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BACKGROUND: A RCT of a novel intervention to detect antidepressant medication response (the PReDicT Test) took place in five European countries, accompanied by a nested study of its acceptability and implementation presented here. The RCT results indicated no effect of the intervention on depression at 8 weeks (primary outcome), although effects on anxiety at 8 weeks and functioning at 24 weeks were found. METHODS: The nested study used mixed methods. The aim was to explore patient experiences of the Test including acceptability and implementation, to inform its use within care. A bespoke survey was completed by trial participants in five countries (n = 778) at week 8. Semi-structured interviews were carried out in two countries soon after week 8 (UK n = 22, Germany n = 20). Quantitative data was analysed descriptively; for qualitative data, thematic analysis was carried out using a framework approach. Results of the two datasets were interrogated together. OUTCOMES: Survey results showed the intervention was well received, with a majority of participants indicating they would use it again, and it gave them helpful extra information; a small minority indicated the Test made them feel worse. Qualitative data showed the Test had unexpected properties, including: instigating a process of reflection, giving participants feedback on progress and new understanding about their illness, and making participants feel supported and more engaged in treatment. INTERPRETATION: The qualitative and quantitative results are generally consistent. The Test's unexpected properties may explain why the RCT showed little effect, as properties were experienced across both trial arms. Beyond the RCT, the qualitative data sheds light on measurement reactivity, i.e., how measurements of depression can impact patients.

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Ambulatory assessment (AA) studies are frequently used to study emotions, cognitions, and behavior in daily life. But does the measurement itself produce reactivity, that is, are the constructs that are measured influenced by participation? We investigated individual differences in intraindividual change in momentary emotional clarity and momentary pleasant-unpleasant mood over the course of an AA study. Specifically, we experimentally manipulated sampling frequency and hypothesized that the intraindividual change over time would be stronger when sampling frequency was high (vs. low). Moreover, we assumed that individual differences in dispositional mood regulation would moderate the direction of intraindividual change in momentary pleasant-unpleasant mood over time. Students (n = 313) were prompted either three or nine times a day for 1 week (data collection took place in 2019 and 2020). Multilevel growth curve models showed that momentary emotional clarity increased within participants over the course of the AA phase, but this increase did not differ between the two sampling frequency groups. Pleasant-unpleasant mood did not show a systematic trend over the course of the study, and mood regulation did not predict individual differences in mood change over time. Again, results were not moderated by the sampling frequency group. We discuss limitations of our study (e.g., WEIRD sample) and potential practical implications regarding sampling frequency in AA studies. Future studies should further systematically investigate the circumstances under which measurement reactivity is more likely to occur.

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Making judgments of learning (JOLs) while studying related word pairs can enhance performance on tests that rely on cue-target associations (e.g., cued recall) compared to studying alone. One possible explanation for this positive JOL reactivity effect is that the prompt to make JOLs, which typically occurs halfway through the presentation of each pair, may encourage learners to devote more attention to the pair during the second half of the encoding episode, which may contribute to enhanced recall performance. To investigate this idea, an online sample of participants (Experiment 1) and undergraduate students (Experiment 2) studied a set of moderately related word pairs (e.g., dairy-cow) in preparation for a cued recall test. Some participants made JOLs for each pair halfway through the presentation, whereas other participants did not. Also, some participants were presented with a fixation point halfway through the presentation, whereas other participants were not. The goal of this fixation point was to simulate the possible "reorienting" effect of a JOL prompt halfway through each encoding episode. In both an unsupervised online context and a supervised laboratory context, cued recall performance was higher for participants who made JOLs compared to those who did not make JOLs. However, presenting a fixation point halfway through the presentation of each pair did not lead to reactive effects on memory. Thus, JOLs are more effective than a manipulation that reoriented participants to the word pairs in another way (i.e., via a fixation point), which provides some initial evidence that positive reactivity for related pairs is not solely driven by attentional reorienting during encoding.

