Robert West

University College London | UCL · Department of Epidemiology and Public Health

Background Systematic reviews of effectiveness estimate the relative average effects of interventions and comparators in a set of existing studies e.g., using rate ratios. However, policymakers, planners and practitioners require predictions about outcomes in novel scenarios where aspects of the interventions, populations or settings may differ. Th...

Background Using reports of randomised trials of smoking cessation interventions as a test case, this study aimed to develop and evaluate machine learning (ML) algorithms for extracting information from study reports and predicting outcomes as part of the Human Behaviour-Change Project. It is the first of two linked papers, with the second paper re...

Background: Investigating and enhancing the effectiveness of behaviour change interventions requires detailed and consistent specification of all aspects of interventions. We need to understand not only their content, that is the specific techniques, but also the source, mode, schedule, and style in which this content is delivered. Delivery style r...

Background and Aims Inadequate reporting of smoking cessation intervention trials is common and leads to significant challenges for researchers. The aim of this study was to tailor CONSORT (Consolidated Standards of Reporting Trials)‐SPI (Social and Psychological Interventions) guidelines to improve reporting of trials of behavioural interventions...

Background Guidelines recommend routine identification of frailty to provide proactive care. In the UK, the electronic Frailty Index (eFI) is built into primary care electronic health records (EHR) to categorise patients according to their frailty score. The eFI uses the ‘cumulative deficit model’, where the frailty score is the proportion of defic...

Background: Behaviour change interventions influence behaviour through causal processes called “mechanisms of action” (MoAs). Reports of such interventions and their evaluations often use inconsistent or ambiguous terminology, creating problems for searching, evidence synthesis and theory development. This inconsistency includes the reporting of Mo...

Objectives: We aimed to identify psychological factors associated with the use of facemasks in shops in England following removal of legal requirements to do so, and to compare associations with and without legal restrictions. Design: Repeated cross-sectional online surveys (n ≈ 2000 adults) between August 2020 and April 2022 (68,716 responses f...

Ontologies are ways of representing aspects of the world in terms of uniquely defined classes of ‘entities’ and relationships between them. They are widely used in biological science, data science and commerce because they provide clarity, consistency, and the ability to link information and data from different sources. Ontologies offer great promi...

Background: The Behaviour Change Technique Taxonomy v1 (BCTTv1) specifies the potentially active content of behaviour change interventions. Evaluation of BCTTv1 showed the need to extend it into a formal ontology, improve its labels and definitions, add BCTs and subdivide existing BCTs. We aimed to develop a Behaviour Change Technique Ontology (BCT...

Introduction Disorders of gut-brain interaction (DGBI) account for a significant proportion of the budget for healthcare in the UK and the workload of gastroenterologists. However, there is minimal epidemiological data comparing the prevalence and impact of DGBI in the UK to other countries. We therefore compared the national prevalence of each of...

Background and aims: Behavioural smoking cessation trials have employed comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (in...

Objective: To explore longitudinally the impact of multiple long-term conditions (LTCs) on frailty progression separately for males and females. Methods: A functional frailty measure (FFM) was used to examine putative determinants of frailty progression among participants aged 65 to 90 in the English Longitudinal Study of Ageing (ELSA), across n...

Background The Behaviour Change Technique Taxonomy v1 (BCTTv1) specifies the potentially active content of behaviour change interventions. Evaluation of the BCTTv1 showed the need to extend it into a formal ontology, improve its labels and definitions, add BCTs and subdivide existing BCTs. We aimed to develop a Behaviour Change Technique Ontology (...

Background: Behaviour change interventions influence behaviour through causal processes called “mechanisms of action” (MoAs). Reports of such interventions and their evaluations often use inconsistent or ambiguous terminology. This includes the reporting of MoAs, creating challenges for searching, evidence synthesis and theory development. An ontol...

Background and aims: Using reports of randomised trials of smoking cessation interventions as a test case, this study aimed to develop and evaluate machine learning (ML) algorithms for extracting information from study reports and predicting outcomes as part of the Human Behaviour Change Project. Methods: Researchers manually annotated 70 items of...

