Where exactly do the social and behavioural sciences fit in One Health?

At its core, One Health promotes multidisciplinary cooperation amongst researchers and practitioners to improve the effectiveness and management of complex problems raised by the interplay of human, animal and environment interactions. Contemporary One Health literature has identified reducing disciplinary barriers as key to progress in the field, along with addressing the notable absence of social sciences from One Health frameworks, among other priorities. Efforts to position social scientists as experts on behaviour change and health decision-making has helped to articulate a concrete role for progressing One Health collaborations. Yet, there are other equally valuable functions the social scientist has in understanding complex systems, like One Health. We make explicit the multiple and diverse knowledge contributions the social sciences and humanities can make to progressing the One Health agenda. Articulating these more clearly invites a broader set of interdisciplinary perspectives to One Health discussions, allowing for stronger connections between sectors, actors, disciplines, and sub-systems. This perspective piece identifies a range of entry points for researchers and practitioners to better utilize the potential contributions social sciences and humanities scholars can make to One Health goals.

Unpacking nudge sensu lato: insights from a scoping review.

Nudges may play an important role in improving infection prevention and control (IPC) in hospitals. However, despite the novelty of the framework, their objectives, strategies and implementation approaches are not new. This review aims to provide an overview of the methods typically used by nudge interventions in IPC in hospitals targeting healthcare workers (HCWs). The initial search in PubMed yielded nine hits. Consequently, the search criteria were broadened and a second search was conducted, introducing 'nudge sensu lato' which incorporates insights from sources beyond the traditional nudge framework while maintaining the same objectives, strategies and approaches. During the second search, PubMed, Epistemonikos, Web of Science and PsycInfo were searched in accordance with the PRISMA guidelines. Abstracts were screened, and reviewers from an interdisciplinary team read the full text of selected papers. In total, 5706 unique primary studies were identified. Of these, 67 were included in the review, and only four were listed as nudge sensu stricto, focusing on changing HCWs' hand hygiene. All articles reported positive intervention outcomes. Of the 56 articles focused on improving hand hygiene compliance, 71.4% had positive outcomes. For healthcare equipment disinfection, 50% of studies showed significant results. Guideline adherence interventions had a 66.7% significant outcome rate. The concept of nudge sensu lato was introduced, encompassing interventions that employ strategies, methods and implementation approaches found in the nudge framework. The findings demonstrate that this concept can enhance the scientific development of more impactful nudges. This may help clinicians, researchers and policy makers to develop and implement effective nudging interventions.

L'adhérence au traitement de maladies chroniques chez les jeunes - Rôle du niveau d'actualisation et de la tolérance au risque.

Adolescents with chronic diseases must adhere to medication regimens to control their symptoms and avoid long-term complications. Despite its importance, medication adherence is low among adolescents. This commentary briefly covers the challenges described in the literature associated with measuring and addressing low medication adherence in adolescents. Next, it presents the evidence for the link between medication adherence and two prevalent psychological characteristics that have not been properly assessed so far: delay discounting (i.e., the relative value assigned to the future compared to the present), and risk tolerance. These psychological traits deserve further studies and are potentially amenable to interventions to improve medication adherence in adolescents with chronic conditions.

Les adolescents atteints d'une maladie chronique doivent adhérer à un régime médicamenteux pour contrôler leurs symptômes et éviter des complications à long terme. Malgré son importance, l'adhérence aux médicaments est faible chez les adolescents.Le présent commentaire décrit brièvement les défis associés à la mesure de l'adhérence médicamenteuse et les facteurs qui les influencent, rapportés dans la littérature scientifique. Il présente ensuite les données probantes démontrant le lien entre l'adhérence aux médicaments et deux caractéristiques psychologiques communes, mais qui ont été peu évaluées jusqu'à maintenant: le taux d'actualisation (la valeur relative que l'on attribue au futur comparativement au présent) et la tolérance au risque.Ces caractéristiques psychologiques méritent d'être approfondies, et pourraient être propices à des interventions pour améliorer l'adhérence au médicament chez les adolescents ayant une maladie chronique.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

Understanding the illicit drug distribution in England: a data-centric approach to the County Lines Model.

