Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA): a randomized controlled trial of a six month pedometer program with financial incentives. Cohort Profile: The Korean Genome and Epidemiology Study (KoGES) Consortium Design and baseline characteristics of participants in the Enhancing Physical Activity and Reducing Obesity through Smartcare and Financial Incentives (EPAROSFI): A pilot randomized controlled trial. Designing theoretically-informed implementation interventions Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya Study protocol for a cluster-randomised controlled trial of an NCD access to medicines initiative: evaluation of Novartis Access in Kenya Knowledge of dietary and behaviour-related determinants of non-communicable disease in urban Senegalese women. Behavioural interventions for type 2 diabetes: an evidence-based analysis. Characterizing Herbal Medicine Use for Noncommunicable Diseases in Urban South Africa Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback Neighborhood clustering of non-communicable diseases: results from a community-based study in Northern Tanzania Knowledge, Attitudes, and Practices Associated with Chronic Kidney Disease in Northern Tanzania: A Community-Based Study Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations The effects of cash and lottery incentives on mailed surveys to physicians: a randomized trial. National Institutes of Health State-of-the-Science Conference Statement: Tobacco Use: Prevention, Cessation, and Control Coupling Financial Incentives With Direct Mail in Population-Based Practice Traditional medicine practices among community members with chronic kidney disease in northern Tanzania: an ethnomedical survey Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial The effect of physician disclosure of financial incentives on trust. Examining the use of process evaluations of randomised controlled trials of complex interventions addressing chronic disease in primary health care—a systematic review protocol Issues in psychopharmacology. Patients as Mercenaries?: The Ethics of Using Financial Incentives in the War on Unhealthy Behaviors Methods and Strategies to Recruit African Americans into Cancer Prevention Surveillance Studies Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public Poverty is a predictor of non-communicable disease among adults in Peruvian cities. Protocol for a systematic review and economic evaluation of the clinical and cost-effectiveness of non-hospital-based non-invasive ventilation (NIV) in patients with stable end-stage COPD with hypercapnic respiratory failure Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol Readiness of Ugandan health services for the management of outpatients with chronic diseases Effect of Direct Mail as a Population-Based Strategy to Increase Mammography Use among Low-Income Underinsured Women Ages 40 to 64 Years Community-based care for the management of type 2 diabetes: an evidence-based analysis. An RCT protocol of varying financial incentive amounts for smoking cessation among pregnant women Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes Efficiency and Contribution of Strategies for Finding Randomized Controlled Trials: A Case Study from a Systematic Review on Therapeutic Interventions of Chronic Depression Drug users' adherence to a 6-month vaccination protocol: effects of motivational incentives. Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) - A randomized controlled trial. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment. Behavioral economic incentives to improve adherence to antiretroviral medication Randomized trial of use of a monetary incentive and a reminder card to increase the response rate to a mailed health survey. Protocol for the development of a core outcome set for pelvic girdle pain, including methods for measuring the outcomes: the PGP-COS study Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results
Non-communicable diseases ( NCDs ) are emerging as the predominant global health challenge of this century . Physical inactivity is one of the primary risk factors for NCDs . Therefore , increasing physical activity levels is a public health imperative . The arrival of affordable wearable technologies , such as wireless pedometers , provides one strategy for encouraging walking . However , the effectiveness of these technologies in promoting sustained behavior change has not been established . Insights from economics suggest that incentives may be a useful strategy for increasing maintenance and effectiveness of behavior change interventions , including physical activity interventions that rely on wearable technologies . The aim of this trial is to test the effectiveness of a common wireless pedometer with or without one of two types of incentives ( cash or donations to charity ) for reaching weekly physical activity goals . We present here the design and baseline characteristics of participants of this four arm r and omized controlled trial . 800 full-time employees ( desk-bound office workers ) belonging to 15 different worksites ( on average , 53 ( sd : 37 ) employees at each worksite ) were successfully r and omized to one of four study arms . If shown to be effective , wearable technologies in concert with financial incentives may provide a scalable and affordable health promotion strategy for governments and employers seeking to increase the physical activity levels of their constituents Worldwide globalization and Westernization in social and economic aspects have led to drastic changes in South Korea during the past several decades . These changes include individual health behaviours , which were reflected as increased prevalence of non-communicable chronic diseases ( NCDs ) , such as type 2 diabetes mellitus ( T2DM ) , hypertension , obesity and cardiovascular disease ( CVD ) . These NCDs are known to be caused by both environmental risk factors and predisposing genetic factors . Population decline is another issue in South Korea ; the recorded fertility rate was 1.3 births per woman , and 10 % of the population were elderly individuals aged 65 years according to the Population and Housing Census results of 2005 - 2010 . We have also been observing an increased influx and efflux of the population due to globalization . In particular , there has been a rising tendency in the marriage-based inflow of South Asian women during the last decade . To attempt to solve public health issues result ing from these population trends and prepare for personalized and preventive health care in the future , the Korean government ( National Research Institute of Health ( NIH ) , Centers for Disease Control and Prevention and the Ministry of Health and Welfare , Korea ) initiated a large prospect i ve cohort study with government funding , named the Korean genome and epidemiology study ( KoGES ) . The study is a consortium project consisting of six prospect i ve cohort studies that would be categorized into population -based and geneenvironment model studies ( Figure 1 ) . The aim of the KoGES was to establish a genome epidemiological study platform for the research community with a health data base and biobank , to investigate the genetic and environmental aetiology of common complex diseases in Koreans ( i.e. T2DM , hypertension , obesity , metabolic syndrome , osteoporosis , CVD , and cancer ) and causes of death with longterm follow-up . The ultimate goal of the KoGES was to develop comprehensive and applicable health care guidelines for common complex diseases in Koreans , reduce the burden of chronic diseases and improve the quality of life BACKGROUND An activity tracker combined with a smartphone application ( smartcare ) may help people track and receive feedback on their own activities . However , activity trackers themselves generally fail to drive long-term sustained engagement for a majority of users . One potential strategy for increasing the effectiveness of smartcare is through the use of incentives . The purpose of this pilot r and omized trial is to test the feasibility of our intervention and to assess the extent to which smartcare with or without financial incentives can increase physical activity levels and reduce weight over a 12-week period . METHODS / DESIGN This study employs a three-arm , open-label r and omized controlled trial design : control ( st and ard basic education ) , smartcare , and smartcare plus financial incentives .  Male university students with body mass index ≥ 27 are enrolled . Our primary and secondary endpoints are the amount of weight loss and the level of physical activity respectively . The weight loss goal is 3 % of baseline at week 4 , 5 % at week 8 , and 7 % at week 12 . The daily physical activity goal was individualized according to the participants ' weight . Process incentives are accumulated when participants met daily physical activity goals , and outcome incentives are provided when they met weight reduction goals . DISCUSSION Given the global increase in physical inactivity and obesity , there is a growing need for effective , scalable , and affordable health promotion strategies . Our proof-of-concept study will provide the evidence for the combination of rising health promotion technology of activity trackers and smartphone applications with the modern concept of behavioral economics using financial incentives Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care . However , the transfer of research findings into practice is unpredictable and can be a slow and haphazard process . Ideally , the choice of implementation strategies would be based upon evidence from r and omised controlled trials or systematic review s of a given implementation strategy . Unfortunately , review s of implementation strategies consistently report effectiveness some , but not all of the time ; possible causes of this variation are seldom reported or measured by the investigators in the original studies . Thus , any attempts to extrapolate from study setting s to the real world are hampered by a lack of underst and ing of the effects of key elements of individuals , interventions , and the setting s in which they were trialled . The explicit use of theory offers a way of addressing these issues and has a number of advantages , such as providing : a generalisable framework within which to represent the dimensions that implementation studies address , a process by which to inform the development and delivery of interventions , a guide when evaluating , and a way to allow for an exploration of potential causal mechanisms . However , the use of theory in design ing implementation interventions is method ologically challenging for a number of reasons , including choosing between theories and faithfully translating theoretical constructs into interventions . The explicit use of theory offers potential advantages in terms of facilitating a better underst and ing of the generalisability and replicability of implementation interventions . However , this is a relatively unexplored method ological area Background Rural setting s in Sub-Saharan Africa ( SSA ) consistently report low participation in non-communicable disease ( NCD ) treatment programs and poor outcomes . Objective The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care ( BIGPIC ) . Design The study prospect ively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group . Participants Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care . Interventions The BIGPIC model utilizes a context ualized care delivery model design ed to address the unique barriers faced in rural setting s. This model emphasizes the following steps : ( 1 ) find patients in the community , ( 2 ) link to peer/microfinance groups , ( 3 ) integrate education , ( 4 ) treat in the community , ( 5 ) enhance economic sustainability and ( 6 ) generate dem and for care through incentives . Main Measures The primary outcome is the linkage frequency , which measures the percentage of patients who return for care after screening positive for either hypertension and /or diabetes . Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic ( SBP ) and diastolic blood pressure ( DBP ) and blood sugar over 12 months . Key Results Of the 879 individuals who were screened , 14.2 % were confirmed to have hypertension , while only 1.4 % were confirmed to have diabetes . The implementation of a comprehensive microfinance-linked , community-based , group care model result ed in 72.4 % of screen-positive participants returning for subsequent care , of which 70.3 % remained in care through the 12 months of the evaluation period . Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [ 95 % CI ( 13.9 to 28.4 ) , P < 0.01 ] and 5 mmHg drop in DBP [ 95 % CI ( 1.4 to 7.6 ) , P < 0.01 ] . Conclusions The implementation of a context ualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction Introduction Novartis recently launched Novartis Access , an initiative to provide a basket of reduced price medicines for non-communicable diseases ( NCDs ) to be sold through the public and private non-profit sectors in programme countries . This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at health facilities and households in Kenya , the first country to receive the programme . Methods and analysis This study will be a cluster-r and omised controlled trial . 8 counties in Kenya will be r and omly assigned to the intervention or control group using a covariate constrained r and omisation method to maximise balance on demographic and health characteristics . In intervention counties , public and private non-profit health facilities will be able to order Novartis Access NCD medicines from the Mission for Essential Drugs and Supplies ( MEDS ) . Data will be collected from a r and om sample of 384 health facilities and 800 households at baseline , midline after 1-year of intervention , and end-line after 2 years . Quarterly surveillance data will also be collected from health facilities and a sub sample of households through phone-based interviews . Households will be eligible if at least one resident has been previously diagnosed and prescribed a medicine for an NCD addressed by Novartis Access , including hypertension and diabetes . The primary outcomes will be availability and price of NCD medicines at health facilities , and availability , price , and expenditures on NCD medicines at households . Impacts will be estimated using intention-to-treat analysis . Ethics and dissemination This protocol was approved by the Institutional Review Boards at Strathmore University and at Boston University . Informed consent will be obtained from all participants at the start of the trial . The findings of the trial will be disseminated through peer- review ed journals , international conferences , and meetings and events organised with local stakeholders . Trial registration number NCT02773095 OBJECTIVE To assess knowledge of dietary and behaviour-related determinants of non-communicable disease ( NCD ) of urban Senegalese women . DESIGN A cross-sectional , population study using an interviewer-administered knowledge question naire , developed and vali date d for this study . The question naire consisted of 24 items with six scores measuring knowledge of : ( 1 )  diet- and behaviour-related causes of NCD ; ( 2 ) diet quality -NCD relationship ; ( 3 )  fruit and vegetable link with NCD ; ( 4 ) health consequences of obesity ; ( 5 ) causes of cardiovascular disease ( CVD ) ; and ( 6 ) causes of certain cancers . SUBJECTS A r and om sample of 301 women aged 20 - 50 years . RESULTS The knowledge scores developed suggest that the health consequences of obesity ( mean score of 65.4 % ) were best understood followed by causes of CVD ( mean score of 60.6 % ) , because obesity , smoking , high blood cholesterol and dietary fat were well recognised as risk factors for CVD . Subjects scored least for their knowledge of the protective effect of fruit and vegetables ( mean score of 19.9 % ) . Knowledge of causes of certain cancers ( mean score of 36.1 % ) was also low . Women who worked outside the home had better knowledge for two scores but otherwise no relationship was found between knowledge and literacy , formal education or body mass index . CONCLUSIONS Findings suggest reasonable overall knowledge concerning diet and behaviour with NCD , especially given the relatively new context of the obesity epidemic in Senegal . However , there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers . Education targeting the benefits of vegetables and fruit may have the greatest impact on NCD prevention UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT Economic challenges associated with noncommunicable diseases ( NCDs ) and the sociocultural outlook of many patients especially in Africa have increased dependence on traditional herbal medicines ( THMs ) for these diseases . A cross-sectional descriptive study design ed to determine the prevalence of and reasons for THM use in the management of NCDs among South African adults was conducted in an urban , economically disadvantaged area of Cape Town , South Africa . In a cohort of 1030 participants recruited as part of the existing Prospect i ve Urban and Rural Epidemiological ( PURE ) study , 456 individuals were identified . The overall prevalence of THM use was 27 % , of which 61 % was for NCDs . Participants used THM because of a family history ( 49 % ) and sociocultural beliefs ( 33 % ) . Hypertensive medication was most commonly used concurrently with THM . Healthcare professionals need to be aware of the potential dualistic use of THM and conventional drugs by patients , as this could significantly influence health outcomes . Efforts should be made to educate patients on the potential for drug/herb interactions Background Non-communicable diseases ( NCDs ) are the leading causes of death globally and are associated with a limited set of common , modifiable health behaviours : tobacco use , physical inactivity , harmful use of alcohol and unhealthy diet . General practice offers an ideal avenue for addressing such health behaviours on a population -wide basis . This paper describes the protocol of a multiple health behaviour change intervention design ed for implementation in general practice and summarises the baseline characteristics of its participants . Method / Design The 10 Small Steps ( 10SS ) study , a r and omised controlled trial , involved 4,678 adult general practice patients in Queensl and , Australia .  Self-reported data were collected to establish the proportion of participants meeting recommended guidelines for ten health behaviours : physical activity , body mass index , alcohol , smoking and six dietary behaviours . Participants were r and omised to four groups : contact at baseline only ( ' single intervention ' and corresponding control group ) and contact at baseline and 3 months ( ' dual intervention ' and corresponding control group ) . At each contact the participants received a computer-tailored feedback and one page information sheet according to their allocation to intervention or control groups . Change in the intervention group compared to the control group was assessed at 3 and 12 months after baseline data collection .Responses were summed to calculate an individual lifestyle score ( the Prudence Score ) , which ranged from 0 to 10 . The baseline response was 56.5 % ( 4678 of 8343 invited participants ) and the study sample was primarily female ( 68.7 % ) with an average age of 47 years . The mean Prudence Score was 5.8 ( 95%CI 5.75 - 5.85 ) . Discussion Baseline data from the 10SS study show that nearly all participants engage in some health behaviours but relatively few adhere simultaneously to a core set of dietary and lifestyle behaviours associated with risk of NCDs . Ample scope exists to improve health behaviour to reduce NCDs in the general practice setting and the 10SS study trial will provide data on the extent to which a minimal computer-tailored intervention can meet this objective . The protocol developed for the 10SS study has potential for translation into routine general practice as it has minimal impact on practice routine whilst contributing to primary prevention objectives .Trial Registration The Australian New Zeal and Clinical Trials Registry Background In order to begin to address the burden of non-communicable diseases ( NCDs ) in sub-Saharan Africa , high quality community-based epidemiological studies from the region are urgently needed . Cluster- design ed sampling methods may be most efficient , but design ing such studies requires assumptions about the clustering of the outcomes of interest . Currently , few studies from Sub-Saharan Africa have been published that describe the clustering of NCDs . Therefore , we report the neighborhood clustering of several NCDs from a community-based study in Northern Tanzania . Methods We conducted a cluster- design ed cross-sectional household survey  between January and June 2014 . We used a three-stage cluster probability sampling method to select thirty-seven sampling areas from twenty-nine neighborhood clusters , stratified by urban and rural . Households were then r and omly selected from each of the sampling areas , and eligible participants were tested for chronic kidney disease ( CKD ) , glucose impairment including diabetes , hypertension , and obesity as part of the CKD-AFRiKA study . We used linear mixed models to explore clustering across each of the samplings units , and we estimated absolute-agreement intra-cluster correlation ( ICC ) coefficients ( ρ ) for the neighborhood clusters . Results We enrolled 481 participants from 346 urban and rural households .  Neighborhood cluster sizes ranged from 6 to 49 participants ( median : 13.0 ; 25th–75th percentiles : 9–21 )  . Clustering varied across neighborhoods and differed by urban or rural setting . Among NCDs , hypertension ( ρ = 0.075 ) exhibited the strongest clustering within neighborhoods followed by CKD ( ρ = 0.440 ) , obesity ( ρ = 0.040 ) , and glucose impairment ( ρ = 0.039 ) . Conclusion The neighborhood clustering was substantial enough to contribute to a design effect for NCD outcomes including hypertension , CKD , obesity , and glucose impairment , and it may also highlight NCD risk factors that vary by setting . These results may help inform the design of future community-based studies or r and omized controlled trials examining NCDs in the region particularly those that use cluster-sampling methods Background Non-communicable diseases ( NCDs ) are a leading cause of death among adults in sub-Saharan Africa , and chronic kidney disease ( CKD ) is a growing public health threat . Underst and ing knowledge , attitudes , and practice s associated with NCDs is vital to informing optimal policy and public health responses in the region , but few community-based assessment s have been performed for CKD . To address this gap , we conducted a cross-sectional survey of adults in northern Tanzania using a vali date d instrument . Methods Between January and June 2014 , we administered a structured survey to a r and om sample of adults from urban and rural communities . The vali date d instrument consisted of 25 items design ed to measure knowledge , attitudes , and practice s associated with kidney disease . Participants were also screened for CKD , diabetes , hypertension , and human immunodeficiency virus . Results We enrolled 606 participants from 431 urban and rural households .  