A S E S C R E E N I N G CONSULTATIONS? C. Keyworth1, P.A. dr Nelson1, C.A. prof. Chew-Graham2, K. Kane1, C.J. Pearce1, A. Chisholm1, C.E.M. Griffiths3, L. Cordingley4 1 Dermatology Research Centre, University of Manchester, MANCHESTER, United Kingdom 2 Research Institute, Primary Care and Health Sciences, Keele University, KEELE, United Kingdom 3 Dermatology Centre, Salford Royal NHS Foundation Trust and MAHSC, MANCHESTER, United Kingdom 4 Dermatology Research Centre, Health Psychology,University of Manchester, MANCHESTER, United Kingdom
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Introduction. Psoriasis is associated with risk factors for cardiovascular disease (CVD) which are linked to lifestyle factors. Knowledge about their own CVD risk is important for patients who may need to make lifestyle changes to reduce that risk. Communicating information about risk remains a challenge for health professionals and little is known about the specific methods used during CVD screening consultations. We examined current methods of risk communication used by primary care practitioners when undertaking CVD screening consultations. Methods. CVD risk screening consultations (n=44) between practitioners and patients with psoriasis across 10 primary care practices in NW England were audio-recorded and analysed using content analysis. A coding frame was designed to record specific techniques used to communicate CVD risk. Results. Practitioners favoured combining verbal descriptors with numerical expressions of risk communication (n=27), over verbal descriptors alone (n=15). No examples of numerical risk communication methods alone were found. Only two participants were given personalised risk calculations. Risk information was commonly presented solely as a blood pressure reading (n=17). Risk communication was rarely followed by discussions about lifestyle changes to reduce risk (n=25). Conclusions. There was little consistency in how CVD risk information was communicated to patients. Given the current literature suggests a conflict in preferred methods of risk communication between practitioners and patients, further research should examine the most optimal methods for communicating information about CVD risk to improve patients’ perception of risk. CORRESPONDING AUTHOR: Mr. C. Keyworth, Dermatology Research Centre, University of Manchester United Kingdom [email protected]
O259 PREDONATION COGNITIONS AND POSTDONATION HEALTHRELATED QUALITY-OF-LIFE OF LIVING KIDNEY DONORS: A PROSPECTIVE MULTICENTER STUDY G.A.A. Wirken1, H. van Middendorp1, C.W. Hooghof2, L.B. Hilbrands2, A.J. Hoitsma2, A.W.M. Evers1 1 Leiden University/Radboudumc, LEIDEN, Nederland 2 Radboudumc, Department of Nephrology, NIJMEGEN, Nederland Introduction: Living kidney transplantation is the preferred treatment for patients with end-stage renal disease, because of better long-term recipient and graft survival, shorter waiting list times, and better recipient quality of life than after postmortal kidney transplantation. The presurgery health-related quality of life of most donors is high, but a small percentage experiences physical or psychosocial problems after donation. Only limited research has examined predonation cognitions (motivation, expectancies, and worries) and health-related quality of life both before and after donation in living kidney donors. Method: Of an ongoing prospective multicenter study in seven Dutch transplantation centers, predonation cognitions were examined with a newly developed questionnaire, together with predonation and 6-month postdonation health-related quality of life in 127 donors. Results: Improved wellbeing of the recipient and idealistic incentives were the most reported motivations for living kidney donation. About 25% of donors reported moderate to severe worries about the wellbeing of the recipient, whereas most donors did not worry about the medical screening, surgery, or physical consequences of donation. At six months after donation, a minority experienced physical or psychosocial problems, such as pain, fatigue, concentration problems, or psychological distress. Conclusions: The wellbeing of the recipient is most prevalent both as motivation and source of worry for living kidney donors. For the subgroup of donors who experience problems in health-related quality of life six months after donation, it is important to determine predictors for their health-related quality of life after donation. CORRESPONDING AUTHOR: G.A.A. Wirken, Leiden University/ Radboudumc, Nederland, [email protected]