Background: The route into the body for many pathogens is through the eyes, nose and mouth (i.e., the 'T-zone') via inhalation or fomite-based transfer during face touching. It is important to understand factors that are associated with touching the T-zone to inform preventive strategies. Purpose: To identify theory-informed predictors of intent...

Objectives: To investigate knowledge of self-isolation rules and factors associated with knowledge. Methods: Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated a...

Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety o...

Aim To evaluate the effectiveness of the offer of Smoke Free – an evidence-informed, widely used app – for smoking cessation versus no support. Design Two-arm individually randomised controlled effectiveness trial. Setting Online with no restrictions on location. Participants 3,143 adult smokers (74.7% female; mean[SD] age 49.0 [11.5] years) mot...

Objectives: We aimed to identify psychological factors associated with use of facemasks in shops in England following removal of legal requirements to do so, and to compare associations with and without legal restrictions.Design: Repeated cross-sectional online surveys (n≈ 2,000 adults) between August 2020and April 2022 (68,716 responses from 45,68...

Despite strong expertise and a sophisticated scientific advisory system, the UK’s response to the Covid-19 pandemic has been, and continues to be, weak in terms of preventing death and illness, and damage to the economy. This article argues that an important reason for this failure has been that the policies of the UK government have at critical ti...

Background and aims: We aimed to create a basic set of definitions and relationships for identity-related constructs, as part of the Addiction Ontology and E-Cigarette Ontology projects, that could be used by researchers with diverse theoretical positions and so facilitate evidence synthesis and interoperability. Methods: We reviewed the use of...

Background Frailty is a risk factor for adverse health outcomes. There is a paucity of literature on frailty progression defined by a cumulative deficit model among community dwelling older people. The objective of this review was to synthesise evidence on these changes in health and mortality among community-dwelling older people. Methods Six dat...

Ontologies are ways of representing aspects of the world in terms of uniquely defined classes of ‘entities’ and relationships between them. They are widely used in biological science, data science and commerce because they provide clarity, consistency, and the ability to link information and data from different sources. Ontologies offer great promi...

We describe a novel approach to explainable prediction of a continuous variable based on learning fuzzy weighted rules. Our model trains a set of weighted rules to maximise prediction accuracy and minimise an ontology-based 'semantic loss' function including user-specified constraints on the rules that should be learned in order to maximise the exp...

Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety o...

Background: To build cumulative evidence about what works in behaviour change interventions, efforts have been made to develop classification systems for specifying the content of interventions. The Behaviour Change Techniques (BCT) Taxonomy v1 (BCTTv1) is one of the most widely used classifications of behaviour change techniques across a variety o...

Background and aims: Ontologies are ways of representing information that improve clarity and the ability to connect different data sources. This paper proposes an initial version of an ontology of tobacco, nicotine and vaping products with the aim of reducing ambiguity and confusion in the field. Methods: Terms related to tobacco, nicotine and...

Background: We examined whether, in adults receiving behavioural support, offering e-cigarettes together with varenicline helps more people stop smoking cigarettes than varenicline alone. Methods: A two-group, parallel-arm, pragmatic randomised controlled trial was conducted in six English stop smoking services from 2019-2020. Adults enrolled on...

Background We examined whether, in adults receiving behavioural support, offering e-cigarettes together with varenicline helps more people stop smoking cigarettes than varenicline alone. Methods A two-group, parallel-arm, pragmatic randomised controlled trial was conducted in six English stop smoking services from 2019-2020. Adults enrolled onto a...

BACKGROUND: We examined whether, in adults receiving behavioural support, offering e-cigarettes together with varenicline helps more people stop smoking cigarettes than varenicline alone. METHODS: A two-group, parallel-arm, pragmatic randomised controlled trial was conducted in six English stop smoking services from 2019-2020. Adults enrolled onto...

Objective: There are few longitudinal studies of poststroke emotionalism (PSE) and our understanding of the psychological associations of PSE is limited, constraining assessment of existing interventions and the development of new therapies. This study aimed to assess the prevalence and course of PSE over the first year poststroke, and its psychol...