Knowledge of the etiologies , symptoms , and treatments for kidney disease was low ( mean score 3.28 out of 10 ; 95 % CI 2.94 , 3.63 ) . There were no significant differences by CKD status . Living in an urban setting and level of education had the strongest independent associations with knowledge score . Attitudes were characterized by frequent concern about the health ( 27.3 % ; 20.2 , 36.0 % ) , economic ( 73.1 % ; 68.2 , 77.5 % ) , and social impact ( 25.4 % ; 18.6 , 33.6 % ) of kidney disease . Practice s included the use of traditional healers ( 15.2 % ; 9.1 , 24.5 % ) and traditional medicines ( 33.8 % ; 25.0 , 43.9 % ) for treatment of kidney disease as well as a willingness to engage with mobile-phone technology in CKD care ( 94.3 % ; 90.1 , 96.8 % ) . Conclusions Community-based adults in northern Tanzania have limited knowledge of kidney disease . However , there is a modest knowledge base upon which to build public health programs to exp and awareness and underst and ing of CKD , but these programs must also consider the variety of means by which adults in this population meet their healthcare needs . Finally , our assessment of local attitudes suggested that such public health efforts would be well-received Abstract Introduction : Successful population ‐level antiretroviral therapy ( ART ) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and , ultimately , the end of AIDS . Although many people living with HIV are adhering well , others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy . Despite the importance of ART adherence , supportive interventions have generally not been implemented at scale . The objective of this review is to summarize the recommendations of clinical , research , and public health experts for scalable ART adherence interventions in re source ‐limited setting s. Methods : In July 2015 , the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in re source ‐limited setting s. This article summarizes that discussion with recent up date s. It is not a systematic review , but rather provides practical considerations for programme implementation based on evidence from individual studies , systematic review s , meta‐analyses , and the World Health Organization Consoli date d Guidelines for HIV , which include evidence from r and omized controlled trials in low‐ and middle‐income countries . Interventions are categorized broadly as education and counselling ; information and communication technology‐enhanced solutions ; healthcare delivery restructuring ; and economic incentives and social protection interventions . Each category is discussed , including descriptions of interventions , current evidence for effectiveness , and what appears promising for the near future . Approaches to intervention implementation and impact assessment are then described . Results and discussion : The evidence base is promising for currently available , effective , and scalable ART adherence interventions for re source ‐limited setting s. Numerous interventions build on existing health care infrastructure and leverage available re sources . Those most widely studied and implemented to date involve peer counselling , adherence clubs , and short message service ( SMS ) . Many additional interventions could have an important impact on ART adherence with further development , including st and ardized counselling through multi‐media technology , electronic dose monitoring , de central ized and differentiated models of care , and livelihood interventions . Optimal targeting and tailoring of interventions will require improved adherence measurement . Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence , so that they do not limit the potential of ART to help bring about the end of AIDS Low response rates , especially among physicians , are a common problem in mailed survey research . We conducted a r and omized trial to examine the effects of cash and lottery incentives on response rates .  A total of 4,850 subjects were r and omized to one of three interventions accompanying a mailed survey-no incentive ( n = 1,700 ) , cash payment [ three levels of Hong Kong dollars ( HKD ) $ 10 , $ 20 , and $ 40 ; N = 50 in each subgroup ] , or entry into a lottery ( three levels of HKD$1,000 , $ 2,000 , and $ 4,000 ; N = 1,000 in each subgroup ) on receipt of the completed question naire . The response rates were higher among those offered incentives than those without ( 19.8 % vs. 16.8 % , P = .012 ) . Cash was the more effective incentive compared to lottery ( 27.3 % vs. 19.4 % , P = .017 ) . Response also increased substantially between the first and second mailings ( 14.2 % vs. 18.8 % , P > .001 ) . In addition , those with specialist qualifications were more willing to participate in mailed surveys . We found no significant differences in response outcomes among the various incentive arms . Cash reward at the $ 20 level was the most cost-effective intervention , in terms of cost per responder . Further systematic examination of the effects of different incentive strategies in epidemiologic studies should be encouraged National Institutes of Health ( NIH ) consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1 ) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality ( AHRQ ) , 2 ) presentations by investigators working in areas relevant to the conference questions during a 2-day public session , 3 ) questions and statements from conference attendees during open discussion periods that are part of the public session , and 4 ) closed deliberations by the panel during the remainder of the second day and the morning of the third . This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government . The statement reflects the panel 's assessment of medical knowledge available at the time the statement was written . Thus , it provides a snapshot in time of the state of knowledge on the conference topic . When reading the statement , keep in mind that new knowledge is inevitably accumulating through medical research . Tobacco use is the leading preventable cause of premature death in the United States . Each year , more than 440000 Americans die of tobacco-related disease , accounting for 1 in every 5 deaths . Cigarette smoking is responsible for more than 30 % of cancer deaths annually in the United States . Smoking also contributes substantially to deaths from heart disease , stroke , and chronic obstructive pulmonary disease . According to current estimates , 21 % of American adults ( 44.5 million individuals ) and 22 % of American high school students ( 3.75 million individuals ) smoke . Cigarettes are the predominant form of tobacco that Americans consume , but tobacco consumption also includes smokeless tobacco , cigars , and pipes . In addition to the toll in human lives , tobacco use is an enormous economic burden on society . From 1995 to 1999 , estimated annual smoking-attributable economic costs in the United States were $ 75.5 billion for direct medical care for adults and $ 81.9 billion for lost productivity . Tobacco use per capita has decreased from about 14 pounds per year in the 1950s to about 5 pounds per year in 2000 , suggesting that public health interventions have been effective . Yet it is unlikely that the United States will reach the Healthy People 2010 objectives of reducing smoking prevalence to 12 % or less in adults and 16 % or less in youth . Further progress in reducing tobacco use is an important challenge facing the public health , medical , and political communities . For these reasons , the National Cancer Institute and the NIH 's Office of Medical Applications of Research sponsored a State-of-the-Science Conference on Tobacco Use : Prevention , Cessation , and Control on 12 - 14 June 2006 in Bethesda , Maryl and . The key questions to be addressed at the State-of-the-Science Conference were : 1 ) What are the effective population - and community-based interventions to prevent tobacco  use in adolescents and young adults , including among diverse population s ? 2 ) What are the effective strategies for increasing consumer dem and for and use of proven , individually oriented cessation treatments , including among diverse population s ? 3 ) What are the effective strategies for increasing the implementation of proven , population -level , tobacco-use cessation strategies , particularly by health care systems and communities ? 4 ) What is the effect of smokeless tobacco product marketing and use on overall harm to the population from tobacco use ? 5 ) What is the effectiveness of prevention and of cessation interventions in population s with co-occurring morbidities and risk behaviors ? 6 ) What research is needed to make the most progress and greatest public health gains nationally and internationally ? At the conference , invited experts presented information pertinent to these questions , and a systematic literature review prepared under contract with AHRQ was summarized . The evidence report ( www.ahrq.gov/clinic/epcix.htm ) emphasized r and omized , controlled trials ; systematic review s ; and other experimental or observational studies with more than 100 participants . During the conference , attendees provided both oral and written statements in response to the key questions . The panel members weighed this evidence as they addressed the key conference questions . 1 . What Are the Effective  Population - and Community-Based Interventions  to Prevent Tobacco Use in Adolescents and Young Adults , Including among Diverse population s ? Never starting to use tobacco is a much better strategy than having to stop . Tobacco use usually begins primarily during adolescence . Almost 25 % of 12th grade rs have smoked in the previous 30 days , and almost all adult daily smokers tried cigarettes before age 18 years . Research reports suggest a flattening of the past decade 's downward trend in adolescent smoking .  Adolescents ( 13 to 18 years of age ) and young adults ( 18 to 24 years of age ) are susceptible to cultural influences , including family , friends , peers , media , community , and tobacco marketing influence . Gender , racial/ethnic background , socioeconomic status , geography , and sexual orientation all influence tobacco use and the effectiveness of strategies to prevent it , which means that many preventive strategies are needed . What We Know Previous review s have identified 3 effective general population approaches to preventing tobacco use in adolescents and young adults : 1 ) increased prices through taxes on tobacco products ; 2 ) laws and regulations that prevent young people from gaining access to tobacco products , reduce their exposure to tobacco smoke , and restrict tobacco industry advertising ; and 3 ) mass media campaigns . Previous review s show that school-based intervention programs aim ed at preventing tobacco use in adolescents are effective in the short term . Comprehensive statewide programs have also reduced overall tobacco use in young adults . What We Need to Learn Although previous evidence shows that clean indoor air and youth access policies reduce adolescent smoking rates , we need to know more about the effectiveness of these policies in specific population s. The evidence that culturally sensitive programs are more effective in reducing smoking among adolescents and young adults is not adequate to support a firm conclusion . We need to develop school-based strategies that lead to sustained reduction in starting tobacco use . 2 . What Are the Effective Strategies for Increasing Consumer Dem and for and Use of Proven , Individually Oriented Cessation Treatments , Including among Diverse Population s ? About 70 % of the 44.5 million adult smokers in the United States want to quit , but of those who try to quit in a given year , fewer than 5 % succeed . Effective treatments can double or triple quit rates , but too few smokers try these interventions and too few physicians offer them . What We Know Previous systematic review s identified effective strategies for increasing use of the following proven individually oriented cessation treatments . A mass media education campaign uses brief , recurring messages to inform and to motivate tobacco users to quit . It is effective in increasing tobacco use cessation when combined with other interventions . For example , media messages that direct viewers to call for further information or support increase use of telephone-based tobacco cessation information or support services . Proactive telephone smoking cessation support occurs when the health care provider initiates contact with the smoker . Advice to stop smoking is effective , especially when combined with other interventions , such as educational approaches or pharmacologic therapies . Increasing the unit price for tobacco products increases tobacco use cessation and reduces consumption regardless of the smoker 's ethnicity , gender , and socioeconomic status . Reducing out-of-pocket costs for effective cessation therapiesfor example , because health insurance pays for the serviceincreases their use . Making smokers aware of their health insurance 's coverage policy can increase use of smoking cessation treatments . Culturally tailored , gender-specific , and language -appropriate programs show promise . What We Need to Learn Generic interventions may be less effective than interventions tailored to specific population s , so we need to underst and how best to tailor interventions . To increase dem and for treatments , smokers must want them , expect them , and ask for them . We need to learn how to make treatments more attractive to tobacco users . We need to create a sustained dem and for effective treatments . 