O260 IMPACT OF LUNG CANCER SCREENING IN A HIGH-RISK POPULATION: THE UK LUNG SCREENING (UKLS) TRIAL KE Brain1, K Lifford1, B Carter1, F McRonald2, G Yadegarfar2, D Baldwin3, D Weller4, DM Hansell5, SW Duffy6, JK Field2 1 Cardiff University, CARDIFF, United Kingdom 2 University of Liverpool, LIVERPOOL, United Kingdom 3 Nottingham University, NOTTINGHAM, United Kingdom 4 University of Edinburgh, EDINBURGH, United Kingdom 5 Imperial College, LONDON, United Kingdom 6 Queen Mary University, LONDON, United Kingdom Introduction: UKLS is a population-based pilot trial of low dose CT screening in individuals at high lung cancer risk. Identifying the impact of participation can help to inform a potential UK lung screening programme. Method: A random sample of individuals aged 50-75 years was contacted using a two-stage postal survey to assess their lung cancer risk. High risk participants completed psychosocial outcome measures including cancer distress, anxiety/depression and decision satisfaction, before and two weeks after randomisation (control arm) or initial CT screening result (intervention arm). Results: Of 247,354 individuals approached, 4060 high risk individuals were randomised to CT screening or usual care. Outcome analyses indicated adverse effects of trial allocation at short-term follow-up, with higher cancer distress scores in the intervention group (p≤.001) and higher depression scores in the control group (p≤.001), although scores remained within the normal range and the absolute differences were small. Follow-up questionnaire completers were more likely to be in the intervention arm, older, male, ex-smokers, more affluent, and to have lower baseline psychosocial scores (p≤.01 for each) compared to noncompleters. A greater proportion of control arm participants were not very satisfied with their decision to participate (66%) compared to intervention arm participants (58%) (p≤.001). Conclusions: Short-term negative consequences of lung screening were not clinically significant, but this may reflect the selected nature of the sample and potentially the impact of being identified as high risk. These findings will be interpreted in light of comparative data from nonparticipants regarding the barriers to UKLS uptake. CORRESPONDING AUTHOR: Dr. E. Brain, Cardiff University, United Kingdom, [email protected]
O261 THE RELATIONSHIP BETWEEN PARTICIPANT EVALUATIONS OF FAECAL OCCULT BLOOD TESTS (FOBT) AND REPARTICIPATION IN SCREENING A. Duncan1, D. Turnbull1, C. Wilson2, S.R. Cole2, J. Osborne2, I. Flight3, I. Zajac3, G.P. Young2 1 The University of Adelaide, ADELAIDE, Australia 2 Flinders Centre for Innovation in Cancer, Flinders University, BEDFORD PARK, Australia 3 Preventative Health Flagship, CSIRO, ADELAIDE, Australia Background: Adherence to regular faecal occult blood test (FOBT) screening reduces colorectal cancer (CRC) incidence and mortality. The majority of CRC research has focused on increasing initial screening uptake, however achieving high rates of ongoing participation is also necessary. Satisfaction following initial screening has been shown to predict re-participation for mammography, however the strength and duration of this effect for FOBT screening is unknown. The aim was to determine whether satisfaction with initial screening predicted reparticipation in next and subsequent rounds of CRC screening Method: Participants were 1,925 men and women, residing in South Australia and aged 50-74 years at recruitment, who were invited annually to participate in a free program of 3 rounds of FOBT screening. After each round, participants rated their overall satisfaction with the FOBT, and the extent that they agreed with several positive (e.g., worthwhile) and negative
(e.g., embarrassing) statements about the screening. Analyses explored the relationship between satisfaction after each screening round and reparticipation in subsequent rounds. Results: Those who gave higher negative ratings in round 1 were significantly more likely to refuse participation in round 2. Similarly, negative experiences in round 2 predicted refusal in round 3. Analyses of patterns of participation over three rounds showed that those who gave higher negative ratings in round 1 were also significantly more likely to refuse participation in round 3. Ratings of the positive aspects of FOBT screening did not significantly predict re-participation. Conclusions: A negative screening experience has both an immediate and ongoing influence on re-participation. CORRESPONDING AUTHOR: C. Duncan, The University of Adelaide, Australia, [email protected]
