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  • 1.
    Alexandrou, Christina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Henriksson, Hanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Henstrom, Maria
    Karolinska Inst, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial2023In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 20, no 1, article id 22Article in journal (Refereed)
    Abstract [en]

    Background:Childhood overweight and obesity is a public health priority. We have previously reported the efficacy of a parent-oriented mobile health (mHealth) app-based intervention (MINISTOP 1.0) which showed improvements in healthy lifestyle behaviors. However, the effectiveness of the MINISTOP app in real-world conditions needs to be established. Objective:To evaluate the real-world effectiveness of a 6-month mHealth intervention (MINISTOP 2.0 app) on childrens intake of fruits, vegetables, sweet and savory treats, sweet drinks, moderate-to-vigorous physical activity, and screen time (primary outcomes), and on parental self-efficacy (PSE) for promoting healthy lifestyle behaviors, and childrens body mass index (BMI) (secondary outcomes). Methods:A hybrid type 1 effectiveness-implementation design was utilized. For the effectiveness outcomes, a two-arm, individually randomized controlled trial was conducted. Parents (n = 552) of 2.5-to-3-year-old children were recruited from 19 child health care centers across Sweden, and, randomized to either a control (standard care) or intervention group (MINISTOP 2.0 app). The 2.0 version was adapted and translated into English, Somali and Arabic to increase reach. All recruitment and data collection were conducted by the nurses. Outcomes were assessed at baseline and after six months, using standardized measures (BMI) and a questionnaire (health behaviors, PSE). Results:Among the participating parents (n = 552, age: 34.1 +/- 5.0 years), 79% were mothers and 62% had a university degree. Twenty-four percent (n = 132) of children had two foreign-born parents. At follow-up, parents in the intervention group reported lower intakes of sweet and savory treats (-6.97 g/day; p = 0.001), sweet drinks (-31.52 g/day; p < 0.001), and screen time (-7.00 min/day; p = 0.012) in their children compared to the control group. The intervention group reported higher total PSE (0.91; p = 0.006), PSE for promoting healthy diet (0.34; p = 0.008) and PSE for promoting physical activity behaviors (0.31; p = 0.009) compared to controls. No statistically significant effect was observed for childrens BMI z-score. Overall, parents reported high satisfaction with the app, and 54% reported using the app at least once a week. Conclusion:Children in the intervention group had lower intakes of sweet and savory treats, sweet drinks, less screen time (primary outcomes) and their parents reported higher PSE for promoting healthy lifestyle behaviors. Our results from this real-world effectiveness trial support the implementation of the MINISTOP 2.0 app within Swedish child health care.

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  • 2.
    Andersson, Claes
    et al.
    Malmo Univ, Sweden; Uppsala Univ, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lindfors, Petra
    Stockholm Univ, Sweden.
    Molander, Olof
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Lindner, Philip
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engström, Karin
    Karolinska Inst, Sweden.
    Berman, Anne H.
    Uppsala Univ, Sweden; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Does the management of personal integrity information lead to differing participation rates and response patterns in mental health surveys with young adults?: A three-armed methodological experiment2021In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 30, no 4, article id e1891Article in journal (Refereed)
    Abstract [en]

    Objectives This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey. Methods A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data. Results No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups. Conclusions Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.

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  • 3.
    Andersson, Claes
    et al.
    Malmo Univ, Sweden; Uppsala Univ, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Molander, Olof
    Karolinska Inst, Sweden; Reg Stockholm, Sweden.
    Granlund, Lilian
    Uppsala Univ, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engstrom, Karin
    Karolinska Inst, Sweden.
    Lindfors, Petra
    Stockholm Univ, Sweden.
    Berman, Anne H.
    Uppsala Univ, Sweden; Karolinska Inst, Sweden; Reg Stockholm, Sweden.
    Symptoms of COVID-19 contagion in different social contexts in association to self-reported symptoms, mental health and study capacity in Swedish university students2022In: BMC Research Notes, E-ISSN 1756-0500, Vol. 15, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

    Objective The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion. Results Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with students self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students self-reported symptoms, nor with their mental health and study capacity. To conclude, during the initial lockdown of universities students self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.

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  • 4.
    Andersson, Claes
    et al.
    Malmo Univ, Sweden; Uppsala Univ, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Molander, Olof
    Stockholm Hlth Care Serv, Sweden.
    Granlund, Lilian
    Uppsala Univ, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engström, Karin
    Karolinska Inst, Sweden.
    Lindfors, Petra
    Stockholm Univ, Sweden.
    Berman, Anne H.
    Uppsala Univ, Sweden; Stockholm Hlth Care Serv, Sweden.
    Associations between compliance with covid-19 public health recommendations and perceived contagion in others: a self-report study in Swedish university students2021In: BMC Research Notes, E-ISSN 1756-0500, Vol. 14, no 1, article id 429Article in journal (Refereed)
    Abstract [en]

    Objective: During the COVID pandemic, government authorities worldwide have tried to limit the spread of the virus. Swedens distinctive feature was the use of voluntary public health recommendations. Few studies have evaluated the effectiveness of this strategy. Based on data collected in the spring of 2020, this study explored associations between compliance with recommendations and observed symptoms of contagion in others, using self-report data from university students. Results: Compliance with recommendations ranged between 69.7 and 95.7 percent. Observations of moderate symptoms of contagion in "Someone else I have had contact with" and "Another person"were markedly associated with reported self-quarantine, which is the most restrictive recommendation, complied with by 81.2% of participants. Uncertainty regarding the incidence and severity of contagion in cohabitants was markedly associated with the recommendation to avoid public transportation, a recommendation being followed by 69.7%. It is concluded that students largely followed the voluntary recommendations implemented in Sweden, suggesting that coercive measures were not necessary. Compliance with recommendations were associated with the symptoms students saw in others, and with the perceived risk of contagion in the students immediate vicinity. It is recommended that voluntary recommendations should stress personal relevance, and that close relatives are at risk.

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  • 5.
    Andersson, Claes
    et al.
    Malmo Univ, Sweden; Uppsala Univ, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Molander, Olof
    Karolinska Inst, Sweden; Stockholm Hlth care Serv, Sweden.
    Lindner, Philip
    Karolinska Inst, Sweden; Stockholm Hlth care Serv, Sweden.
    Granlund, Lilian
    Uppsala Univ, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engstroem, Karin
    Karolinska Inst, Sweden.
    Lindfors, Petra
    Stockholm Univ, Sweden.
    Berman, Anne H. H.
    Uppsala Univ, Sweden; Karolinska Inst, Sweden; Stockholm Hlth care Serv, Sweden.
    Academic self-efficacy: Associations with self-reported COVID-19 symptoms, mental health, and trust in universities management of the pandemic-induced university lockdown2022In: Journal of American College Health, ISSN 0744-8481, E-ISSN 1940-3208Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students academic performance will be adversely affected.

  • 6.
    Andersson, Roland
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Cty Hosp Ryhov, Sweden; Acad Hlth & Care, Sweden.
    Agiorgiti, Maria
    Bra Liv Eksjo Primary Care Ctr, Sweden; Univ Ioannina, Greece.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Spontaneous Resolution of Uncomplicated Appendicitis may Explain Increase in Proportion of Complicated Appendicitis During Covid-19 Pandemic: a Systematic Review and Meta-analysis2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, p. 1901-1916Article, review/survey (Refereed)
    Abstract [en]

    BackgroundReports of an increased proportion of complicated appendicitis during the Covid-19 pandemic suggest a worse outcome due to delay secondary to the restrained access to health care, but may be explained by a concomitant decrease in uncomplicated appendicitis. We analyze the impact of the pandemic on the incidences of complicated and uncomplicated appendicitis.MethodWe did a systematic literature search in the PubMed, Embase and Web Of Science databases on December 21, 2022 with the search terms (appendicitis OR appendectomy) AND ("COVID" OR SARS-Cov2 OR "coronavirus"). Studies reporting the number of complicated and uncomplicated appendicitis during identical calendar periods in 2020 and the pre-pandemic year(s) were included. Reports with indications suggesting a change in how the patients were diagnosed and managed between the two periods were excluded. No protocol was prepared in advance. We did random effects meta-analysis of the change in proportion of complicated appendicitis, expressed as the risk ratio (RR), and of the change in number of patients with complicated and uncomplicated appendicitis during the pandemic compared with pre-pandemic periods, expressed as the incidence ratio (IR). We did separate analyses for studies based on single- and multi-center and regional data, age-categories and prehospital delay.ResultsThe meta-analysis of 100,059 patients in 63 reports from 25 countries shows an increase in the proportion of complicated appendicitis during the pandemic period (RR 1.39, 95% confidence interval (95% CI 1.25, 1.53). This was mainly explained by a decreased incidence of uncomplicated appendicitis (incidence ratio (IR) 0.66, 95% CI 0.59, 0.73). No increase in complicated appendicitis was seen in multi-center and regional reports combined (IR 0.98, 95% CI 0.90, 1.07).ConclusionThe increased proportion of complicated appendicitis during Covid-19 is explained by a decrease in the incidence of uncomplicated appendicitis, whereas the incidence of complicated appendicitis remained stable. This result is more evident in the multi-center and regional based reports. This suggests an increase in spontaneously resolving appendicitis due to the restrained access to health care. This has important principal implications for the management of patients with suspected appendicitis.