The County Lines Model (CLM) is a relatively new illicit drugs distribution method found in Great Britain. The CLM has brought modern slavery and public health issues, while challenging the law-enforcement capacity to act, as coordination between different local police forces is necessary. Our objective is to understand the territorial logic behind the line operators when establishing a connection between two places. We use three different spatial models (gravity, radiation and retail models), as each one of them understands flow from place i to j in a different way. Using public data from the Metropolitan Police of London, we train and cross-validate the models to understand which of the different physical and socio-demographic variables are considered when establishing a connection. We analyse hospital admissions by drugs, disposable household income, police presence and knife crime events, in addition to the population of a particular place and the distance and travel times between two different locations. Our results show that knife crime events and hospital admissions by misuse of drugs are the most important variables. We also find that London operators distribute to the territory known as the 'south' of England, as negligible presence of them is observed outside of it.

Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The Neotree.

Introduction: Improving peri- and postnatal facility-based care in low-resource settings (LRS) could save over 6000 babies' lives per day. Most of the annual 2.4 million neonatal deaths and 2 million stillbirths occur in healthcare facilities in LRS and are preventable through the implementation of cost-effective, simple, evidence-based interventions. However, their implementation is challenging in healthcare systems where one in four babies admitted to neonatal units die. In high-resource settings healthcare systems strengthening is increasingly delivered via learning healthcare systems to optimise care quality, but this approach is rare in LRS. Methods: Since 2014 we have worked in Bangladesh, Malawi, Zimbabwe, and the UK to co-develop and pilot the Neotree system: an android application with accompanying data visualisation, linkage, and export. Its low-cost hardware and state-of-the-art software are used to support healthcare professionals to improve postnatal care at the bedside and to provide insights into population health trends. Here we summarise the formative conceptualisation, development, and preliminary implementation experience of the Neotree. Results: Data thus far from ~18 000 babies, 400 healthcare professionals in four hospitals (two in Zimbabwe, two in Malawi) show high acceptability, feasibility, usability, and improvements in healthcare professionals' ability to deliver newborn care. The data also highlight gaps in knowledge in newborn care and quality improvement. Implementation has been resilient and informative during external crises, for example, coronavirus disease 2019 (COVID-19) pandemic. We have demonstrated evidence of improvements in clinical care and use of data for Quality Improvement (QI) projects. Conclusion: Human-centred digital development of a QI system for newborn care has demonstrated the potential of a sustainable learning healthcare system to improve newborn care and outcomes in LRS. Pilot implementation evaluation is ongoing in three of the four aforementioned hospitals (two in Zimbabwe and one in Malawi) and a larger scale clinical cost effectiveness trial is planned.

Active Ingredients of Interventions Improving Smoking Cessation Support by Dutch Primary Care Providers: A Systematic Review.

The objective was to assess active ingredients, change mechanisms, and fidelity in interventions aiming to increase the quality of smoking cessation care in the Dutch primary healthcare setting. We conducted a systematic review searching five scientific databases on August 2nd, 2019, updated on October 28th, 2021. We included effect data of behavioural interventions aiming at improving the provision of smoking cessation support by Dutch primary care providers to their patients. We excluded studies published before 2000 and those without a behavioural support intervention for primary care providers targeting smoking cessation in their patients. We found 1939 articles and included 15 distinct interventions in the review. We provided an overview of study characteristics, intervention effects, fidelity, active ingredients and change mechanisms using the Behaviour Change Techniques (BCT) Taxonomy and Mechanisms of Action (MoAs) protocols. Interventions seemed more effective when including a face-to-face component, using active learning strategies and providing a tool to help follow the guidelines in practice (e.g., physical cards with information). BCTs, MoAs, and fidelity were overall poorly reported on. To support the application of smoking cessation practices in Dutch primary care, we recommend implementation of face-to-face training programs incorporating active skill training elements combined with practical tools.

Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta-synthesis.

BACKGROUND AND OBJECTIVE: Acquired brain injury (ABI) can result in considerable life changes. Having choice and control over daily life is valued by people following ABI. This meta-synthesis will analyse and integrate international research exploring perspectives of choice and control in daily life following ABI. METHODS: Databases were searched from 1980 to 13 January 2022 for eligible qualitative studies. After duplicates were removed, 22,768 studies were screened by title and abstract, and 241 studies received full-text assessment with 56 studies included after pearling. Study characteristics and findings were extracted that related to personal perspectives on choice and control by people with an ABI (including author interpretation and quotes). Data from each study were coded and then segments of coded data across the studies were compared to create multiple broad categories. FINDINGS: Findings were then reduced from categories into 3 overarching themes with 12 subthemes. These themes were: (1) feeling like a second-class citizen; (2) reordering life and (3) choosing a path. Participants with an ABI tussled between their feelings of loss following brain injury and their thinking about how they start to regain control and become agents of their own choices. The themes describe their sense of self, their changed self and their empowered self in relation to 'choice and control'. CONCLUSIONS: Re-engaging with choice and control after ABI is dynamic and can be challenging. Health professionals and supporters need to facilitate a gradual and negotiated return to agency for people following ABI. A sensitive and person-centred approach is needed that considers the readiness of the person with ABI to reclaim choice and control at each stage of their recovery. Clear service or process indicators that are built on lived experience research are needed to facilitate changes in service delivery that are collaborative and inclusive. PATIENT OR PUBLIC CONTRIBUTION: This review included the voices of 765 people living with ABI and was conducted by a diverse team of allied health professionals with practice knowledge and research experience with people following ABI. Twenty-nine of the 56 included studies had participants contributing to their design or analysis.

Systematic review of factors promoting behaviour change toward antibiotic use in hospitals.

BACKGROUND: Antimicrobial stewardship (AMS) programmes include actions to improve antibiotic use. OBJECTIVES: This study aimed to identify factors of AMS interventions associated with behaviour change toward antibiotic use in hospitals, applying behavioural sciences. DATA SOURCES: PubMed and Scopus online databases were searched. STUDY ELIGIBILITY CRITERIA: Studies published between January 2015 and December 2020 were included. The required study outcomes were as follows: effect of the intervention reported in terms of antibiotic consumption, antibiotic costs, appropriateness of prescription, duration of therapy, proportion of patients treated with antibiotics, or time to appropriate antibiotic therapy. PARTICIPANTS: Participants included health care professionals involved in antibiotic prescription and use in hospitals and patients receiving or susceptible to receiving antibiotics. INTERVENTIONS: Studies investigating AMS interventions in hospitals were included. METHODS: Risk of bias was determined using the integrated quality criteria for review of multiple study designs tool. A systematic review of AMS interventions was conducted using the behaviour change wheel to identify behaviour changes functions of interventions; and the action, actor, context, target, and time framework to describe how they are implemented. Relationships between intervention functions and the action, actor, context, target, and time domains were explored to deduce factors for optimal implementation. RESULTS: Among 124 studies reporting 123 interventions, 64% were effective in reducing antibiotic use or improving the quality of antibiotic prescription. In addition, 91% of the studies had a high risk of bias. The main functions retrieved in the effective interventions were enablement, environmental restructuring, and education. The most common subcategories were audit and feedback and real-time recommendation for enablement function, as well as material resources, human resources, and new tasks for environmental restructuring function. Most AMS interventions focused on prescriptions, targeted prescribers, and were implemented by pharmacists, infectious diseases specialists, and microbiologists. Interventions focusing on specific clinical situation were effective in 70% of cases. CONCLUSIONS: Knowledge of factors associated with behaviour changes will help address local barriers and enablers before implementing interventions.

Behavioural change as a theme that integrates behavioural sciences in dental education.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

Mental health and implications for antiretroviral adherence in a multiethnic Asian cohort.

