Imperial College London

Dr Gaby Judah

Faculty of MedicineDepartment of Surgery & Cancer

Non-Clinical Lecturer in Behavioural Sciences
 
 
 
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g.judah

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

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Summary

 

Publications

Publication Type
Year
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40 results found

Almukhtar A, Batcup C, Bowman M, Winter Beatty J, Leff D, Demirel P, Porat T, Judah Get al., 2024, Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework, International Journal of Surgery, Vol: 110, Pages: 554-568, ISSN: 1743-9159

Background:The health sector contributes significantly to the climate crisis. Operating theatres in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. We systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in operating theatres, categorising these using the TheoreticalDomains Framework (TDF).Method:Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000- June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants weremapped to TDF domains and further themes as required.Findings:Twenty-one studies were selected for analysis and assessment (seventeen surveys and four interview studies) comprising 8286 participants, including surgeons, nurses and anaesthetists. Eighteen themes across ten TDF domains were identified. The mostcommon barriers to adoption of green behaviours in operating theatres were in domains of: ‘knowledge’ (N=18) e.g. knowledge of sustainable practices;‘environmental context and resources’ (N=16) e.g.‘personnel shortage and workload and inadequate recycling facilities; ‘social influences’ (N=9) e.g. lack ofleadership/organisational mandate or support; ‘beliefs about consequences’ (N=9) e.g. concerns regarding safety. Intention was the most common facilitator, with eleven studies citing it.Discussion:Despite intentions to adopt sustainable practices in operating theatres, this review identifies several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, inst

Journal article

Hine J, Fleming L, Judah G, Bush A, Desimoni A, Griffiths Cet al., 2023, M17 PATIENT ENGAGEMENT WITH ADHERENCE TECHNOLOGY: LEARNINGS FROM THE ‘FINANCIAL INCENTIVES TO IMPROVE ASTHMA’ (FINA) STUDY, Pages: A269-A270, ISSN: 0040-6376

Background Digital interventions are acceptable and often effective for improving short-term medication adherence for children and young people (CYP) with asthma. Interventions using electronic monitoring devices (EMDs) can be supported by behaviour change techniques such as reminders and financial incentives. Most digital interventions require patient engagement; however, it is important to understand how patients engage to maximise effectiveness. As part of the feasibility assessment of the FINA study, a pilot RCT of a digital financial incentives intervention, patient engagement with EMDs and smartphone app was explored. Methods During the FINA study, CYP (aged 11–17 years old) with asthma monitored their adherence for 24-weeks using an EMD. Participants randomised to financial incentives intervention viewed their adherence (table and bar-graph) and their reward progress (totaliser, traffic-light calendar, and weekly notifications) through a smartphone app. Financial reward was delivered regularly (at 4-, 8- and 12-weeks) and relied upon real-time data; participants were advised to sync their EMD and app daily. Control group viewed their sensor syncing history only and were advised to sync their EMD and app weekly. All participants were requested to promptly report any problems to the research team. Patient engagement was explored using syncing data, technical issue reporting and research team involvement. Results 32 participants are enrolled in on-going trial (intervention, n=16); 84% have completed first 12-weeks. Technical problems were experienced by 13/16 intervention and 8/16 control participants; 12 of whom did not report these until research visit 2 (12-weeks, post-intervention). 7/16 intervention participants did not sync their EMD and app as advised and were reminded by research team at least once ahead of reward delivery; 1 participant only synced once throughout intervention. 14/16 control participants did not sync weekly. Discussion Limited pat

Conference paper

Acharya A, Darzi A, Judah G, 2023, An SMS and animated video intervention to increase uptake of breast cancer screening: a randomised controlled trial., Lancet, Vol: 402 Suppl 1