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  • 7.
    Anne, Berman
    et al.
    Department of Psychology, Uppsala University, Sweden ; Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Molander, Olof
    Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden.
    Lindfors, Petra
    Department of Psychology, Stockholm University, Sweden.
    Lindner, Philip
    Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Sweden.
    Granlund, Lilian
    Department of Psychology, Uppsala University, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engström, Karin
    Department of Global Public Health, Karolinska Institutet, Sweden.
    Andersson, Claes
    Department of Psychology, Uppsala University, Sweden ; Department of Criminology, Malmö University, Sweden.
    Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 1, p. 70-84Article in journal (Refereed)
    Abstract [en]

    Aims: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibilityfor compliance. Universities were one of few public institutions subject to strict closure, meaning that students had toadapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance andassociations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacyamong university students in Sweden in May–June 2020. Methods: This was a cross-sectional 23 question online survey inwhich data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesistesting. Results: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%.Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of theparticipants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacywere reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertaintyabout contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.Conclusions: Students generally followed public health recommendations during strict closure of universities,but many reported considerable negative consequences related to mental health and academic self-efficacy.Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviatestudent suffering during the pandemic and future similar crises.

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  • 8.
    Barticevic, Nicolas A.
    et al.
    Pontificia Univ Catolica Chile, Chile.
    Poblete, Fernando
    Pontificia Univ Catolica Chile, Chile.
    Bradshaw, Laura
    Pontificia Univ Catolica Chile, Chile.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Effectiveness of a health technician-delivered brief intervention for alcohol: a Bayesian reanalysis of a clinical trial2022In: BMC Research Notes, E-ISSN 1756-0500, Vol. 15, no 1, article id 182Article in journal (Refereed)
    Abstract [en]

    Objective To reanalyze a clinical trial on the effectiveness of a Brief Intervention (BI) delivered by non-professionals to reduce risky alcohol drinking. Our previous null-hypothesis test of the effects of the BI yielded a non-significant p-value, yet remained uninformative. Here we use the Bayesian paradigm which allows for expressing the probability of different effect sizes to better inform public policy decisions. Results The posterior probability of the odds of risky drinking at follow-up favored a marked effect of the BI, with 96% of the probability mass being less than OR = 1, and 84% being less than OR = 0.8. Our findings show that there is a high probability that the BI delivered by health technicians lowered risky alcohol use. The posterior distributions of the BIs effects are presented to help contextualize the evidence for policy making in Chile.

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  • 9.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    A Gentle Introduction to the Comparison Between Null Hypothesis Testing and Bayesian Analysis: Reanalysis of Two Randomized Controlled Trials2018In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 20, no 10, article id e10873Article in journal (Refereed)
    Abstract [en]

    The debate on the use and misuse of P values has risen and fallen throughout their almost century-long existence in scientific discovery. Over the past few years, the debate has again received front-page attention, particularly through the public reminder by the American Statistical Association on how P values should be used and interpreted. At the core of the issue lies a fault in the way that scientific evidence is dichotomized and research is subsequently reported, and this fault is exacerbated by researchers giving license to statistical models to do scientific inference. This paper highlights a different approach to handling the evidence collected during a randomized controlled trial, one that does not dichotomize, but rather reports the evidence collected. Through the use of a coin flipping experiment and reanalysis of real-world data, the traditional approach of testing null hypothesis significance is contrasted with a Bayesian approach. This paper is meant to be understood by those who rely on statistical models to draw conclusions from data, but are not statisticians and may therefore not be able to grasp the debate that is primarily led by statisticians.

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  • 10.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    An Electronic Screening and Brief Intervention for Hazardous and Harmful Drinking Among Swedish University Students: Reanalysis of Findings From a Randomized Controlled Trial Using a Bayesian Framework2019In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 12, article id e14420Article in journal (Refereed)
    Abstract [en]

    Background: Due to a resurgent debate on the misuse of P values, the Journal of Medical Internet Research is hosting a standing theme issue inviting the reanalysis of (primarily digital health) trial data using a Bayesian framework. This first paper in this series focuses on an electronic screening and brief intervention (eSBI), targeting harmful and hazardous alcohol consumption, which student health care centers across Sweden have routinely administerd to all students during the past decade. The second Alcohol Email Assessment and Feedback Study Dismantling Effectiveness for University Students (AMADEUS-2) trial aimed to assess the effect of the eSBI on alcohol consumption among students who were harmful and hazardous drinkers. A two-arm randomized controlled trial design was employed, randomizing eligible participants to either a waiting list or direct access to an eSBI. Follow-up assessments were conducted 2 months after randomization. Subsequent analysis of the trial followed the conventional null hypothesis approach, and no statistical significance was found between groups at follow-up with respect to the number of standard drinks consumed weekly. However, in an unspecified sensitivity analysis, it was discovered that removing three potential outliers made the difference between the groups significant.

    Objective: The objective of this study is to reperform the primary and sensitivity analysis of the AMADEUS-2 trial using a Bayesian framework and to compare the results with those of the original analysis.

    Methods: The same regression models used in the original analysis were employed in this reanalysis (negative binomial regression). Model parameters were given uniform priors. Markov chain Monte Carlo was used for Bayesian inference, and posterior probabilities were calculated for prespecified thresholds of interest.

    Results: Null hypothesis tests did not identify a statistically significant difference between the intervention and control groups, potentially due to a few extreme data points. The Bayesian analysis indicated a 93.6% probability that there was a difference in grams of alcohol consumed at follow-up between the intervention and control groups and a 71.5% probability that the incidence rate ratio was <0.96. Posterior probabilities increased when excluding three potential outliers, yet such post hoc analyses were not necessary to show the preference toward offering an eSBI to harmful and hazardous drinkers among university students.

    Conclusions: The null hypothesis framework relies on point estimates of parameters. P values can therefore swing heavily, depending on a single or few data points alone, casting doubt on the value of the analysis. Bayesian analysis results in a distribution over parameter values and is therefore less sensitive to outliers and extreme values. Results from analyses of trials of interventions where small-to-modest effect sizes are expected can be more robust in a Bayesian framework, making this a potentially better approach for analyzing digital health research data.

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  • 11.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Avoiding Under- and Overrecruitment in Behavioral Intervention Trials Using Bayesian Sequential Designs: Tutorial2022In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 24, no 12, article id e40730Article in journal (Refereed)
    Abstract [en]

    Reducing research waste and protecting research participants from unnecessary harm should be top priorities for researchers studying interventions. However, the traditional use of fixed sample sizes exposes trials to risks of under- and overrecruitment by requiring that effect sizes be determined a priori. One mitigating approach is to adopt a Bayesian sequential design, which enables evaluation of the available evidence continuously over the trial period to decide when to stop recruitment. Target criteria are defined, which encode researchers’ intentions for what is considered findings of interest, and the trial is stopped once the scientific question is sufficiently addressed. In this tutorial, we revisit a trial of a digital alcohol intervention that used a fixed sample size of 2129 participants. We show that had a Bayesian sequential design been used, the trial could have ended after collecting data from approximately 300 participants. This would have meant exposing far fewer individuals to trial procedures, including being allocated to the waiting list control condition, and the evidence from the trial could have been made public sooner.

  • 12.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Bayesian Optimisation of Gated Bayesian Networks for Algorithmic Trading2015In: / [ed] John Mark Agosta, Rommel Novaes Carvalho, CEUR-WS.org , 2015, Vol. 1565, p. 2-11Conference paper (Refereed)
    Abstract [en]

    Gated Bayesian networks (GBNs) are an extension of Bayesian networks that aim to model systems that have distinct phases. In this paper, we aim to use GBNs to output buy and sell decisions for use in algorithmic trading systems. These systems may have several parameters that require tuning, and assessing the performance of these systems as a function of their parameters cannot be expressed in closed form, and thus requires simulation. Bayesian optimisation has grown in popularity as a means of global optimisation of parameters where the objective function may be costly or a black box. We show how algorithmic trading using GBNs, supported by Bayesian optimisation, can lower risk towards invested capital, while at the same time generating similar or better rewards, compared to the benchmark investment strategy buy-and-hold.

