Communicating cardiovascular risk: Systematic review of qualitative evidence.

INTRODUCTION: Cardiovascular risk prediction models are widely used to help individuals understand risk and make decisions. METHODS: Systematic review of qualitative evidence. We searched MEDLINE, Embase, PsycINFO and CINAHL. We included English-language qualitative studies on the communication of cardiovascular risk. We assessed study quality using Hawker et al.'s tool and synthesised data thematically. RESULTS: Thirty-seven studies were included. Many patients think that risk scores are of limited practical value. Other sources of information feed into informal estimates of risk, which may lead patients to reject the results of clinical risk assessment when the two conflict. Clinicians identify a number of barriers to risk communication, including patients' limited understanding of risk and excessive anxiety. They use a range of strategies for adapting risk communication. Both clinicians and individuals express specific preferences for risk communication formats. DISCUSSION: Ways of communicating risk that provide some comparison or reference point seem more promising. The broader context of communication around risk may be more important than the risk scoring instrument. Risk communication interventions, in practice, may be more about appeals to emotion than a rationalistic model of decision-making.

Nigerian and Ghanaian Young People's Experiences of Care for Common Mental Disorders in Inner London: Protocol for a Multimethod Investigation.

BACKGROUND: The Care Quality Commission published a review in 2018 in England titled "Are We Listening," which revealed that child and adolescent mental health services are not responsive to the specific needs of young Black people and other ethnic minorities even in areas with ethnically diverse populations. It found that commissioners and service planners failed to engage with these young people and their families to understand their needs and expectations. OBJECTIVE: The purpose of this study is to engage Nigerian and Ghanaian young people (NAGYP) with experiences of care for common mental disorders (CMDs) in London, to increase understanding of their needs, and to give voice to their views and preferences. Their parents', caregivers', and practitioners' views will also be sought for service improvement. METHODS: Three combined contemporary complementary methodologies-thematic analysis, interpretative phenomenological analysis (IPA), and intersectionality-based policy analysis (IBPA)-will be used across 3 comprehensive phases. First, a scoping review where relevant themes will be critically analyzed will inform further phases of this study. Detailed mapping of community and mental health care services in 13 inner London boroughs to investigate what professionals actually do rather than what they say they do. Second, IBPA will be used to scrutinize improving access to psychological therapies and other legislations and policies relevant to NAGYP to undertake an intersectional multileveled analysis of power, models, and constraints. Third, IPA will "give voice" and "make sense" of NAGYP lived experiences of CMDs via a representative sample of NAGYP participants' (n=30) aged 16-25 years, parents or caregivers' (n=20), and practitioners' (n=20) perspectives will be captured. RESULTS: The study has been approved by the UCL Institute of Education Research Ethics Committee (Z6364106/2022/02/28; health research) and University College London (Z6364106/2022/10/24; social research). Recruitment has begun in 13 inner boroughs of London. Data collection through observation, semistructured interviews, and focus groups are expected to be finalized by early 2024, and the study will be published by early 2025. CONCLUSIONS: Combining multiple qualitative methodologies and methods will enable rigorous investigation into NAGYP's lived experiences of care received for CMDs in London. Findings from this study should enable a reduction in the negative connotations and harmful superstitions associated with mental health-related issues in this group, inform evidence-based interventions, and facilitate preventive or early access to interventions. There may also be an indirect impact on problems resulting from mental illness such as school dropout, antisocial behaviors, knife crimes, juvenile detention centers, and even death. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/42575.

Oral anticoagulants: a systematic overview of reviews on efficacy and safety, genotyping, self-monitoring, and stakeholder experiences.

BACKGROUND: This systematic overview was commissioned by England's Department of Health and Social Care (DHSC) to assess the evidence on direct (previously 'novel') oral anticoagulants (OACs), compared with usual care, in adults, to prevent stroke related to atrial fibrillation (AF), and to prevent and treat venous thromboembolism (VTE). Specifically, to assess efficacy and safety, genotyping, self-monitoring, and patient and clinician experiences of OACs. METHODS: We searched MEDLINE, Embase, ASSIA, and CINAHL, in October, 2017, updated in November 2021. We included systematic reviews, published from 2014, in English, assessing OACs, in adults. We rated review quality using AMSTAR2 or the JBI checklist. Two reviewers extracted and synthesised the main findings from the included reviews. RESULTS: We included 49 systematic reviews; one evaluated efficacy, safety, and cost-effectiveness, 17 assessed genotyping, 23 self-monitoring or adherence, and 15 experiences (seven assessed two topics). Generally, the direct OACs, particularly apixaban (5 mg twice daily), were more effective and safer than warfarin in preventing AF-related stroke. For VTE, there was little evidence of differences in efficacy between direct OACs and low-molecular-weight heparin (prevention), warfarin (treatment), and warfarin or aspirin (secondary prevention). The evidence suggested that some direct OACs may reduce the risk of bleeding, compared with warfarin. One review of genotype-guided warfarin dosing assessed AF patients; no significant differences in stroke prevention were reported. Education about OACs, in patients with AF, could improve adherence. Pharmacist management of coagulation may be better than primary care management. Patients were more adherent to direct OACs than warfarin. Drug efficacy was highly valued by patients and most clinicians, followed by safety. No other factors consistently affected patients' choice of anticoagulant and adherence to treatment. Patients were more satisfied with direct OACs than warfarin. CONCLUSIONS: For stroke prevention in AF, direct OACs seem to be more effective and safer than usual care, and apixaban (5 mg twice daily) had the best profile. For VTE, there was no strong evidence that direct OACs were better than usual care. Education and pharmacist management could improve coagulation control. Both clinicians and patients rated efficacy and safety as the most important factors in managing AF and VTE. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017084263-one deviation; efficacy and safety were from one review.