P262 ARE LONELINESS AND SOCIAL NETWORK SIZE ASSOCIATED WITH COGNITIVE FUNCTION IN DEPRESSED OLDER PERSONS? J.S. Kuiper1, N. Smidt1, R.C. Oude Voshaar1, S.U. Zuidema1, E.R. van den Heuvel1, H.C. Comijs2, M.L. Stek2, M. Zuidersma1, R.P. Stolk1 1 University Medical Center Groningen, GRONINGEN, Nederland 2 VU University Medical Center Amsterdam/GGZinGeest, AMSTERDAM, Nederland Introduction: Social network and loneliness are two well-established risk factors for cognitive impairments among healthy older persons. However, this association has rarely been investigated in a specific population of depressed older persons, even though depressive symptoms are associated with both social relations and cognitive function. The aim of this study is to investigate the association between social network size and loneliness in a well-identified sample of depressed older persons. Method: Data was used from the NESDO study; a case-control study, including 378 depressed older persons (60 - 90 years). Participants completed questionnaires on loneliness (de Jong Gierveld Loneliness Scale) and social network size (Close Person Inventory). Three tests of cognitive function were performed; a modified version of the Auditory Verbal Learning Test, the Stroop Colour-word test, and the subtest Digit Span from the Wechsler Adult Intelligence Scale (WAIS). Scores were summarized in four cognitive domains; memory, executive function, working memory, and processing speed. Analyses were performed adjusting for age, gender, education, alcohol use, physical activity, and severity of depressive symptoms. Results: Neither social networks size nor loneliness were significantly associated with cognitive function among this specifically identified sample of depressed older persons. Results ranged from B=0.000 to B=0.035 for loneliness and from B=-0.050 to B=0.302 for social network size (all not significant). Conclusions: Although many studies suggest that a small social network and loneliness are associated with cognitive impairment in older persons, we could not confirm this in a sample of depressed older persons. CORRESPONDING AUTHOR: J.S. Kuiper, University Medical Center Groningen, Nederland [email protected]
P263 AGE-RELATED DIFFERENCES IN THE CONTROL OF WEIGHTSHIFTING WITHIN THE SURFACE OF SUPPORT E A De Vries, S.R. Caljouw, M.J.M. Coppens, K. Postema, G.J. Verkerke, C.J.C. Lamoth University Medical Center Groningen, University of Groningen, GRONINGEN, Nederland Introduction: An important reason for falling in elderly is incorrect weight-shifting. In many daily life activities quick and accurate weightshifting is needed to maintain balance and to prevent from falling. The
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present study aims to gain more insight in age-related differences in the control of weight-shifting. Methods: Nine healthy older adults (70.3±6.9 years) and twelve young adults (20.9±0.5 years) participated in the study. They performed a weight-shifting task by moving the body’s center of pressure, represented by a red dot on a screen, in different directions, towards targets of different sizes and at different distances projected on a screen. Movement time (MT), fluency (counts on goal target and dwelling time around goal target (CoG, DT)) and accuracy (maximal deviation (MD) and number of peaks (nP) in the performed path) of the movement were determined. Results: Significant main effects of target size, target distance and age on all outcome measures were found. With decreasing target size, increasing target distance and increasing age, MT significantly increased and fluency and accuracy significantly decreased (nP, MD, CoG, DT increased). In addition, significant interaction effects of size*age and distance*age were found. Conclusion: Older adults needed more time to perform the weight-shifting task and their movements were less fluent and accurate compared to younger adults, especially with increasing task difficulty. This indicates that elderly might have difficulties with executing an adequate adaptation to a perturbation in daily life. CORRESPONDING AUTHOR: E.A. De Vries, University Medical Center Groningen, University of Groningen Nederland [email protected]
P264 SOCIAL FACTORS AND COGNITIVE DECLINE AND DEMENTIA: A SYSTEMATIC REVIEW J.S. Kuiper, M. Zuidersma, R.C Oude Voshaar., S.U. Zuidema, R.P. Stolk, N. Smidt University Medical Center Groningen, GRONINGEN, Nederland Introduction: A wide variety of social factors are shown to be associated with cognitive decline and dementia, but it remains unclear to what extent social factors play a causal role in cognitive decline and dementia. In this systematic review we will determine to what extent social factors influence cognitive decline and dementia. Method: Data sources were MEDLINE, EMBASE and PsycINFO. Eligible studies consisted of longitudinal, observational studies investigating cognitive function (i.e. Neuropsychological tests or dementia diagnosis by specialist) over time (minimum 6 weeks follow-up) in healthy adults and measured the relation between social factors and cognitive function at follow-up. Two reviewers independently performed the quality assessment using an adjusted version of QUIPS (6 items) and data-extraction of all included studies. Results: The search identified8527 unique