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  • 13.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Electronic Screening for Alcohol Use and Brief Intervention by Email for University Students: Reanalysis of Findings From a Randomized Controlled Trial Using a Bayesian Framework2019In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 21, no 11, article id e14419Article in journal (Refereed)
    Abstract [en]

    Background: Almost a decade ago, Sweden became the first country to implement a national system enabling student health care centers across all universities to routinely administer (via email) an electronic alcohol screening and brief intervention to their students. The Alcohol email assessment and feedback study dismantling effectiveness for university students (AMADEUS-1) trial aimed to assess the effect of the student health care centers routine practices by exploiting the lack of any standard timing for the email invitation and by masking trial participation from students. The original analyses adopted the conventional null hypothesis framework, and the results were consistently in the expected direction. However, since for some tests the P values did not pass the conventional .05 threshold, some of the analyses were necessarily inconclusive. Objective: The outcomes of the AMADEUS-1 trial were derived from the first 3 items of the Alcohol Use Disorders Identification Test (AUDIT-C). The aim of this paper was to reanalyze the two primary outcomes of the AMADEUS-1 trial (AUDIT-C scores and prevalence of risky drinking), using the same models used in the original publication but applying a Bayesian inference framework and interpretation. Methods: The same regression models used in the original analysis were employed in this reanalysis (linear and logistic regression). Model parameters were given uniform priors. Markov chain Monte Carlo was used for Bayesian inference, and posterior probabilities were calculated for prespecified thresholds of interest. Results: Where the null hypothesis tests showed inconclusive results, the Bayesian analysis showed that offering an intervention at baseline was preferable compared to offering nothing. At follow-up, the probability of a lower AUDIT-C score among those who had been offered an intervention at baseline was greater than 95%, as was the case when comparing the prevalence of risky drinking. Conclusions: The Bayesian analysis allows for a more consistent perspective of the data collected in the trial, since dichotomization of evidence is not looked for at some arbitrary threshold. Results are presented that represent the data collected in the trial rather than trying to make conclusions about the existence of a population effect. Thus, policy makers can think about the value of keeping the national system without having to navigate the treacherous landscape of statistical significance.

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  • 14.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Science & Engineering.
    Feasibility of a Fully Automated Multiple Session Alcohol Intervention to University Students, Using Different Modes of Electronic Delivery: The TOPHAT 1 Study2013In: Journal of Software Engineering and Applications, ISSN 1945-3116, E-ISSN 1945-3124, no 6, p. 14-26Article in journal (Refereed)
    Abstract [en]

    Background: In recent years more and more electronic health behaviour interventions have been developed in order to reach individuals with an unhealthy behaviour such as risky drinking. This is especially relevant in university students who are among those who most frequently are risky drinkers. This study explored the acceptability and feasibility, in an unselected group of university students, of a fully automated multiple session alcohol intervention offering different modes of delivery such as email, SMS and Android.

    Material and Methods: A total of 11,283 students at Linköping University in Sweden were invited to perform a single session alcohol intervention and among those accepting this (4916 students) a total of 24.7% accepted to further participate in the extended multiple intervention lasting 3 - 6 weeks. The students could choose mode of delivery, total length of the intervention (between 3 - 6 weeks) and number of messages per week (3, 5, or 7 per week). A follow-up questionnaire was applied after the intervention to which 82.7% responded.

    Results: most students wanted to receive the messages by email with the shortest intervention length (3 weeks) and as few messages as possible per week (3 messages). However, no major difference was seen regarding satisfaction with the length and frequency of the intervention despite chosen length and frequency. Most students also expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking.

    Discussion and Conclusion: Based upon feedback from the students, a multiple push-based intervention appears to be feasible to offer additional help for those who have interest after a single session alcohol intervention. In a forthcoming study we will further explore the optimal mode of delivery and length of intervention and number of messages per week.

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  • 15. Order onlineBuy this publication >>
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Gated Bayesian Networks2017Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Bayesian networks have grown to become a dominant type of model within the domain of probabilistic graphical models. Not only do they empower users with a graphical means for describing the relationships among random variables, but they also allow for (potentially) fewer parameters to estimate, and enable more efficient inference. The random variables and the relationships among them decide the structure of the directed acyclic graph that represents the Bayesian network. It is the stasis over time of these two components that we question in this thesis.

    By introducing a new type of probabilistic graphical model, which we call gated Bayesian networks, we allow for the variables that we include in our model, and the relationships among them, to change overtime. We introduce algorithms that can learn gated Bayesian networks that use different variables at different times, required due to the process which we are modelling going through distinct phases. We evaluate the efficacy of these algorithms within the domain of algorithmic trading, showing how the learnt gated Bayesian networks can improve upon a passive approach to trading. We also introduce algorithms that detect changes in the relationships among the random variables, allowing us to create a model that consists of several Bayesian networks, thereby revealing changes and the structure by which these changes occur. The resulting models can be used to detect the currently most appropriate Bayesian network, and we show their use in real-world examples from both the domain of sports analytics and finance.

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  • 16.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Heterogeneous treatment effects of a text messaging smoking cessation intervention among university students2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 3, article id e0229637Article in journal (Refereed)
    Abstract [en]

    Introduction

    Despite tobacco being an important preventable factor with respect to ill health and death, it is a legal substance that harms and kills many of those who use it. Text messaging smoking cessation interventions have been evaluated in a variety of contexts, and are generally considered to have a positive effect on smoking cessation success. In order for text messaging interventions to continue to be useful as prevalence of smoking decreases, it may be necessary to tailor the interventions to specific individuals. However, little is known with regard to who benefits the most and least from existing interventions.

    Methods

    In order to identify heterogenous treatment effects, we analyzed data from a randomized controlled trial of a text messaging smoking cessation intervention targeting university students in Sweden. We used a Bayesian hierarchical model where the outcome was modelled using logistic regression, and so-called horseshoe priors were used for coefficients. Predictive performance of the model, and heterogeneous treatment effects, were calculated using cross-validation over the trial data.

    Results

    Findings from the study of heterogenous treatment effects identified less effect of the intervention among university students with stronger dependence of nicotine and students who smoke a greater quantity of cigarettes per week. No heterogeneity was found with respect to sex, number of years smoking, or the use of snuff.

    Discussion

    Results emphasize that individuals with a more developed dependence of nicotine may have a harder time quitting smoking even with support. This questions the dissemination and development of text messaging interventions to university students in the future, as they may not be the optimal choice of intervention for those with a more developed dependence. On the other hand, text messaging interventions may be useful to disseminate among university students that are at risk of developing a strong dependence.

    Trial registration

    International Standard Randomized Controlled Trial Number (ISRCTN): 75766527; http://www.controlled-trials.com/ISRCTN75766527.

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  • 17.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Regime Aware Learning2016In: Proceedings of the Eighth International Conference on Probabilistic Graphical Models, JMLR , 2016, Vol. 52, p. 1-12Conference paper (Refereed)
    Abstract [en]

    We propose a regime aware learning algorithm to learn a sequence of Bayesian networks (BNs) that model a system that undergoes regime changes. The last BN in the sequence represents the system’s current regime, and should be used for BN inference. To explore the feasibility of the algorithm, we create baseline tests against learning a singe BN, and show that our proposed algorithm outperforms the single BN approach. We also apply the learning algorithm on real world data from the financial domain, where it is evident that the algorithm is able to produce BNs that have adapted to the regime changes during the most recent global financial crisis of 2007-08.

  • 18.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Regimes in baseball players' career data2017In: Data mining and knowledge discovery, ISSN 1384-5810, E-ISSN 1573-756X, Vol. 31, no 6, p. 1580-1621Article in journal (Refereed)
    Abstract [en]

    In this paper we investigate how we can use gated Bayesian networks, a type of probabilistic graphical model, to represent regimes in baseball players’ career data. We find that baseball players do indeed go through different regimes throughout their career, where each regime can be associated with a certain level of performance. We show that some of the transitions between regimes happen in conjunction with major events in the players’ career, such as being traded or injured, but that some transitions cannot be explained by such events. The resulting model is a tool for managers and coaches that can be used to identify where transitions have occurred, as well as an online monitoring tool to detect which regime the player currently is in.

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  • 19.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Text Messaging Interventions for Reducing Alcohol Consumption Among Harmful and Hazardous Drinkers: Protocol for a Systematic Review and Meta-Analysis2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 4, article id e12898Article in journal (Refereed)
    Abstract [en]

    Background: Mobile phone-based interventions have become popular for lifestyle behavior change, particularly the use of text messaging as it is a technology ubiquitous in mobile phones. Reviews and meta-analyses of digital interventions for reducing harmful and hazardous use of alcohol have mainly focused on Web-based interventions; thus, there is a need for a body of evidence to guide health practitioners, policy makers, and researchers with respect to the efficacy of available text messaging interventions.

