Imperial College London

Dr Gaby Judah

Faculty of MedicineDepartment of Surgery & Cancer

Non-Clinical Lecturer in Behavioural Sciences







Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus





Publication Type

22 results found

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Stevenson A, Darzi Aet al., 2021, Investigating the implementation of SMS and mobile messaging In Population Screening (The SIPS Study): Protocol for a Delphi Study, JMIR Research Protocols, Vol: 10, Pages: 1-8, ISSN: 1929-0748

BackgroundThe use of mobile messaging including Short Message Service (SMS) and Web-based messaging in healthcare has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances including population screening. These programmes, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. ObjectiveThis protocol describes the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programmes in England.Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will incorporate a literature review of publications from 1st January 2000 to the present. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used in the consensus generation. Patient and Public Involvement groups will be convened to ensure that a comprehensive item list is generated, which represents the public’s perspective. Each item will then be anonymously voted upon by experts as to its importance and feasibility of implementation in screening, during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible eligible for inclusion into the final recommendation. A list of desirable items (important, but not currently feasible) will be developed to guide future work. ResultsThe Institutional Review Board at Imperial College London has granted ethical approval (20IC6088). Results are expected to involve a list of recommendations to screening services with findings made available to screening services

Journal article

Brazier A, Larson E, Xu Y, Judah G, Egan M, Burd H, Darzi Aet al., 2021, ‘Dear Doctor’: a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists, Anaesthesia, ISSN: 0003-2409

One in four doctors in training in the UK reports feeling ‘burnt out’ because of their work and these figures are replicated globally. This two-group non-blinded randomised controlled trial aimed to determine if a novel text message intervention could reduce burnout and increase well-being in UK trainee anaesthetists. A total of 279 trainee anaesthetists (Core Training Year 2, Specialty Training Years 3 or 4) were included. All participants received one initial message sharing support resources. The intervention group (139 trainees) received 22 fortnightly text messages, over approximately 10 months centred around 11 evidence-based themes (including gratitude; social support; planning; self-efficacy; and self-compassion). Primary outcomes were burnout (Copenhagen Burnout Inventory) and well-being (Short Warwick-Edinburgh Mental Wellbeing Scale). Secondary outcomes were: meaning in work; professional value; sickness absence; and consideration of career break. Outcomes were measured via online surveys. Measures of factors that may have affected well-being were included post-hoc, including the impact of COVID-19 (the first UK wave of which coincided with the second half of the trial). The final survey was completed by 153 trainees (74 in the intervention and 79 in the control groups). There was no significant group differences in: burnout (β = -1.82, 95%CI -6.54–2.91, p = 0.45); well-being (-0.52, -1.73–0.69, p = 0.40); meaning (-0.09, -0.67–0.50, p = 0.77); value (-0.01, -0.67–0.66, p = 0.99); sick days (0.88, -2.08–3.83, p = 0.56); or consideration of career break (OR = 0.44, -0.30 to 1.18, p = 0.24). Exploratory post-hoc analysis found the intervention was associated with reduced burnout in participants reporting personal or work-related difficulties during the trial period (-9.56, -17.35 to -1.77, p = 0.02) and in participants reporting that the COVID-19 pandemic had a big negative impact on their well-being (-10.38, -

Journal article

Acharya A, Sounderajah V, Ashrafian H, Darzi A, Judah Get al., 2021, A systematic review of interventions to improve breast cancer screening health behaviours, Preventive Medicine, Vol: 153, ISSN: 0091-7435

Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level.

Journal article

Bond Z, Scanlon T, Judah G, 2021, Systematic review of RCTs assessing the effectiveness of mHealth interventions to improve statin medication adherence: using the behaviour-change technique taxonomy to identify the techniques that improve adherence., Healthcare (Basel), Vol: 9, ISSN: 2227-9032