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Making immediate judgments of learning (JOLs) during study can influence later memory performance, with a common outcome being that JOLs improve cued-recall performance for related word pairs (i.e., positive reactivity) and do not impact memory for unrelated pairs (i.e., no reactivity). The cue-strengthening hypothesis proposes that JOL reactivity will be observed when a criterion test is sensitive to the cues used to inform JOLs (Soderstrom et al., Journal of Experimental Psychology: Learning, Memory, and Cognition, 41 (2), 553-558, 2015). Across four experiments, we evaluated this hypothesis with category pairs (e.g., A type of gem - Jade) and letter pairs (e.g., Ja - Jade). Participants studied a list comprised of both pair types, made (or did not make) JOLs, and completed a cued-recall test (Experiments 1a/b). The cue-strengthening hypothesis predicts greater positive reactivity for category pairs than for letter pairs, because making a JOL strengthens the relationship between the cue and target, which is more beneficial for material with an a priori semantic relationship. Outcomes were consistent with this hypothesis. We also evaluated and ruled out alternative explanations for this pattern of effects: (a) that they arose due to overall differences in recall performance for the two pair types (Experiment 2); (b) that they would also occur even when the criterion test is not sensitive to the cues used to inform JOLs (Experiment 3); and (c) that JOLs only increased memory strength for the targets (Experiment 4). Thus, the current experiments rule out plausible accounts of reactivity effects and provide further, converging evidence for the cue-strengthening hypothesis.

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OBJECTIVES: To estimate the extent of reactivity to measurement of physical activity (PA) and sedentary behavior among women in midlife with elevated risk for cardiovascular disease (CVD). DESIGN: Secondary analysis of a 10-day observational study of PA and sedentary behavior. MAIN OUTCOME MEASURES: PA (steps, minutes of light PA, total minutes of moderate-to- vigorous PA [MVPA]) and percent time in sedentary behavior per day were assessed using ActiGraph GT3X tri-axial accelerometers in 75 women in midlife with elevated CVD risk (e.g. hypertension; MAge = 51.61, MBMI = 34.02 kg/m2). Two-level multilevel models were used to test for evidence of reactivity, with the addition of random effects to test for evidence of individual differences in observed trends. RESULTS: All outcomes showed linear trends across days (ps < 0.001), though this masked what appeared to be meaningful dropoff after Day 1 or Day 2 (with little difference between subsequent days; srs ranging from 0.15 to 0.32). The random effect was significant only for percent time in sedentary behavior (χ2[1] = 10.40, p = 0.02). CONCLUSIONS: Consistent small to medium effects were found for all PA and sedentary behavior outcomes, underscoring the importance of considering measurement reactivity in populations with elevated CVD risk.

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BACKGROUND: Experience sampling methods (ESMs) are increasingly being used to study ecological emotion dynamics in daily functioning through repeated assessments taken over several days. However, most of these ESM approaches are only based on self-report assessments, and therefore, studies on the ecological trajectories of their underlying mechanisms are scarce (ie, cognitive biases) and require evaluation through experimental tasks. We developed a novel ESM tool that integrates self-report measures of emotion and emotion regulation with a previously validated app-based cognitive task that allows for the assessment of underlying mechanisms during daily functioning. OBJECTIVE: The objective of the study is to test this new tool and study its usability and the possible factors related to compliance with it in terms of latency and missing responses. Among the compliance predictors, we considered psychological and time-related variables, as well as usability, measurement reactivity, and participants' satisfaction with the tool. METHODS: We conducted 2 extensive ESM studies-study 1 (N=84; a total of 3 assessments per day for 5 days) and study 2 (N=135; a total of 3 assessments per day for 10 days). RESULTS: In both studies, participants found the tool highly usable (average usability score >81). By using mixed regression models, we found both common and specific results for the compliance predictors. In both study 1 and study 2, latency was significantly predicted by the day (P<.001 and P=.003, respectively). Participants showed slower responses to the notification as the days of the study progressed. In study 2 but not in study 1, latency was further predicted by individual differences in overload with the use of the app, and missing responses were accounted for by individual differences in stress reactivity to notifications (P=.04). Thus, by using a more extensive design, participants who experienced higher overload during the study were characterized by slower responses to notifications (P=.01), whereas those who experienced higher stress reactivity to the notification system were characterized by higher missing responses. CONCLUSIONS: The new tool had high levels of usability. Furthermore, the study of compliance is of enormous importance when implementing novel ESM methods, including app-based cognitive tasks. The main predictors of latency and missing responses found across studies, specifically when using extensive ESM protocols (study 2), are methodology-related variables. Future research that integrates cognitive tasks in ESM designs should take these results into consideration by performing accurate estimations of participants' response rates to facilitate the optimal quality of novel eHealth approaches, as in this study.