records. Finally 46 studies were included in the review of which 30 studies focusing on cognitive decline (total sample size=58517/62.1% women/mean age at baseline=72.2 years) and 14 studies on dementia (total sample size=22099/59.3% women/mean age at baseline=76.2 years). Two studies focused on both outcomes (total sample size=3259/mean age at baseline=79.9 years). The methodological quality of the included studies showed that most studies were hampered by differences between participants who completes the study and those who dropped out, and by the appropriate adjustment for certain covariates in the analyses. At conference, the results will be presented. Conclusions: Our findings will provide implications to whether it will be worthwhile to involve social factors in interventions on cognitive decline and in the evaluation, screening and treatment of dementia. CORRESPONDING AUTHOR: J.S. Kuiper, University Medical Center Groningen, Nederland, [email protected]
P265 HOW TO REACH OLDER ADULTS FOR THE GRIP&GLEAM INTERVENTIONS AIMED AT IMPROVING WELL-BEING AND LONELINESS M.M. Goedendorp, R. Sanderman, N. Steverink University Medical Center Groningen, University of Groningen, GRONINGEN, Nederland
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Introduction: The GRIP&GLEAM [Dutch: GRIP&GLANS] interventions are offered in various forms to moderately frail older adults. The target group consists of older adults who are vulnerable at psychosocial domains such as depressive mood and loneliness. However, it is difficult to reach the target group. We explored which factors influence the intention to participate in the G&G group-intervention for older women. Method: Older women were approached in malls of eight cities with short leaflets about the intervention. Of the 301 approached women 204 completed the questionnaire and interview. Based on the social marketing theory and the theory of planned behavior various factors were assessed to investigate factors associated with intention. Results: Of the women 28% indicated that they had the intention to participated. Regression analyses showed that a lower life satisfaction, a smaller social network, positive attitude, higher perceived control, and acceptable costs of the intervention, were factors associated with intention. Conclusions: Part of the target group can be reached. Women with lower life satisfaction and smaller social network seem to identify with information on the leaflet. The main message was that the intervention is for women who would like to add more ‘gleam’ to their lives. The additional information focused on coping with deterioration of health and losing a dear one. Framing the information to a more positive message might attract a different segment of the target group., e.g. women with higher life satisfaction who want to take preventive actions to avoid isolation. This will be investigated in follow-up research. CORRESPONDING AUTHOR: Dr. M.M. Goedendorp, University Medical Center Groningen, University of Groningen Nederland [email protected]
P266 PACE AND PREDICTORS OF INITIAL IMPLEMENTATION OF THE G&G GROUP INTERVENTION FOR OLDER ADULTS D. Kuiper, M.M. Goedendorp, R. Sanderman, S.A. Reijneveld, N. Steverink University Medical Center Groningen, GRONINGEN, Nederland Introduction.The GRIP&GLEAM (G&G) interventions are evidencebased in improving self-management ability and well-being in older adults. Implementation of new EBPs is challenging. Arrays of factors operate on different stakeholder levels and evidence which factors are important at what phase is scarce. The aim of this study is (1) to assess how many professionals attain initial implementation and at what pace (2) to identify predictors of initial implementation in context. Method.The study is performed in routine health and social care. Theoretically informed, factors at two hierarchical levels (i.e. professionals nested in organizations) are assessed. Pace of initial implementation is described as the mean time in months and its natural variation. Predictors of initial implementation are determined by applying single- and multilevel techniques with first use (yes/no) at the professional level as the dependent variable. Results.Two third of the professionals attain initial implementation. Their mean pace is 7.5 months (SD 4.2). Six percent are early implementers (within 3 months) and 8% are laggards (longer than a year). Predictors at the professional level are ‘ownership’, ‘relative advantage’, ‘support’ and ‘compatibility’. Predictors at the organizational level are ‘size’ and ‘innovation-task orientation fit’. When analyzed in context ‘compatibility’ is shown to be the only significant predictor. Conclusion. Initial implementation of the G&G group intervention was relatively successful and done at an average pace. Compatibility at the professional level (i.e. being able to combine implementation efforts with other designated tasks) is an important predictor of initial implementation, regardless of characteristics of the organization. CORRESPONDING AUTHOR: Msc D. Kuiper, University Medical Center Groningen, Nederland, [email protected]
