Wendy Hardeman | University of East Anglia (original) (raw)

Papers by Wendy Hardeman

Trials, 2015

Infancy is a period of rapid growth and habit formation and hence could be a critical period for ... more Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year. We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months. The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth. ISRTCN20814693 . Registration date 13 January 2011.

British journal of sports medicine, Jan 5, 2015

To determine whether brief interventions promoting physical activity are cost-effective in primar... more To determine whether brief interventions promoting physical activity are cost-effective in primary care or community settings. Systematic review of economic evaluations. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit, SPORTDiscus, PEDro, the Cochrane library, National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry up to 20 August 2014. Web of Knowledge was used for cross-reference search. We included studies investigating the cost-effectiveness of brief interventions, as defined by National Institute for Health and Care Excellence, promoting physical activity in primary care or the community. Methodological quality was assessed using Drummond's checklist for economic evaluations. Data were extracted from individual studies fulfilling selection criteria using a standardised pro forma. Comparisons of cost-effectiveness and cost-utility ratios were made between studies. Of 1840 identified publications, 13 studies fulfilled the inclu...

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 20, 2015

The aim of this paper is to assess the frequency of identification as well as the inter-coder and... more The aim of this paper is to assess the frequency of identification as well as the inter-coder and test-retest reliability of identification of behavior change techniques (BCTs) in written intervention descriptions. Forty trained coders applied the "Behavior Change Technique Taxonomy version 1" (BCTTv1) to 40 intervention descriptions published in protocols and repeated this 1 month later. Eighty of 93 defined BCTs were identified by at least one trained coder, and 22 BCTs were identified in 16 (40 %) or more of 40 descriptions. Good inter-coder reliability was observed across 80 BCTs identified in the protocols: 66 (80 %) achieved mean prevalence and bias-adjusted kappa (PABAK) scores of 0.70 or greater, and 59 (74 %) achieved mean scores of 0.80 or greater. There was good within-coder agreement between baseline and 1 month, demonstrating good test-retest reliability. BCTTv1 can be used by trained coders to identify BCTs in intervention descriptions reliably. However, some...

International Journal of Behavioral Medicine

Annals of Behavioral Medicine, 2014

International Journal of Behavioral Nutrition and Physical Activity

There is limited evidence about predictors of health behaviour change in people with type 2 diabe... more There is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes. ADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40--69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression. Participants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increas...

BMC public health, Jan 8, 2015

There is increasing interest in brief and very brief behaviour change interventions for physical ... more There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which 'active ingredients' (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acce...

BMJ (Clinical research ed.), 2015

Journal of the American Heart Association, 2013

The purpose of this study was to determine whether interventions including components to improve ... more The purpose of this study was to determine whether interventions including components to improve adherence to antihypertensive medications in patients after stroke/transient ischemic attack (TIA) improve adherence and blood pressure control. We searched MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, and article reference lists to October 2012. Search terms included stroke/TIA, adherence/prevention, hypertension, and randomized controlled trial (RCT). Inclusion criteria were participants with stroke/TIA; interventions including a component to improve adherence to antihypertensive medications; and outcomes including blood pressure, antihypertensive adherence, or both. Two reviewers independently assessed studies to determine eligibility, validity, and quality. Seven RCTs were eligible (n=1591). Methodological quality varied. All trials tested multifactorial interventions. None targeted medication adherence alone. Six trials measured blood pressure and 3 adherence. Meta-analysis of 6 trials s...

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2003

To conduct a descriptive systematic review into the nature and effectiveness of family involvemen... more To conduct a descriptive systematic review into the nature and effectiveness of family involvement in weight control, weight maintenance and weight-loss interventions. We searched Medline and Psyclit for English language papers describing randomised trials with at least 1-y follow-up that evaluated interventions incorporating a family-based component. Studies involving people with eating disorders, learning disabilities and undernutrition or malnutrition were excluded. Data were extracted on characteristics of the participants, study design, target behaviours, nature of the intervention and study outcomes. A taxonomy was developed and used to classify family involvement in behaviour change interventions. Interventions were also classified according to an existing taxonomy that characterised the behaviour change techniques employed. A total of 21 papers describing 16 intervention studies were identified. Studies were small (mean sample size: 52), heterogeneous, poorly described but w...