3 . What Are the Effective Strategies for Increasing the Implementation of Proven , Population -Level Tobacco Use Cessation Strategies , Particularly by Health Care Systems and Communities ? Despite strong evidence that a variety of pharmacologic and behavioral interventions increase tobacco cessation , only a small proportion of tobacco users ever try them . Strategies that target individual tobacco users may be effective but fail to reach most smokers . Community-level strategies target broad geographic population s ( for example , cities ) or smaller , more localized groups of people ( for example , military bases , colleges ) . Clinical setting s in which to implement community-level strategies range in scope from individual practice s to large integrated organizations . What We Know Community-based interventions aim to increase dem and for cessation interventions ( media campaigns , higher prices , smoke-free environments ) or facilitate access to cessation services ( community-level quit lines , offering cessation services in community setting s ) . Evidence suggests that media campaigns , telephone-counseling programs ( quit lines ) , and increases in tobacco prices and taxes are effective . Providing cessation services in non clinical community setting s shows some promise , but the literature lacks good evidence of community setting interventions in the United States . Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy . However , little is known about how to translate incentive-based strategies to public health practice geared toward improving population -level health , and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail . This study reports results of a population -based r and omized controlled trial testing a direct mail , incentive-based intervention for promoting mammography uptake . The study population was composed of a r and om sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening . Participants ( N = 18,939 ) were r and omized into three groups : ( 1 ) Direct Mail only , ( 2 ) Direct Mail plus Incentive , and ( 3 ) Control . Both direct mail groups received two mailers with a message about the importance of mammography ; however , Mail plus Incentive mailers also offered a $ 25 incentive for getting a mammogram . Logistic regression analyses measured intervention effects . Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups . The use of incentives also proved to be cost-effective . Additionally , the Direct Mail only group was more likely to receive mammography than the Control group . Findings offer experimental evidence on how the population -based strategy of direct mail coupled with a financial incentive can encourage healthy behavior , as well as how incentive-based programs can be translated into health promotion practice aim ed at achieving population -level impact Background In sub-Saharan Africa , chronic kidney disease ( CKD ) is being recognized as a non-communicable disease ( NCD ) with high morbidity and mortality . In countries like Tanzania , people access many sources , including traditional medicines , to meet their healthcare needs for NCDs , but little is known about traditional medicine practice s among people with CKD . Therefore , we sought to characterize these practice s among community members with CKD in northern Tanzania . Methods Between December 2013 and June 2014 , we administered a previously-developed survey to a r and om sample of adult community-members from the Kilimanjaro Region ; the survey was design ed to measure traditional medicine practice s such as types , frequencies , reasons , and modes . Participants were also tested for CKD , diabetes , hypertension , and HIV as part of the CKD-AFRiKA study . To identify traditional medicines used in the local treatment of kidney disease , we review ed the qualitative sessions which had previously been conducted with key informants . Results We enrolled 481 adults of whom 57 ( 11.9 % ) had CKD . The prevalence of traditional medicine use among adults with CKD was 70.3 % ( 95 % CI 50.0–84.9 % ) , and among those at risk for CKD ( n = 147 ; 30.6 % ) , it was 49.0 % ( 95 % CI 33.1–65.0 % ) . Among adults with CKD , the prevalence of concurrent use of traditional medicine and biomedicine was 33.2 % ( 11.4–65.6 % ) . Symptomatic ailments ( 66.7 % ; 95 % CI 17.3–54.3 ) , malaria/febrile illnesses ( 64.0 % ; 95 % CI 44.1–79.9 ) , and chronic diseases ( 49.6 % ; 95 % CI 28.6–70.6 ) were the most prevalent uses for traditional medicines . We identified five plant – based traditional medicines used for the treatment of kidney disease : Aloe vera , Commifora africana , Cymbopogon citrullus , Persea americana , and Zanthoxylum chalybeum . Conclusions The prevalence of traditional medicine use is high among adults with and at risk for CKD in northern Tanzania where they use them for a variety of conditions including other NCDs . Additionally , many of these same people access biomedicine and traditional medicines concurrently . The traditional medicines used for the local treatment of kidney disease have a variety of activities , and people with CKD may be particularly vulnerable to adverse effects . Recognizing these traditional medicine practice s will be important in shaping CKD treatment programs and public health policies aim ed at addressing CKD Background The scale-up of antiretroviral treatment ( ART ) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis , non-communicable diseases ( NCDs ) and mental health disorders . Depression is one such disorder that is associated with higher rates of non-adherence , progression to AIDS and greater mortality . Detection and treatment of comorbid depression is critical to achieve viral load suppression in more than 90 % of those on ART and is in line with the recent 90 - 90 - 90 Joint United Nations Programme on HIV/AIDS ( UNAIDS ) targets . The CobALT trial aims to provide evidence on the effectiveness and cost-effectiveness of scalable interventions to reduce the treatment gap posed by the growing burden of depression among adults on lifelong ART . Methods The study design is a pragmatic , parallel group , stratified , cluster r and omised trial in 40 clinics across two rural districts of the North West Province of South Africa . The unit of r and omisation is the clinic , with outcomes measured among 2000 patients on ART who screen positive for depression using the Patient Health Question  naire ( PHQ-9 ) . Control group clinics are implementing the South African Department of Health ’s Integrated Clinical Services Management model , which aims to reduce fragmentation of care in the context of rising multimorbidity , and which includes training in the Primary Care 101 ( PC101 ) guide covering communicable diseases , NCDs , women ’s health and mental disorders . In intervention clinics , we supplemented this with training specifically in the mental health components of PC101 and clinical communications skills training to support nurse-led chronic care . We strengthened the referral pathways through the introduction of a clinic-based behavioural health counsellor equipped to provide manualised depression counselling ( eight sessions , individual or group ) , as well as adherence counselling sessions ( one session , individual ) . The co- primary patient outcomes are a reduction in PHQ-9 scores of at least 50 % from baseline and viral load suppression rates measured at 6 and 12 months , respectively . Discussion The trial will provide real-world effectiveness of case detection and collaborative care for depression including facility-based counselling on the mental and physical outcomes for people on lifelong ART in re source -constrained setting s . Trial registration Clinical Trials.gov ( NCT02407691 ) registered on 19 March 2015 ; Pan African Clinical Trials Registry ( 201504001078347 ) registered on 19/03/2015 ; South African National Clinical Trials Register ( SANCTR ) ( DOH-27 - 0515 - 5048 ) NHREC number 4048 issued on 21/04/2015 BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician  disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship Background R and omised controlled trials ( RCTs ) of complex interventions in primary health care ( PHC ) are needed to provide evidence -based programmes to achieve the Declaration of Alma Ata goal of making PHC equitable , accessible and universal and to effectively address the rising burden from chronic disease . Process evaluations of these RCTs can provide insight into the causal mechanisms of complex interventions , the context ual factors , and inform as to whether an intervention is ineffective due to implementation failure or failure of the intervention itself . To build on this emerging body of work , we aim to consoli date the methodology and methods from process evaluations of complex interventions in PHC and their findings of facilitators and barriers to intervention implementation in this important area of health service delivery . Methods Systematic review of process evaluations of r and omised controlled trials of complex interventions  which address prevalent major chronic diseases in PHC setting s. Published process evaluations of RCTs will be identified through data base and clinical trial registry search es and contact with authors . Data from each study will be extracted by two review ers using st and ardised forms . Data extracted include descriptive items about ( 1 ) the RCT , ( 2 ) about the process evaluations ( such as methods , theories , risk of bias , analysis of process and outcome data , strengths and limitations ) and ( 3 ) any stated barriers and facilitators to conducting complex interventions . A narrative synthesis of the findings will be presented . Discussion Process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other context s. Publishing this protocol serves to encourage transparency in the reporting of our synthesis of current literature on how process evaluations have been conducted thus far and a deeper underst and ing of potential challenges and solutions to aid in the implementation of effective interventions in PHC beyond the research setting . Systematic review registration PROSPERO Although pharmacologic treatment remains a critical element in the short- and long-term management of schizophrenia  , the past decade has been a challenging time in terms of real progress . Despite the introduction of several new medications as well as the conduct of larger and more diverse clinical trials , there remains considerable debate as to how far we have progressed in addressing some of the fundamental unmet needs in treating this disorder . A theme in this issue of Schizophrenia Bulletin addresses a number of topics in this context . Although the notion of careful , systematic , and critical summaries of all relevant r and omized controlled trials is not a new one , the Cochrane Schizophrenia Group is relatively young . Clive Adams , one of its founders , and colleagues provide the rationale and history of the group as well as review ing its methods and contributions . The Bulletin also carries a “ Cochrane Corner ” in each issue to alert the field to schizophrenia-related review s. Systematic meta-analyses are playing an increasingly important role in informing both the research agenda and clinical practice . The work of the Cochrane collaboration has been enormously valuable in this process . In recent years , the field of schizophrenia research has benefited from the application of various clinical trial method ologies to enhance the study of treatment outcomes and determine generalizability . Large effectiveness trials have provided data to exp and our knowledge base beyond that which is provided by traditional efficacy trials . Stroup and Geddes provide examples of each type of trial to illustrate their relative advantages and disadvantages . Within the context of different trial design s , Leucht et al provide an overview addressing critical aspects of trial design , potential population sampling bias , endpoint choices and definitions , quality of assessment s , data analysis and reporting , as well as , other potential sources of bias or confounds relevant to the interpretation of clinical trials data in schizophrenia . One of the most difficult challenges in the design , conduct , analysis , and interpretation of clinical trials is the problem of dropouts — those individuals who do not complete the trial , often for unknown reasons . A variety of statistical techniques have been developed and applied in order to address this issue ; however , none is entirely satisfactory . Rabinowitz and Davidov discuss the association of dropout and outcome in trials of antipsychotic medication and its implication s for strategies to address missing data . Another strategy to minimize dropouts in acute treatment trials would be to shorten the length of the trial , particularly when placebo control groups are included . Addressing this issue and drawing on recent meta- analysis suggesting that a substantial proportion of antipsychotic drug response occurs within the first 2 weeks , McMahon and colleagues present an exploratory analysis from short-term placebo controlled clinical trial data suggesting the potential feasibility of reducing the duration of such trials . Much more work needs to be done to determine the benefits and risks of such an approach , but this is a very valuable first step . In the final article , we provide a review of unanswered questions in the pharmacologic treatment of schizophrenia .  