Applying machine classifiers to update searches: Analysis from two case studies.

Manual screening of citation records could be reduced by using machine classifiers to remove records of very low relevance. This seems particularly feasible for update searches, where a machine classifier can be trained from past screening decisions. However, feasibility is unclear for broad topics. We evaluate the performance and implementation of machine classifiers for update searches of public health research using two case studies. The first study evaluates the impact of using different sets of training data on classifier performance, comparing recall and screening reduction with a manual screening 'gold standard'. The second study uses screening decisions from a review to train a classifier that is applied to rank the update search results. A stopping threshold was applied in the absence of a gold standard. Time spent screening titles and abstracts of different relevancy-ranked records was measured. Results: Study one: Classifier performance varies according to the training data used; all custom-built classifiers had a recall above 93% at the same threshold, achieving screening reductions between 41% and 74%. Study two: applying a classifier provided a solution for tackling a large volume of search results from the update search, and screening volume was reduced by 61%. A tentative estimate indicates over 25 h screening time was saved. In conclusion, custom-built machine classifiers are feasible for reducing screening workload from update searches across a range of public health interventions, with some limitation on recall. Key considerations include selecting a training dataset, agreeing stopping thresholds and processes to ensure smooth workflows.

A scoping review of ontologies related to human behaviour change.

Ontologies are classification systems specifying entities, definitions and inter-relationships for a given domain, with the potential to advance knowledge about human behaviour change. A scoping review was conducted to: (1) identify what ontologies exist related to human behaviour change, (2) describe the methods used to develop these ontologies and (3) assess the quality of identified ontologies. Using a systematic search, 2,303 papers were identified. Fifteen ontologies met the eligibility criteria for inclusion, developed in areas such as cognition, mental disease and emotions. Methods used for developing the ontologies were expert consultation, data-driven techniques and reuse of terms from existing taxonomies, terminologies and ontologies. Best practices used in ontology development and maintenance were documented. The review did not identify any ontologies representing the breadth and detail of human behaviour change. This suggests that advancing behavioural science would benefit from the development of a behaviour change intervention ontology.

Intervention Component Analysis (ICA): a pragmatic approach for identifying the critical features of complex interventions.

BACKGROUND: In order to enable replication of effective complex interventions, systematic reviews need to provide evidence about their critical features and clear procedural details for their implementation. Currently, few systematic reviews provide sufficient guidance of this sort. METHODS: Through a worked example, this paper reports on a methodological approach, Intervention Component Analysis (ICA), specifically developed to bridge the gap between evidence of effectiveness and practical implementation of interventions. By (a) using an inductive approach to explore the nature of intervention features and (b) making use of trialists' informally reported experience-based evidence, the approach is designed to overcome the deficiencies of poor reporting which often hinders knowledge translation work whilst also avoiding the need to invest significant amounts of time and resources in following up details with authors. RESULTS: A key strength of the approach is its ability to reveal hidden or overlooked intervention features and barriers and facilitators only identified in practical application of interventions. It is thus especially useful where hypothesised mechanisms in an existing programme theory have failed. A further benefit of the approach is its ability to identify potentially new configurations of components that have not yet been evaluated. CONCLUSIONS: ICA is a formal and rigorous yet relatively streamlined approach to identify key intervention content and implementation processes. ICA addresses a critical need for knowledge translation around complex interventions to support policy decisions and evidence implementation.

Preparing undergraduate nurses to provide smoking cessation advice and help.

Nurses in New Zealand are expected to provide the Ministry of Health recommended ABC approach to smoking cessation interventions; but not all nurses receive adequate preparation. A national online survey was conducted to investigate the extent that smoking cessation education content is included in undergraduate nursing curricula in New Zealand's 17 Schools of Nursing. Fourteen schools responded. Of these 12 provide some form of smoking cessation education: five teach the recommended ABC approach and seven teach approaches not recommended by the Ministry of Health. Nine schools include education about nicotine replacement therapy (NRT). In seven schools smoking cessation education was found to be fragmented across the curriculum. In the majority of nursing programmes preparation of undergraduate nurses to provide smoking cessation advice and help is insufficient. It is recommended schools audit and update their curricula to include coordinated undergraduate smoking cessation education congruent with current national guidelines.