The objective was to test, in a trial cohort of sedentary adults at risk of Type 2 diabetes, whet... more The objective was to test, in a trial cohort of sedentary adults at risk of Type 2 diabetes, whether theory of planned behaviour (TPB) cognitions about becoming more physically active predicted objective and self-reported activity levels and change. Participants of a randomized controlled trial underwent measurement at baseline, 6 and 12 months. Participants (N= 365, 30-50 years) were recruited via their parent or family history registers at 20 general practices in the UK. Energy expenditure was measured objectively at baseline and 1 year. Participants completed questionnaires assessing physical activity and beliefs about becoming more physically active over the next year at baseline, 6 and 12 months. Between baseline and 12 months, objective energy expenditure in the cohort increased by an average of 20 minutes of brisk walking per day. Based on the 252 participants who provided complete data, affective attitude and perceived behavioural control consistently predicted intention, but intention and perceived behavioural control failed to predict physical activity levels or change (p-values > .05). Failure of the theory to predict behaviour and behaviour change may be due to inapplicability of the theory to this at-risk population or to trial participation and intensive measurement facilitating behaviour change without affecting measured cognitions, or lack of correspondence between cognitive and behavioural measures. A wide range of potential personal and environmental mediators should be considered when designing physical activity interventions among at-risk groups. High-quality experimental tests of the theory are needed in clinical populations.

Background: BCT Taxonomy v1 may be used to write descriptions of interventions during their devel... more Background: BCT Taxonomy v1 may be used to write descriptions of interventions during their development phase or when writing up for publication. The reliable application of BCT taxonomies is a skilled task that requires training. This study assessed the quality of descriptions written by trained/untrained users, with/without access to v1. Methods: Writers attended six workshops in groups of 16 to 48. The workshops trained the use of 12 BCTs and a method for using BCT definitions to describe active content of interventions. Writers were shown videos of interventions delivered in practice and asked to write descriptions. Descriptions were assessed by two independent groups; raters rated ease of understanding and replicability and trained coders identified presence/absence of BCTs, rating ease of identification for each BCT identified. Both groups assessed ease of recognition by sorting descriptions according to those that described the same intervention. Results: Multivariate analyse...

Nutrition and Health, 1997

In 1992, a community-based 'Fat Watch' campaign w... more In 1992, a community-based 'Fat Watch' campaign was held in the city of Alkmaar in the Netherlands. The campaign was implemented within the framework of the nationwide mass-mediated 'Fat Watch' campaign (1991-1994), which aimed at a 10% reduction in fat intake among the general Dutch population. The intervention was carried out as a pilot project to study the effectiveness of strategies and activities, and to apply them subsequently in more cities. The campaign aimed primarily at the active involvement of intermediaries. Effects of the campaign were studied by telephone questionnaires among about 500 respondents, before and after the campaign in both the experimental and a control community. The questionnaire was based on the 'attitude, social influence, self-efficacy' (ASE) model. The results showed that 56% of the respondents were aware of a campaign in their community and that the campaign was positively evaluated by those familiar with it. After the campaign, self-rated fat consumption was significantly higher. No differences between the experimental and control community were found regarding attitude, social influence or self-efficacy expectations towards a reduction in fat consumption or intention to buy low-fat food products. However, as opposed to the control community, there was a significant decrease in actual fat consumption between pre- and post-test in Alkmaar. Furthermore, after the campaign, significantly more respondents in the experimental community intended to eat lower-fat food products and reported a behavioral change in the last six months. It was concluded that the campaign was quite successful as far as campaign awareness was concerned, but that it did not result in substantial change of behavior. The limited decrease in fat consumption observed should be interpreted with care.

Background: To increase effective implementation and replication of behaviour change intervention... more Background: To increase effective implementation and replication of behaviour change interventions, behavioural medicine needs to improve methods of specifying and reporting ‘active ingredients’. An on-going internationally supported project has developed a hierarchically structured taxonomy of behaviour change techniques (BCTs). This study aimed to test its reliability. Methods: In round one, five researchers coded 45 intervention descriptions by BCTs. Discrepancies were used to refine the taxonomy. Reliability of the refined taxonomy was assessed by six researchers coding 40 descriptions. In both rounds, each description was coded independently by two researchers. Descriptions were selected using quota sampling of articles published 2009-2010 in three international journals that represented a spread of interventions addressing prevention, illness management and health professional behaviours. Agreement by BCT was assessed by adjusted Kappa for BCTs observed more than five times. R...