BACKGROUND: Breast cancer screening attendance in the UK has fallen, and London has the lowest uptake nationally. This study tested the impact of a behavioural science-informed reminder SMS, and animated video intervention on screening uptake. METHODS: This three-armed randomised controlled trial took place in two screening services in London (each service operated across a range of static sites such as hospitals, and mobile sites). We included participants who were registered with GP as female, aged 50-70 years, and not screened in the past 3 years. We excluded those who had opted out of screening messages or were in care. Participants were assigned into three groups via the final two digits of their NHS number (ratio 34:33:33): control group (received usual care reminder), behavSMS group (behavioural science-informed SMS reminder addressing reducing negative emotions and information on health consequences), or behavSMS+video group (behavioural SMS plus link to animation). Researchers were masked to allocation. The SMS and video were co-designed with stakeholders using the Behaviour Change Wheel. Invitation processes changed during the COVID-19 pandemic, and therefore, we did separate analyses for those receiving a timed appointment (n=9027), and an open invitation to book an appointment (n=25 020). Messages were sent 7 days and 1 day before the appointment, plus 7 days after the open invitation letter. Group differences in the primary outcome of attendance within 3 months of invitation (and secondary outcome of booking for open invites) were assessed using χ2, and logistic regression controlling for age, ethnicity, deprivation, and first invitation. This trial is registered with ClinicalTrials.gov, NCT05395871. FINDINGS: Recruitment took place between July 18, and Oct 21, 2022. For timed invitations, 3094 participants were assigned to the control group, 2952 to the behavSMS group, and 2981 to the behavSMS+video group. For open invitations groups sizes were 865

Journal article

Markiewicz O, Lorencatto F, D'Lima D, Sanford N, Lavelle M, Acharya A, Anderson J, Darzi A, Judah Get al., 2023, Improving the quality of written communication at patient discharge: triangulation of qualitative analyses and intervention co-design., Lancet, Vol: 402 Suppl 1

BACKGROUND: Poor handovers between hospital and primary care threaten safe discharges, with elderly and frail patients most at risk of harm. Using Behavioural Science we explored influences and identified relevant behaviour change techniques (BCTs) to improve written handovers and safety during discharge. METHODS: We conducted two qualitative studies: (1) ethnographic observations (>80 h) collected by five researchers in five purposively sampled clinical areas of a London teaching hospital, investigating routine work and interactions of hospital staff involved in discharges; and (2) 12 semi-structured interviews with hospital staff involved in discharge exploring influences on preparations of written handovers. Written consent was sought from clinical leads for ethnographic observations and from interview participants. Ethnographic fieldnotes and interview transcripts were thematically analysed using inductive and deductive approaches, respectively. Study findings were triangulated to identify key influences, mapped onto the Theoretical Domains Framework (TDF). We identified appropriate BCTs to address observed influences within each TDF domain using the Theory and Techniques Tool. Health-care workers (n=15), patients (n=2) and carers (n=2) selected and designed an intervention to improve written handovers in two workshops. Hospital workshop participants were involved with preparing written discharge handovers. Public participants had either recently been discharged from hospital or cared for someone recently discharged, including patients from groups especially vulnerable during discharge. FINDINGS: Triangulation of study findings generated 11 key influences on preparations of written handovers within five TDF domains: knowledge (eg, lack of awareness of guidelines), skills (staff experience), social or professional role and identity (effective communication), environmental context and resources (working patterns), and social influences (lack of feedback). 14 BC

Journal article

Fleming L, Hine J, Bush A, Judah G, Di Simoni A, Griffiths C, Lee Bet al., 2023, Patient financial incentives to improve asthma management: a systematic review, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055

Objectives The objectives of this systematic review are to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma.Design Systematic review with narrative synthesis.Data sources Electronic databases (MEDLINE, Embase, Global Health, PsycINFO, CINAHL, PubMed and Web of Science) and grey literature sources (NHS Digital, CORE, ProQuest, Clinical Trials Register and EU Clinical Trials Register) were searched in November 2021 and updated March 2023.Eligiblity criteria Eligible articles assessed financial incentives to improve asthma management behaviours (attendance at appointments, medication adherence, tobacco smoke/allergen exposure, inhaler technique and asthma education) for patients with asthma or parents/guardians of children with asthma. Eligible study design included randomised controlled, controlled or quasi-randomised trials and retrospective/prospective cohort, case-controlled or pilot/feasibility studies.Synthesis A narrative synthesis was conducted; eligible studies were grouped by asthma management behaviours and financial incentive framework domains.Results We identified 4268 articles; 8 met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1). Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Five studies demonstrated positive behaviour change, four of which were significant (attendance at appointments (n=3) showed significant differences between intervention and control: 73% and 49% in one study, 46.3% and 28.9% in another, and 35.7% and 18.9%, respectively; medication adherence (n=1) showed significant change from 80% during intervention to 33% post intervention). These four