    Objective: The aim of this systematic review and meta-analysis is to assess the effectiveness of text messaging interventions for reducing the amount of alcohol consumed among harmful and hazardous drinkers; this is compared to receiving no, minimal, or unrelated health information. Specifically, we ask the following questions: (1) Can interventions consisting of only text messages be effective in reducing alcohol consumption compared to no intervention or a minimal or unrelated intervention? (2) Can interventions consisting of only text messages be effective in reducing the prevalence of risky drinking compared to no intervention or a minimal or unrelated intervention?

    Methods: Several databases will be searched, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, the Conference Proceedings Citation Index, ClinicalTrials.gov, OpenGrey, among others. Reports of studies that evaluate text messaging interventions for reducing the amount of alcohol consumed will be included. Primary outcomes of interest will be weekly alcohol consumption and frequency of heavy episodic drinking. The Cochrane Collaboration Risk of Bias tool will be used to assess bias in reports, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the body of evidence. A narrative review will be presented, and a meta-analysis will be conducted in case of homogeneity among included studies.

    Results: The systematic review has not yet begun but is expected to start in May of 2019; publication of the final review and meta-analysis is expected at the end of 2019.

    Conclusions: The technology for text messaging is ubiquitous in mobile phones; thus, the potential reach of interventions utilizing this technique is great. However, there are no meta-analyses to date that limit the scope to the use of text messaging interventions for alcohol consumption reduction. Therefore, the proposed systematic review and meta-analysis will help health practitioners, policy decision makers, researchers, and others to better understand the effects of these interventions.

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  • 20.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    The P Value Line Dance: When Does the Music Stop?2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 8, article id e21345Article in journal (Refereed)
    Abstract [en]

    When should a trial stop? Such a seemingly innocent question evokes concerns of type I and II errors among those who believe that certainty can be the product of uncertainty and among researchers who have been told that they need to carefully calculate sample sizes, consider multiplicity, and not spend P values on interim analyses. However, the endeavor to dichotomize evidence into significant and nonsignificant has led to the basic driving force of science, namely uncertainty, to take a back seat. In this viewpoint we discuss that if testing the null hypothesis is the ultimate goal of science, then we need not worry about writing protocols, consider ethics, apply for funding, or run any experiments at all—all null hypotheses will be rejected at some point—everything has an effect. The job of science should be to unearth the uncertainties of the effects of treatments, not to test their difference from zero. We also show the fickleness of P values, how they may one day point to statistically significant results; and after a few more participants have been recruited, the once statistically significant effect suddenly disappears. We show plots which we hope would intuitively highlight that all assessments of evidence will fluctuate over time. Finally, we discuss the remedy in the form of Bayesian methods, where uncertainty leads; and which allows for continuous decision making to stop or continue recruitment, as new data from a trial is accumulated.

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  • 21.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Feasibility and user perception of a fully automated push-based multiple-session alcohol intervention for university students: randomized controlled trial.2014In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 2, no 2, p. e30-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers.

    OBJECTIVE: This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email.

    METHODS: A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded.

    RESULTS: No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group.

    CONCLUSIONS: Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted.

  • 22.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Henriksson, Hanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Müssener, Ulrika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    The Mobile Health Multiple Lifestyle Behavior Interventions Across the Lifespan (MoBILE) Research Program: Protocol for Development, Evaluation, and Implementation2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 4, article id e14894Article in journal (Refereed)
    Abstract [en]

    Background: Clustering of multiple lifestyle risk behaviors has been associated with a greater risk of noncommunicable diseases and mortality than one lifestyle risk behavior or no lifestyle risk behaviors. The National Board of Health and Welfare in Sweden reported in 2018 that it is important to provide additional support to individuals with multiple lifestyle risk behaviors, as risks from these behaviors are multiplicative rather than additive. However, the same report emphasized that there is a lack of knowledge regarding interventions that support changes to unhealthy lifestyle behaviors.

    Objective: The MoBILE (Mobile health Multiple lifestyle Behavior Interventions across the LifEspan) research program has brought together two Swedish research groups supported by international collaborators. Through this collaboration, we aim to design and evaluate a number of novel and tailored mobile health (mHealth) multiple lifestyle behavior interventions across the life span of different health care populations. In addition, the MoBILE research program will extend ongoing research to include mHealth interventions for migrant pregnant women and children.

    Methods: Each project within the MoBILE program will focus on a specific group: pregnant women, preschool children, high school and university students, and adults in primary and clinical care. All the projects will follow the same 4 phases: requirements, development, evaluation, and implementation. During the requirements phase, implementers and end users will aid the design of content and functionality of the interventions. In the development phase, findings from the first phase will be synthesized with expert domain knowledge and theoretical constructs to create interventions tailored to the target groups. The third phase, evaluation, will comprise randomized controlled trials conducted to estimate the effects of the interventions on multiple lifestyle risk behaviors (eg, alcohol, nutrition, physical activity, and smoking). The final phase will investigate how the interventions, if found effective, can be disseminated into different health care contexts.

    Results: The research program commenced in 2019, and the first results will be available in 2020. Projects involving pregnant women, preschool children, and high school and university students will be completed in the first 3 years, with the remaining projects being planned for the program’s final 3 years.

    Conclusions:The development of evidence-based digital tools is complex, as they should be guided by theoretical frameworks, and requires large interdisciplinary teams with competence in technology, behavioral science, and lifestyle-specific areas. Individual researchers or smaller research groups developing their own tools is not the way forward, as it means reinventing the wheel over and over again. The MoBILE research program therefore aims to join forces and learn from the past 10 years of mHealth research to maximize scientific outcomes, as well as the use of financial resources to expand the growing body of evidence for mHealth lifestyle behavior interventions.

     

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  • 23.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Müssener, Ulrika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Six-Month Outcomes from the NEXit Junior Trial of a Text Messaging Smoking Cessation Intervention for High School Students: Randomized Controlled Trial With Bayesian Analysis2021In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 9, no 10, article id e29913Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of daily or occasional smoking among high school students in Sweden was approximately 20% in 2019, which is problematic since lifestyle behaviors are established in adolescence and track into adulthood. The Nicotine Exit (NEXit) Junior trial was conducted in response to a lack of evidence for the effects of text message smoking cessation interventions among high school students in Sweden. Objective: The aim of this study was to estimate the 3-and 6-month effects of a text messaging intervention among high school students in Sweden on smoking cessation outcomes. Methods: A 2-arm, single-blind randomized controlled trial was employed to estimate the effects of the intervention on smoking cessation in comparison to treatment as usual. Participants were recruited from high schools in Sweden using advertising and promotion by school staff from January 10, 2018, to January 10, 2019. Weekly or daily smokers who were willing to make a quit attempt were eligible for inclusion. Prolonged abstinence and point prevalence of smoking cessation were measured at 3 and 6 months after randomization. Results: Complete case analysis was possible on 57.9% (310/535) of the participants at 6 months, with no observed statistically significant effect on 5-month prolonged abstinence (odds ratio [OR] 1.27, 95% CI 0.73-2.20; P=.39) or 4-week smoking cessation (OR 1.42; 95% CI 0.83-2.46; P=.20). Sensitivity analyses using imputation yielded similar findings. Unplanned Bayesian analyses showed that the effects of the intervention were in the anticipated direction. The findings were limited by the risk of bias induced by high attrition (42.1%). The trial recruited high school students in a pragmatic setting and included both weekly and daily smokers; thus, generalization to the target population is more direct compared with findings obtained under more strict study procedures. Conclusions: Higher than expected attrition rates to follow-up 6 months after randomization led to null hypothesis tests being underpowered; however, unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. Future trials of smoking cessation interventions targeting high school students should aim to prepare strategies for increasing retention to mid-and long-term follow-up. Trial Registration: IRCTN Registry ISRCTN15396225; https://www.isrctn.com/ISRCTN15396225 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3028-2

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  • 24.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Garnett, Claire
    UCL, England.
    Toner, Paul
    Queens Univ Belfast, North Ireland.
    Shorter, Gillian W.
    Queens Univ Belfast, North Ireland.
    Correction: The Effect of Question Order on Outcomes in the Core Outcome Set for Brief Alcohol Interventions Among Online Help-Seekers: Protocol for a Factorial Randomized Trial (vol 10, e26578, 2021)2021In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 10, no 2, article id e26578Article in journal (Other academic)
    Abstract [en]

    n/a

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  • 25.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Garnett, Claire
    UCL, England.
    Toner, Paul
    Queens Univ Belfast, North Ireland.
    Shorter, Gillian W.
    Queens Univ Belfast, North Ireland.
    The Effect of Question Order on Outcomes in the Core Outcome Set for Brief Alcohol Interventions Among Online Help-Seekers: Protocol for a Factorial Randomized Trial2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 11, article id e24175Article in journal (Refereed)
    Abstract [en]

