Focusing on fidelity: narrative review and recommendations for improving intervention fidelity within trials of health behaviour change interventions.

Background: Interventions to change behaviour have substantial potential to impact positively on individual and overall public health. Despite an increasing focus on health behaviour change intervention research, interventions do not always have the desired effect on outcomes, while others have diluted effects once implemented into real-life settings. There is little investment into understanding how or why such interventions work or do not work. Methodological inadequacies of trials of behavioural interventions have been previously suggested as a barrier to the quality and advancement of behavioural research, with intervention fidelity acknowledged as a key area for improvement. However, there is much ambiguity regarding the terminology and conceptualisation of intervention fidelity and a lack of practical guidance regarding how to address it sufficiently, particularly within trials of complex behavioural interventions. Objectives: This article outlines specific issues concerning intervention fidelity within trials of health behaviour change interventions and suggests practical considerations and specific recommendations for researchers, with examples from the literature presented. Conclusions: Recommendations pertain to (1) clarifying how fidelity is defined and conceptualised, (2) considering fidelity beyond intervention delivery, (3) considering strategies to both enhance and assess fidelity, (4) making use of existing frameworks and guidance, (5) considering the quality and comprehensiveness of fidelity assessment strategies, (6) considering the balance between fidelity and adaptation and (7) reporting the use of fidelity enhancement and assessment strategies and their results. Suggestions for future research to improve our understanding of, and ability to, address fidelity in behaviour change interventions are also provided.

Healthy learning mind - Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial.

BACKGROUND: Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. METHODS: Finnish school children and adolescents (N = 3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). RESULTS: Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (ß=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (ß=-0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (ß=-1.37, SE 0.69, p = 0.049) and at T26 (ß=-1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. LIMITATIONS: The inactive control group was smaller than the intervention and active control groups, reducing statistical power. CONCLUSIONS: A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.

A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents.

Lack of physical activity (PA) and high levels of sedentary behaviour (SB) have been associated with health problems. This systematic review evaluates the effectiveness of school-based interventions to increase PA and decrease SB among 15-19-year-old adolescents, and examines whether intervention characteristics (intervention length, delivery mode and intervention provider) and intervention content (i.e. behaviour change techniques, BCTs) are related to intervention effectiveness. A systematic search of randomised or cluster randomised controlled trials with outcome measures of PA and/or SB rendered 10 results. Risk of bias was assessed using the Cochrane risk of bias tool. Intervention content was coded using Behaviour Change Technique Taxonomy v1. Seven out of 10 studies reported significant increases in PA. Effects were generally small and short-term (Cohen's d ranged from 0.132 to 0.659). Two out of four studies that measured SB reported significant reductions in SB. Interventions that increased PA included a higher number of BCTs, specific BCTs (e.g., goal setting, action planning and self-monitoring), and were delivered by research staff. Intervention length and mode of delivery were unrelated to effectiveness. More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents.

What is setting the stage for abdominal obesity reduction? A comparison between personality and health-related social cognitions.

The present longitudinal study examines whether changes in waist circumference are best predicted by relatively stable and broad personality traits (dispositional optimism and pessimism), by modifiable and domain-specific social cognitions (health-related self-efficacy), or a combination of these. Altogether 385 participants (74% women; 50-65 years) attended the GOAL Implementation Trial, a lifestyle counseling intervention to improve diet and physical activity. Measurements were conducted prior to the intervention (Time 1), and 3 months (Time 2) and 12 months (Time 3) after Time 1. Three different models of the potential interplay between dispositional optimism and pessimism and health-related self-efficacy were tested. The analyses showed that the change in health-related self-efficacy during the intervention (Time 1-Time 2) was negatively related with waist circumference change between Time 1 and Time 3, indicating that increases in self-efficacy during the intervention resulted in reduction in waist circumference over 12 months. However, optimism and pessimism were unrelated to waist circumference change either directly or indirectly through changes in self-efficacy. Interventions enhancing participants' positive health-related expectancies such as self-efficacy are likely to be effective even when participants' dispositional expectancies are pessimistic.