Despite numerous trials being conducted with antipsychotic medication , there are many clinical decisions that must be made on a day-to-day basis for which sufficient data are not available to provide an adequate evidence base . We hope that these articles will provide a snapshot of current challenges and opportunities for further progress in the design , conduct , and interpretation of psychopharmacologic trials in schizophrenia Consider the following paradox : few people would balk if research ers offered smokers $ 1,000 to participate in a year-long r and omized trial of a smoking cessation intervention , yet many would find it distasteful for a large employer to pay its smoking employees an extra $ 1,000 if they remained smoke-free for one year . Such discrepant judgments are underst and able from the perspective of classical economics . Research participants merit compensation for the risks and opportunity costs they endure in the service of public health , whereas individuals should need no reward for promoting their own well being . However , contrary to traditional theories of rationality , people frequently fail to make health-promoting choices , particularly when such choices require short-term sacrifices to foster long-term goals .1,2 Thus , corporate and government health plan leaders are increasingly applying extrinsic motivations such as financial incentives and other programs to augment health – particularly cardiovascular health – while hopefully increasing productivity and restraining costs.3 , 4 Early evidence suggests that financial incentives can effectively promote the cardioprotective behaviors of smoking cessation,5 , 6 weight loss,7 , 8 and cholesterol reduction.9  Incentives are also currently being studied as a means of promoting warfarin adherence.10 Although the results of these early studies are promising , further research is needed to determine which incentive structures and amounts are optimal , assess the ability of incentives to produce sustained behavior changes , and evaluate the cost-effectiveness of implementing incentive programs  . Ethical dimensions of the incentives themselves are also in need of further analysis . For example , some have charged that financial incentive programs are coercive , inequitable , and inconsistent with shared social values.11 Others have even suggested that implementing incentive programs serves to punish patients for their illnesses.12 In this essay , we outline the rationale for incentive programs to promote cardiovascular health , identify the ethical arguments that have been used to challenge such programs , and assess the merits of these arguments Objective : Recruitment of African Americans into health research studies is a major challenge . This report describes a study of different methods and strategies to recruit African Americans into a population -based assessment of cancer behavioral risk factors . Methods : African Americans ages 18 to 70 years in North Carolina ( n = 5,000 ) were r and omly selected from the Department of Motor Vehicle rosters and assigned at r and om to one of five different recruitment strategies based on variations of approach letters ( generic versus culturally sensitive ) and inclusion , exclusion , or promise of a small incentive . Prospect i ve participants were sent an 11-page question naire by mail but could complete it by telephone or Internet as well as by mail . Results : The overall response rate was 17.5 % ( 747 completed surveys of 4,276 delivered ) : 655 , 84 , and 8 by mail , Internet , and telephone , respectively . Among eligible respondents , response was significantly higher for incentive-based than nonincentive strategies ; 23.9 % for the generic letter plus incentive compared with 15.8 % for the generic letter only ( P < 0.001 ) . The culturally sensitive letter had little effect on participation ( 15.8 % for both the generic and culturally sensitive letters ) . The  mean age of eligible respondents was 43.9 years , 41 % were male , 37 % were college graduates , and 75 % were overweight/obese . There were no differences in respondent characteristics by assigned recruitment strategy . Conclusions : Incentive-based strategies yielded the highest survey responses , whereas a culturally sensitive letter did not appreciably increase participation among African Americans in North Carolina . This study adds to what is known about culturally sensitive recruitment strategies for African Americans and challenges their usefulness in survey-based studies Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 BACKGROUND Rapid health and nutrition transitional changes are result ing in greater prominence of non-communicable disease ( NCD ) in Latin America , particularly among the poor . OBJECTIVE The study aims to examine the extent to which NCD pxfsrevails in Peru and the socioeconomic status ( SES ) as a risk factor . DESIGN Between 1998 and 2000 , health surveys and clinical assessment s were completed on 2337 adults in six cities , 18 to 60 years of age . Stratified by social class , multi-staged r and om sampling was used . Anthropometric data , blood pressure and serum sample s were collected . RESULTS Adjusting for age , hypertension , low HDL cholesterol , high total cholesterol and diabetes was found in 47 % , 40 % , 21 % and 17 % of women and in 44 % , 38 % , 27 % and 19 % of men , respectively . Over one quarter of the population exhibited multiple risk factors , not including overweight and obesity . Across all study sites , lowest SES revealed highest burden of NCD and appeared as an independent risk factor for associated NCD indicators . CONCLUSION The high prevalence of NCD in urban areas of Peru is not only associated with excess body weight , but also with poverty itself . The greater burden of NCD in the poorest areas of society requires a better underst and ing of causal determinants and may have implication s in terms of public health policies and interventions Background Chronic obstructive pulmonary disease ( COPD ) remains a significant public health burden . Non-invasive ventilation ( NIV ) is a method of supported breathing used as st and ard care for acutely unwell patients in hospital with COPD , but there is uncertainty around the potential benefits of using NIV in the treatment of stable patients in a non-hospital setting . This is a protocol for systematic review s of the clinical and cost-effectiveness of NIV in this context , being undertaken in support of a model based economic evaluation . Methods / Design St and ard systematic review methods aim ed at minimising bias will be employed for study identification , selection and data extraction for both the clinical and economic systematic review s. Bibliographic data bases ( for example MEDLINE , EMBASE ) and ongoing trials registers will be search ed from 1980 onwards . The search strategy will combine terms for the population with those for the intervention . Studies will be selected for review if the population includes adult patients with COPD and hypercapnic respiratory failure , however defined . Systematic review s , r and omised controlled trials and observational studies ( with n > 1 ) will be included , and quality assessment will be tailored to the different study design s. The primary outcome measures of interest are survival , quality of life , and healthcare utilisations ( hospitalisation and Accident and Emergency attendances ) . Meta-analyses will be undertaken where clinical and method ological homogeneity exists , supported by predefined subgroup analyses where appropriate . A systematic review of the evidence on the cost-effectiveness of non-hospital NIV will be completed , and a model-based cost-utility analysis undertaken to determine the cost-effectiveness of non-hospital-based NIV compared with st and ard care . Discussion These review s will attempt to clarify the clinical effectiveness of non-hospital NIV in COPD patients as well as the cost-effectiveness . The findings may indicate whether NIV in a non-hospital setting should be considered more routinely in this patient group , and what the likely cost implication s will be . PROSPERO registration 2012:CRD42012003286 Background Violence during pregnancy is a global problem , associated with serious health risks for both the mother and baby . Evaluation of interventions targeted for reducing or controlling domestic violence ( DV ) is still in its infancy , and the majority of findings are primarily from high-income countries ( HICs ) . Therefore , there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries ( LMICs ) . Methods Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines will be employed to structure the review . A comprehensive search will be carried out via electronic data bases including MEDLINE , CINAHL , Scopus , Embase , Web of Science , PsycINFO , and The Cochrane library . Gray literature will also be scrutinized for potential articles . An optimal search strategy has been developed following consultations with subject-matter experts and librarians . This search strategy will be adapted to the different data bases . Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review . The review will only include literature written in English . Two review ers will independently screen and assess studies for inclusion in the review . A third author will resolve any discrepancies between the review ers . Risk of bias will be assessed based on the Cochrane risk of bias assessment tool , and overall quality of the evidence will be judged using Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) criteria . Findings will be presented with the narrative synthesis , and if applicable , they will be further quantified using r and om-effects meta- analysis . Effect size , risk ratio for dichotomous variables , and st and ardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3 . Discussion Systematic review s to evaluate the efficacy of interventions to address DV within the perinatal context have been limited . Hence , no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences . The evidence generated from this systematic review will inform research ers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area . This in turn will contribute towards violence prevention in LMICs . Systematic review registration PROSPERO Abstract Objective Traditionally , health systems in sub‐Saharan Africa have focused on acute conditions . Few data exist on the readiness of African health facilities ( HFs ) to address the growing burden of chronic diseases ( CDs ) , specifically chronic , non‐communicable diseases ( NCDs ) . Methods A stratified r and om sample of 28 urban and rural Ug and an HFs was surveyed to document the burden of selected CDs by analysing the service statistics , service availability and service readiness using a modified WHO Service Availability and Readiness Assessment question naire . Knowledge , skills and practice in the management of CDs of 222 health workers were assessed through a self‐completed question naire . Results Among adult outpatient visits at hospitals , 33 % were for CDs including HIV vs. 14 % and 4 % at medium‐sized and small health centres , respectively . Many HFs lacked guidelines , diagnostic equipment and essential medicines for the primary management of CDs ; training and reporting systems were weak . Lower‐level facilities routinely referred patients with hypertension and diabetes . HIV services accounted for most CD visits and were stronger than NCD services . Systems were weaker in lower‐level HFs . Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care . Conclusion Compared with higher level HFs , lower‐level ones are less prepared and little used for CD care . Health systems in Ug and a , particularly lower‐level HFs , urgently need improvement in managing common NCDs to cope with the growing burden . This should include the provision of st and ard guidelines , essential diagnostic equipment and drugs , training of health workers , supportive supervision and improved referral systems . Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible Women with inadequate health insurance have lower mammography rates than the general population . Finding successful strategies to enroll eligible women is an ongoing challenge for the National Breast and Cervical Cancer Early Detection Program . To test the effectiveness of a population -based strategy to increase mammography utilization among low-income underinsured women ages 40 to 64 years , a r and omized trial was conducted to assess the effect of two mailed interventions on mammography utilization through Sage , the National Breast and Cervical Cancer Early Detection Program in Minnesota . Women ( N = 145,467 ) ages 40 to 63 years [ mean ( SD ) , 49.7 ( 6.8 ) ] with estimated household incomes below $ 50,000 ( 47.9 % were < $ 35,000 ) from a commercial data base were r and omized to three groups : Mail , Mail Plus Incentive , or Control . Both the Mail and the Mail Plus Incentive groups received two simple mailings prompting them to call a toll-free number to access free mammography services . The Mail Plus Incentive intervention offered a small monetary incentive for a completed mammogram . After 1 year , both intervention groups had significantly higher Sage mammography rates than the Controls , and the Mail Plus Incentive group had a significantly higher rate than the Mail group . The Mail and Mail Plus Incentive interventions were estimated to produce increases in Sage screening rates of 0.23 % and 0.75 % , respectively , beyond the composite Control rate of 0.83 % . Direct mail is an effective strategy for increasing mammography use through Sage . Coupling direct mail with an incentive significantly enhances the intervention 's effectiveness .  Direct mail should be considered as a strategy to increase mammography use among low-income , medically underserved women UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes  : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , the Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups Background Smoking during pregnancy is harmful to the unborn child . Few smoking cessation interventions have been successfully incorporated into st and ard antenatal care . The main aim of this study is to determine the feasibility of a personal financial incentive scheme for encouraging smoking cessation among pregnant women . Design A pilot r and omised control trial will be conducted to assess the feasibility and potential effectiveness of two varying financial incentives that increase incrementally in magnitude ( $ 20 vs. $ 40AUD ) , compared to no incentive in reducing smoking in pregnant women attending an Australian public hospital antenatal clinic . Method Ninety ( 90 ) pregnant women who self-report smoking in the last 7 days and whose smoking status is biochemically verified , will be block r and omised into one of three groups : a. No incentive control group ( n=30 ) , b. $ 20 incremental incentive group ( n=30 ) , and c. $ 40 incremental incentive group ( n=30 ) . Smoking status will be assessed via a self-report computer based survey in nine study sessions with saliva cotinine analysis used as biochemical validation . Women in the two incentive groups will be eligible to receive a cash reward at each of eight measurement points during pregnancy if 7-day smoking cessation is achieved . Cash rewards will increase incrementally for each period of smoking abstinence . Discussion Identifying strategies that are effective in reducing the number of women smoking during pregnancy and are easily adopted into st and ard antenatal practice is of utmost importance . A personal financial incentive scheme is a potential antenatal smoking cessation strategy that warrants further investigation . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) number : Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Background Across the developed world , we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision . Integrated care pathways ( ICPs ) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration . ICPs map out a patient 's journey , providing coordination of services for users . They aim to have : ' the right people , doing the right things , in the right order , at the right time , in the right place , with the right outcome ' . The value for ICPs in supporting the delivery of care across organisational boundaries , providing greater consistency in practice , improving service continuity and increasing collaboration has been advocated by many . However , there is little evidence to support their use , and the need for systematic evaluations in order to measure their effectiveness has been widely identified . A recent Cochrane review assessed the effects of ICPs on functional outcome , process of care , quality of life and hospitalisation costs of in patients with acute stroke , but did not specifically focus on service integration or its derivatives . To the best of our knowledge , no such systematic review of the literature exists . Objectives To systematic ally review all high‐ quality studies which have evaluated the impact of care pathway technologies on ' service integration ' and its derivatives in stroke care To examine how elements of service integration are defined in such studies To examine the type of evidence utilised to measure service integration To analyse the weight of evidence used to support cl aims about the effectiveness of ICPs on improving service integration To produce recommendations for ICP developers , users and evaluators . Inclusion criteria Types of participants The review focused on the care of adult patients who had suffered a stroke . It included the full spectrum of services ‐ acute care , rehabilitation and long‐term support ‐ in hospital and community setting s. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest , defined for the purpose of this review as ' a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and st and ardise the outcome orientated care ' . Here ' multidisciplinary ' is taken to refer to the involvement of two or more disciplines . Types of outcomes Service integration ' was the outcome of interest however , this was defined and measured in the selected studies . Types of studies This review was concerned with how ' service integration ' was defined in evaluations of ICPs ; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on ' service integration ' . Studies that made an explicit link between ICPs and service integration were included in the review . Evidence generated from r and omised controlled trials , quasi‐experimental , qualitative and health economics research was sought . The search was limited to publications after 1980 , coinciding with the emergence of ICPs in the healthcare context . Assessment for inclusion of foreign papers was based on the English‐ language abstract , where available . These were included only if an English translation was available . Exclusion criteria This review excluded studies that : focused only on a single aspect of stroke care ( e.g. dysphasia ) evaluated ICPs as part of a wider program of service development did not make an explicit link between ICPs and service integration did not meet the definition of ICP utilised for the purpose s of the review focused exclusively on the outcomes of variance analysis Search strategy In order to avoid replication , the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Data base and the Cochrane Library were search ed to establish that no systematic review s existed and none were in progress . A three‐stage search strategy was then used to identify both published and unpublished studies ( see Appendix III ) . Data collection Our search strategy located 2123 papers , of which 39 were retrieved for further evaluation . We critically appraised seven papers , representing five studies . These were all evaluation studies and , as is typical in this field , comprised a range of study design s and data collection methods . Owing to the diversity of the study types included in the review , we developed a single‐ appraisal checklist and data ‐ extraction tool which could be applied to all research design s.32 The tool drew on the Joanna Briggs Institute ( JBI ) appraisal checklists for experimental studies and interpretive and critical research , and also incorporated specific information and issues which were relevant for our purpose s ( see Appendix VI ) . This extends the thinking outlined in Lyne et al.31 in which , drawing on Campbell and Stanley 's classic paper , the case is made for developing an appraisal tool which is applicable to all types of evaluation , irrespective of study design . In assessing the quality of the papers , we were sympathetic to the method ological challenges of evaluating complex interventions such as ICPs . We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare context s. In accordance with the aims of this particular review , we have included studies , which are method ologically weaker than is typical of many systematic review s because , in our view , in the absence of stronger evidence , they yield useful information . Data synthesis Given the heterogeneity of the included studies , meta‐ analysis and /or qualitative synthesis was not possible . A narrative summary of the study findings is presented . Results ICPs can be effective in ensuring that patients receive relevant clinical interventions and /or assessment s in a timely manner , although these improvements may reflect better documentation rather than actual changes in practice . ICPs can be effective in improving the documentation of rehabilitation goals , documentation of communication with patients , carers ( diagnosis , prognosis and follow‐up arrangements ) and documentation of notification of primary care physicians of discharge . However , this can create additional burdens of work for staff . Early studies of  ICP‐managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination , morbidity or mortality . These effects do not reach statistical significance , however , and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay . While later studies in the acute and rehabilitation context s do not reveal any significant reduction in length of stay , they do report greater documented use of certain clinical interventions and assessment s , suggesting that ICPs can be effective in mobilising hospital re sources around the patient . ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections , although we do not know whether this can be attributed to improved service integration . ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher‐level functioning and carer needs influencing perceptions of quality of life . ICP management may assist in clarifying role boundaries and a shared underst and ing of the work , but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation . There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement , but in situations in which multidisciplinary working is effective , their positive effects may be limited . Furthermore , it is far from clear what the active ingredients of ICPs actually are . Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.20 None of the studies assessed the balance of costs and benefits of ICP use . Therefore , we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits . Conclusions Implication s for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care . This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of re sources around the patient without incurring additional increases in length of stay . ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable . Their value in the context of rehabilitation setting s in which recovery pathways are more variable is less clear . There is some evidence that ICPs may be effective in bringing about behavioural changes in context s where deficiencies in service provision have been identified . Their value in context s where inter‐professional working is well established is less clear . While earlier before and after studies show a reduction in length of stay in ICP‐managed care , this may reflect wider healthcare trends , and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced . There is some evidence to suggest that ICPs bring about improvements in documentation , but we do not know how far documented practice reflects actual practice . It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use . As none of the studies review ed included an economic evaluation , moreover , it remains unclear whether the benefits of ICPs Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO Scientific background Poor compliance or adherence in  drug therapy  can cause increased morbidity , mortality and enormous costs in the healthcare system ( in Germany annually approximately 10 billion euros ) . Different methods are used for enhancing the compliance or adherence . Research questions The evaluation addresses the questions about existence , efficacy , cost-benefit relation as well as ethical-social and juridical implication s of strategies for enhancing compliance or adherence in drug therapy with concomitant improvements in treatment outcomes . Methods A systematic literature search was conducted in the medical , also health economic relevant , literature data bases in January 2007 , beginning from 2002 . Systematic review s on the basis of ( r and omised controlled trials ( RCT ) concerning interventions to enhance compliance or adherence with regard to treatment outcomes as well as systematic review s of health economic analyses were included in the evaluation . Additionally , it was also search ed for publications which primarily considered ethical-social and juridical aspects of these interventions for the German context . Results One systematic review with data for 57 RCT was included in the medical evaluation and one systematic review with data for six studies into the health economic evaluation . No publication primary concerning ethical-social or juridical implication s could be identified . A significant positive effect on the treatment outcome was reported for 22 evaluated interventions . For many interventions the results can be classified as reliable : counseling with providing an information leaflet and compliance diary chart followed by phone consultation for helicobacter pylori positive patients , repeated counseling for patients with acute asthma symptoms , telephone calls to establish the level of compliance and to make recommendations based on that for the therapy of cardiovascular diseases , calls of an automated telephone system with phone counseling in problem cases for diabetics , different family based interventions including repeated family counseling , education and " culturally modified family therapy " in patients with schizophrenia , repeated " compliance therapy " sessions for patients with acute psychosis . For other interventions the results should be viewed with more concern ( because of the poor method ical quality of the underlying studies ) . The effect size of the interventions can not be estimated from the available data . From the available data , no reliable results can be provided concerning the cost-benefit relation of these strategies . Discussion Many of the reported studies had a poor reporting and method ological quality . The reliability of the conclusions of the studies is restricted because of method ical shortcomings . Efficacy and cost estimates determined in the health economic studies are not transferable to the current situation in Germany . It has been discussed recently that the compliance or adherence enhancing interventions can restrict the autonomy and the privacy of the patients . Conclusions In drug therapy some compliance or adherence enhancing interventions with concomitant positive effect on the treatment outcome may be used . The cost-benefit relation of these interventions is to be estimated . Using these interventions the patient ’s autonomy and privacy are to be restricted as few as possible Background Identifying all existing evidence is a crucial aspect in conducting systematic review s. Since the retrieval of electronic data base search es alone is limited , guidelines recommend the use of additional search strategies . The aim of this investigation was to assess the efficiency and contribution of additional search strategies for identifying r and omized controlled trials in conducting a systematic review on interventions after performing a sensitive electronic data base search . Design and Methods Seven electronic data bases , 3 journals and 11 systematic review s were search ed . All first authors of the included studies were contacted ; citation tracking and a search in clinical trial registers were performed . A priori defined evaluation criteria were calculated for each search strategy . Results A total of 358 full-text articles were identified ; 50 studies were included in the systematic review , wherefrom 84.0 % ( 42 ) were acquired by the sensitive electronic data base search and 16.0 % ( 8) through additional search strategies . Screening reference lists of related systematic review s was the most beneficial additional search strategy , with an efficiency of 31.3 % ( 5 ) and a contribution of 10.0 % ( 5/50 ) , whereas h and - search ing and author contacts contributed two and one additional studies , respectively . Citation tracking and search ing clinical trial registers did not lead to any further inclusion of primary studies . Conclusions Based on our findings , h and - search ing contents of relevant journals and screening reference lists of related systematic review s may be helpful additional strategies to identify an extensive body of evidence . In case of limited re sources , a sensitive electronic data base search may constitute an appropriate alternative for identifying relevant trials . Significance for public health Systematic review s provide the strongest form of evidence synthesis for therapeutic interventions and are of high relevance for decision makers in public health . Preparing high quality systematic review s can be very time-consuming since all existing evidence should be identified , but the retrieval of electronic data base search es is limited and therefore additional search strategies are recommended . However , the time needed for conducting full systematic review s does often not address the need for urgent evidence . Thus , priorities of summarizing all available evidence and providing fast evidence -based recommendations may conflict . So far , no consensus exists regarding which additional search strategies are beneficial and sparsely time-consuming for conducting systematic review s. We examined the efficiency and contribution of additional search strategies performed after a sensitive electronic data base search . Our results provide highly relevant information for research ers conducting systematic review s in various fields of public health research and for establishing guidelines for conducting rapid review Vaccines represent a new and promising avenue of treatment for drug abuse but pose new medication adherence challenges due to prolonged and widely spaced administration schedules . This study examined effects of prize-based incentives on retention and medication adherence among 26 cocaine users involved in a 6-month hepatitis B vaccination series . Participants could meet with research staff weekly for 24 weeks and receive 7 injections containing either the Hepatitis B vaccine or a placebo . All participants received $ 10 at each weekly visit ( maximum of $ 240 ) . Those r and omly assigned to the incentive program received additional monetary payments on an escalating schedule for attendance at weekly monitoring and vaccination visits with maximum possible earnings of $ 751 . Group attendance diverged after study week 8 with attendance better sustained in the incentive than control group ( group by time interaction , p=.035 ) . Overall percent of weekly sessions attended was 82 % for incentive versus 64 % for control ( p=.139 ) . Receiving all scheduled injections were 77 % of incentive versus 46 % of control participants ( p=.107 ) . A significantly larger percentage ( 74 % versus 51 % ; p=.016 ) of injections were received by incentive versus control participants on the originally scheduled day . Results suggest that monetary incentives can successfully motivate drug users to attend sessions regularly and to receive injected medications in a more reliable and timely manner than may be seen under usual care procedures . Thus , incentives may be useful for addressing adherence and allowing participants to reap the full benefits of newly developed medications The prevalence of overweight and obesity has more than doubled in the past three decades , leading to rising rates of non-communicable diseases . This study tests whether adding a payment/rewards ( term reward ) program to an existing evidence -based weight loss program can increase weight loss and weight loss maintenance . We conducted a parallel-group r and omized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals r and omized to either control or reward arm in a 1:2 ratio . Control and reward arm participants received a four month weight loss program at the LIFE ( Lifestyle Improvement and Fitness Enhancement ) Centre at Singapore General Hospital . Those in the reward arm paid a fee of S$165.00 ( 1 US$ = 1.35S$ ) to access a program that provided rewards of up to S$660 for meeting weight loss and physical activity goals . Participants could choose to receive rewards as guaranteed cash payments or a lottery ticket with a 1 in 10 chance of winning but with the same expected value . The primary outcome was weight loss at months 4 , 8 , and 12 . 161 participants were r and omized to control ( n = 54 ) or reward ( n = 107 ) arms .  Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 when the program concluded ( 3.4 kg vs 1.4 kg , p < 0.01 ) , month 8 when rewards concluded ( 3.3 kg vs 1.8 kg , p < 0.05 ) , and at month 12 ( 2.3 kg vs 0.8 kg , p < 0.05 ) . These results reveal that a payment/rewards program can be used to improve weight loss and weight loss maintenance when combined with an evidence -based weight loss program . Future efforts should attempt to replicate this approach and identify how to cost effectively exp and these programs to maximize their reach . This study is registered at www . clinical trials.gov ( Identifier : NCT01533454 ) BACKGROUND Ventilator-associated pneumonia ( VAP ) is an important cause of morbidity and mortality in ventilated critically ill patients . Despite a large amount of research evidence , the optimal diagnostic and treatment strategies for VAP remain controversial . PURPOSE The aim of this study was to develop evidence -based clinical practice guidelines for the diagnosis and treatment of VAP . Data sources include Medline , EMBASE , Cumulative Index to Nursing and Allied Health Literature , and the Cochrane Data base of Systematic Review s and Register of Controlled Trials . STUDY SELECTION The authors systematic ally search ed for all relevant r and omized controlled trials and systematic review s on the diagnosis and treatment of VAP in mechanically ventilated adults that were published from 1980 to October 1 , 2006 . DATA EXTRACTION Independently and in duplicate , the panel critically appraised each published trial . The effect size , confidence intervals , and homogeneity of the results were scored using predefined definitions . The full guideline development panel arrived at a consensus for scores on safety , feasibility , and economic issues . LEVELS OF EVIDENCE Based on the scores for each topic , the following