    Background: A core outcome set (COS) for trials and evaluations of the effectiveness and efficacy of alcohol brief interventions (ABIs) has recently been established through international consensus to address the variability of outcomes evaluated. Objective: This is a protocol for studies to assess if there are order effects among the questions included in the COS. Methods: The 10 items of the COS are organized into 4 clusters. A factorial design will be used with 24 arms, where each arm represents 1 order of the 4 clusters. Individuals searching online for help will be asked to complete a questionnaire, and consenting participants will be randomized to 1 of the 24 arms (double-blind with equal allocation). Participants will be included if they are 18 years or older. The primary analyses will (1) estimate how the order of the clusters of outcomes affects how participants respond and (2) investigate patterns of abandonment of the questionnaire. Results: Data collection is expected to commence in November 2020. A Bayesian group sequential design will be used with interim analyses planned for every 50 participants completing the questionnaire Data collection will end no more than 24 months after commencement, and the results are expected to be published no later than December 2023. Conclusions: Homogenizing the outcomes evaluated in studies of ABIs is important to support synthesis, and the COS is an important step toward this goal. Determining whether there may be issues with the COS question order may improve confidence in using it and speed up its dissemination in the research community We encourage others to adopt the protocol as a study within their trial as they adopt the ORBITAL (Outcome Reporting in Brief Intervention Trials: Alcohol) COS to build a worldwide repository and provide materials to support such analysis.

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  • 26.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Garnett, Claire
    UCL, England.
    Toner, Paul
    Queens Univ Belfast, North Ireland.
    Shorter, Gillian W.
    Queens Univ Belfast, North Ireland; Queens Univ Belfast, North Ireland.
    The effect of question order on outcomes in the orbital core outcome set for alcohol brief interventions among online help-seekers (QOBCOS): Findings from a randomised factorial trial2023In: Digital Health, E-ISSN 2055-2076, Vol. 9Article in journal (Refereed)
    Abstract [en]

    ObjectiveA core outcome set (COS) has been developed in alcohol brief intervention (ABI) research through international consensus. This study aimed to estimate order effects among questions in the COS. MethodsIndividuals aged 18 or older who searched online for alcohol-related help were invited to complete the COS. The order of questions was randomised following a factorial design. Primary outcomes were order effects among the COS items and patterns of attrition. ResultsBetween 21/10/2020 and 26/11/2020, we randomised 7334 participants, of which 5256 responded to at least one question and were available for analyses. Current non-drinkers were excluded. We found evidence of higher self-reported average consumption and odds of harmful and hazardous drinking was found among those who first answered questions on recent consumption and impact of alcohol use. Lower self-reported recent consumption was found among those first asked about average consumption. Quality of life (QoL) was reported lower among those who first responded to when questions on impact of alcohol use were asked first, which in turn was lower among those who first answered question on when average consumption and QoL were asked first. Attrition was lowest when average consumption was asked first, and highest when QoL or impact of alcohol use was asked first. Median completion time for the COS was 4.3 min. ConclusionsQuestion order affects outcomes and attrition. If the aim is to minimize attrition, consumption measures should be asked before QoL and impact of alcohol use; however, this order impacts self-reported alcohol consumption and so researchers should be guided by study priorities. At a minimum, all participants should be asked the same questions in the same order.

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  • 27.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Linderoth, Catharina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Mobile Phone-Based Smoking-Cessation Intervention for Patients Undergoing Elective Surgery: Protocol for a Randomized Controlled Trial2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 3, article id e12511Article in journal (Refereed)
    Abstract [en]

    Background: Several large studies have shown that the risk of cardiovascular, respiratory, and wound-healing complications (including death) within 30 days of surgery is greater for smokers than for nonsmokers. However, there is evidence that even short-term perioperative smoking cessation may reduce postoperative morbidity. Over the past few years, it has become more evident that short message service (SMS)–based interventions can help individuals quit smoking.

    Objective: The overall aim of this project is to fill the knowledge gap on whether an SMS-based smoking-cessation intervention can be effective in helping patients stop smoking perioperatively. The aim of this trial is to evaluate the effectiveness of an SMS-based intervention on smoking behavior of patients undergoing elective surgery.

    Methods: A two-arm parallel-group randomized controlled trial will be conducted at 20 surgical departments in southeast Sweden. Smokers undergoing elective surgery who own a mobile phone will be included. Power calculations indicate that it will be necessary to randomize 434 participants. One group will be given access to a novel 12-week SMS program, which includes daily SMS messages with behavior change–enforcing text content and hyperlinks to interactive modules, while the other group will not be given access to the intervention. Both groups will have access to the surgical departments’ current routine for smoking cessation prior to surgery. Primary outcome measures, prolonged abstinence, and point prevalence of smoking cessation will be measured through questionnaires at 3, 6, and 12 months after randomization. Logistic regression models adjusted using baseline characteristics will be explored to identify potential effects of the intervention.

    Results: Recruitment started in late October 2018 and is expected to last for a maximum of 30 months. The first results are expected to be available approximately 3 months after the final date of recruitment.

    Conclusions: Owing to the structural problems and scarcity of time and resources, patients at most Swedish surgical departments are simply instructed to quit smoking, and perhaps, referred to a primary health care clinic. An SMS-based smoking-cessation aid can be effective in helping individuals quit smoking and is a very simple and time-efficient tool for surgical departments to use.

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  • 28.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Department of Health Sciences, University of York, UK.
    Causal models accounted for research participation effects when estimating effects in a behavioral intervention trial2021In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 136, p. 77-83Article in journal (Refereed)
    Abstract [en]

    Objective Participants in intervention studies are asked to take part in activities linked to the conduct of research, including signing consent forms and being assessed. If participants are affected by such activities through mechanisms by which the intervention is intended to work, then there is confounding. We examine how to account for research participation effects analytically.

    Study design and setting Data from a trial of a brief alcohol intervention among Swedish university students is used to show how a proposed causal model can account for assessment effects.

    Results The proposed model can account for research participation effects as long as researchers are willing to use existing data to make assumptions about causal influences, for instance on the magnitude of assessment effects. The model can incorporate several research processes which may introduce bias.

    Conclusions As our knowledge grows about research participation effects, we may move away from asking if participants are affected by study design, toward rather asking by how much they are affected, by which activities and in which circumstances. The analytic perspective adopted here avoids assuming there are no research participation effects.

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  • 29.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    University of York, York, United Kingdom.
    Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 4, article id e13119Article in journal (Refereed)
    Abstract [en]

    Background: Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption.

    Objective: This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions.

    Methods: A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group.

    Results: Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol.

    Conclusions: If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit.

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  • 30.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Univ York, England.
    Åsberg, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Text messaging interventions for reducing alcohol consumption among risky drinkers: systematic review and meta-analysis2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 5, p. 1021-1033Article, review/survey (Refereed)
    Abstract [en]

    Background and Aims The global growth of mobile phone use has led to new opportunities for health interventions, including through text messaging. We aimed to estimate the effects of text messaging interventions on alcohol consumption among risky drinkers. Methods Systematic review and meta-analysis of reports on randomized controlled trials (RCTs) published in English. Searches were conducted on 23 May 2019 in PubMed; PubMed Central; CENTRAL; CDSR; DARE; NHS-EED; Scopus; PsycINFO; PsycARTICLES; CINAHL; and Web of Science. Measurements included number of episodes of heavy drinking (HED) per month and weekly alcohol consumption (WAC) in grams. Trials among risky drinkers who were not receiving co-interventions were included in the review (n = 3481, mean age 29 years, 41% female). Data were extracted from reports and authors were contacted for additional data. Results Ten trials were included and all analyses were based on random-effects models. Primary analyses, including seven trials (n = 2528) for HED and five trials (n = 2236) for WAC, found that the interventions may reduce self-reported HED [-0.33 episodes per month; 95% confidence interval (CI) = -0.79, 0.12] and WAC (-18.62 g per week; 95% CI = -39.61, 2.38), although both estimates included the null. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality of evidence was judged to be low for both HED and WAC, primarily due to risk of attrition and performance bias, heterogeneity and influence of pilot trials on estimates. Conclusions Text messaging alcohol interventions may reduce alcohol consumption compared with no or basic health information; however, there are doubts about the overall quality of the evidence.

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  • 31.
    Bendtsen, Marcus
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Müssener, Ulrika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Linderoth, Catharina
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    Thomas, Kristin
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health.
    A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial2020In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 3, article id e17208Article in journal (Refereed)
    Abstract [en]

    Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population.

    Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design.

    Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones.

    Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables.

    Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion.

    Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632

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  • 32.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Peña, Jose M.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Gated Bayesian Networks2013In: TWELFTH SCANDINAVIAN CONFERENCE ON ARTIFICIAL INTELLIGENCE (SCAI 2013), Amsterdam: IOS Press, 2013, p. 35-44Conference paper (Refereed)
    Abstract [en]

    This paper introduces a new probabilistic graphical model called gated Bayesian network (GBN). This model evolved from the need to represent real world processes that include several distinct phases. In essence a GBN is a model that combines several Bayesian networks (BN) in such a manner that they may be active or inactive during queries to the model. We use objects called gates to combine BNs, and to activate and deactivate them when predefined logical statements are satisfied. These statements are based on combinations of posterior probabilities of the variables in the BNs. Although GBN is a new formalism there are features of GBNs that are similar to other formalisms and research, including influence diagrams, context-specific independence and structural adaptation.

  • 33.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Peña, Jose M.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Gated Bayesian Networks for Algorithmic Trading2016In: International Journal of Approximate Reasoning, ISSN 0888-613X, E-ISSN 1873-4731, Vol. 69, p. 58-80Article in journal (Refereed)
    Abstract [en]

    Gated Bayesian networks (GBNs) are a recently introduced extension of Bayesian networks that aims to model dynamical systems consisting of several distinct phases. In this paper, we present an algorithm for semi-automatic learning of GBNs. We use the algorithm to learn GBNs that output buy and sell decisions for use in algorithmic trading systems. We show how using the learnt GBNs can substantially lower risks towards invested capital, while at the same time generating similar or better rewards, compared to the benchmark investment strategy buy-and-hold.

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  • 34.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Peña, Jose M.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, The Institute of Technology.
    Learning Gated Bayesian Networks for Algorithmic Trading2014In: Probabilistic Graphical Models: 7th European Workshop, PGM 2014, Utrecht, The Netherlands, September 17-19, 2014. Proceedings / [ed] Linda C. van der Gaag and Ad J. Feelders, Springer, 2014, p. 49-64Conference paper (Refereed)
    Abstract [en]

    Gated Bayesian networks (GBNs) are a recently introduced extension of Bayesian networks that aims to model dynamical systems consisting of several distinct phases. In this paper, we present an algo- rithm for semi-automatic learning of GBNs. We use the algorithm to learn GBNs that output buy and sell decisions for use in algorithmic trading systems. We show how using the learnt GBNs can substantially lower risks towards invested capital, while at the same time generating similar or better rewards, compared to the benchmark investment strat- egy buy-and-hold. 

  • 35.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Peña, Jose M.
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Science & Engineering.
    Modelling regimes with Bayesian network mixtures2017In: Proceedings of the 30th Annual Workshop of the Swedish Artificial Intelligence Society SAIS 2017, May 15–16, 2017, Karlskrona, Sweden / [ed] Niklas Lavesson, Linköping: Linköping University Electronic Press, 2017, Vol. 137, p. 20-29, article id 002Conference paper (Refereed)
    Abstract [en]

    Bayesian networks (BNs) are advantageous when representing single independence models, however they do not allow us to model changes among the relationships of the random variables over time. Due to such regime changes, it may be necessary to use different BNs at different times in order to have an appropriate model over the random variables. In this paper we propose two extensions to the traditional hidden Markov model, allowing us to represent both the different regimes using different BNs, and potential driving forces behind the regime changes, by modelling potential dependence between state transitions and some observable variables. We show how expectation maximisation can be used to learn the parameters of the proposed model, and run both synthetic and real-world experiments to show the model’s potential.

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    Modelling regimes with Bayesian network mixtures
  • 36.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Seiterö, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Olsson, Hanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Müssener, Ulrika
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    mHealth intervention for multiple lifestyle behaviour change among high school students in Sweden (LIFE4YOUth): Protocol for a randomised controlled trial2021In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 21, no 1Article in journal (Refereed)
    Abstract [en]

    BackgroundNational surveys in Sweden demonstrate that the majority of young people do not engage in health promoting behaviours at levels recommended by the Public Health Agency of Sweden. The objective of this study is to estimate the effectiveness of a novel mHealth intervention named LIFE4YOUth, which targets multiple lifestyle behaviours (alcohol, diet, physical activity, and smoking) among high school students in Sweden.MethodsA 2-arm parallel groups single blind randomised controlled trial (1:1) will be employed to estimate the effectiveness of the novel mHealth intervention. Students will be recruited at high schools throughout Sweden, and will be included if they fulfil one of six criteria relating to unhealthy behaviours with respect to alcohol, diet, physical activity and smoking. Eligible participants will be randomised to either receive the novel intervention immediately, or to be placed on a waiting list for 4 months. The intervention consists of a combination of recurring screening, text messages, and an interactive platform which is adaptable to individual preferences. Outcome measures with respect to alcohol, diet, physical activity and smoking will be assessed through questionnaires at 2 and 4 months post randomisation.DiscussionThe findings of this trial could be generalised to a diverse high-school student population as our recruitment encompass a large proportion of schools throughout Sweden with various educational profiles. Furthermore, if effective, the mHealth intervention has good potential to be able to be scaled up and disseminated at high schools nationally.Trial registrationRegistered prospectively on 2020-05-20 in ISRCTN (ISRCTN34468623).

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  • 37.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mental health promotion among university students using a mobile health intervention: longitudinal findings from a randomized controlled trial2021In: European Journal of Applied Positive Psychology, ISSN 2397-7116, Vol. 5, article id 12Article in journal (Refereed)
    Abstract [en]

    Background: Research shows that positive psychology interventions have a small to medium effect on wellbeing, depression, anxiety, and stress. However, few studies have investigated long-term mental health outcomes.

    Methods: This paper reports on the 6- and 12-month effects of a mobile phone based positive psychology intervention on wellbeing among university students in Sweden. A 2-arm, single blind (researchers), parallel groups, randomized controlled trial was employed.

    Results: In total 654 individuals (25 years median age, 78% female) were randomized to the intervention (n=348) or control group (n=306). Primary outcome was positive mental health (Mental Health Continuum-Short Form).  Secondary outcomes were depression and anxiety symptomatology (Hospital Anxiety and Depression Scale). A lasting effect on wellbeing was observed. An immediate positive effect was observed on anxiety and depression outcomes which waned over time.

    Discussion and conclusions: The findings suggest that mobile phone-based interventions could be an important tool in a wider strategy for mental health promotion. Future research could improve on the effects observed in this study by finding ways to optimise person-activity fit and tailor the intervention content.

  • 38.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Linderoth, Catharina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Effects of a Text Messaging Smoking Cessation Intervention Among Online Help Seekers and Primary Health Care Visitors in Sweden: Protocol for a Randomized Controlled Trial Using a Bayesian Group Sequential Design2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 12, article id e23677Article in journal (Refereed)
    Abstract [en]

    Background: A steady decline of the smoking prevalence in Sweden has been recorded over the past decade; however, people still start and continue to smoke. There is a need for effective smoking cessation interventions that can scale to a national level and that are designed to reach individuals requiring smoking cessation support in the general population. Objective: Previous randomized controlled trials of smoking cessation interventions among high school and university students in Sweden have found consistent evidence that text messaging interventions are effective in helping students quit smoking. However, there are no studies that investigate the effects of text messaging interventions in a more general population. The objective of this study is to estimate the effects of a text messaging intervention on individuals seeking help to quit online and individuals visiting primary health care units. Methods: A 2-arm, parallel-group (1:1), randomized controlled trial will be employed to address the study objectives. The trial will follow a Bayesian group sequential design. Recruitment will be conducted using online advertisement (Google, Bing, and Facebook) and through health care professionals at primary health care units. All participants will receive treatment as usual; however, participants who are allocated to the intervention arm will also be given access to a 12-week text message smoking cessation intervention. Primary outcomes are 8-week prolonged abstinence and 4-week point prevalence, measured 3 months and 6 months postrandomization. Mediator variables (self-efficacy, importance, and know-how) will be measured to estimate causal mediation models. Results: Recruitment commenced in September 2020 and will not exceed 24 months. This means that a complete dataset will be available at the latest towards the end of 2022. We expect to publish the findings from this trial by June 2023. Conclusions: This trial will further our understanding of the effects of text messaging interventions among a more general population than has previously been studied. We also aim to learn about differential effects between those who seek support online and those who are given facilitated support at primary health care units. Trial recruitment is limited to the Swedish population; however, a strength of this study is the pragmatic way in which participants are recruited. Through online advertisements, individuals are recruited in reaction to their own interest in seeking help to quit. At primary health care units, individuals who were not necessarily looking for smoking cessation support are given information about the trial. This closely mimics the way the intervention would be disseminated in a real-world setting and may therefore strengthen the argument of generalizability of findings.