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Self-report measures of health behaviour have several limitations including measurement reactivity, i.e., changes in people's behaviour, cognitions or emotions due to taking part in research. This systematic review investigates whether digital in-the-moment measures induce reactivity to a similar extent and why it occurs. Four databases were searched in December 2020. All observational or experimental studies investigating reactivity to digital in-the-moment measurement of a range of health behaviours were included if they were published in English in 2008 or later. Of the 11,723 records initially screened, 30 publications reporting on 31 studies were included in the qualitative synthesis/ 7 studies in the quantitative synthesis. Eighty-one percent of studies focused on reactivity to the measurement of physical activity indicators; small but meaningful pooled effects were found (Cohen's ds: 0.27-0.30). Only a small number of studies included other behaviours, yielding mixed results. Digital in-the-moment measurement of behaviour thus may be as prone to reactivity as self-reports in questionnaires. Measurement reactivity may be amplified by (1) ease of changing the behaviour (2) awareness of being measured and social desirability, and (3) resolving discrepancies between actual and desired behaviour through self-regulation.

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When learners make judgments of learning (JOLs) for some word pairs but not others, how and why is recall performance affected? Participants studied related and unrelated word pairs and made JOLs for a randomly selected half of the pairs. We evaluated two hypotheses. The changed-goal hypothesis states that making JOLs leads learners to notice differences in pair difficulty and to change their learning goal. Because JOLs are manipulated within participants, such a goal change should influence how all (judged or non-judged) pairs are processed on the list, which should lead to no JOL reactivity. The cue-strengthening hypothesis predicts greater positive reactivity (i.e., higher recall for judged versus non-judged pairs) for related than unrelated pairs, because making a JOL strengthens the relationship between the two words in a pair, which would be more beneficial for pairs with an a priori relationship. Across experiments, we found positive reactivity for both related and unrelated pairs (albeit to a lesser degree for the latter). We also found no evidence that learners make qualitative changes in their reported strategy use when judging pairs. Making JOLs for some pairs on a list influenced memory performance and the pattern of reactivity provided support for the cue-strengthening hypothesis.

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BACKGROUND: Qualitative data are crucial for capturing implementation processes, and thus necessary for understanding implementation trial outcomes. Typical methods for capturing such data include observations, focus groups, and interviews. Yet little consideration has been given to how such methods create interactions between researchers and study participants, which may affect participants' engagement, and thus implementation activities and study outcomes. In the context of a clinical trial, we assessed whether and how ongoing telephone check-ins to collect data about implementation activities impacted the quality of collected data, and participants' engagement in study activities. METHODS: Researchers conducted regular phone check-ins with clinic staff serving as implementers in an implementation study. Approximately 1 year into this trial, 19 of these study implementers were queried about the impact of these calls on study engagement and implementation activities. The two researchers who collected implementation process data through phone check-ins with the study implementers were also interviewed about their perceptions of the impact of the check-ins. RESULTS: Study implementers' assessment of the check-ins' impact fell into three categories: (1) the check-ins had no effect on implementation activities, (2) the check-ins served as a reminder about study participation (without relating a clear impact on implementation activities), and (3) the check-ins caused changes in implementation activities. The researchers similarly perceived that the phone check-ins served as reminders and encouraged some implementers' engagement in implementation activities; their ongoing nature also created personal connections with study implementers that may have impacted implementation activities. Among some study implementers, anticipation of the check-in calls also improved their ability to recount implementation activities and positively affected quality of the data collected. CONCLUSION: These results illustrate the potential impact of qualitative data collection on implementation activities during implementation science trials. Mitigating such effects may prove challenging, but acknowledging these consequences-or even embracing them, perhaps by designing data collection methods as implementation strategies-could enhance scientific rigor. This work is presented to stimulate debate about the complexities involved in capturing data on implementation processes using common qualitative data collection methods. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02325531 . Registered 15 December 2014.

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There is evidence that simply measuring physical activity alone can increase self-reported physical activity behaviour. The aim of this review was to describe changes in objectively-measured physical activity within control groups in primary care physical activity intervention studies. Five electronic databases (PubMed, MEDLINE, SPORTDiscus, PsychINFO and CINAHL) were searched from inception to February 2019. Physical activity controlled intervention studies objectively measuring physical activity in primary care with adults were included and meta-analyses were completed. Thirty studies were eligible and 22 studies were included in the meta-analysis. No statistically significant change in steps.day-1, counts.day-1 and counts.minute-1 were found in the meta-analyses within control groups. Moderate-to-vigorous physical activity minutes.day-1 significantly decreased (-3.97; 95% CI -6.31 to -1.64; P < 0.001). Sub-analyses revealed there was a trend for steps.day-1 to increase in participants < 50 years old (504; 95% CI -20 to 1029; P = 0.06). Noteworthy increases (≥10%) in objectively-measured physical activity within control groups were found in 17% of studies. Noteworthy increases were reported in studies with younger participants, one-third of the pedometer studies, one-third of studies with participants at risk of chronic disease and in studies with a shorter duration between measurements. No control group improvements were found in participants with chronic disease. Overall, no significant improvements in objectively-measured physical activity were found within control groups in primary care. Further investigation of noteworthy increases in control group physical activity levels is indicated, particularly in certain sub-groups of participants as this may effect physical activity research and interventions in these populations.