P267 SHARED DECISION MAKING IN LONG-TERM ELDERLY CARE K. Kuipers1, C.H.C. Drossaert2, A. Dijkstra1 1 NHL Hogeschool, LEEUWARDEN, Nederland 2 University of Twente, ENSCHEDE, Nederland Background: Although Shared Decision Making (SDM) is increasingly being advocated in medical practice, little is known about client involvement in decision making in long-term care. The aim of the present study was to explore decision making and client involvement in decisions about care and daily life in so called “care plan meeting”in long-term care settings. Methods: Care plan meetings (n=27) were audio-taped and transcribed verbatim. Decision moments were selected and coded for subject of decision (open coding), category (care, treatment, living conditions and well being) and the level of SDM (using the Observer-OPTION-5-item scale) by two independent coders. In addition, a Delphi-study with focus groups of clients, their family members and care professionals was conducted to explore which factors facilitate or hinder client involvement. Results: Care plan meetings contained a mean number of 2.9 decision moments (SD 1,8) with a range from 0 till 8 decision moments per care plan meeting. In total, 77 decision moments were selected and further analyzed. Most decision moments were about care delivery (37%), followed by well-being (30%), treatment (21%) and living conditions (11%). According to the Observer-OPTION-5-scores, SDM was not common. The focus groups are currently being conducted. Preliminary results suggest that care professionals mention other barriers to SDM than clients and their family. Conclusions: Decision moments do take place in care plan meetings, but the level of SDM is low. Limitations in care budgets make SDM in elderly care even more important. Interventions to increase SDM in long-term care should be implemented. CORRESPONDING AUTHOR: drs. K. Kuipers, NHL Hogeschool, Nederland, [email protected]
P268 IS THERE A LINK BETWEEN EDUCATION, RISK PERCEPTION, HEALTH OUTCOMES IN DIABETES IN THE ELDERLY? M.P. Padua, J.S. Santos, H.H. Horta Instituto Superior Técnico, LISBON, Portugal Background.The association between education, risk perception and health outcomes in secondary/ tertiary intervention is well-documented but under-analyzed in primary prevention context, particularly for the elderly. Objective. To examine among the elderly with low literacy, one of the groups more at risk of developing diabetes, whether there is a link between education, risk perception, preventive behavior, health outcomes. Methods. A cross-sectional study was carried in vulnerable urban areas of Lisbon, Portugal. Interviews with 356 subjects were conducted to assess their perceptions on risk and knowledge on diabetes. The risk of having this diseaseand habits with regard to modifiable risk factors were assessed based on Finish diabetes risk score. The age of the sample was M=62, 25; SD=15, 64. 16% of the subjects were illiterate, 73% had a basic education and 10.7% had a secondary education. Results. The risk of developing diabetes was found to correlate significantly and negatively with education (p .05. Conclusion: Asexuality appeared to be a multidimensional construct related to sexual cognition, romantic attraction, and sexual desire. Statistical analyses determined that the developed asexuality measure had high internal consistency and acceptable specificity and sensitivity. Results suggest that sexual aversion is not related to the construct of asexuality and that participants who experience more sexual desire are less likely to be asexual. CORRESPONDING AUTHOR: N.K.R. Robbins, Yale University, United States of America, [email protected]
P335 MEASURING HEALTH OUTCOMES WITH VALID WHO-ICF CONTENT IN DIVERSE POPULATIONS ILLUSTRATION OF METHODS WITH SF-36 M. Johnston1, B. Pollard1, D. Dixon2 1 University of Aberdeen, ABERDEEN, United Kingdom 2 Strathclyde University, GLASGOW, United Kingdom Introduction. Health outcome measures vary in content and may not be equally valid for all populations. The WHO-ICF provides a theoretical framework for classifying content as Impairment (I), Activity Limitations (AL) and/or Participation Restrictions (PR). Recent developments in the quantitative assessment of Discriminant Content Validity (DCV) and Differential Item Functioning (DIF) allow assessment of content of existing measures against the ICF and identification of items invalid for specific populations. This paper illustrates the application of DCV and DIF to the SF-36.