Introduction: It has been estimated that smokers tend to fail to report unsuccessful quit attempts that lasted a short time and occurred a longer time ago. However, it is unclear whether the failure to report unsuccessful quit attempts varies by the type of cessation aid used. Methods: A total of 5,892 smokers aged 16+ years who had made 1+ quit...

Ontologies aim to represent the world in terms of uniquely defined classes and their properties which are expressed as relationships with other classes. They are becoming widely used in science to improve clarity, searching, inference and the ability to link data from different sources. Ontological definitions are descriptions that represent the es...

Since the start of the covid-19 pandemic, in the UK and elsewhere, the phrase “living with covid”—and variations such as “live with it,” “learning to live with the virus”—has circulated in public discourse. It refers to, and summarises, increasingly polarised positions with regards to the pandemic: on the one hand, accept the virus and resist adapt...

Findings from randomized controlled trials (RCTs) of behaviour change interventions encode much of our knowledge on intervention efficacy under defined conditions. Predicting outcomes of novel interventions in novel conditions can be challenging, as can predicting differences in outcomes between different interventions or different conditions. To p...

This report summarises the presentations and discussions that took place during the first Ontologies for Research in the Behavioural and Social Sciences (OntoBess) workshop, held in Bozen-Bolzano and virtually on the 18th September 2021. The workshop highlighted the relevance of ontologies to address overarching challenges in the behavioural and so...

Background: Failure to understand the rules and procedures regarding self-isolation when symptomatic with Covid-19 may have contributed to the low level of adherence found in the UK. We investigated knowledge of these rules and factors associated with knowledge.Methods: Data were drawn from repeated weekly/fortnightly online surveys of nationally r...

Objectives: Working from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors.Study design: Data from the ongoing CORSAIR survey...

Background Implementing evidence-based recommendations is challenging in UK primary care, especially given system pressures and multiple guideline recommendations competing for attention. Implementation packages that can be adapted and hence applied to target multiple guideline recommendations could offer efficiencies for recommendations with commo...

The COVID-19 pandemic has shone a light on the complex relationship between science and policy. Policymakers have had to make decisions at speed in conditions of uncertainty, implementing policies that have had profound consequences for people's lives. Yet this process has sometimes been characterised by fragmentation, opacity and a disconnect betw...

Aims The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time...

Background and aims Cigarette smoking takes place within a cultural and social context. Political views and practices are an important part of that context. To gain a better understanding of smoking, it may be helpful to understand its association with voting patterns as an expression of the political views and practices of the population who smoke...

The 1988 U.S. Surgeon General’s Report titled ‘Nicotine Addiction’ was a comprehensive treatise setting out the evidence that tobacco is addictive and showing that nicotine lies at the heart of this addiction. It likened tobacco to drugs such as cocaine and heroin, and provided a powerful rationale for combining public health and clinical approache...

Background Improving adherence to self-protective behaviours is a public health priority. We aimed to assess the potential effectiveness and ease of use of an online version of the Risk Acceptance Ladder (RAL) in promoting help-seeking for cigarette smoking, excessive alcohol consumption, insufficient physical activity, or low fruit and vegetable c...

Objectives Delivery of craving management tools via smartphone applications (apps) may improve smoking cessation rates, but research on such programmes remains limited, especially in real-world settings. This study evaluated the effectiveness of adding craving management tools in a cessation app (BupaQuit). Methods The study was a two-arm pragmati...

Background In recent years the UK has expanded the provision of liaison mental health services (LMHS). Little work has been undertaken to explore first-hand experiences of them. Aims The aim of this study was to gain insights into the experiences of users of LMHS in both emergency departments and acute inpatient wards in the UK. Methods This cros...

Objectives: The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England's Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. Methods: With minimal direct evidence available,...

Objectives: Working from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. / Study design: Data from the ongoing CORSAIR surv...

Importance: Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy. Objective: To examine whether standard cytisin...

