Understanding how primary care practitioners can be supported to recognise, screen and initially diagnose oropharyngeal dysphagia: protocol for a behavioural science realist review.

INTRODUCTION: Oropharyngeal dysphagia (OD) affects around 15% of older people; however, it is often unrecognised and underdiagnosed until patients are hospitalised. Screening is an important process which aims to facilitate proactive assessment, diagnosis and management of health conditions. Healthcare systems do not routinely screen for OD in older people, and healthcare professionals (HCPs) are largely unaware of the need to screen. This realist review aims to identify relevant literature and develop programme theories to understand what works, for whom, under what circumstances and how, to facilitate primary care HCPs to recognise, screen and initially diagnose OD. METHODS AND ANALYSIS: We will follow five steps for undertaking a realist review: (1) clarify the scope, (2) literature search, (3) appraise and extract data, (4) evidence synthesis and (5) evaluation. Initial programme theories (IPTs) will be constructed after the preliminary literature search, informed by the Theoretical Domains Framework and with input from a stakeholder group. We will search Medline, Google Scholar, PubMed, EMBASE, CINAHL, AMED, Scopus and PsycINFO databases. We will obtain additional evidence through grey literature, snowball sampling, lateral searching and consulting the stakeholder group. Literature will be screened, evaluated and synthesised in Covidence. Evidence will be assessed for quality by evaluating its relevance and rigour. Data will be extracted and synthesised according to their relation to IPTs. We will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication standards to report study results. ETHICS AND DISSEMINATION: Formal ethical approval is not required for this review. We will disseminate this research through publication in a peer-reviewed journal, written pieces targeted to diverse groups of HCPs on selected online platforms and public engagement events. PROSPERO REGISTRATION NUMBER: CRD42022320327.

Evolution and development of methodologies in social and behavioural science research in relation to oral health.

The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.

Predicting reliability through structured expert elicitation with the repliCATS (Collaborative Assessments for Trustworthy Science) process.

As replications of individual studies are resource intensive, techniques for predicting the replicability are required. We introduce the repliCATS (Collaborative Assessments for Trustworthy Science) process, a new method for eliciting expert predictions about the replicability of research. This process is a structured expert elicitation approach based on a modified Delphi technique applied to the evaluation of research claims in social and behavioural sciences. The utility of processes to predict replicability is their capacity to test scientific claims without the costs of full replication. Experimental data supports the validity of this process, with a validation study producing a classification accuracy of 84% and an Area Under the Curve of 0.94, meeting or exceeding the accuracy of other techniques used to predict replicability. The repliCATS process provides other benefits. It is highly scalable, able to be deployed for both rapid assessment of small numbers of claims, and assessment of high volumes of claims over an extended period through an online elicitation platform, having been used to assess 3000 research claims over an 18 month period. It is available to be implemented in a range of ways and we describe one such implementation. An important advantage of the repliCATS process is that it collects qualitative data that has the potential to provide insight in understanding the limits of generalizability of scientific claims. The primary limitation of the repliCATS process is its reliance on human-derived predictions with consequent costs in terms of participant fatigue although careful design can minimise these costs. The repliCATS process has potential applications in alternative peer review and in the allocation of effort for replication studies.

A Call for Behavioral Science in Embedded Bioethics.

Bioethicists today are taking a greater role in the design and implementation of emerging technologies by "embedding" within the development teams and providing their direct guidance and recommendations. Ideally, these collaborations allow ethical considerations to be addressed in an active, iterative, and ongoing process through regular exchanges between ethicists and members of the technological development team. This article discusses a challenge to this embedded ethics approach-namely, that bioethical guidance, even if embraced by the development team in theory, is not easily actionable in situ. Many of the ethical problems at issue in emerging technologies are associated with preexisting structural, socioeconomic, and political factors, making compliance with ethical recommendations sometimes less a matter of choice and more a matter of feasibility. Moreover, incentive structures within these systemic factors maintain them against reform efforts. The authors recommend that embedded bioethicists utilize principles from behavioral science (such as behavioral economics) to better understand and account for these incentive structures so as to encourage the ethically responsible uptake of technological innovations.