Statin non-adherence is a common problem in the management of cardiovascular disease (CVD), increasing patient morbidity and mortality. Mobile health (mHealth) interventions may be a scalable way to improve medication adherence. The objectives of this review were to assess the literature testing mHealth interventions for statin adherence and to identify the Behaviour-Change Techniques (BCTs) employed by effective and ineffective interventions. A systematic search was conducted of randomised controlled trials (RCTs) measuring the effectiveness of mHealth interventions to improve statin adherence against standard of care in those who had been prescribed statins for the primary or secondary prevention of CVD, published in English (1 January 2000-17 July 2020). For included studies, relevant data were extracted, the BCTs used in the trial arms were coded, and a quality assessment made using the Risk of Bias 2 (RoB2) questionnaire. The search identified 17 relevant studies. Twelve studies demonstrated a significant improvement in adherence in the mHealth intervention trial arm, and five reported no impact on adherence. Automated phone messages were the mHealth delivery method most frequently used in effective interventions. Studies including more BCTs were more effective. The BCTs most frequently associated with effective interventions were "Goal setting (behaviour)", "Instruction on how to perform a behaviour", and "Credible source". Other effective techniques were "Information about health consequences", "Feedback on behaviour", and "Social support (unspecified)". This review found moderate, positive evidence of the effect of mHealth interventions on statin adherence. There are four primary recommendations for practitioners using mHealth interventions to improve statin adherence: use multifaceted interventions using multiple BCTs, consider automated messages as a digital delivery method from a credible source

Journal article

Huf S, Kerrison RS, King D, Chadborn T, Richmond A, Cunningham D, Friedman E, Shukla H, Tseng F-M, Judah G, Darzi A, Vlaev Iet al., 2020, Behavioral economics informed message content in text message reminders to improve cervical screening participation: Two pragmatic randomized controlled trials, Preventive Medicine, Vol: 139, ISSN: 0091-7435

The objective of the reported research was to assess the impact of text message (SMS) reminders and their content on cervical screening rates. Women invited for cervical screening in Northwest London from February-October 2015 were eligible. 3133 women aged 24-29 (Study 1) were randomized (1, 1) to 'no SMS' (control), or a primary care physician (PCP) endorsed SMS (SMS-PCP). 11,405 women aged 30-64 (Study 2), were randomized (1, 1:1:1:1:1:1) to either: no SMS, an SMS without manipulation (SMS), the SMS-PCP, an SMS with a total or proportionate social norm (SMS-SNT or SMS-SNP), or an SMS with a gain-framed or loss-framed message (SMS-GF and SMS-LF). The primary outcome was participation at 18 weeks. In Study 1 participation was significantly higher in the SMS-PCP arm (31.4%) compared to control (26.4%, aOR, 1.29, 95%CI: 1.09-1·51; p = 0.002). In Study 2 participation was highest in the SMS-PCP (38.4%) and SMS (38.1%) arms compared to control (34.4%), (aOR: 1.19, 95%CI: 1.03-1.38; p = 0.02 and aOR: 1.18, 95%CI: 1.02-1.37; p = 0.03, respectively). The results demonstrate that behavioral SMSs improve cervical screening participation. The message content plays an important role in the impact of SMS. The results from this trial have already been used to designing effective policy for cervical cancer screening. The NHS Cervical Screening Programme started running a London-wide screening SMS campaign which was based on the cervical screening trial described here. According to figures published by Public Health England, after six months attendance increased by 4.8%, which is the equivalent of 13,400 more women being screened at 18 weeks.

Journal article

Judah G, Cunningham D, Johnson M-C, Olander Eet al., 2020, Individualised physical activity and physiotherapy behaviour change intervention tool for breast cancer survivors using self-efficacy and COM-B: feasibility study., European Journal of Physiotherapy, ISSN: 2167-9169

ObjectiveBreast cancer survivors who are physically active have lower recurrence and allcause mortality. Breast cancer survivors often struggle to initiate and maintainphysically active lifestyles. Barriers include psychosocial, environmental, andmusculoskeletal factors. An individualised physical activity intervention, informed byphysiotherapy and behaviour change principles, may comprehensively addressthese barriers. This study tests the feasibility of this intervention.MethodsFollowing ethical approval and informed consent, stage I and II breast cancersurvivors within 18 months of diagnosis were recruited from a secondary care NHSbreast cancer unit. The intervention used tools combining musculoskeletaldysfunction, self-efficacy measurement and the COM-B model to allow personaltailoring of intervention techniques. The feasibility of recruitment, retention,acceptability and practicality of delivery of the physical activity intervention wastested using a single arm study.ResultsNine of 36 (25%) potential participants were recruited. Seven (77%) were retained tothe study end. All participants reported that the intervention was acceptable. Eightwould recommend the intervention and reported that their physical activity levelincreased due to the intervention. The intervention was practical to deliver withinroutine physiotherapy appointments.ConclusionsThis small feasibility study has promising findings and will now need to be tested withmore participants.