OBJECTIVES: Research suggests a high prevalence of depression and anxiety in people living with HIV, resulting in negative health outcomes and poorer help-seeking behaviours when undetected. Subsequent disease progression and non-adherence to treatment constitute a significant barrier to HIV treatment. This paper aims to identify the risk factors for the development of psychological distress and non-adherence to antiretroviral medication in people living with HIV. METHODS: An HIV outpatient clinical service screened for anxiety and depressive symptoms. As part of a retrospective analysis of the cohort, independent sample t-test and χ2 test were conducted to examine differences between symptomatic and asymptomatic patients in demographic variables such as mode of transmission and disclosure to family; clinical indicators such as psychiatric history and history of alcohol and substance use; and outcome variables such as current psychological distress and non-adherence. Binary logistic regression was conducted to determine predictors of psychological distress and non-adherence. RESULTS: After adjusting for age, no history of alcohol use and psychiatric history were found to be significant risk factors for psychological distress during the programme. Older patients were less likely to be symptomatic during the programme. After adjusting for age, having received intervention and psychiatric history, significant risk factors for non-adherence to antiretroviral medication were mode of transmission, history of smoking and being symptomatic during the programme. CONCLUSION: Significant psychological distress occurring early in HIV care predicts future non-adherence to antiretroviral treatment, highlighting the importance of early detection and intervention for psychological distress in people living with HIV. Mental health interventions should be intercalated with treatment adherence interventions to improve HIV treatment outcomes.

Factors associated with leisure-time physical activity participation among individuals with spinal cord injury who ambulate.

PURPOSE: The purpose of this study was to employ the theoretical domains framework (TDF) to identify behaviour change factors related to leisure-time physical activity (LTPA) in spinal cord injury (SCI) ambulators. METHODS: A cross-sectional design was employed. Among 43 SCI ambulators, the TDF behaviour change factors were assessed, along with the duration, types, and intensities of LTPA performed over the previous week. RESULTS: The TDF behaviour change factors identified as barriers to LTPA included: knowledge, beliefs about capabilities, coping planning, and goal conflict. Approximately 71.81 mins/day (SD = 75.41) was spent doing LTPA. Participants reported aerobic and resistance training activities, along with several other types of LTPA (e.g., rock climbing). Coping planning, action planning, goal conflict, and skills explained significant variance in time spent on LTPA (R2adjusted = 0.259, p < 0.01), but only action planning uniquely predicted LTPA. CONCLUSIONS: Greater use of coping and action planning, lower levels of goal conflict and stronger skills were associated with greater participation in LTPA. These factors will be targeted for a future LTPA-enhancing intervention for SCI ambulators, informed by behaviour change theory. SCI ambulators participate in a surprisingly wide range of LTPA. Rehabilitation specialists can use this list to suggest activities for patients with SCI who ambulate.IMPLICATIONS FOR REHABILITATIONBarriers to leisure-time physical activity for individuals with spinal cord injury (SCI) who ambulate include lack of knowledge, weak beliefs about capabilities, lack of coping planning, and high goal conflict.Physical activity interventions for individuals with SCI who ambulate should include action and coping planning, goal conflict, and skills.Physical activity interventions should be created systematically using behaviour change theory and involvement of stakeholders throughout the development process.Practitioners can promote skills training in adapted activities like gardening, cycling, and rock-climbing for ambulators with SCI.

Beyond behaviour as individual choice: A call to expand understandings around social science in health research.

The focus of behavioural sciences in shaping behaviour of individuals and populations is well documented. Research and practice insights from behavioural sciences improve our understanding of how people make choices that in turn determine their health, and in turn the health of the population. However, we argue that an isolated focus on behaviour - which is one link in a chain from macro to the micro interventions - is not in sync with the public health approach which per force includes a multi-level interest. The exclusive focus on behaviour manipulation then becomes a temporary solution at best and facilitator of reproduction of harmful structures at worst. Several researchers and policymakers have begun integrating insights from behavioural economics and related disciplines that explain individual choice, for example, by the establishment of Behavioural Insight Teams, or nudge units to inform the design and implementation of public health programs. In order to comprehensively improve public health, we discuss the limitations of an exclusive focus on behaviour change for public health advancement and call for an explicit integration of broader structural and population-level contexts, processes and factors that shape the lives of individuals and groups, health systems and differential health outcomes.

