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![(a) Kernel density plot of repeat assessment participants by baseline BMI (BMI = 25 cut‐off); (b) Kernel density plot of repeat assessment participants by baseline BMI (BMI = 30 cut‐off) [Colour figure can be viewed at wileyonlinelibrary.com]](publication/327920800/figure/fig2/AS:11431281174596661@1689269414945/a-Kernel-density-plot-of-repeat-assessment-participants-by-baseline-BMI-BMI25.png)
(a) Kernel density plot of repeat assessment participants by baseline BMI (BMI = 25 cut‐off); (b) Kernel density plot of repeat assessment participants by baseline BMI (BMI = 30 cut‐off) [Colour figure can be viewed at wileyonlinelibrary.com]
Source publication
Using a regression‐discontinuity approach on a U.K. longitudinal dataset, this research analyses whether personalised weight feedback resulted in individuals losing weight over a period of between 2 and 7 years. The analysis presented here finds that being told one was “overweight” had, on average, no effect on subsequent weight loss; however, bein...
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Citations
... Population-based screening is typically a "light touch" intervention, in which individuals are informed of their hypertension status and encouraged to consult a physician for treatment. However, the available evidence has shown mixed results regarding the effect of simply communicating a new diagnosis on medium-term behavioral changes and health improvements, both in the case of hypertension [4][5][6][7][8][9] and other diseases [10][11][12][13][14][15][16][17][18]. Studies in China and South Africa found that hypertension screening and counseling reduced BP and improved lifestyle outcomes at 2 years [4][5][6][7]. ...
... Our paper adds to the literature investigating the effect of receiving a disease diagnosis on health behavior and health outcomes. Existing evidence has shown that receiving a type 2 diabetes diagnosis [10][11][12][13], an overweight diagnosis [13,[15][16][17], an HIV diagnosis [18], or a high cholesterol diagnosis [14] led to mostly modest changes in the relevant health behavior. These effects occurred typically in the short period after the diagnosis but subsequently faded away completely. ...
... These effects occurred typically in the short period after the diagnosis but subsequently faded away completely. The majority of these studies used experimental [17] or quasi-experimental methodologies, like RD [12,13,15,16] or instrumental variable (IV) estimation, [18] and thus allowed the identification of a causal effect of diagnosis. As reported by Kim and colleagues [13], one of the reasons why these studies did not find any sustained causal effect of the screening on behavior is that a simple diagnosis might not be effective if it is not combined with further more salient interventions. ...
Background
Hypertension represents one of the major risk factors for cardiovascular morbidity and mortality globally. Early detection and treatment of this condition is vital to prevent complications. However, hypertension often goes undetected, and even if detected, not every patient receives adequate treatment. Identifying simple and effective interventions is therefore crucial to fight this problem and allow more patients to receive the treatment they need. Therefore, we aim at investigating the impact of a population-based blood pressure (BP) screening and the subsequent “low-threshold” information treatment on long-term cardiovascular disease (CVD) morbidity and mortality.
Methods and findings
We examined the impact of a BP screening embedded in a population-based cohort study in Germany and subsequent personalized “light touch” information treatment, including a hypertension diagnosis and a recommendation to seek medical attention. We pooled four waves of the KORA study, carried out between 1984 and 1996 ( N = 14,592). Using a sharp multivariate regression discontinuity (RD) design, we estimated the impact of the information treatment on CVD mortality and morbidity over 16.9 years. Additionally, we investigated potential intermediate outcomes, such as hypertension awareness, BP, and behavior after 7 years.
No evidence of effect of BP screening was observed on CVD mortality (hazard ratio (HR) = 1.172 [95% confidence interval (CI): 0.725, 1.896]) or on any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]) for individuals just above (versus below) the threshold for hypertension. Stratification for previous self-reported diagnosis of hypertension at baseline did not reveal any differential effect. The intermediate outcomes, including awareness of hypertension, were also unaffected by the information treatment. However, these results should be interpreted with caution since the analysis might not be sufficiently powered to detect a potential intervention effect.
Conclusions
The study does not provide evidence of an effect of the assessed BP screening and subsequent information treatment on BP and behavior, but also on long-term CVD mortality and morbidity. Future studies should consider larger datasets to detect possible effects and a shorter follow-up for the intermediate outcomes (i.e., BP and behavior) to detect short-, medium-, and long-term effects of the intervention along the causal pathway.
... Zhao et al. (2013), for example, find that people who receive a hypertension diagnosis can effectively reduce fat intake. In contrast, other researchers find that people are reluctant to make such behavior changes (Bennett et al., 2015;Cook, 2018;Hut & Oster, 2020;Oster, 2018;Roosen et al., 2009). In an effort to probe how information exposure could lead to behavior change or not, both strands of the literature find large heterogeneity in responsiveness to such exposure. ...
This paper explores how a diagnosis of hypertension might affect a person's health-related behaviors. The analysis uses a two-dimensional regression discontinuity design because hypertension is diagnosed when a person's systolic or diastolic blood pressure (SBP or DBP) surpasses a pre-established threshold. We find that those closely above the SBP threshold significantly adjusted their lifestyle, such as reducing daily fat intake and quitting smoking, while those just surpassing the DBP cutoff did not. Further mechanism analysis suggests that the possibility of constraints, rather than education and income gradients, does more to explain the disparate behaviors of subjects near the SBP and DBP thresholds. Those around the DBP threshold generally have tighter work schedules and undertake more competitive jobs, which hinder them from improving their lifestyle. Overall, our findings complement the existing literature by posing a new perspective for understanding people's potential reluctance to adjust their behavior.
