Integrating behaviour change interventions and patient decision aids: How to accomplish synergistic effects?

Gültzow, Thomas; Hoving, Ciska; Smit, Eline Suzanne; Bekker, Hilary

doi:10.1016/j.pec.2021.04.007

Cited by 11 publications

(15 citation statements)

References 46 publications

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“…DAs can come in a range of formats, such as digital or hard copy leaflets and webpages, and many are designed to be used in conjunction with consultations with HCPs [ 10 ]. They seek to improve knowledge regarding screening options and consequences to assist people to reach the right decision for them [ 11 ], simplifying complex discussions [ 12 ]. Evidence has shown that DAs used with HCPs are more effective in increasing understanding and recall of medical facts than HCPs alone [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Collectively, these models highlight the importance of cues to action, and the individual’s perception of how severe the condition is, how susceptible they are to it (risk factors), the costs, benefits, barriers, and outcomes to screening, the feasibility and efficacy of screening, their ability to undertake the action, their intention to be screened, and what others do and would approve of [ 15 – 17 ]. However, while DAs are “underpinned by theories on how we make decisions under risk and uncertainty, and the factors influencing our judgement and choices […] it is reported that theories are underused” [ 11 ] (p.3105).…”

Section: Introductionmentioning

confidence: 99%

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Investigating informed choice in screening programmes: a mixed methods analysis

et al. 2022

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Background Screening programmes aim to identify individuals at higher risk of developing a disease or condition. While globally, there is agreement that people who attend screening should be fully informed, there is no consensus about how this should be achieved. We conducted a mixed methods study across eight different countries to understand how countries address informed choice across two screening programmes: breast cancer and fetal trisomy anomaly screening. Methods Fourteen senior level employees from organisations who produce and deliver decision aids to assist informed choice were interviewed, and their decision aids (n = 15) were evaluated using documentary analysis. Results We discovered that attempts to achieve informed choice via decision aids generate two key tensions (i) between improving informed choice and increasing uptake and (ii) between improving informed choice and comprehensibility of the information presented. Comprehensibility is fundamentally at tension with an aim of being fully informed. These tensions emerged in both the interviews and documentary analysis. Conclusion We conclude that organisations need to decide whether their overarching aim is ensuring high levels of uptake or maximising informed choice to participate in screening programmes. Consideration must then be given to all levels of development and distribution of information produced to reflect each organisation’s aim. The comprehensibility of the DA must also be considered, as this may be reduced when informed choice is prioritised.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Investigating informed choice in screening programmes: a mixed methods analysis

et al. 2022

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“…Once they have reached a higher stage, they could then be provided with a traditional DA, such as VISOR. In other words, insights from behavior change could be used to further improve DAs for specific groups of decision makers [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial

Gültzow¹,

Smit²,

Crutzen³

et al. 2022

J Med Internet Res

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Background Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist; however, their use is limited. The choice between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial; however, insights into their effective elements are lacking. Objective This study tested the added value of an effective element (ie, an “explicit value clarification method” paired with computer-tailored advice indicating the most fitting cessation assistance) of a web-based smoking cessation DA. Methods A web-based randomized controlled trial was conducted among smokers motivated to stop smoking within 6 months. The intervention group received a DA with the aforementioned elements, and the control group received the same DA without these elements. The primary outcome measure was 7-day point prevalence abstinence 6 months after baseline (time point 3 [t=3]). Secondary outcome measures were 7-day point prevalence of abstinence 1 month after baseline (time point 2 [t=2]), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately after DA; time point 1). Logistic and linear regression analyses were performed to assess the outcomes. Analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation) outcome scenarios: complete cases, worst-case scenario (assuming that dropouts still smoked), and multiple imputations. A priori sample size calculation indicated that 796 participants were needed. The participants were mainly recruited on the web (eg, social media). All the data were self-reported. Results Overall, 2375 participants were randomized (intervention n=1164, 49.01%), of whom 599 (25.22%; intervention n=275, 45.91%) completed the DAs, and 276 (11.62%; intervention n=143, 51.81%), 97 (4.08%; intervention n=54, 55.67%), and 103 (4.34%; intervention n=56, 54.37%) completed time point 1, t=2, and t=3, respectively. More participants stopped smoking in the intervention group (23/63, 37%) than in the control group (14/52, 27%) after 6 months; however, this was only statistically significant in the worst-case scenario (crude P=.02; adjusted P=.04). Effects on the secondary outcomes were only observed for smoking abstinence after 1 month (15/55, 27%, compared with 7/46, 15%, in the crude and adjusted models, respectively; P=.02) and for cessation assistance uptake after 1 month (26/56, 46% compared with 18/47, 38% only in the crude model; P=.04) and 6 months (38/61, 62% compared with 26/50, 52%; crude P=.01; adjusted P=.02) but only in the worst-case scenario. Nonuse attrition was 34.19% higher in the intervention group than in the control group (P<.001). Conclusions Currently, we cannot confidently recommend the inclusion of explicit value clarification methods and computer-tailored advice. However, they might result in higher nonuse attrition rates, thereby limiting their potential. As a lack of statistical power may have influenced the outcomes, we recommend replicating this study with some adaptations based on the lessons learned. Trial Registration Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID) RR2-10.2196/21772

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“…Individuals in initial stages could, for example, be offered interventions that are merely educational and supportive in nature, while individuals in active deliberation stages could be offered 'traditional' DAs and individuals in later stages could be offered support to implement their decision. In other words, insights from behavior change could be used to further improve DAs for specific groups of decision makers [285].…”

Section: Lack Of Statistical Powermentioning

confidence: 99%

When informed decision making meets health promotion

Gültzow¹

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Integrating behaviour change interventions and patient decision aids: How to accomplish synergistic effects?

Cited by 11 publications

References 46 publications

Investigating informed choice in screening programmes: a mixed methods analysis

Investigating informed choice in screening programmes: a mixed methods analysis

Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial

When informed decision making meets health promotion

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