Journal article

Judah G, Mullan B, Yee M, Johansson L, Allom V, Liddelow Cet al., 2020, A habit-based randomised controlled trial to reduce sugar-sweetened beverage consumption: the impact of the substituted beverage on behaviour and habit strength, International Journal of Behavioral Medicine, Vol: 27, Pages: 623-635, ISSN: 1070-5503

BackgroundExcess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention–based intervention.MethodAn online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months.ResultsThere was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit.ConclusionThis study demonstrates that an implementation intention–based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Journal article

Markiewicz O, Lavelle M, Lorencatto F, Judah G, Ashrafian H, Darzi Aet al., 2020, Threats to safe transitions from hospital to home: a consensus study in North West London primary care, British Journal of General Practice, Vol: 70, Pages: e9-e19, ISSN: 0960-1643

Background Transitions between healthcare settings are vulnerable points for patients.Aim To identify key threats to safe patient transitions from hospital to primary care settings.Design and setting Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.Method Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1–3: ‘not important’, 4–6: ‘somewhat important’, 7–9: ‘very important’). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%.Results A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. ‘Poor quality of handover instructions from secondary to primary care teams’ achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a ‘very important’ threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.Conclusion This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.

Journal article

Johnson M-C, Judah G, Cunningham D, Olander Eet al., 2019, Feasibility study - individual physical activity behaviour change intervention for breast cancer survivors within the NHS, Publisher: Elsevier BV, Pages: e74-e75, ISSN: 0031-9406

Conference paper

Judah G, Gardner B, Kenward MG, DeStavola B, Aunger Ret al., 2018, Exploratory study of the impact of perceived reward on habit formation, BMC Psychology, Vol: 6, Pages: 62-62, ISSN: 2050-7283

BACKGROUND: Habits (learned automatic responses to contextual cues) are considered important in sustaining health behaviour change. While habit formation is promoted by repeating behaviour in a stable context, little is known about what other variables may contribute, and whether there are variables which may accelerate the habit formation process. The aim of this study was to explore variables relating to the perceived reward value of behaviour - pleasure, perceived utility, perceived benefits, and intrinsic motivation. The paper tests whether reward has an impact on habit formation which is mediated by behavioural repetition, and whether reward moderates the relationship between repetition and habit formation. METHODS: Habit formation for flossing and vitamin C tablet adherence was investigated in the general public following an intervention, using a longitudinal, single-group design. Of a total sample of 118 participants, 80 received an online vitamin C intervention at baseline, and all 118 received a face-to-face flossing intervention four weeks later. Behaviour, habit, intention, context stability (whether the behaviour was conducted in the same place and point in routine every time), and reward variables were self-reported every four weeks, for sixteen weeks. Structured equation modelling was used to model reward-related variables as predictors of intention, repetition, and habit, and as moderators of the repetition-habit relationship. RESULTS: Habit strength and behaviour increased for both target behaviours. Intrinsic motivation and pleasure moderated the relationship between behavioural repetition and habit. Neither perceived utility nor perceived benefits predicted behaviour nor interacted with repetition. Limited support was obtained for the mediation hypothesis. Strong intentions unexpectedly weakened the repetition-habit relationship. Context stability mediated and for vitamin C, also moderated the repetition-habit relationship. CONCLUSIONS: Pleasure an

Journal article

Judah G, Darzi A, Vlaev I, Gunn L, King D, King D, Valabhji J, Bicknell Cet al., 2018, Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial, British Journal of Ophthalmology, Vol: 102, Pages: 1014-1020, ISSN: 0007-1161

OBJECTIVE: Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. METHODS AND ANALYSIS: A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. RESULTS: 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. CONCLUSION: Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

Journal article

Bodansky D, Oskrochi Y, Judah G, Lewis M, Fischer B, Narayan Bet al., 2017, Change the habit to change the practice: Do audits really ever change anything?, Injury, Vol: 48, Pages: 1999-2002, ISSN: 0020-1383