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OBJECTIVES: The question-behavior effect (QBE) refers to whether asking people questions can result in changes in behavior. Such changes in behavior can lead to bias in trials. This study aims to update a systematic review of randomized controlled trials investigating the QBE, in light of several large preregistered studies being published. STUDY DESIGN AND SETTING: A systematic search for newly published trials covered 2012 to July 2018. Eligible trials randomly allocated participants to measurement vs. non-measurement control conditions or to different forms of measurement. Studies that reported health-related behavior as outcomes were included. RESULTS: Forty-three studies (33 studies from the original systematic review and 10 new studies) compared measurement vs. no measurement. An overall small effect was found using a random effect model: standardized mean difference = 0.06 (95% CI: 0.02-0.09), n = 104,388. Statistical heterogeneity was substantial (I2 = 54%). In an analysis restricted to studies with a low risk of bias, the QBE remained small but significant. There was positive evidence of publication bias. CONCLUSION: This update shows a small but significant QBE in trials with health-related outcomes but with considerable unexplained heterogeneity. Future trials with lower risk of bias are needed, with preregistered protocols and greater attention to blinding.

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The testing effect is when patient-reported outcomes (PRO) improve with repeated administration without intervention. The testing effect can confound interpretation of clinical trials using PROs as endpoints. This study investigated potential mechanisms. The parent study (n = 302) investigated a self-management intervention for depression. We qualitatively analyzed exit interview feedback from the 89 control group participants completing the last assessment. Participants reported several perceived benefits from control group participation including novel mechanisms (study participation was meaningful, emotional support, appreciating outreach), a possible negative testing effect and mechanisms previously identified (behavioral change).

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BACKGROUND: There is some evidence that simply measuring physical activity alone can increase self-reported physical activity behaviour. Objective measures of physical activity in intervention studies have increased substantially over the last decade. Yet, there is no synthesised evidence of observed changes in the control group physical activity in trials that have used objective physical activity measurement approaches. Understanding factors associated with control group increases (or decreases) in physical activity may have implications for planning physical activity research and in clinical settings where objective measures of physical activity may be used. The aim of this systematic review is to describe changes in objectively measured physical activity that have occurred within control groups in primary care physical activity intervention studies and, if possible, identify factors that are potentially associated with these changes. METHODS: The PRISMA-P reporting guidelines for systematic review protocols will be followed. Five electronic databases (PubMed, MEDLINE, SPORTDiscuss, PsychINFO, CINAHL) will be searched to identify physical activity controlled (randomised, cluster, quasi-experimental) studies conducted with adults in primary care. Search terms will be based on previous systematic reviews, and only peer-reviewed articles published in English will be considered. The main outcome measure is the change in objectively measured physical activity within the control group. Risk of bias will be assessed using the Cochrane Collaboration tool and the Risk Of Bias in Non-randomised Studies-of Interventions tool. Meta-analyses will be conducted where possible among studies with sufficient homogeneity. DISCUSSION: This systematic review and meta-analysis will determine the extent to which physical activity measurement alone is associated with changes in objectively measured physical activity levels in control groups in primary care. Findings from this study will inform future physical activity intervention research and practice. If measuring physical activity alone is associated with increases in physical activity levels that may be considered beneficial for health, this could indicate that measurement alone may be a low cost, efficient and effective method to increase a proprotion of the population's physical activity levels. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018104896.