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Method. DCV: 10 judges rated each SF-36 item to indicate confidence that the item measured only I, AL or PR or a mixture. Single sample ttests assessed which construct(s) each item measured. DIF: Data from 763 community residents with osteoarthritis were analysed using regression DIF methods to examine whether items loaded equally on full scores for groups differing on age, gender and social deprivation. Results. DCV showed that 16 items were significantly pure I, 7 pure AL and 2 PR; others were mixed. DIF was found for 6 items for age, 2 for gender and 1 for social deprivation (adjusting for age). Conclusions. It is important that health outcome measures are valid for the constructs being measured and for the population assessed. DCV and DIF methods are valuable in assessing the validity of measures. The results suggest that the SF-36 a) cannot be used to measure ICF constructs without selection of valid items, and b) has items which may bias results for some populations. CORRESPONDING AUTHOR: Professor M. Johnston, University of Aberdeen, United Kingdom, [email protected]
P336 ILLNESS AMONG SCHOOL-CHILDREN: COMPARISON OF SMS DATA FROM PARENTS AND QUESTINAIRE DATA FROM CHILDREN A.M. Denbaek, A. Johansen, C.T. Bonnesen, A. Andersen, B.E. Holstein, B. Laursen, P. Due National Institute of Public Health, University of Southern Denmark, COPENHAGEN K, Denmark Introduction We collected data about illness among 6-15-year olds by means of SMS communication with parents and questionnaires answered by the children. The aim was to examine 1) participation and adherence in a 22-week SMS-study, 2) potential selection bias due to low parental participation, and 3) differences in illness reported by children and parents. Methods We invited parents to a 22-week SMS-study through their child’s school. Each Sunday, parents received a text message asking how many days the child had been home due to illness past week. The children answered a questionnaire about socio-demographic background, health and absence from school due to illness past week. We used questionnaire data to examine what characterized children whose parent signed up for the SMS-study. Results 3015 parents (35.7%) signed up for the SMS-study of which 90% participated at least 18 weeks. The participation rate among the children was 89.2%, n=7525. Children in 5th-8th grade whose parents signed up for the SMS-study were more likely to live with both parents (p=0,0108), be ethnic Danish (p9 points) feedback and treatment recommendations are given to the cardiologist in charge. Half of the patients are randomized into the intervention group and receive feedback, patient tailored information on depression and contact addresses. Primary endpoint is level of depression after one and six months. As secondary endpoint number of treated patients, quality-adjusted years of life, direct and indirect health costs are assessed. Results. The rational, implementation, and a detailed sample description will be presented. To date, 2279 cardiac patients were screened. In total, 17.8% (n=403) patients had a suspected depression. Of these, 40.2% (n=162) were randomized into the intervention group and received a direct patient tailored feedback. Primary endpoint and secondary endpoints are currently assessed and will be evaluated. Conclusion. Design and procedure as well as research implications and limitations of Depscreen-INFO will be discussed. To our knowledge, Depscreen-INFO is the first RCT that will answer the pending question whether depression screening in cardiac settings is clinically efficient and cost-effective. So far, the successful recruitment already shows that depression screening is feasible in cardiac outpatient clinics.