Phenomenological analysis of maladaptive daydreaming associated with internet gaming addiction: a case report.

Maladaptive daydreaming (MD) is an immersive fantasy activity that leads to distress and socio-occupational dysfunction. MD has many features suggestive of behavioural addiction, but research exploring the phenomenology of this clinical construct is limited. MD has also been purported to be a maladaptive strategy to cope with distress, but often leads to uncontrollable absorption in fantasy world, social withdrawal and neglected aspects of everyday life. In this paper, we report the case of a 16-year-old boy who developed internet gaming disorder and MD after experiencing cyberbullying from his peers. The patient engaged in vivid, fanciful imagery that lasted for hours, leading to social dysfunction and academic deterioration. Baseline assessment revealed a Maladaptive Daydreaming Scale-16 score of 65 (cut-off 50) and an Internet Gaming Test-20 score of 86 (cut-off 71). The patient was managed primarily with psychological intervention. The therapy focused on behaviour modification and cognitive restructuring. Patients in clinical setting should be questioned about MD when presenting with excessive use of technology or other forms of behavioural addictions. Further studies are necessary to determine the biopsychosocial factors of MD and its correlates. There is also a need to study treatment and management approaches for treating MD.

Mindfulness-based mobile app reduces anxiety and increases self-compassion in healthcare students: A randomised controlled trial.

OBJECTIVE: To compare the effect of a mindfulness-based mobile application versus an in-person mindfulness-based training program in terms of reducing anxiety and increasing empathy, self-compassion, and mindfulness in a population of healthcare students. METHODS: The authors conducted a single-blind, randomised controlled trial with three parallel groups. Participants were allocated to the mobile app, the in-person mindfulness-based program (IMBP), or a control group. Assessments at baseline and postintervention (8 weeks) included measures of anxiety, empathy, self-compassion, and mindfulness. RESULTS: Of 168 students randomised, 84 were analysed on an intention-to-treat basis (app: n = 31; IMBP: n = 23; control: n = 30). The mobile app group showed a large effect size for reductions in trait anxiety compared with controls (g = 0.85, p = 0.003), and a medium, nonsignificant effect compared with the IMBP group (g = 0.52, p = 0.152). Participants from both interventions experienced a significant increase in self-compassion and mindfulness compared with controls. Levels of empathy remained unchanged for the 3 arms. CONCLUSIONS: A mobile app can be as effective as an IMBP in reducing anxiety and increasing self-compassion and mindfulness among healthcare students.

Knowledge, behaviour, and policy: questioning the epistemic presuppositions of applying behavioural science in public policymaking.

The aim of this article is to question the epistemic presuppositions of applying behavioural science in public policymaking. Philosophers of science who have examined the recent applications of the behavioural sciences to policy have contributed to discussions on causation, evidence, and randomised controlled trials. These have focused on epistemological and methodological questions about the reliability of scientific evidence and the conditions under which we can predict that a policy informed by behavioural research will achieve the policymakers' goals. This paper argues that the philosophical work of Helen Longino can also help us to have a better and fuller understanding of the knowledge which the behavioural sciences provide. The paper advances an analysis of the knowledge claims that are made in the context of policy applications of behavioural science and compares them with the behavioural research on which they are based. This allows us to show that behavioural policy and the debates accompanying it are based on an oversimplified understanding of what knowledge behavioural science actually provides. Recognising this problem is important as arguments that justify reliance on the behavioural sciences in policy typically presume this simplification.

Perceptions of an HIV self-testing intervention and its potential role in addressing the barriers to HIV testing among at-risk heterosexual men: a qualitative analysis.