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Background: Bereavement can be considered a potentially traumatic experience, and concerns have been raised about conducting grief research responsibly online. Objective: Given that online research introduces new methodological opportunities and challenges, we aimed to develop a greater understanding of how bereaved individuals experience participation in online research. Method: One day after participation in an online grief study, 876 participants, bereaved on average for 40 months, received a 'check-in' email to support well-being and offer further contact if needed. Although not explicitly asked to respond if no help was needed, 300 participants sent email replies, with only six requesting support. These responses were analysed qualitatively using content analysis. Results: Results suggested that participants found it acceptable to be asked about their grief and while difficult emotions were frequently described in response to the questionnaires, these reactions were temporary. A range of positive reactions was also reported, including new realizations arising from completing the research and changes in thinking related to grief. Participants also wrote about their appreciation for the study and how it was carried out, as well as a desire to contribute more to the study and to help others in a similar position. Conclusions: We suggest that the use of the check-in email to support well-being following study completion, along with advice on preparing to take part, contributed to positive experiences of participation and we recommend these strategies for future studies. These findings could allay clinical concerns about conducting online research with vulnerable populations, as well as raising questions about the possible therapeutic impact of measurement.

Antecedentes: El duelo se puede considerar una experiencia potencialmente traumática, y han surgido preocupaciones respecto a la realización responsable de investigaciones de duelo en línea. Objetivo: Dado que la investigación en línea plantea nuevas oportunidades y desafíos metodológicos, intentamos ampliar la comprensión sobre cómo las personas en duelo experimentan la participación en investigación en línea. Método: Un día después de participar en un estudio de duelo en línea, 876 participantes en duelo, con un promedio de pérdida de 40 meses, recibieron un correo electrónico de 'registro' para apoyar el bienestar y ofrecer contacto adicional de ser necesario. Aunque no se les pidió explícitamente a los participantes que respondieran si no necesitaban ayuda, 300 enviaron respuestas por correo electrónico, con sólo seis de ellos solicitando apoyo. Estas respuestas se analizaron cualitativamente mediante análisis de contenido. Resultados: Los resultados sugirieron que los participantes consideraron aceptable que se les preguntara sobre su dolor y, aunque frecuentemente se describieron emociones difíciles en respuesta a los cuestionarios, estas reacciones fueron temporales. También se reportaron una serie de reacciones positivas, incluyendo nuevos entendimientos derivados de la finalización de la investigación y cambios en el pensamiento relacionado con el duelo. Los participantes también escribieron acerca de su apreciación por el estudio y su ejecución, así como el deseo de contribuir más al estudio y ayudar a otros en una posición similar. Conclusiones: Sugerimos que el uso del correo electrónico de registro para apoyar el bienestar seguido de la participación en el estudio, junto con consejos sobre cómo prepararse para participar, contribuyó a experiencias positivas de participación, y recomendamos el uso de estas estrategias para estudios futuros. Estos hallazgos podrían disipar las preocupaciones clínicas sobre la realización de investigaciones en línea con poblaciones vulnerables, así como plantear preguntas sobre el posible impacto terapéutico de las mediciones.

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BACKGROUND: Screening programmes with referral are a valuable strategy for mitigating consequences of perinatal depression on mothers and their families. The effectiveness of these screening programmes needs to be measured. One potential problem in assessing outcomes is measurement reactivity where the actual measure results in changes in the people being measured. AIM: The aim of this article is to explain the mechanisms and circumstances by which measurement reactivity occurred in a sample of antenatal women who participated in a screening interview. METHODS: Fifty-five women who participated in an antenatal screening interview in their second trimester were re-interviewed in their third trimester. These qualitative interviews were conducted between September 2015 and April 2016. RESULTS: The qualitative data suggested that measurement reactivity occurred through mechanisms such as the disclosure, gaining self-knowledge, validation of experiences, and personal agency which resulted in them seeking out support from others. CONCLUSION: Although the screening interview appeared to improve women's outcomes, this may have occurred through measurement reactivity. This needs to be considered when designing studies that aim to assess the effectiveness of screening with intervention for antenatal depression.

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BACKGROUND: Measuring physical activity (PA) and sedentary time (ST) by self-report or device as well as assessing related health factors may alter those behaviors. Thus, in intervention trials assessments may bias intervention effects. The aim of our study was to examine whether leisure-time PA, transport-related PA, and overall ST measured via self-report vary after assessments and whether a brief tailored letter intervention has an additional effect. METHODS: Among a sample of subjects with no history of myocardial infarction, stroke, or vascular intervention, a number of 175 individuals participated in a study comprising multiple repeated assessments. Of those, 153 were analyzed (mean age 54.5 years, standard deviation = 6.2; 64% women). At baseline, participants attended a cardiovascular examination (standardized measurement of blood pressure and waist circumference, blood sample taking) and wore an accelerometer for seven days. At baseline and after 1, 6, and 12 months, participants completed the International Physical Activity Questionnaire. A random subsample received a tailored counseling letter intervention at month 1, 3, and 4. Changes in PA and ST from baseline to 12-month follow-up were analyzed using random-effects modelling. RESULTS: From baseline to 1-month assessment, leisure-time PA did not change (Incidence rate ratio = 1.13, p = .432), transport-related PA increased (Incidence rate ratio = 1.45, p = .023), and overall ST tended to decrease (b = - 1.96, p = .060). Further, overall ST decreased from month 6 to month 12 (b = - 0.52, p = .037). Time trends of the intervention group did not differ significantly from those of the assessment-only group. CONCLUSIONS: Results suggest an effect of measurements on PA and ST. Data of random-effects modelling results revealed an increase of transport-related PA after baseline to 1-month assessment. Decreases in overall ST may result from repeated assessments. A brief tailored letter intervention seemed to have no additional effect. Thus, measurement effects should be considered when planning intervention studies and interpreting intervention effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT02990039. Registered 7 December 2016. Retrospectively registered.