Examining the influences on the use of behavioural science within UK local authority public health: Qualitative thematic analysis and deductive mapping to the COM-B model and Theoretical Domains Framework.

Background: Behavioural science and its contribution towards improving public health is receiving increased recognition. Yet, the translation of these insights into public health practice is under-researched. This study explored the factors influencing the use of behavioural science within public health at a local authority level. Methods: Fourteen local authority staff (n = 13 female) in the south of England participated in semi-structured interviews, which were analysed inductively to identify key themes. These were later mapped deductively to the COM-B model and Theoretical Domains Framework. Findings: Nine themes were identified as factors that influence the use of behavioural science in local authority public health: (1) "Limited past experience," (2) "Narrow understanding," (3) "Perceived value of behavioural science," (4) "Translational gap from theory-to-practice," (5) "No protected time," (6) "Old ways of working," (7) "Political influence and organisational culture," (8) "Relationships with key stakeholders," (9) "Access to behavioural science resources". Deductive mapping of these themes revealed that five of the COM constructs (excluding Physical Capability) and eleven of the TDF domains influenced behavioural science use, with "Social influences" and "Knowledge" being the most prominent. Discussion: Use of behavioural science within local authority public health practice is limited and inconsistent. For it to be successfully implemented, there must be an understanding of its role and value, alongside strategies to overcome a translational gap from theory to practice. Public health teams would benefit from protected time to enable application and strategies to break old habits of using a common-sense approach. System-wide buy-in, particularly related to senior leadership and system partners is needed, which would benefit from organisational and political culture change. Training opportunities, practical resources and expert in-house support should be considered a priority across public health teams.

Incomplete preferences and rational framing effects.

The normative principle of description invariance presupposes that rational preferences must be complete. The completeness axiom is normatively dubious, however, and its rejection opens the door to rational framing effects. In this commentary, we suggest that Bermúdez's insightful challenge to the standard normative view of framing can be clarified and extended by situating it within a broader critique of completeness.

Practical behavioural solutions to COVID-19: Changing the role of behavioural science in crises.

For a very long time in the COVID-19 crisis, behavioural change leading to physical distancing behaviour was the only tool at our disposal to mitigate virus spread. In this large-scale naturalistic experimental study we show how we can use behavioural science to find ways to promote the desired physical distancing behaviour. During seven days in a supermarket we implemented different behavioural interventions: (i) rewarding customers for keeping distance; (i) providing signage to guide customers; and (iii) altering shopping cart regulations. We asked customers to wear a tag that measured distances to other tags using ultra-wide band at 1Hz. In total N = 4, 232 customers participated in the study. We compared the number of contacts (< 1.5 m, corresponding to Dutch regulations) between customers using state-of-the-art contact network analyses. We found that rewarding customers and providing signage increased physical distancing, whereas shopping cart regulations did not impact physical distancing. Rewarding customers moreover reduced the duration of remaining contacts between customers. These results demonstrate the feasibility to conduct large-scale behavioural experiments that can provide guidelines for policy. While the COVID-19 crisis unequivocally demonstrates the importance of behaviour and behavioural change, behaviour is integral to many crises, like the trading of mortgages in the financial crisis or the consuming of goods in the climate crisis. We argue that by acknowledging the role of behaviour in crises, and redefining this role in terms of the desired behaviour and necessary behavioural change, behavioural science can open up new solutions to crises and inform policy. We believe that we should start taking advantage of these opportunities.