OBJECTIVES: Voluntary HIV testing rates are still low in several Asian countries including Singapore. HIV self-testing (HIVST) has the potential to increase testing, leading to earlier diagnosis and better prognosis. However, the views of at-risk individuals, especially heterosexual men (HSM), who are not coming forward for testing are still poorly understood. In this study, we examined the barriers and facilitators to and delivery preferences for HIVST in order to implement an effective intervention in Singapore. METHODS: From May 2017 to June 2018, 48 in-depth interviews were conducted with HSM aged 21-66 years and at risk of HIV infection. Participants were purposively sampled based on ethnicity, age and testing behaviour. Recruitment was done mainly at brothels and entertainment establishments in Singapore. Participants gave their views on HIV testing, factors affecting HIVST use and their preferred HIVST service delivery model. RESULTS: Most participants preferred HIVST over conventional testing for its convenience, privacy, anonymity and autonomy, but older men still preferred conventional testing. Low self-perceived risk, low awareness and self-efficacy for HIVST, and non-comprehensive test for other STIs were reported as barriers to HIVST. There were mixed opinions on kit preference. A blood-based kit was favoured for higher accuracy, while the oral-fluid-based kit was favoured for ease of use. Participants wanted a human touch for post-test counselling and linkage to care only if they self-tested positive. Traditional media, internet and social media, and venue-based outreach were potential advertising platforms mentioned. CONCLUSIONS: A locally acceptable and feasible HIVST intervention must address the barriers and facilitators of using HIVST in order to improve HIV testing rates among this at-risk population who might otherwise delay or fail to present for testing.

Assessing sociology and psychology in UK undergraduate medical education: Square peg in a round hole?

This article was migrated. The article was marked as recommended. Background: Attention has turned in recent years to the broader inclusion of sociology and psychology in medical curricula. Despite this, there is limited published evidence about how best to assess these subjects. This lack of evidence is significant given that most medical schools are likely to include some form of assessment of sociology and psychology, and that sociology and psychology are included in areas examined in admissions tests and in licensing exams. Methods: We ran three one day workshops in the UK (London, Edinburgh and Manchester, June - July 2019), to consult with educators involved in sociology and psychology teaching in medicine on: what methods are being used to assess sociology and psychology in UK undergraduate medical education, and the challenges and opportunities experienced. 36 participants attended the workshops, representing 19 of the 33 UK medical schools. Following the workshops, we collated the notes and presentations in order to develop a summary of current assessment practices and synthesis of the main themes identified. Results: There were many examples of good practice and development of innovative assessments, particularly in the early years of the programmes. At the same time, participants raised several challenges and tensions in relation tothe method, timing, and placement of sociology and psychology assessment. Participants reported that many of these issues related to dominant assessment cultures in medical education. As a result, assessing sociology and psychology in medicine can seem like fitting a square peg into a round hole. Solutions to these challenges may require wider changes to assessment practices and cultures. Conclusion: The challenges shared by participants are evident; nonetheless, there are important opportunities. Our participants were unanimous in their desire to become involved in dialogue and consultation about assessment. This article, reporting on the views of UK SBS educators, is a positive step towards creating a more robust evidence base upon which to engage in these conversations and inform best practice in sociology and psychology assessment.

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review.

BACKGROUND: Overuse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities' antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes. METHOD: A systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as 'very promising' (all outcomes statistically significant), 'quite promising' (some outcomes statistically significant), or 'not promising' (no outcomes statistically significant). 'Promise ratios' (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2. RESULTS: Twenty studies (of19 interventions) were included. Seven interventions (37%) were 'very promising', eight 'quite promising' (42%) and four 'not promising' (21%). Most promising intervention types were 'persuasion' (n = 12; promise ratio (PR) = 5.0), 'enablement' (n = 16; PR = 4.33) and 'education' (n = 19; PR = 3.75). Most promising behaviour change techniques were 'feedback on behaviour' (n = 9; PR = 8.0) and 'restructuring the social environment' (e.g. staff role changes; n = 8; PR = 7.0). CONCLUSION: Systematic identification of the active ingredients of antimicrobial stewardship in long-term care facilities was facilitated through the application of behavioural science frameworks. Incorporating environmental restructuring and performance feedback may be promising intervention strategies for antimicrobial stewardship interventions within long-term care facilities.