IntroductionMethicillin resistant staphylococcus aureus (MRSA) eradication by nurses and pre-op induction antibiotics are mandated for emergency surgery, where true status is unknown. We assessed adherence to local MRSA guidelines for patients undergoing emergency hip fracture surgery and employed point of decision prompts to influence clinicians’ behaviour.MethodsWe undertook a retrospective record review for all patients undergoing emergency hip fracture surgery at a UK major trauma centre over 3-months. Demographics, MRSA eradication therapy and antibiotics were recorded. Admission-to-MRSA swab result time was compared to the admit-to-operation time. Posters on induction antibiotics were placed in anaesthetic rooms, stickers on MRSA eradication therapy on nursing care bundles and standards re-audited after 6 months.ResultsThe case-mix was similar in both audit cycles: initial audit (n = 69, mean age 76.9, range 33–94), re-audit (n = 77, mean age 73.8, range 18–95). There was a small rise in adherence to eradication therapy prescription (1% vs 8%) after sticker distribution, although compliance was poor pre and post intervention. Correct antibiotic choice for MRSA unknown patients (18% vs 94%) improved significantly after poster intervention. Operations occurred at a median of 24.05 h (Q1 17.6, Q3 32.3) from admission but MRSA swab results returned at a median of 48 h (Q1 41.5, Q3 59.5) p = <0.0001.ConclusionProviding reminders at the points where decisions are to be made are effective. Audit interventions should be easily undertaken and will become habitual if connected in sequence to old behaviours.

Journal article

Judah G, de Witt Huberts J, Drassal A, Aunger Ret al., 2017, The development and validation of a Real Time Location System to reliably monitor everyday activities in natural contexts, PLoS ONE, Vol: 12, ISSN: 1932-6203

IntroductionThe accurate measurement of behaviour is vitally important to many disciplines and practitioners of various kinds. While different methods have been used (such as observation, diaries, questionnaire), none are able to accurately monitor behaviour over the long term in thenatural context of people’s own lives. The aim of this work was therefore to develop and testa reliable system for unobtrusively monitoring various behaviours of multiple individualswithin the same household over a period of several months.MethodsA commercial Real Time Location System was adapted to meet these requirements andsubsequently validated in three households by monitoring various bathroom behaviours.ResultsThe results indicate that the system is robust, can monitor behaviours over the long-term indifferent households and can reliably distinguish between individuals. Precision rates werehigh and consistent. Recall rates were less consistent across households and behaviours,although recall rates improved considerably with practice at set-up of the system. Theachieved precision and recall rates were comparable to the rates observed in more controlled environments using more valid methods of ground truthing.ConclusionThese initial findings indicate that the system is a valuable, flexible and robust system formonitoring behaviour in its natural environment that would allow new research questions tobe addressed.

Journal article

Gardner B, Phillips A, Judah GD, 2016, Habitual instigation and habitual execution: definition, measurement, and effects on behaviour frequency, British Journal of Health Psychology, Vol: 21, Pages: 613-630, ISSN: 1359-107X

Objectives‘Habit’ is a process whereby situational cues generate behaviour automatically, via activation of learned cue–behaviour associations. This article presents a conceptual and empirical rationale for distinguishing between two manifestations of habit in health behaviour, triggering selection and initiation of an action (‘habitual instigation’), or automating progression through subactions required to complete action (‘habitual execution’). We propose that habitual instigation accounts for habit–action relationships, and is the manifestation captured by the Self-Report Habit Index (SRHI), the dominant measure in health psychology.DesignConceptual analysis and prospective survey.MethodsStudent participants (N = 229) completed measures of intentions, the original, non-specific SRHI, an instigation-specific SRHI variant, an execution-specific variant, and, 1 week later, behaviour, in three health domains (flossing, snacking, and breakfast consumption). Effects of habitual instigation and execution on behaviour were modelled using regression analyses, with simple slope analysis to test habit–intention interactions. Relationships between instigation, execution, and non-specific SRHI variants were assessed via correlations and factor analyses.ResultsThe instigation-SRHI was uniformly more predictive of behaviour frequency than the execution-SRHI and corresponded more closely with the original SRHI in correlation and factor analyses.ConclusionsFurther, experimental work is needed to separate the impact of the two habit manifestations more rigorously. Nonetheless, findings qualify calls for habit-based interventions by suggesting that behaviour maintenance may be better served by habitual instigation and that disrupting habitual behaviour may depend on overriding habits of instigation. Greater precision of measurement may help to minimize confusion between habitual instigation and execution.