La ética de los nudges sanitarios: una discusión sobre su aceptabilidaden salud pública / The ethics of health nudges: a discussion about their acceptability in public health

En ciencias del comportamiento, la expresiónnudge (del inglés, empujón, codazo) se refiere a cualquier aspecto de la arquitectura dela decisión que altera predeciblemente la conducta de las personas en su propio beneficio sin prohibir o restringir de forma signifi-cativa sus opciones. Sus promotores invocan elpaternalismo libertario para justificarlo, lo que significa que se promueve el beneficiodel individuo sin contar con su autonomía, pero sin llegar al punto de coartar la libertad de elección cuando ésta es manifiesta. Eneste trabajo se analiza el papel de losnudges en el ámbito de las políticas de salud. Se lleva a cabo un análisis cognitivo de ellos yse distinguen losnudges clínicos (aquellos que tienen lugar en el seno de la relación sanitario-paciente) de losnudges salubristas(específicos de políticas de salud pública). Se analizan los aspectos éticos de ambas categorías para señalar algunas de sus virtudes ylos retos éticos que plantean. El estudio se centra, de manera particular, en losnudges salubristas, para considerar si es razonable, ycon qué límites, su implementación en crisis sanitarias (por ejemplo, pandemias), donde las políticas públicas se enfrentan al dilemaentre preservar la libertad a costa de la salud pública o, por el contrario, priorizar ésta hasta el punto de limitar aquélla. Se plantea sien este contexto se deberían permitir mayores restricciones de las libertades individuales (por ejemplo, mediante confinamientos ycuarentenas obligatorias, vacunación impuesta, etc.) o bien utilizarnudges como una salida intermedia y menos lesiva de derechosindividuales para promover medidas sanitarias.(AU)

In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people’s behavior to impro-ve the chooser’s own welfare without forbidding or significantly restricting their choices. Its promoters invokelibertarian paternalism,which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the otherhand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzesthe role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinicalnudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specificto public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and theethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and withwhat limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma betweenpreserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whe-ther in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns andquarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individualrights to promote health measures.(AU)

A novel behavioral science-based health checkup program and subsequent metabolic risk reductions in a workplace: Checkup championship.

The effectiveness of general health checkups and lifestyle counseling has been questioned. This study examined whether a workplace health promotion program implemented during a health checkup was associated with metabolic syndrome-related indicators. Hakuhodo DY group, one of Japan's largest advertising agencies, implemented a behavioral science-based program called "Checkup Championship" (Kenshin-sen in Japanese) in 2019, in which all employees could voluntarily participate. We studied 3697 employees (2818 men and 879 women, mean age: 40.7 years), consisting of 1509 program participants and 2188 non-participants. The characteristics of participants and non-participants were balanced using inverse probability weighting. We used their data from the health checkups in 2018 and 2019 together with other covariates and performed a difference-in-differences analysis using a linear mixed model. After program implementation, greater reductions were observed among participants compared with non-participants in weight (-0.66 kg, 95% confidence interval: -0.84 to -0.47), body mass index (-0.23 kg/m2, -0.29 to -0.16), waist circumference (-0.67 cm, -0.91 to -0.43), systolic blood pressure (-1.13 mmHg, -2.10 to -0.16), and diastolic blood pressure (-0.84 mmHg, -1.53 to -0.15). In addition, we observed greater reductions in weight, body mass index, waist circumference, and low-density lipoprotein cholesterol among participants who were with two or more risk factors for metabolic syndrome than other participants. We found that participation in a health checkup program based on behavioral science was associated with reduced metabolic syndrome-related indicators. There may be room for improvement in the effectiveness of general health checkups.

The effectiveness of a behavioral science and design intervention for family savings on use of maternal health services and male involvement: study protocol for a randomized controlled trial.

