Does an Explicit Value Clarification Method with Computer-Tailored Advice Increase the Effectiveness of a Web-based Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance? Findings From a Randomized Controlled Trial. (Preprint)

BACKGROUND Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist, but their use is limited. The decision between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial, but insights into their effective elements are lacking. OBJECTIVE To test the added value of an effective element (ie, an 'explicit value clarification method' [VCM] paired with computer-tailored advice) of a web-based DA focusing on cessation assistance. The computer-tailored advice indicated the most fitting cessation assistance. The primary outcome measure was 7-day point prevalence abstinence 6 months post baseline (t=3). Secondary outcome measures were 7-day point prevalence abstinence 1 month post baseline (t=2), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately post DA, t=1). METHODS A randomized controlled trial (RCT) was conducted. The intervention group received a DA with an explicit VCM with computer-tailored advice, the control group received the same DA without these elements. Participants were mainly recruited online (eg, social media). All data was self-reported. Logistic and linear regression analyses (crude and adjusted for covariates) were performed to assess the outcomes. To test the robustness, analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation outcomes) different scenarios: (1) Complete cases, (2) worst-case scenario (dropout respondents are considered to smoke, smoking outcomes only), and (3) multiple imputations. According to an a priori sample size calculation (α=.05; β=.20), 796 participants were needed. RESULTS 2375 participants were randomized (n = 1164 intervention), 599 participants completed the DAs (n = 275 intervention), 276 (n = 143 intervention), 97 (n = 54 intervention), and 103 (n = 56 intervention) participants completed t=1, t=2 and t=3, respectively. Effects in favor of the intervention group on the primary outcome were only observed in the worst-case scenario (P = .02 [crude]; P = .04 [adjusted]). Effects on the secondary outcomes were only observed regarding smoking abstinence after 1 month (P = .02 in the crude and adjusted model), cessation assistance uptake after 1 months (only in the crude model, P = .04) and after 6 months (P = .01 [crude]; P = .02 [adjusted]), but also only in the worst-case scenario. Non-usage attrition was 34.19% higher in the intervention group than in the control group (P < .001). CONCLUSIONS We cannot confidently recommend the inclusion of explicit VCMs and computer-tailored advice at this point. In fact, they might result in higher attrition rates during DA completion, thereby limiting their potential. However, because a lack of statistical power may influenced our findings regarding the outcomes, we recommend replicating this study, taking our lessons learned into account. For example, we found indications that a stronger emphasis on usage times is justified in relation to digital DAs. CLINICALTRIAL Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 INTERNATIONAL REGISTERED REPORT RR2-10.2196/21772

Flood-Resilient Communities: How We Can Encourage Adaptive Behaviour Through Smart Tools in Public–Private Interaction

To achieve a more flood-resilient society, it is essential to involve citizens. Therefore, new instruments, such as tailor-made advice for homeowners, are being developed to inform homeowners about adaptive strategies in building to motivate them to implement these measures. This article evaluates if public–private interactions, such as tailored advice, change risk behaviour and therefore increase flood resilience among homeowners. The article conducted semi-structured interviews with homeowners who had received advice as well as involved experts in two case study regions in Europe: Flanders in Belgium and Vorarlberg in Austria. The results show how the tailored advice helps homeowners who are already aware of flood risks and provides them with answers on how to adapt a house. However, the tool seems to lack the ability to inform and “recruit” new groups of homeowners who are not as familiar with flood risks. As such, this article concludes that this initiative has a relatively low impact in raising flood risk awareness among homeowners but may be more successful in serving as a tool that suggests tailored property-level flood risk adaptation measures for those who are already aware. Alternatively, more automated tailored information systems might be more efficient for unaware homeowners.

Laying the Foundation for Pregnancy Physical Activity Profiling: A Framework for Providing Tailored Physical Activity Advice and Guidance to Pregnant Women

The aim of this study was to examine the predictive utility of the theory of planned behaviour (TPB) in explaining pregnant women’s physical activity (PA) intentions and behaviour and to scrutinise the role of past behaviour within this context. Pregnant women (n = 89) completed the pregnancy physical activity questionnaire (PPAQ) and newly developed TPB questionnaire on two separate occasions during their pregnancy. Analyses were carried out in relation to three scenarios. Firstly, when considering the original TPB, intention emerged as the strongest determinant of pregnant women’s PA behaviour. Secondly, controlling for past behaviour attenuated the influence of intention and perceived behavioural control on behaviour, with neither of the original variables providing a unique influence. Finally, the addition of past behaviour added significantly to the prediction of intention with the model as a whole, explaining 85% of the variance in pregnant women’s PA intention, and with past behaviour uniquely contributing 44.8% of the variance. Pregnancy physical activity profiling based on intention and behaviour status is subsequently introduced as a novel and practical framework. This provides healthcare professionals with the opportunity and structure to provide tailored advice and guidance to pregnant women, thereby facilitating engagement with PA throughout motherhood.