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  • 39.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ulfsdotter Gunnarsson, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Univ York, England.
    Effects of a waiting list control design on alcohol consumption among online help-seekers: protocol for a randomised controlled trial2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 8, article id e049810Article in journal (Refereed)
    Abstract [en]

    Introduction Sparse attention has been given to the design of control conditions in trials, despite their important role as contrasts for novel treatments, and thus as a key determinant of effect sizes. This undermines valid inferences on effect estimates in trials, which are fundamentally comparative in nature. Such challenges to understanding also makes generalisation of effect estimates complex, for example, it may not be clear to what degree real-world alternatives to the novel treatments in pragmatic trials are similar to the control conditions studied. The present study aims to estimate the effects of being allocated to a waiting list control condition. Methods and analysis Individuals searching online for help to reduce their drinking will be invited to take part in a study. Individuals aged 18 years or older, who in the past month consumed six or more drinks on one occasion, or consumed 10 or more drinks the past week, will be eligible to participate. Both groups will receive identical feedback and advice on behaviour change; however, one group will be informed that they have to wait 1 month for the intervention materials. One month postrandomisation, participants will receive an email with the follow-up questionnaire measuring the primary outcomes: (1) frequency of heavy episodic drinking (defined as at study entry) in the past month; and (2) overall past week alcohol consumption. Differences between groups will be analysed using negative binomial regression models estimated using Bayesian inference. Recruitment will begin in October 2021. A Bayesian group sequential design will be employed to determine when to end enrolment (expected to be between 500 and 1500 individuals). Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2021-01-25 (Dnr 2020-06267). Findings will be disseminated in open access peer-reviewed journals no later than 2023.

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  • 40.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Åsberg, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    McCambridge, Jim
    Univ York, England.
    Effectiveness of a digital intervention versus alcohol information for online help-seekers in Sweden: a randomised controlled trial2022In: BMC Medicine, E-ISSN 1741-7015, Vol. 20, no 1, article id 176Article in journal (Refereed)
    Abstract [en]

    Background: The ubiquity of Internet connectivity, and widespread unmet needs, requires investigations of digital interventions for people seeking help with their drinking. The objective of this study was to test the effectiveness of a digital alcohol intervention compared to existing online resources for help seekers. Methods: This parallel randomised controlled trial included 2129 risky drinkers with access to a mobile phone and aged 18 years or older. Randomised sub-studies investigated consent procedures and control group design. Simple computerised randomisation was used. Participants were aware of allocation after randomisation; research personnel were not. The digital intervention was designed around weekly monitoring of alcohol consumption followed by feedback and tools for behaviour change. Primary outcomes were total weekly consumption (TWC) and frequency of heavy episodic drinking (HED), measured 2 and 4 months post-randomisation. Results: Between 25/04/2019 and 26/11/2020, 2129 participants were randomised (intervention: 1063, control: 1066). Negative binomial regression was used to contrast groups, with both Bayesian and maximum likelihood inference. The posterior median incidence rate ratio (IRR) of TWC was 0.89 (95% CI = 0.81;0.99, 98.2% probability of effect, P-value = 0.033) at 2 months among 1557 participants and 0.77 (95% CI = 0.69;0.86, &gt; 99.9% probability of effect, P-value &lt; 0.001) at 4 months among 1429 participants. For HED, the IRR was 0.83 (95% CI = 0.75;0.93, &gt; 99.9% probability of effect, P-value = 0.0009) at 2 months among 1548 participants and 0.71 (95% CI = 0.63;0.79, probability of effect &gt; 99.9%, P-value &lt; 0.0001) at 4 months among 1424 participants. Analyses with imputed data were not markedly different. Conclusions: A digital alcohol intervention produced self-reported behaviour change among online help seekers in the general population. The internal and external validity of this trial is strong, subject to carefully considered study limitations arguably inherent to trials of this nature. Limitations include higher than anticipated attrition to follow-up and lack of blinding.

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  • 41.
    Bendtsen, Marcus
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Åsberg, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Mccambridge, Jim
    Univ York, England.
    Mediators of effects of a digital alcohol intervention for online help-seekers: Findings from an effectiveness trial2023In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 251, article id 110957Article in journal (Refereed)
    Abstract [en]

    Background: Digital alcohol interventions have been shown to exert effects in helping individuals reduce their drinking. However, little is known about the mechanisms which mediate such effects. The objective of this study was to estimate natural direct and indirect effects of a digital alcohol intervention. Methods: This secondary analysis of mediated effects used data from a randomised controlled trial which included individuals with unhealthy alcohol use with access to a mobile phone aged 18 years or older in Sweden. The comparator was basic alcohol and health information. The digital intervention was centrally designed around weekly monitoring of consumption followed by feedback and tools to support behaviour change. Mediated ef-fects were estimated using measures from 1-, 2-, and 4-months post-randomisation. Primary outcomes were total weekly consumption (TWC) and frequency of heavy episodic drinking (HED). A counterfactual framework was used to estimate three hypothesised mediators: importance, knowledge of how to change (know-how), and confidence. Results: Between 25/04/2019 and 26/11/2020, 2129 participants were randomised. The intervention improved know-how and confidence, which in turn mediated the effects on TWC and HED at 2-and 4-months. Analyses with imputed data were not markedly different. Conclusions: A digital alcohol intervention was found to exert effects in reducing consumption by means of improving individuals knowledge of how to reduce their consumption and confidence in their ability to reduce. The use of face-valid single item measures is a study limitation notwithstanding observed findings, as is attrition and lack of blinding of participants.

  • 42.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Database and information techniques. Linköping University, Faculty of Science & Engineering.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    White, Ian R.
    Cambridge Institute Public Heatlh, England.
    McCambridge, Jim
    University of York, England.
    Online Alcohol Assessment and Feedback for Hazardous and Harmful Drinkers: Findings From the AMADEUS-2 Randomized Controlled Trial of Routine Practice in Swedish Universities2015In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 17, no 7, p. e170-Article in journal (Refereed)
    Abstract [en]

    Background: Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results. Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale, there is a need for further study. Objective: This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden. Methods: Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question. These students (N=1605) gave consent and were randomized into a 2-arm parallel group randomized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback. Results: After 2 months, there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses, although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10% reduction (95% CI -30% to 10%) in total weekly alcohol consumption. Also, differences in effect sizes between universities were seen with participants from a major university (n=365) reducing their weekly alcohol consumption by 14% (95% CI -23% to -4%). However, lower recruitment than planned and differential attrition in the intervention and control group (49% vs 68%) complicated interpretation of the outcome data. Conclusions: Any effects of current national provision are likely to be small and further research and development work is

  • 43.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    McCambridge, Jim
    London School of Hygiene and Tropical Medicine, United Kingdom.
    Bendtsen, Marcus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Effectiveness of a proactive mail-based alcohol Internet intervention for university students: dismantling the assessment and feedback components in a randomized controlled trial2012In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 14, no 5Article in journal (Refereed)
    Abstract [en]

    Background: University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs.Objective: To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se.Methods: This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned.Results: Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback.Conclusions: This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group.Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24735383; http://www.controlled-trials.com/ISRCTN24735383 (Archived by WebCite at http://www.webcitation.org/6Awq7gjXG)

  • 44.
    Blomqvist, Jenny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ulfsdotter Gunnarsson, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Operations management NSV. Dept Med Specialist, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Effects of a text messaging smoking cessation intervention amongst online help-seekers and primary health care visitors: findings from a randomised controlled trial2023In: BMC Medicine, E-ISSN 1741-7015, Vol. 21, no 1, article id 382Article in journal (Refereed)
    Abstract [en]

    Background Smoking continues to be a leading risk factor for several diseases globally. We hypothesised that an intervention delivered via text messages could help individuals who were looking to quit.Methods A two-arm, parallel-groups, randomised controlled trial was employed. Both groups received treatment as usual, with the intervention group also receiving a 12-week text messaging intervention. Participants were adult, weekly or more frequent smokers, recruited online and in primary health care centres. Research personnel were blinded, while participants were not. Primary outcomes were prolonged abstinence and point prevalence of abstinence, 3 and 6 months post-randomisation. All randomised participants were included in analyses.Results Between 18 September 2020 and 16 June 2022, we randomised 1012 participants (intervention: 505, control: 507). Outcome data was available for 67% (n = 682) of participants at 3 months and 64% (n = 643) at 6 months. At 3 months, the odds ratio (OR) of prolonged abstinence was 2.15 (95% compatibility interval [CoI] = 1.51; 3.06, probability of effect [POE] &gt; 99.9%, p &lt; 0.0001), and for point prevalence of abstinence, it was 1.70 (95% CoI = 1.18; 2.44, POE = 99.8%, p = 0.0034) in favour of the text messaging intervention. At 6 months, the OR of prolonged abstinence was 2.38 (95% CoI = 1.62; 3.57, POE &gt; 99.9%, p = &lt; 0.0001), and for point prevalence, it was 1.49 (95% CoI = 1.03; 2.14, POE = 98.3%, p = 0.0349) in favour of the text messaging intervention. Analyses with imputed data were not markedly different.Conclusions Amongst general population help-seekers-who on average had smoked for 25 years-access to a 12-week text messaging intervention produced higher rates of self-reported smoking abstinence in comparison to treatment as usual only. The intervention could be part of the societal response to the burden which smoking causes; however, findings are limited by risk of bias due to attrition, self-reported outcomes, and lack of blinding.