statements of recommendation were used : recommend , consider , do not recommend , and no recommendation because of insufficient or conflicting evidence . DATA SYNTHESIS For the diagnosis of VAP in immunocompetent patients , we recommend that endotracheal aspirates with nonquantitative cultures be used as the initial diagnostic strategy . When there is a suspicion of VAP , we recommend empiric antimicrobial therapy ( in contrast to delayed or culture directed therapy ) and appropriate single agent antimicrobial therapy for each potential pathogen as empiric therapy for VAP . Choice of antibiotics should be based on patient factors and local resistance patterns . We recommend that an antibiotic discontinuation strategy be used in patients who are treated of suspected VAP . For patients who receive adequate initial antibiotic therapy , we recommend 8 days of antibiotic therapy . We do not recommend nebulized endotracheal tobramycin or intratracheal instillation of tobramycin for the treatment of VAP . CONCLUSION We present evidence -based recommendations for the diagnosis and treatment of VAP . Implementation of these recommendations into clinical practice may lessen the morbidity and mortality of patients who develop VAP Objective : Fixed incentives have been largely unsuccessful in improving adherence to antiretroviral medication . Therefore , we evaluate whether small incentives based on behavioral economic theory can increase adherence to antiretroviral medication among treatment-mature adults in Kampala , Ug and a. Design : A r and omized control trial design tests whether providing small incentives based on either attending timely clinic visits ( intervention group 1 ) or achieving high medication adherence ( intervention group 2 ) can increase antiretroviral adherence . Antiretroviral adherence is measured by medical event monitoring system ( MEMS ) caps . Methods : Overall , 155 HIV-infected men and women age 19–78 were r and omized into one of two intervention groups and received small prizes of US $ 1.50 awarded through a drawing conditional on either attending scheduled clinic appointments or achieving at least 90 % antiretroviral adherence . The control group received the usual st and ard of care . Results : Preliminary results based on pooling the intervention groups showed individuals receiving incentives were 23.7 percentage points more likely to achieve 90 % antiretroviral adherence compared with the control group [ 95 % confidence interval ( CI ) , 6.7–40.7 % ] . Specifically , 63.3 % ( 95 % CI , 52.9–72.8 % ) of participants in the pooled intervention groups maintained at least 90 % mean adherence during the first 9 months of the intervention , compared with 39.6 % ( 95 % CI , 25.8–54.7 % ) in the control group . Conclusion : Small prize incentives result ed in a statistically significant increase in antiretroviral adherence . Although more traditional fixed incentives have not produced the desired results , these findings suggest that small incentives based on behavioral economic theory may be more effective in motivating long-term adherence among treatment-mature adults Insufficient response rates are a frequent problem in mailed epidemiologic health surveys . As part of a health survey of 1,235 young adults conducted from November 1992 through January 1993 in Geneva , Switzerl and , a r and omized factorial trial was carried out to assess the contributions of two tactics to increase response rates . The first incentive was the promise of sending 10 Swiss francs ( 7 US dollars ) to respondents ; the second was a red postcard , mailed 2 days after the question naire , which reminded potential participants to complete the question naire . The most effective strategy according to interim analysis was to be selected for follow-up mailings . Two weeks after the first mailing , response rates were 65 % for those who had received both incentives , 57 % for those who had been offered the money reward only , 54 % for recipients of the reminder card , and 48 % for those who had received neither incentive ( p based on chi 2 ( 3 df ) test < 0.001 ) . The relative hazards of responding were 1.34 ( 95 % confidence interval 1.15 - 1.55 ) for the money reward and 1.22 ( 95 % confidence interval 1.05 - 1.41 ) for the reminder card . Follow-up mailings to all nonrespondents included both incentives . At the end of data collection , 1,007 persons ( 82 % ) had returned the question naire . The final response rates were 83 , 84 , 82 , and 78 % in the four groups , respectively ( p = 0.29 ) . Both the promise of a monetary reward and a reminder postcard considerably improved early response rates . The use of both incentives in follow-up mailings brought final response rates above 80 % , except for those who had received no initial incentive . Testing various combinations of incentives in the early stages of a mailed health survey may be a generally useful strategy Background Pelvic Girdle Pain ( PGP ) is an important cause of disability and economic cost worldwide . There is a need for effective preventative and management strategies . Emerging studies measure a variety of outcomes rendering synthesis and translation to clinical practice difficult . A Core Outcome Set ( COS ) can address this problem by ensuring that data are relevant , useful and usable for making well-informed healthcare choices . The aim of this study is to develop a consensus-based PGP-COS , including agreement on methods ( e.g. instruments ) for measuring the construct outcomes in the COS for use in research and clinical practice . Furthermore , as there is uncertainty as to whether incorporating stakeholder interviews in addition to conducting a systematic review to determine an initial list of outcomes for the Delphi survey , or , whether using different rating scales in a Delphi survey impacts on the final COS , we propose to embed two method ological studies within the PGP-COS development process to address these questions . Methods The PGP-COS study will include five phases : ( 1 ) A systematic review of the literature and semi-structured interviews with 15 patients ( three countries ) to form the initial list of outcomes for the Delphi survey ; ( 2 ) A 3-round Delphi including patients , clinicians , research ers and service providers ; ( 3 ) A systematic review of methods for measuring the outcomes in the preliminary PGP-COS identified in the Delphi survey ; ( 4 ) A face-to-face consensus meeting to agree on the final PGP-COS and methods for measuring the COS ; ( 5 ) Global dissemination . To address the method ological questions , we will assess the number and type of outcomes , in the final PGP-COS , that were exclusively derived from the interviews . Secondly , we will r and omise Delphi survey participants to either a 5-point or 9-point importance rating scale , and examine potential differences in ‘ important ’ ratings between the groups . Discussion There is currently no COS for measuring/monitoring PGP in trials and clinical practice . A PGP-COS will ensure that relevant outcomes are measured using appropriate measurement instruments for patients with PGP globally . Core outcome set registration This PGP-COS was registered with COMET ( Core Outcome Measures for Effectiveness Trials ) in January 2017 ( http://www.comet-initiative.org/ studies /details/958 ) Introduction The uptake of Clinical Practice Guideline ( CPG ) recommendations that improve outcomes in heart failure ( HF ) remains suboptimal . We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations , those with clear evidence that benefits outweigh the risks . We will use American , Canadian and European HF guidelines as our reference . Methods and analysis We will conduct a literature search in the data bases of MEDLINE , EMBASE , HEALTHSTAR , CINAHL , Cochrane Library , Campbell Collaboration , Joanna Briggs Institute Evidence Based Practice , Centre for Review s and Dissemination and Evidence Based Practice Centres . We will include prospect i ve studies evaluating implementation interventions aim ed at improving uptake of class I CPG recommendations in HF . We will extract data in duplicate . We will classify interventions according to their level of application ( ie , provider , organisation , systems level ) and common underlying characteristics ( eg , education , decision-support , financial incentives ) using the Cochrane Effective Practice and Organisation of Care Taxonomy . We will assess the impact of the intervention on adherence to the CPGs . Outcomes will include proportion of eligible patients who were : prescribed a CPG-recommended pharmacological treatment ; referred for device consideration ; provided self-care education at discharge ; and provided left ventricular function assessment . We will include clinical outcomes such as hospitalisations , readmissions and mortality , if data is available . We will identify the common elements of successful and failing interventions , and examine the context in which they were applied , using the Process Re design context ual framework . We will synthesis e the results narratively and , if appropriate , will pool results for meta- analysis . Discussion and dissemination In this review , we will assess the impact of implementation strategies and context ual factors on physician adherence to HF CPGs . We will explore why some interventions may succeed in one setting and fail in another . We will disseminate our findings through briefing reports , publications and presentations . Trial registration number CRD42015017155 Background Healthcare decision makers face challenges when using guidelines , including underst and ing the quality of the evidence or the values and preferences upon which recommendations are made , which are often not clear . Methods GRADE is a systematic approach towards assessing the quality of evidence and the strength of recommendations in healthcare . GRADE also gives advice on how to go from evidence to decisions . It has been developed to address the weaknesses of other grading systems and is now widely used internationally . The Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence ( DECIDE ) consortium ( http://www.decide-collaboration.eu/ ) , which includes members of the GRADE Working Group and other partners , will explore methods to ensure effective communication of evidence -based recommendations targeted at key stakeholders : healthcare professionals , policymakers , and managers , as well as patients and the general public . Surveys and interviews with guideline producers and other stakeholders will explore how presentation of the evidence could be improved to better meet their information needs . We will collect further stakeholder input from advisory groups , via consultations and user testing ; this will be done across a wide range of healthcare systems in Europe , North America , and other countries . Targeted communication strategies will be developed , evaluated in r and omized trials , refined , and assessed during the development of real guidelines . Discussion Results of the DECIDE project will improve the communication of evidence -based healthcare recommendations . Building on the work of the GRADE Working Group , DECIDE will develop and evaluate methods that address communication needs of guideline users . The project will produce strategies for communicating recommendations that have been rigorously evaluated in diverse setting s , and it will support the transfer of research into practice in healthcare systems globally
Our primary conclusion is that there is a lack of compelling evidence that incentives of any form represent a compelling NCD reduction strategy .
The rising epidemic of non-communicable diseases ( NCDs ) poses substantial health and economic challenges to both individuals and society .
Application of incentive-based strategies based on traditional and behavioural economic theory has emerged as a potential strategy to address rising rates of NCDs .
Yet , whether or not incentives truly represent a promising strategy for addressing NCDs has not been systematic ally addressed nor is it clear whether certain behavioural economic strategies outperform others or simply offering a cash-based incentive for meeting a goal .
In this systematic review we aim to determine whether there is an evidence base for any of these strategies .