BACKGROUND: Lack of financial preparedness for pregnancy can lead to adverse outcomes during childbirth. Behavioral science interventions have been shown to influence savings behavior. Financial savings interventions can be adapted for the purpose of encouraging individuals to save towards maternal healthcare costs. This article describes a protocol to assess the effectiveness of an intervention formulated with a behavioral science approach for encouraging use of maternal health services through increased financial savings for birth preparedness and maternal healthcare costs among pregnant women or their partners in Uganda. METHODS: A randomized controlled trial will be conducted to assess the effectiveness of the intervention among pregnant women or their partners in Uganda's central region, including the capital of Kampala. Seven hundred pregnant women (12-35 gestational weeks) or their partners will be recruited. All participants will receive access to a committed mobile money health savings account provided by a local organization that also offers savings targets and reminders for antenatal care appointments and health tips as part of a "Mamas Program" offered to expectant mothers. The time period in the intervention is from the day of enrollment until two weeks after the delivery date. The control group will receive the standard Mama Program offering. The intervention group will receive the standard Mama Program offering plus behavioral designs encouraging savings behavior through short-message service (SMS) text messages. The primary outcome is usage of maternal health services measured by level of birth preparedness and delivery at a health facility. Secondary outcomes include male involvement in maternal healthcare, measured by financial support, as well as total savings for healthcare, assessed using the validated amount of savings accrued in participants' clinicPesa accounts from the day of enrollment plus any withdrawals for healthcare expenditures during the intervention period. DISCUSSION: The study will contribute to a better understanding of the effectiveness of behavioral designs encouraging financial savings during pregnancy into committed mobile money health savings accounts. The study could contribute to demonstrating the effectiveness of savings on birth preparedness, usage of maternal health services, and male involvement in maternal healthcare. TRIAL REGISTRATION: UMIN-CTR Clinical Trial, UMIN000046472. Registered on 19 January 2022. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000053008.

The development of the Religious Health Interventions in Behavioural Science (RHIBS) Taxonomy: a scientific classification of religious practices in health.

The development and delivery of religiously integrated health interventions is increasing, however lack of nomenclature to specify the religious components presents barriers to replication, implementation, and evidence synthesis. We describe the development of the "Religious Health Interventions in Behavioural Sciences (RHIBS)" Taxonomy, the first scientific classification of religious intervention components to be used globally by chaplains, healthcare providers, and researchers interested in the scientific study of religion, spirituality, and health. We developed a taxonomy of empirically used religious intervention components in health, sought international cross-disciplinary consensus for definitions and tested its usability. Study 1: systematic review of intervention studies to identify religious components tested within healthcare; development of taxonomy nomenclature, definitions, and categories. Study 2: Delphi exercise with 19 international, cross-disciplinary experts from a variety of religions. Study 3: "think aloud" study and usability testing with 10 end-users. Study 1: 12,337 papers identified from search, 167 intervention studies included, plus an additional 74 from hand-searching 14 systematic reviews. A taxonomy of 191 religious components, grouped into 27 categories resulted. Study 2: two Delphi rounds resulted in international and cross-disciplinary consensus of a revised taxonomy of 81 religious components grouped into 23 categories. Study 3: usability testing by participants (range of disciplines, geography, and religions) led to a final taxonomy comprising 82 religious components grouped into 22 categories and supported by online training. The "RHIBS Taxonomy," is the first multidisciplinary, global shared language within religion, spirituality, and health, ushering in a new era for religious interventions to be precisely defined, developed, and tested; shaping the evidence-base for future healthcare research/practice.

Currently, religious health interventions are poorly defined and internationally we do not have a shared language that we can use when discussing religious practices. A shared language will help us to understand the different religious practices used. We need this, because we can then find out which religious practices are helpful and which are unhelpful in improving health outcomes. Our project answered the following questions: "Can religious practices within health interventions be scientifically classified? Can the classification gain international, cross-disciplinary agreement? Can the classification be reliably and easily used?" We found 82 religious practices that have been explored scientifically, we grouped these practices into 22 larger categories to organize and build a classification system that received agreement from international experts from a range of occupational backgrounds. The religious practices have been labeled and defined to make a common language that everyone internationally can share when talking about religious practices in relation to health. The classification system will help to identify and implement the most beneficial religious practices to health and will inform healthcare practice.