Trials, 2015

Infancy is a period of rapid growth and habit formation and hence could be a critical period for ... more Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year. We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months. The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth. ISRTCN20814693 . Registration date 13 January 2011.

British journal of sports medicine, Jan 5, 2015

To determine whether brief interventions promoting physical activity are cost-effective in primar... more To determine whether brief interventions promoting physical activity are cost-effective in primary care or community settings. Systematic review of economic evaluations. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, EconLit, SPORTDiscus, PEDro, the Cochrane library, National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry up to 20 August 2014. Web of Knowledge was used for cross-reference search. We included studies investigating the cost-effectiveness of brief interventions, as defined by National Institute for Health and Care Excellence, promoting physical activity in primary care or the community. Methodological quality was assessed using Drummond's checklist for economic evaluations. Data were extracted from individual studies fulfilling selection criteria using a standardised pro forma. Comparisons of cost-effectiveness and cost-utility ratios were made between studies. Of 1840 identified publications, 13 studies fulfilled the inclu...

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 20, 2015

The aim of this paper is to assess the frequency of identification as well as the inter-coder and... more The aim of this paper is to assess the frequency of identification as well as the inter-coder and test-retest reliability of identification of behavior change techniques (BCTs) in written intervention descriptions. Forty trained coders applied the "Behavior Change Technique Taxonomy version 1" (BCTTv1) to 40 intervention descriptions published in protocols and repeated this 1 month later. Eighty of 93 defined BCTs were identified by at least one trained coder, and 22 BCTs were identified in 16 (40 %) or more of 40 descriptions. Good inter-coder reliability was observed across 80 BCTs identified in the protocols: 66 (80 %) achieved mean prevalence and bias-adjusted kappa (PABAK) scores of 0.70 or greater, and 59 (74 %) achieved mean scores of 0.80 or greater. There was good within-coder agreement between baseline and 1 month, demonstrating good test-retest reliability. BCTTv1 can be used by trained coders to identify BCTs in intervention descriptions reliably. However, some...

International Journal of Behavioral Medicine

Annals of Behavioral Medicine, 2014

International Journal of Behavioral Nutrition and Physical Activity

There is limited evidence about predictors of health behaviour change in people with type 2 diabe... more There is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes. ADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40--69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression. Participants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increas...

BMC public health, Jan 8, 2015

There is increasing interest in brief and very brief behaviour change interventions for physical ... more There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which 'active ingredients' (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acce...

BMJ (Clinical research ed.), 2015

Journal of the American Heart Association, 2013

The purpose of this study was to determine whether interventions including components to improve ... more The purpose of this study was to determine whether interventions including components to improve adherence to antihypertensive medications in patients after stroke/transient ischemic attack (TIA) improve adherence and blood pressure control. We searched MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, and article reference lists to October 2012. Search terms included stroke/TIA, adherence/prevention, hypertension, and randomized controlled trial (RCT). Inclusion criteria were participants with stroke/TIA; interventions including a component to improve adherence to antihypertensive medications; and outcomes including blood pressure, antihypertensive adherence, or both. Two reviewers independently assessed studies to determine eligibility, validity, and quality. Seven RCTs were eligible (n=1591). Methodological quality varied. All trials tested multifactorial interventions. None targeted medication adherence alone. Six trials measured blood pressure and 3 adherence. Meta-analysis of 6 trials s...

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2003

To conduct a descriptive systematic review into the nature and effectiveness of family involvemen... more To conduct a descriptive systematic review into the nature and effectiveness of family involvement in weight control, weight maintenance and weight-loss interventions. We searched Medline and Psyclit for English language papers describing randomised trials with at least 1-y follow-up that evaluated interventions incorporating a family-based component. Studies involving people with eating disorders, learning disabilities and undernutrition or malnutrition were excluded. Data were extracted on characteristics of the participants, study design, target behaviours, nature of the intervention and study outcomes. A taxonomy was developed and used to classify family involvement in behaviour change interventions. Interventions were also classified according to an existing taxonomy that characterised the behaviour change techniques employed. A total of 21 papers describing 16 intervention studies were identified. Studies were small (mean sample size: 52), heterogeneous, poorly described but w...