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PURPOSE: The objective of this article is to describe how self-monitoring contributed to measurement reactivity in a randomized clinical trial (RCT). The implications of measurement reactivity on self-monitoring and suggestions for minimizing its effect will be discussed. DESIGN: The study involved a secondary data analysis of responses from 145 participants who completed a 12-month long RCT. The original sample consisted of 202 community-living adults with long-term indwelling urinary catheters. METHODS: The data analyzed were from the participants' brief responses to the final study question concerning their perceived study participation value. The data were discussed and coded iteratively until three researchers reached consensus. At the end, each item was recoded into eight categories and minor codes. FINDINGS: Our belief that the calendar was the probable cause of reactivity was not fully supported as the control group also learned about paying attention to urinary catheter problems by the questions asked through the seven bimonthly interviews. CONCLUSIONS: The calendar and interview questions were reactive by increasing participants' self-monitoring of catheter problems. Specifically, the frequent interviews exposed participants to catheter-related concerns and provided them with ideas as to how to better manage them. CLINICAL RELEVANCE: This article provides insight related to the internal validity threat of measurement reactivity in RCTs and gives suggestions to reduce its effects.

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BACKGROUND: Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. OBJECTIVE: In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-of-care quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. DESIGN: Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. PARTICIPANTS: All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. MAIN MEASURES: The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. KEY RESULTS: Measured performance improved over time (P < 0.001). Notably, the proportion of patients with SUD program contact who qualified for the denominator decreased more rapidly after the measure was implemented (p = 0.02). Facilities with higher pre-implementation denominator prevalence had steeper declines in denominator prevalence after implementation (p < 0.001). CONCLUSIONS: These results should motivate the development of measures that are less vulnerable to denominator management, and also the exploration of "shadow measures" to monitor and reduce undesirable denominator management.

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Measurement reactivity effects, such as the mere measurement effect, have been proposed as a reason for behavioural changes in a number of theory of planned behaviour intervention studies. However, it is unclear whether such changes are the result of the mere measurement effect or of other artefacts of intervention study design. The aim of this study is to determine the size and direction of changes in health behaviours from baseline to follow-up in prospective studies using the theory of planned behaviour. Electronic databases were searched for the theory of planned behaviour studies which measured health behaviours at two or more time points. Change in behaviour was calculated for all studies. Sixty-six studies were included. Mean effect sizes across all studies were small and negative (d = -.03). Effect size was moderated by behaviour, behaviour type and follow-up length. Subgroup analyses showed significant decreases in socially undesirable behaviour (d = -.28), binge drinking (d = -.17), risk driving (d = -.20), sugar snack consumption (d = -.43) and sun-protective behaviour (d = -.18). Measurement of intention at baseline resulted in significant decreases in undesirable behaviour. Changes in undesirable behaviours reported in other studies may be the result of the mere measurement effect.

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Despite growing popularity of experience sampling methodology (ESM) for evaluations of state-based components of body image, there have been concerns that the frequent repeated measurement might encourage problematic responding resulting in low data quantity and/or quality. Using a sample of 105 women (mean age=24.84), this study used multilevel modelling to investigate whether (a) there were changes in compliance or response variability across a 7-day period, and (b) whether such changes are explained by participant characteristics. Present findings suggest that demands of ESM protocol undermine quantity more so than quality of obtained data. Decline in procedural compliance across the testing period correlated with BMI and body shame, whereas reduced variability in state-based assessments did not adversely impact the strength of association between state body satisfaction ratings and other variables in the dataset. The authors make several recommendations for ensuring the quality of ESM-based data in future studies.

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