  • 45.
    Collier, Elizabeth S.
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. RISE Res Inst Sweden, Sweden.
    Blomqvist, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Satisfaction with a digital support tool targeting alcohol consumption: perspectives from participants in a randomized control trial2023In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502Article in journal (Refereed)
    Abstract [en]

    Aim Intervention design may be improved through evaluating the feedback from those who have been exposed to such interventions. As such, here the perspectives of the intervention group from a recent randomized control trial investigating the effectiveness of a digital alcohol intervention, in terms of perceived suitability and usefulness of the support tool they engaged with, were investigated.Methods Respondents (N=475; 45% of the intervention group) answered five quantitative questions addressing user experience, completed the 10-item System Useability Scale, and were offered the opportunity to write free-text feedback. Quantitative measures were analysed using ordinal and linear regression with baseline characteristics as predictors, and free-text responses were evaluated using content analysis.Results Overall, respondents were positive towards the intervention in terms of it fitting their needs, the usefulness of the tools included, and the usefulness of text message content. The intervention was perceived as more helpful by respondents with lower total weekly alcohol consumption, higher self-reported confidence in their ability to reduce their drinking, and the perceived importance there of, at baseline. The free-text comments revealed the value of reminders as prompts to reflect on ones own drinking behaviour. Nonetheless, criticisms of the intervention were voiced, primarily highlighting the repetitive nature of the reminders and the lack of individuation in advice. Some also feltlike the intervention was impersonal and targeted only a specific drinking pattern.Conclusions Experiences of the intervention group in this trial were generally positive, though there may be demand for more individualised, targeted intervention design. Short Summary: Perspectives from participants in a recent parallel group randomized effectiveness trial of a digital alcohol intervention are investigated. Experiences were generally positive, and the efficacy of the behavioural change mechanisms underpinning the intervention design are supported. Nonetheless, more individualized, targeted intervention design may be beneficial in the future.

  • 46.
    Collier, Elizabeth S.
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. RISE Res Inst Sweden, Sweden.
    Blomqvist, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Crawford, Joel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Univ York, England.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Exploratory mixed methods analysis of self-authored content from participants in a digital alcohol intervention trial2023In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 18, no 1, article id 60Article in journal (Refereed)
    Abstract [en]

    BackgroundDigital interventions readily permit data capture of participant engagement with them. If future interventions are intended to be more interactive, tailored, or a useful resource offered to users, it may be valuable to examine such data. One module available in a digital alcohol intervention recently tested in a randomised control trial offered participants the opportunity to self-author prompts that were sent to them by a text message at a time of their choosing. This study thus aimed to evaluate these self-authored prompts to increase knowledge on how individuals negotiate behaviour change and assess whether intervention content can be improved in the future.MethodsThe self-authored prompts were evaluated qualitatively using a combination of content and thematic analysis. The identified themes and subcategories are exemplified using anonymized quotes, and the frequency that each identified theme was coded for among the prompts was calculated. Associations between baseline characteristics and the odds of authoring a prompt at all, as well as a prompt within each theme, were investigated using logistic regression.ResultsFive themes were identified (Encouragement Style, Level of Awareness, Reminders of reasons to reduce/quit, Strategies to reduce/quit, and Timescale), all with several subcategories. The prompts module was more likely to be used by women and older individuals, as well as those for whom reducing alcohol consumption was perceived as important, or who felt they had the know-how to do so. Participants who had immediate access to the support tool (intervention group) were more than twice as likely to author a prompt (OR = 2.36; probability of association &gt; 99%) compared to those with 4-month delayed access (control group).ConclusionsIndividuals who engaged with the prompts module showed evidence of using the information provided in the support tool in an active way, with several showing goal setting and making plans to change their drinking behaviour. Individuals also used this opportunity to remind themselves of personal and specific reasons they wanted to change their drinking, as well as to encourage themselves to do so.

  • 47.
    Collier, Elizabeth S.
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. RISE Res Inst Sweden, Sweden.
    Harris, Kathryn L.
    RISE Res Inst Sweden, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Norman, Cecilia
    RISE Res Inst Sweden, Sweden.
    Niimi, Jun
    RISE Res Inst Sweden, Sweden.
    Just a matter of taste? Understanding rationalizations for dairy consumption and their associations with sensory expectations of plant-based milk alternatives2023In: Food Quality and Preference, ISSN 0950-3293, E-ISSN 1873-6343, Vol. 104, article id 104745Article in journal (Refereed)
    Abstract [en]

    Although knowledge surrounding the obstacles omnivorous consumers face when substituting meat products with plant-based alternatives has increased dramatically, less is known about their perspectives on plant-based alternatives to dairy products. Here, these perspectives are assessed in two survey-based studies. Study 1 (N = 175) adapts an existing scale (the 4Ns of meat consumption) to dairy products in an effort to identify similarities and differences between rationalizations for meat and dairy consumption. This 16-item scale quantifies four factors (Natural, Necessary, Normal, and Nice) describing common rationalizations for meat consumption. The results revealed that the 4Ns transfer well to the dairy category, and that endorsement of dairy products as Nice was the strongest predictor of dairy consumption, relative to the other 3Ns. This is further supported by evaluation of consumers own qualitative descriptions of why they do or do not consume meat/dairy products, where "taste" was the most frequently used word in both categories. Study 2 replicates the relationships between dairy 4Ns scores and reported dairy consumption found in Study 1 and builds upon these results by showing that 4N score could accurately categorize consumers as frequent (N = 192) or infrequent (N = 210) consumers of plant-based milk alternatives (PBMAs). Differences in consumers expectations for the sensory characteristics of cows milk and PBMAs are identified, and the impact of rationalization (total 4N score) on the likelihood of expected sensory attribute associations is described. The role of rationalization in shaping sensory expectations and impacting dietary choices, in particular resistance to adopting PBMAs, is discussed.

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  • 48.
    Collier, Elizabeth S.
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. RISE Res Inst Sweden, Sweden.
    Harris, Kathryn L.
    RISE Res Inst Sweden, Sweden.
    Jecks, Michael
    Independent Scholar, UK.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Dont throw the individual perspective out while waiting for systemic change2023In: Behavioral and Brain Sciences, ISSN 0140-525X, E-ISSN 1469-1825, Vol. 46, article id e154Article in journal (Other academic)
    Abstract [en]

    Although it is clear that i-frame approaches cannot stand alone, the impact of s-frame changes can plateau. Combinations of these approaches may best reflect what we know about behavior and how to support behavioral change. Interactions between i-frame and s-frame thinking are explored here using two examples: alcohol consumption and meat consumption.

  • 49.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Operations management NSV.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Implementing smoking cessation in routine primary care-a qualitative study2023In: FRONTIERS IN HEALTH SERVICES, ISSN 2813-0146, Vol. 3, article id 1201447Article in journal (Refereed)
    Abstract [en]

    BackgroundThe use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice.ObjectivesTo explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work.MethodsA qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers.ResultsInformants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools.ConclusionsImplementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.

  • 50.
    Ek, Anna
    et al.
    Karolinska Inst, Sweden.
    Alexandrou, Christina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Söderström, Emmie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bergman, Patrick
    Linnaeus Univ, Sweden.
    Nystrom, Christine Delisle
    Karolinska Inst, Sweden.
    Direito, Artur
    Natl Univ Singapore, Singapore.
    Eriksson, Ulf
    Stromstad Acad, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Maddison, Ralph
    Deakin Univ, Australia.
    Lagerros, Ylva Trolle
    Karolinska Inst, Sweden; Stockholm Hlth Serv, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial2020In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 8, no 6, article id e18531Article in journal (Refereed)
    Abstract [en]

    yyy Background: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking. Objective: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA). Methods: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months. Results: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was &gt;5 minute MVPA per day. Conclusions: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.

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