Journal article

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Harris M, Stevenson A, Darzi Aet al., 2023, Investigating the national implementation of SMS and mobile messaging In Population Screening (The SIPS Study), EBioMedicine, Vol: 93, Pages: 1-11, ISSN: 2352-3964

BackgroundThe increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake.MethodsInitial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed ‘core’ recommendations. Those reaching this threshold on importance only, were labelled ‘desirable’. All items were subsequently discussed at an expert meeting to confirm suitability. FindingsOf the initial 101 items, 23 reached consensus regarding importance and feasibility. These ‘core’ items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. ‘Core’ items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 ‘desirable’ items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification.InterpretationThese findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow.FundingNIHR Imperial Patient Safety Translation

Journal article

Judah G, Gardner B, Picariello F, Mohideen A, Bouvin Cet al., 2023, Feasibility and acceptability of a personalised script-elicitation method for improving evening sleep hygiene habits, Health Psychology and Behavioral Medicine, Vol: 11, Pages: 1-16, ISSN: 2164-2850

BackgroundAttempts to improve evening sleep hygiene have overlooked that sleep preparation behaviours are often undertaken automatically with little awareness; that is, habitually. This mixed-methods study assessed aspects of the feasibility and acceptability of a novel behavioural intervention procedure (‘script elicitation’), which encourages reflection on and reorganisation of the content and sequencing of habitual evening pre-sleep routines.MethodsThe study was advertised via social media, and circular lists at a UK university. Twenty-four UK-based adults, reporting <6 h/night sleep, were recruited. At baseline, they completed sleep hygiene and quality measures, then participated in an online, one-to-one script elicitation interview. This involved the interviewer working with the participant to generate a fine-grained description of the content, organisation and variability of their typical pre-sleep routine, and plan a more sleep-conducive alternative routine to follow over the next week. One week later, participants completed sleep quality and hygiene measures, and a semi-structured interview about the intervention. Feasibility was assessed using quantitative data on response rates and attrition, and acceptability via sleep hygiene and quality scores, and qualitative data on intervention experiences.ResultsAll criteria were met. The target response rate was exceeded, none of the 24 participants dropped out, and sleep hygiene and quality scores either improved or remained stable. In interviews, all participants reported finding script elicitation useful. Script elicitation raised participants’ awareness of habitual sleep hygiene routines, which gave many a newfound sense of autonomy over changing their sleep hygiene habits. While the habitual nature of existing routines obstructed change for some participants, most reported successfully changing aspects of their routine, and achieving behaviour, sleep and wellbeing improvements.DiscussionSc

Journal article

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Harris M, Stevenson A, Darzi Aet al., 2022, Investigating the implementation of mobile messaging in population screening programmes: a modified Delphi study, LANCET, Vol: 400, Pages: 15-15, ISSN: 0140-6736

Journal article

Judah G, Wingfield D, Dryden S, Sun Q, Chang M, Mackay J, Sever Pet al., 2022, Adherence to antihypertensive drugs: measuring self-reported and objective levels of adherence and reasons for non-adherence in UK patients with hypertension, Publisher: SPRINGERNATURE, Pages: 7-7, ISSN: 0950-9240

Conference paper

Acharya A, Ashrafian H, Cunnignham D, Ruwende J, Darzi A, Judah Get al., 2022, Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial, BMC Public Health, Vol: 22, ISSN: 1471-2458

BackgroundBreast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques. MethodsA 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals’ healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall. DiscussionIn addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and t

Journal article

Acharya A, Ashrafian H, Cunnigham D, Ruwende J, Darzi A, Judah Get al., 2022, Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial, BMC Public Health, ISSN: 1471-2458

Journal article

Judah G, Faisal D, Ara D, Huf Set al., 2022, A population survey on beliefs around cervical cancer screening: determining the barriers and facilitators associated with attendance, BMC Cancer, Vol: 22, ISSN: 1471-2407