... Comparable with findings in wider digital health literature, patients also highlighted how technologies should provide individualized feedback and reviews on post-operative progress.[40] Personalization of feedback has previously been associated with positive health behaviour change and increased patient engagement with care.[41][42][43] One participant suggested connecting the technologies to health system identifiers, such as an individuals' NHS number, to support the delivery of personalized care.In-line with current research, perspectives of becoming 'digitally engaged patients' were discussed by many of the participants.[44] ...
A patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. Research has focused on implementing digital technologies and measuring their effectiveness in various surgical cohorts, yet there is limited work concerning the desires, suggestions and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patient perspectives on technology features that would support them to change their lifestyle behaviours during the pre- and post-operative periods, to potentially maintain long-term healthy lifestyles following surgery.
... Comparable with findings in wider digital health literature, the patients in this study also highlighted the benefits of functionalities that offer support on an individualized basis, such as enabling the provision of individualized feedback and personalized reviews on postoperative progress [57]. Personalization of feedback has previously been associated with positive health behavior changes and increased patient engagement with care [58][59][60]. A participant suggested connecting technologies to health system identifiers, such as an individual's NHS number, to support the delivery of personalized care. ...
Background:
A patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery.
Objective:
This study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey.
Methods:
Patients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority.
Results:
A total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study.
Conclusions:
Perceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies.
... (38) Personalisation of feedback has previously been associated with positive health behaviour change and increased patient engagement with care. (39)(40)(41) One participant suggested connecting the technologies to health system identi ers, such as an individuals' NHS number, to support the delivery of personalised care. Numerous participants referred to the surgical journey as a process, suggesting that it may bene t from technology-enabled checklists to create an engaged 'package of care' between patients and clinicians; a novel nding from this research. ...
Background
A patient’s capability, motivation, and opportunity to change their lifestyle are significant determinants of successful outcomes following bariatric surgery. Healthier lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been shown to contribute to greater post-surgical weight loss and improved long-term health. Integrating patient-centred digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviours and provide holistic patient support, to improve surgical success. This study explores the desires, suggestions, and reflections of perioperative patients in the context of integrating digital technologies within the surgical pathway.
Methods
Patients attending bariatric surgery clinics within one hospital in the North of England were invited to take part in the study. Semi-structured interviews were conducted with pre- and post-operative patients to discuss lifestyle behaviour change and perspectives of using digital technologies to complement current care. Interviews were audio-recorded and transcribed verbatim. Thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the NHS Health Research Authority.
Results
Eighteen patients were interviewed. Four overarching themes were identified relating to patient perspectives of optimised technology functionality to: 1) provide tailored content and support, 2) facilitate self-monitoring and goal-setting, 3) deliver information in an accessible, trusted, and usable manner, and 4) meet patient information-seeking and engagement needs.
Conclusions
We make recommendations to address the unmet needs of this patient cohort. These findings have the potential to influence the design of person-centred, perioperative technologies.
... In light of recent successful interventions elsewhere that provided this feedback more directly to individual prescribers in formats informed by behavioural science, we adopted the same social norm feedback approach used in England for use in Northern Ireland and evaluated the effect size and duration using regression discontinuity (RD) design, which has comparable robustness to a randomised trial, and is suited to interventions delivered on the basis of a threshold value. [21][22][23][24] ...
Background
Reducing antibiotic prescribing is a priority for health authorities responsible for preventing antimicrobial resistance. Northern Ireland has high rates of antimicrobial use. We implemented a social norm feedback intervention and evaluated its impact.
Objectives
To estimate the size and duration of the effect of a social norm feedback letter to GPs who worked in the 20% of practices with the highest antimicrobial prescribing.
Methods
The letter was sent in October 2017 to 221 GPs in 67 practices. To assess the effect of the intervention, we used a sharp non-parametric regression discontinuity (RD) design, with prescribing rates in the four calendar quarters following the intervention as the outcome variables.
Results
In the quarter following the intervention (October to December 2017) there was a change of −25.7 (95% CI = −42.5 to −8.8, P = 0.0028) antibiotic items per 1000 Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU). At 1 year, the coefficient was −58.7 (95% CI = −116.7 to −0.7, P = 0.047) antibiotic items per 1000 STAR-PU. The greatest change occurred soon after the intervention. Approximately 18 900 fewer antibiotic items were prescribed than if the intervention had not been made (1% of Northern Ireland’s annual primary care antibiotic prescribing).
Conclusions
A social norm feedback intervention reduced antibiotic prescribing in the intervention practices. The diminishing effect over time suggests the need for more frequent feedback. The RD method allowed measurement of the effectiveness of an intervention that was delivered as part of normal business, without a randomized trial.
The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (-0.12 kg/m2, 95% CI [confidence interval]: -0.15 to -0.09); BMI for women (-0.09 kg/m2, 95% CI: -0.13 to -0.06); and WCF for men (-0.36 cm, 95% CI: -0.47 to -0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.
Despite an increasing interest in the effect of health information on health-behaviours, evidence on the causal impact of a diagnosis on lifestyle factors is still mixed and does not often account for long-term effects. We explore the role of health information in individual health-related decisions by identifying the causal impact of a type-2 diabetes diagnosis on body mass index (BMI) and lifestyle behaviours. We employ a fuzzy regression discontinuity design (RDD) exploiting the exogenous cut-off value in the diagnosis of type-2 diabetes provided by a biomarker (glycated haemoglobin) drawn from unique administrative longitudinal data from Spain. We find that following a type-2 diabetes diagnosis individuals appear to reduce their weight in the short-term. Differently from previous studies, we also provide evidence of statistically significant long-term impacts of a type-2 diabetes diagnosis on BMI up to three years from the diagnosis. We do not find perceivable effects of a type-2 diabetes diagnosis on quitting smoking or drinking. Overall, health information appears to have a sustained causal impact on weight reduction, a key lifestyle and risk factor among individuals with type-2 diabetes.