The objective was to test, in a trial cohort of sedentary adults at risk of Type 2 diabetes, whet... more The objective was to test, in a trial cohort of sedentary adults at risk of Type 2 diabetes, whether theory of planned behaviour (TPB) cognitions about becoming more physically active predicted objective and self-reported activity levels and change. Participants of a randomized controlled trial underwent measurement at baseline, 6 and 12 months. Participants (N= 365, 30-50 years) were recruited via their parent or family history registers at 20 general practices in the UK. Energy expenditure was measured objectively at baseline and 1 year. Participants completed questionnaires assessing physical activity and beliefs about becoming more physically active over the next year at baseline, 6 and 12 months. Between baseline and 12 months, objective energy expenditure in the cohort increased by an average of 20 minutes of brisk walking per day. Based on the 252 participants who provided complete data, affective attitude and perceived behavioural control consistently predicted intention, but intention and perceived behavioural control failed to predict physical activity levels or change (p-values > .05). Failure of the theory to predict behaviour and behaviour change may be due to inapplicability of the theory to this at-risk population or to trial participation and intensive measurement facilitating behaviour change without affecting measured cognitions, or lack of correspondence between cognitive and behavioural measures. A wide range of potential personal and environmental mediators should be considered when designing physical activity interventions among at-risk groups. High-quality experimental tests of the theory are needed in clinical populations.

Background: BCT Taxonomy v1 may be used to write descriptions of interventions during their devel... more Background: BCT Taxonomy v1 may be used to write descriptions of interventions during their development phase or when writing up for publication. The reliable application of BCT taxonomies is a skilled task that requires training. This study assessed the quality of descriptions written by trained/untrained users, with/without access to v1. Methods: Writers attended six workshops in groups of 16 to 48. The workshops trained the use of 12 BCTs and a method for using BCT definitions to describe active content of interventions. Writers were shown videos of interventions delivered in practice and asked to write descriptions. Descriptions were assessed by two independent groups; raters rated ease of understanding and replicability and trained coders identified presence/absence of BCTs, rating ease of identification for each BCT identified. Both groups assessed ease of recognition by sorting descriptions according to those that described the same intervention. Results: Multivariate analyse...

Nutrition and Health, 1997

In 1992, a community-based 'Fat Watch' campaign w... more In 1992, a community-based 'Fat Watch' campaign was held in the city of Alkmaar in the Netherlands. The campaign was implemented within the framework of the nationwide mass-mediated 'Fat Watch' campaign (1991-1994), which aimed at a 10% reduction in fat intake among the general Dutch population. The intervention was carried out as a pilot project to study the effectiveness of strategies and activities, and to apply them subsequently in more cities. The campaign aimed primarily at the active involvement of intermediaries. Effects of the campaign were studied by telephone questionnaires among about 500 respondents, before and after the campaign in both the experimental and a control community. The questionnaire was based on the 'attitude, social influence, self-efficacy' (ASE) model. The results showed that 56% of the respondents were aware of a campaign in their community and that the campaign was positively evaluated by those familiar with it. After the campaign, self-rated fat consumption was significantly higher. No differences between the experimental and control community were found regarding attitude, social influence or self-efficacy expectations towards a reduction in fat consumption or intention to buy low-fat food products. However, as opposed to the control community, there was a significant decrease in actual fat consumption between pre- and post-test in Alkmaar. Furthermore, after the campaign, significantly more respondents in the experimental community intended to eat lower-fat food products and reported a behavioral change in the last six months. It was concluded that the campaign was quite successful as far as campaign awareness was concerned, but that it did not result in substantial change of behavior. The limited decrease in fat consumption observed should be interpreted with care.

Background: To increase effective implementation and replication of behaviour change intervention... more Background: To increase effective implementation and replication of behaviour change interventions, behavioural medicine needs to improve methods of specifying and reporting ‘active ingredients’. An on-going internationally supported project has developed a hierarchically structured taxonomy of behaviour change techniques (BCTs). This study aimed to test its reliability. Methods: In round one, five researchers coded 45 intervention descriptions by BCTs. Discrepancies were used to refine the taxonomy. Reliability of the refined taxonomy was assessed by six researchers coding 40 descriptions. In both rounds, each description was coded independently by two researchers. Descriptions were selected using quota sampling of articles published 2009-2010 in three international journals that represented a spread of interventions addressing prevention, illness management and health professional behaviours. Agreement by BCT was assessed by adjusted Kappa for BCTs observed more than five times. R...