Background:Cervical screening saves approximately 5000 lives annually in England. However, screening rates have been falling continuously, and coverage in London is particularly low (64.7%). While demographic predictors of uptake have been well researched, there has been less thorough investigation of the individual barriers and facilitators which predict cervical screening attendance. Understanding modifiable factors influencing attendance can guide the design of effective interventions to increase cervical screening uptake. The aim of this study was to understand the demographic, and individual factors associated with self-reported attendance at cervical screening in London.Methods:The study used an online survey of 500 women in London (June-July 2017). The survey included self-reported measures of past attendance, demographic variables (including age, household income, ethnicity), past experience variables, and individual variables (list of potential barriers and facilitators developed based on the Theoretical Domains Framework and existing literature, which included: environmental context and resources, perceived risk, anticipated pain/embarrassment). Participants were categorised into regular attenders and non-regular attenders. Backwards stepwise logistic regression investigated the barriers and facilitators predicting past attendance. Demographic variables with significant differences between regular and non-regular attenders were added to the final regression model.Results:Of women who had previously been invited (n = 461, age range: 25–65), 34.5% (n = 159) were classified as non-regular attenders, and 65.5% (n = 302) as regular attenders. The individual barriers and facilitators predicting attendance were: cervical screening priority, memory, environmental context and resources, and intention. The only demographic variables related to regular attendance were relationship status (married/civil partnership havin

Journal article

Rahman M, Judah G, Murphy D, Garfield SFet al., 2022, Which domains of the theoretical domains framework should be targeted in interventions to increase adherence to antihypertensives? A systematic review, Journal of Hypertension, Vol: 40, Pages: 853-859, ISSN: 0263-6352

<jats:sec> <jats:title /> <jats:p>Nonadherence to antihypertensives is prevalent and is associated with poorer health outcomes. This study aimed to identify psychological factors associated with adherence in patients taking antihypertensives as these are potentially modifiable, and can, therefore, inform the development of effective interventions to increase adherence. PubMed, EMBASE and PsychINFO were searched to identify studies that tested for significant associations between psychological domains and adherence to antihypertensives. The domains reported were categorized according to the Theoretical Domains Framework. The quality of included studies was evaluated using the National Institute for Clinical Excellence critical appraisal of questionnaire checklist. Thirty-one studies were included. Concerns about medicines (a subdomain of ‘beliefs about consequences’) and ‘beliefs about capabilities’ consistently showed association with adherence in over five studies. Healthcare professionals should actively ask patients if they have any concerns about their antihypertensives and their belief in their ability to control their blood pressure through taking antihypertensives.</jats:p> </jats:sec>

Journal article

Brazier A, Larson E, Xu Y, Judah G, Egan M, Burd H, Darzi Aet al., 2022, ‘Dear Doctor’: a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists, Anaesthesia, Vol: 77, Pages: 405-415, 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

Judah G, Cunningham D, Johnson M-C, Olander Eet al., 2022, 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, Vol: 24, Pages: 119-128, 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

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

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

Brazier A, Larson E, Frerichs J, Milward J, Judah G, Darzi Aet al., 2021, "Dear Doctor" text message intervention to reduce burnout in trainee anaesthetists: an interview study, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 26-26, ISSN: 0140-6736

Conference paper

Brazier A, Larson E, Xu Y, Judah G, Egan M, Burd H, Darzi Aet al., 2021, "Dear Doctor" text message intervention to reduce burnout in trainee anaesthetists: a randomised controlled trial, LANCET, Vol: 398, Pages: 1-1, ISSN: 0140-6736

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

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 (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

Garfield S, Judah G, 2021, Learning from successes: designing medication adherence intervention research so that we can learn what works and why, BMJ Quality & Safety, Vol: 31, Pages: 83-85, ISSN: 2044-5415

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, 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

Huf S, King D, Kerrison R, Chadborn T, Richmond A, Cunningham D, Friedman E, Shukla H, Tseng F-M, Judah G, Vlaev I, Darzi Aet al., 2017, Behavioural text message reminders to improve participation in cervical screening: a randomised controlled trial, Public Health Science Conference, Publisher: ELSEVIER SCIENCE INC, Pages: S46-S46, ISSN: 0140-6736

Conference paper

Huf S, King D, Judah G, Fuller C, Vlaev I, Cunningham D, Darzi Aet al., 2017, Behavioural text message reminders to improve participation in breast screening: a randomised controlled trial, Public Health Science Conference, Publisher: ELSEVIER SCIENCE INC, Pages: S45-S45, ISSN: 0140-6736

Conference paper

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