CORRESPONDING AUTHOR: Dr. S. Kohlmann, University Medical Center Hamburg, Eppendorf, [email protected]
P589 IMPROVING PATIENT SAFETY VIA A PERSUASIVE REGISTRATION AND MONITORING SYSTEM FOR INFECTIONS IN NURSING HOMES N. de Jong1, A. Eikelenboom-Boskamp2, A. Voss2, J.E.W.C. Van Gemert-Pijnen1 1 University of Twente, ENSCHEDE, Nederland 2 Canisius Wilhelmina Hospital & Radboud University Medical Centre, NIJMEGEN, Nederland BACKGROUND Patient safety is increasingly threatened by healthcareassociated infections. Insight into the occurrence of (risk factors for) these infections is necessary for early detection and treatment. Therefore, the regional network iPrevent started to register which (risk factors for) infections occur and what antibiotics are used, via an online questionnaire. However, the questionnaire seemed prone to interpretation errors and not very user friendly. Therefore, via user-centered design a persuasive registration system was developed. METHODS For successful monitoring, it is important that the registration system fits existing work processes and needs of end-users (elderly care physicians). Therefore, we closely cooperated with end-users during development, combining multiple methods (literature search, expert discussion, questionnaire, interviews and scenario-based user-tests). Furthermore, we included elements of Persuasive Systems Design (PSD) in the system. RESULTS User-centered design allowed us to find opportunities for improvement. PSD enabled us to deal with them. Questions were simplified; Routing was added to omit redundant questions; Shown information was tailored to the individual user; Reminders/alerts (to add missing information) were added. Thus, the new registration system uses elements of Primary Task Support, Dialogue Support and System Credibility Support. The system was used during two prevalence measurements, registering a total of about 3.000 nursing home residents, living in 37 nursing homes. After some teething troubles, overall user experiences are positive. Currently, we are planning to do a summative evaluation to quantify these initial responses. Therefore, together with University of Oulu, we also started a questionnaire validation study, to validate the Perceived Persuasiveness Questionnaire. CORRESPONDING AUTHOR: MSc N. de Jong, University of Twente, Nederland, [email protected]
P590 PREVALENCE RATE AND POSITIVE PREDICTIVE VALUE ON SEMI-HEALTH SYMPTOMS AMONG YOUNG ADULTS H.Y. Yamazaki1, S.S. Sakabe2, J.G.Z. Zhang3, X.Q. Xiao4 1 Tokoha University, HAMAMATSU, Japan 2 Soka University, TOKYO, Japan 3 Nanjing Normal University, NANJING, China 4 Ken-yu, TOKYO, Japan Introduction: The purpose of the present study was to identify a cutoff point on the semi-health index, which evaluated a level of condition in the susceptibility phase based on the natural history of disease, and to clarify prevalence rate and positive predictive value of semi-health symptoms among young adults in Japan. Chronic diseases, such as metabolic syndrome and circulatory diseases, are called life-style related diseases in Japan. They are not only serious causes of death but also risk factors of broken health. They have been steadily increasing. Method: The self-report questionnaire, which consisted of 53 items, was administered to 2,074 young adults in Japan between 2011 and 2012.
Results: Then a principal components analysis was applied to the valid data in order to extract indices which evaluated structural characteristics on semi-health conditions. By this analysis, four principal components were extracted. Especially, the first principal component was extracted as an index which indicated a quantitative aspect of the semi-health condition. Every eigenvector of its component had a mark of plus. Therefore, this component was used as the semi-health index. Furthermore, a distribution of young adults with semi-health symptoms was determined by using this index. Then a cutoff point was calculated from the value of the index in order to determine predictive values of discriminating the semihealth from good health conditions. Conclusions: Finally, the prevalence rate (13.1%) and positive predictive value (46.0%) on the semi-health condition were derived form the distribution based on the semi-health criterion. CORRESPONDING AUTHOR: Prof. HY Yamazaki, Tokoha University, Japan, [email protected]
P591 EXPLORING ATTITUDES TO HPV SELF-SAMPLING: THE ROLE OF SELF-EFFICACY D. Williams1, A. Fiander1, M. Davies2, D. Farewell1, K. Brain1 1 Cardiff Univerisity, CARDIFF, United Kingdom 2 Bangor University, BANGOR, United Kingdom Background: Cervical screening coverage is below the target of 80% across the UK. Testing for Human Papillomavirus (HPV) is being incorporated into the cervical screening programme, with the possible future introduction of HPV self-sampling. Women’s attitudes and intentions towards HPV self-sampling were examined using an extended Health Belief Model (HBM). It was expected that women with higher selfefficacy would have a higher intention to self-sample. Methods: Women were recruited opportunistically through Cervical Screening Wales, sexual health clinics and community groups. A crosssectional survey operationalising HBM constructs (perceived benefits, barriers, severity, susceptibility and self-efficacy) in relation to HPV selfsampling was used to identify determinants of HPV self-sampling intentions. Results: A total 194 out of 291 (67%) women aged 20-64yrs were recruited, of whom 69% (n=133) reported that they would be likely to self-sample. Women with higher self-sampling intentions reported significantly higher self-efficacy (p.05) for psychological distress and .093 (p