[Impact of university students lifestyle in the promotion of public health policies. The case of nudges.] / Impacto del estilo de vida de los estudiantes universitarios en la promoción de políticas públicas en salud. El caso de los nudges.

OBJECTIVE: In the last decade, public policy makers are applying new tools to promote healthy habits, starting from the behavioral economics sciences and social psychology. These tools are known as nudges, and before being applied, the degree of acceptance that the population presents about them must be analyzed. The objective of this study was to determine if there is a relationship between the lifestyle of the university population and the degree of acceptance of tools for the promotion of public health policies. METHODS: Cross-sectional correlational study of a representative sample of 590 university students (95% CI, α=5%) from Spanish universities using an online questionnaire. Bivariate and multivariate analyzes were performed applying Chi-squared test and Student t-test for independent samples. RESULTS: Young university students have an inadequate diet, with a deficient consumption of fruit and vegetables (only 27.8% consume them several times a day, the recommended daily amount being 5 pieces) and a high consumption of junk food, alcohol (68.81% and 63.39%, respectively, consumed between 1 and 2 times a week) and meat (consumed 3 to 4 times a week by 46.61%). By correlating the socio-demographic variables with food, significant results were found. The group of men, the youngest students, who are more supportive of the political right, and the religious practitioners, are the ones with the worst habits. In addition, those with older, more affiliated with the political left, less religious practice and better eating habits, they performed more responsible habits. There was a positive correlation between approval of nudges and responsible habits and less meat consumption (p<0,001), being significant in the nudges on food. CONCLUSIONS: The acceptance of public policies on health is related to healthy eating and to the most socially committed behaviors. In addition, these factors are more frequent among women, the older group, who show more support for the political left and have fewer religious beliefs.

OBJETIVO: En la última década, los responsables de políticas públicas están aplicando nuevas herramientas para el fomento de hábitos saludables, partiendo de las ciencias de la economía conductual y la psicología social. Estas herramientas se conocen como nudges, y antes de ser aplicadas ha de analizarse el grado de aceptación que la población presenta sobre ellas. El objetivo de este estudio fue determinar si existía relación entre el estilo de vida de la población universitaria y el grado de aceptación de herramientas para el fomento de políticas públicas en salud. METODOS: Se elaboró un estudio correlacional transversal de una muestra representativa de 590 estudiantes universitarios (IC 95%, α=5%) de universidades españolas, mediante un cuestionario en línea. Se realizaron análisis bivariados y multivariados aplicando chi-cuadrado y la prueba t de Student para muestras independientes. RESULTADOS: Los jóvenes universitarios tienen una alimentación inadecuada, con un deficiente consumo de fruta y verdura (solo el 27,8% las consumen varias veces al día, siendo la cantidad diaria recomendada de 5 piezas) y un consumo elevado de comida basura, alcohol (el 68,81% y el 63,39%, respectivamente, los consumían entre 1 y 2 veces por semana) y carne (consumida de 3 a 4 veces por semana por el 46,61%). Al correlacionar las variables sociodemográficas con la alimentación se encontraron resultados significativos, siendo los hombres y los estudiantes más jóvenes que apoyaban más a la derecha política, y los practicantes de alguna religión quienes tenían peores hábitos. Se obtuvo una correlación positiva entre la aprobación de nudges y los hábitos responsables con el menor consumo de carne (p<0,001), siendo significativo en los nudges que abordaban medidas sobre alimentación. CONCLUSIONES: La aceptación de políticas públicas en salud está relacionada con la alimentación saludable y con las conductas socialmente más comprometidas. Además, estos factores son más frecuentes entre las mujeres, en el grupo de mayor edad, entre quienes muestran más apoyo a la izquierda política y entre quienes tienen menos creencias religiosas.