Policy recommendations of international bureaucracies: the importance of country-specificity

Many international bureaucracies give policy advice to national administrative units. Why is the advice given by some international bureaucracies more influential than the recommendations of others? We argue that targeting advice to member states through national embeddedness and country-tailored research increases the influence of policy advice. Subsequently, we test how these characteristics shape the relative influence of 15 international bureaucracies’ advice in four financial policy areas through a global survey of national administrations from more than 80 countries. Our findings support arguments that global blueprints need to be adapted and translated to become meaningful for country-level work. Points for practitioners National administrations are advised by an increasing number of international bureaucracies, and they cannot listen to all of this advice. Whereas some international bureaucracies give ‘one-size-fits-all’ recommendations to rather diverse countries, others cater their recommendations to the national audience. Investigating financial policy recommendations, we find that national embeddedness and country-tailored advice render international bureaucracies more influential.

Can Fall Risk Screening and Fall Prevention Advice in Hospital Settings Motivate Older Adult Patients to Take Action to Reduce Fall Risk?

Objective: We investigated whether an in-hospital intervention consisting of fall risk screening and tailored advice could prompt patients to take preventive action. Method: Patients (≥70) attending the emergency department and nephrology outpatient clinic in a Dutch hospital were screened. Patients at high risk received tailored advice based on their individual risk factors. Three months after screening, preventive steps taken by patients were surveyed. Results: Two hundred sixteen patients were screened. Of the 83 patients completing a 3-month follow-up, 51.8% took action; among patients who received tailored advice ( n = 20), 70% took action. Patients most often adhered to advice on improving muscle strength and undergoing vision checkups (20%). Tailored advice and a reported low quality of life were associated with consulting a health care provider. Discussion: Patients at risk in these settings are inclined to take action after screening. However, they do not always adhere to the tailored prevention advice.

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial

Background Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (ie, behavioral support, nicotine replacement therapy, or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. Objective We describe the development process of an online DA (called “VISOR”) that helps smokers to choose evidence-based cessation assistance. Additionally, we provide a description of the protocol of an ongoing randomized controlled trial in which the DA containing an explicit value clarification method (VCM) and tailored advice is compared with a DA without an explicit VCM and tailored advice. Methods The development of “VISOR” was based on the International Patient Decision Aid Standards guidelines. Viewpoints of end users (collected through 20 interviews with smokers) and clinical and scientific experts (assessed using 2 Delphi studies with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha-tested in September 2019 and beta-tested for usability in December 2019; feedback was incorporated and resulted in a final version. The final DA contains (1) an information section, (2) an optional knowledge quiz, (3) a brief smoking assessment, (4) intuitive decision, (5) intermediate advice, (6) an explicit VCM, (7) tailored advice, and (8) access information. A randomized controlled trial is currently being conducted to assess the DA’s (cost-)effectiveness compared to a DA that does not include the explicit VCM and the tailored advice; specifically, the DA’s effect on smoking abstinence, uptake of evidence-based cessation assistance, smoking abstinence mediated through uptake of evidence-based cessation assistance, and decisional conflict are investigated. Participants are randomly allocated to receive access to 1 of the 2 DAs and are asked to complete 5 questionnaires (including the baseline questionnaire) over a period of 12 months. To evaluate the effects of the DA on the outcome measures, logistic and linear regression analyses as well as mediation analyses will be carried out. An economic evaluation will be performed to assess the cost-effectiveness. Results Data regarding the effect of the VISOR DA are currently being collected, and data collection is expected to be concluded in 2021. Conclusions By making use of an iterative process that integrated different stakeholders’ perspectives (including end users), we were able to systematically design an evidence-based DA. The study will contribute to the current knowledge regarding smoking cessation DA application, the added value of explicit VCMs, and the effect of behavioral and informed decision-making outcomes. Trial Registration Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID) DERR1-10.2196/21772

An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial (Preprint)