Objectives Working from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. Study design Data from the ongoing CORSAIR survey...

Background: Digital interventions have the potential to reduce alcohol consumption, although evidence on the effectiveness of apps is lacking. Drink Less is a popular, evidence-informed app with good usability, putting it in a strong position to be improved upon prior to conducting a confirmatory evaluation. This paper describes the process of refi...

Purpose: Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: We need evidence to inform how to achieve this. We aimed to synthesize evidence on interventions to increase six personal protective behaviours (e.g., hand hygiene, face mask use, maintaining physical distancing) to...

Aim To investigate predictors of participant eligibility, recruitment and retention in behavioural randomized controlled trials (RCTs) for smoking cessation. Method Systematic review and pre-specified meta-regression analysis of behavioural RCTs for smoking cessation including adult (≥ 18-year-old) smokers. The pre-specified predictors were identif...

Aims Recently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences o...

International evidence indicates that older people with frailty are more likely to access social care services, compared to nonfrail older people. There is, however, no robust evidence on costs of social care provided for community-dwelling older people living with frailty in their own homes. The main objective of this study was to examine the rela...

Background and aims: Cigarette smoking takes place within a cultural and social context. Political views and practices are an important part of that context. To gain a better understanding of smoking, it may be helpful to understand its association with voting patterns as an expression of the political views and practices of the population who smok...

PURPOSE: Increasing personal protective behaviours is critical for stopping the spread of respiratory viruses, including SARS-CoV-2: we need evidence to inform how to achieve this. We aimed to synthesise evidence on interventions to increase six personal protective behaviours (e.g. hand hygiene, face mask use) to limit the spread of respiratory vir...

Background and aims: Analysed using classical frequentist hypothesis testing with alpha set to 0.05, the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) did not find enough evidence to reject the hypothesis of no difference in neuropsychiatric adverse events (NPSAEs) attributable to varenicline, bupropion, or nicotine patch...

Background: Identifying how behaviour change interventions are delivered, including by whom, is key to understanding intervention effectiveness. However, information about who delivers interventions is reported inconsistently in intervention evaluations, limiting communication and knowledge accumulation. This paper reports a method for consistent r...

Background and aims: Working from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. Methods: Data from the ongoing CORSAIR su...

Background: Conventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psycholo...

Background: Investigating and improving the effects of behaviour change interventions requires detailed and consistent specification of all aspects of interventions. An important feature of interventions is the way in which these are delivered, i.e. their mode of delivery. This paper describes an ontology for specifying the mode of delivery of inte...

Aims To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and sociodemographic profile of those smokers. Design and setting Nationally representative cross‐sectional survey of adults in England conducted between January 2009 and July 2019. Par...

Introduction Gastrointestinal symptom-specific anxiety and somatisation have both been associated with higher symptom severity in patients with irritable bowel syndrome (IBS). However, the relationship between these two factors and IBS symptom severity has not been explored fully. In addition, the performance of the instrument that measures gastroi...

Introduction Conventionally, patients with irritable bowel syndrome (IBS) are divided into subgroups based on their predominant stool pattern, either diarrhoea, constipation, or mixed stool form. However, factors other than gastrointestinal symptoms, such as psychological co-morbidities, are also highly relevant to IBS symptomatology. We explored a...

Introduction: Activities promoting research reproducibility and transparency are crucial for generating trustworthy evidence. Evaluation of smoking interventions is one area where vested interests may motivate reduced reproducibility and transparency. Aims: Assess markers of transparency and reproducibility in smoking behaviour change interventi...

Background: Behaviour change interventions (BCI), their contexts and evaluation methods are heterogeneous, making it difficult to synthesise evidence and make recommendations for real-world policy and practice. Ontologies provide a means for addressing this. They represent knowledge formally as entities and relationships using a common language abl...

Background: Smartphone apps are increasingly used for health-related behaviour change and people discover apps through different sources. However, it is unclear whether users differ by mode of app discovery. Drink Less is an alcohol reduction app that received national media coverage in the UK caused by celebrity influence (a male TV and radio nati...