Journal article

Judah G, Vlaev I, Gunn L, King D, King D, Valabhji J, Darzi A, Bicknell Cet al., 2016, Incentives in Diabetic Eye Assessment by Screening (IDEAS): study protocol of a three-arm randomized controlled trial using financial incentives to increase screening uptake in London., BMC Ophthalmology, Vol: 16, ISSN: 1471-2415

BACKGROUND: Diabetes is an increasing public health problem in the UK and globally. Diabetic retinopathy is a microvascular complication of diabetes, and is one of the leading causes of blindness in the UK working age population. The diabetic eye screening programme in England aims to invite all people with diabetes aged 12 or over for retinal photography to screen for the presence of diabetic retinopathy. However, attendance rates are only 81 %, leaving many people at risk of preventable sight loss. METHODS: This is a three arm randomized controlled trial to investigate the impact of different types of financial incentives (based on principles from behavioral economics) on increasing attendance at diabetic eye screening appointments in London. Eligible participants will be aged 16 or over, and are those who have been invited to screening appointments annually, but who have not attended, or telephoned to rearrange an appointment, within the last 24 months. Eligible participants will be randomized to one of three conditions: 1. Control condition (usual invitation letter) 2. Fixed incentive condition (usual invitation letter, including a voucher for £10 if they attend their appointment) 3. Probabilistic incentive condition (invitation letter, including a voucher for a 1 in 100 chance of winning £1000 if they attend their appointment). Participants will be sent invitation letters, and the primary outcome will be whether or not they attend their appointment. One thousand participants will be included in total, randomized with a ratio of 1.4:1:1. In order to test whether the incentive scheme has a differential impact on patients from different demographic or socio-economic groups, information will be recorded on age, gender, distance from screening center, socio-economic status and length of time since they were last screened. A cost-effectiveness analysis will also be performed. DISCUSSION: This study will be the first trial of financial incentives

Journal article

Judah G, Gardner B, Aunger R, 2013, Forming a flossing habit: An exploratory study of the psychological determinants of habit formation, BRITISH JOURNAL OF HEALTH PSYCHOLOGY, Vol: 18, Pages: 338-353, ISSN: 1359-107X

Journal article

Fleischman DS, Webster GD, Judah G, de Barra M, Aunger R, Curtis VAet al., 2011, Sensor recorded changes in rates of hand washing with soap in response to the media reports of the H1N1 pandemic in Britain, BMJ Open, Vol: 1, Pages: 1-7, ISSN: 2044-6055

Objectives To examine how the frequency of information regarding a real disease threat influences hand washing with soap.Design and setting The authors installed wireless devices in highway service station lavatories in England to record the proportion of individuals washing hands with soap from May 2009 to January 2010.Participants Participants were users of men's and women's toilets. Combined there was an average of 6800 participant entrances into the lavatories daily.Primary outcome measure The primary outcome measure is the proportion of soap usage to the number of entries into the lavatories.Results Hand-washing rates were positively related to both H1NI coverage in blogs and the news; however, these relationships were stronger for men than for women.Conclusions Hand washing with soap increases proportionally to the frequency of media key words related to H1N1. Women's hand washing was more strongly associated with incidence of media keywords than men's.

Journal article

Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt W-Pet al., 2011, The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands, International Journal of Environmental Research and Public Health, Vol: 8, Pages: 97-104, ISSN: 1660-4601

Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases.

Journal article

Judah G, Donachie P, Cobb E, Schmidt W, Holland M, Curtis Vet al., 2010, Dirty hands: bacteria of faecal origin on commuters' hands, EPIDEMIOLOGY AND INFECTION, Vol: 138, Pages: 409-414, ISSN: 0950-2688

Journal article

Judah G, Aunger R, Schmidt W-P, Michie S, Granger S, Curtis Vet al., 2009, Experimental Pretesting of Hand-Washing Interventions in a Natural Setting, AMERICAN JOURNAL OF PUBLIC HEALTH, Vol: 99, Pages: S405-S411, ISSN: 0090-0036

Journal article

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Stevenson A, Darzi Aet al., Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study (Preprint)

<sec> <title>BACKGROUND</title> <p>The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England.</p> </sec> <sec> <title>METHODS</title> <p>This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important

Journal article

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