BACKGROUND Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (ie, behavioral support, nicotine replacement therapy, or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. OBJECTIVE We describe the development process of an online DA (called “VISOR”) that helps smokers to choose evidence-based cessation assistance. Additionally, we provide a description of the protocol of an ongoing randomized controlled trial in which the DA containing an explicit value clarification method (VCM) and tailored advice is compared with a DA without an explicit VCM and tailored advice. METHODS The development of “VISOR” was based on the International Patient Decision Aid Standards guidelines. Viewpoints of end users (collected through 20 interviews with smokers) and clinical and scientific experts (assessed using 2 Delphi studies with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha-tested in September 2019 and beta-tested for usability in December 2019; feedback was incorporated and resulted in a final version. The final DA contains (1) an information section, (2) an optional knowledge quiz, (3) a brief smoking assessment, (4) intuitive decision, (5) intermediate advice, (6) an explicit VCM, (7) tailored advice, and (8) access information. A randomized controlled trial is currently being conducted to assess the DA’s (cost-)effectiveness compared to a DA that does not include the explicit VCM and the tailored advice; specifically, the DA’s effect on smoking abstinence, uptake of evidence-based cessation assistance, smoking abstinence mediated through uptake of evidence-based cessation assistance, and decisional conflict are investigated. Participants are randomly allocated to receive access to 1 of the 2 DAs and are asked to complete 5 questionnaires (including the baseline questionnaire) over a period of 12 months. To evaluate the effects of the DA on the outcome measures, logistic and linear regression analyses as well as mediation analyses will be carried out. An economic evaluation will be performed to assess the cost-effectiveness. RESULTS Data regarding the effect of the VISOR DA are currently being collected, and data collection is expected to be concluded in 2021. CONCLUSIONS By making use of an iterative process that integrated different stakeholders’ perspectives (including end users), we were able to systematically design an evidence-based DA. The study will contribute to the current knowledge regarding smoking cessation DA application, the added value of explicit VCMs, and the effect of behavioral and informed decision-making outcomes. CLINICALTRIAL Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21772

International high-tech SMEs innovative foreign knowledge inflows: effects of host country weak network ties and absorptive capacity

Purpose The main purpose of this study is to explain the combined effects of host country weak network ties and absorptive capacity on the innovative foreign knowledge inflows of international high-tech small- and medium-sized enterprises (SMEs). Design/methodology/approach Data are drawn from the two largest and most authoritative German Federal Government census-databases of biotech and nanotech SMEs. A structured survey questionnaire was administered and regression analysis adopted. Findings This study demonstrates weak network ties in the host country and developing absorptive capacity produce a combined effect that positively influences international high-tech SMEs innovative foreign knowledge inflows. Also, host country weak network ties and absorptive capacity when considered separately, each respectively, positively influence innovative foreign knowledge inflows. Practical implications The results help inform key personnel in international high-tech SMEs about the relevance of host country weak network ties and absorptive capacity for foreign knowledge inflows. In addition, the results help policymakers and think-tanks to promote tailored advice and guidance e.g. those policymakers implementing the EU Entrepreneurship 2020 Action Plan. Originality/value There is a recent call in the literature to combine network theory and absorptive capacity theory to better explain knowledge creation in the context of international high-tech SMEs knowledge sourcing. By addressing this call, the study provides a more refined and comprehensive account of international high-tech SMEs innovative foreign knowledge inflows.

Infection in older adults: a qualitative study of patient experience

BackgroundInfection is common in older adults. Serious infection has a high mortality rate and is associated with unplanned hospital admissions. Little is known about the factors that prompt older patients to seek medical advice when they may have an infection.AimTo explore the symptoms of infection from the perspective of older adults, and when and why older patients seek healthcare advice for a possible infection.Design and settingA qualitative interview study among adults aged ≥70 years with a clinical diagnosis of infection recruited from ambulatory care units in Oxford, UK.MethodInterviews were semi-structured and based on a flexible topic guide. Participants were given the option to be interviewed with their carer. Thematic analysis was facilitated using NVivo (version 11).ResultsA total of 28 participants (22 patients and six carers) took part. Patients (aged 70–92 years) had experienced a range of different infections. Several early non-specific symptoms were described (fever, feeling unwell, lethargy, vomiting, pain, and confusion/delirium). Internally minimising symptoms was common and participants with historical experience of infection tended to be better able to interpret their symptoms. Factors influencing seeking healthcare advice included prompts from family, specific or intolerable symptoms, symptom duration, and being unable to manage with self-care. For some, not wanting to be a burden affected their desire to seek help.ConclusionTailored advice to older adults highlighting early symptoms of infection may be beneficial. Knowing whether patients have had previous experience of infection may help healthcare professionals in assessing older patients with possible infection.

HDDL: An Extension to PDDL for Expressing Hierarchical Planning Problems

The research in hierarchical planning has made considerable progress in the last few years. Many recent systems do not rely on hand-tailored advice anymore to find solutions, but are supposed to be domain-independent systems that come with sophisticated solving techniques. In principle, this development would make the comparison between systems easier (because the domains are not tailored to a single system anymore) and – much more important – also the integration into other systems, because the modeling process is less tedious (due to the lack of advice) and there is no (or less) commitment to a certain planning system the model is created for. However, these advantages are destroyed by the lack of a common input language and feature set supported by the different systems. In this paper, we propose an extension to PDDL, the description language used in non-hierarchical planning, to the needs of hierarchical planning systems.