Gender differences in endowed chairs in Departments of Psychiatry and Behavioral Sciences from the top-10 NIH-funded medical schools in the US.

The current study examined gender differences in endowed chairs within Departments of Psychiatry and Behavioral Sciences across the top 10 NIH-funded Schools of Medicine. The names of full professors with and without endowed chairs were collected and a multivariable logistic regression model was constructed to predict having an endowed chair considering gender, primary degree, NIH funding, and citation number. Secondary analyses repeated the models separately for individuals holding an MD or MD/PhD versus those with a non-MD doctoral degree (i.e., PhD). There were 715 full professors (36% women) and 115 endowed chairs (35% women). When adjusting for primary degree type, funding, and citations, women were significantly more likely to hold an endowed chair than men. Secondary models indicated that findings differed based on primary degree type. Among those with an MD or MD/PhD, gender was not associated with holding an endowed chair while among faculty with a PhD, women full professors were significantly more likely to hold an endowed chair than men. These results diverge from a prior study of Departments of Medicine in which endowed chairs were found to favor men.

Dismantling Institutional Racism: The Role of Behavioral Science.

Institutionalized racism embeds our systems of healthcare delivery and medical education. This produces racial healthcare disparities which have been shown to severely impact both physical and behavioral health outcomes. Efforts to address institutionalized racism often focus on individualized efforts directed towards the healthcare workforce. However, more effective system level approaches are emerging. The behavioral health sciences can play a role in dismantling institutionalized racism by providing the evidence needed to understand effects on individuals and develop targeted system level approaches.

Evidence based opioid weaning with behavioral support - Forum for Behavioral Science Edition.

Nationally published guidelines state that many patients prescribed chronic opioids would benefit from gradually reducing and/or eliminating their use of these medications. This is easier said than done. Patients are often resistant or fearful, physicians are often uncomfortable prescribing an opioid taper, and patients often do not get the needed behavioral health support in this process. It is critical to develop a comprehensive behavioral and medical plan, however the field lacks practical approaches to guide physicians (and patients) through this challenge. In this manuscript our team of primary care providers and behaviorists walk through a case involving complex opioid weaning in a Family Medicine residency clinic environment. Through the lens of our patient's case, we will discuss best practices for getting patient buy-in, opioid weaning strategies, behavioral support during the wean, identifying co-morbid opioid use disorders, and deciding on acceptable end points for the taper.

Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial.

BACKGROUND: Breast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques. METHODS: A 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals' healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall. DISCUSSION: In addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and the general population, incorporates several behavioural techniques to overcome the barriers to attendance. Understanding its potential impact in a real-world setting therefore may provide significant information on how to address reducing attendance and healthcare disparities. TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov ( NCT05395871 ) on the 27th May 2022.

The role of behavioral science in addressing cardiovascular health disparities: A narrative review of efforts, challenges, and future directions.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Deviations from typical paths: a novel approach to working with GPS data in the behavioral sciences.

BACKGROUND: Behavioral science researchers are increasingly collecting detailed location data such as second-by-second GPS tracking on participants due to increased ease and affordability. While intraindividual variability has been discussed in the travel literature for decades, traditional methods designed for studying individual differences in central tendencies limit the extent to which novel questions about variability in lived experiences can be answered. Thus, new methods of quantifying behavior that focus on intraindividual variability are needed to address the context in which the behavior occurs and the location tracking data from which behavior is derived. METHODS: We propose deviations from typical paths as a data processing technique to separate individual-level typical travel behavior from a location tracking data set in order to highlight atypical travel behavior as an outcome measure. RESULTS: A simulated data example shows how the method works to produce deviation measures from a location dataset. Analysis of these deviations offers additional insights compared to traditional measures of maximum daily distance from home. CONCLUSIONS: This process can be integrated into larger research questions to explore predictors of atypical behavior and potential mechanisms of behavior change.