Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework

Background Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. Aim To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. Methods Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. Results A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. Conclusion(s) The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.

GABA relates to functional connectivity changes and retention in visuomotor adaptation

SummaryInteracting with our ever-changing physical environment requires continual recalibration of the motor system. One mechanism by which this occurs is motor adaptation. Understanding how motor adaptation is implemented by the human brain, how different regions work in concert to retain adaptive movement accuracy, and how this function is linked to metabolic use of neurochemicals poses an important challenge in neuroscience. In humans, motor sequence learning is related to concentration of γ-aminobutyric acid (GABA) in the primary motor cortex (M1). However, the role of M1 GABA in adaptation – where behaviour is acquired outside M1 but retained within M1 – is unclear. Here, we used an ultra-high field MR multimodal acquisition to address the hypothesis that M1 GABA and M1-Cerebellar functional connectivity would relate to retention of adaptation, but not acquisition of adaptation. As such, we demonstrate higher baseline M1 [GABA] relates to greater retention but does not relate to adaptation-acquisition. This relationship is mediated by change in M1-Cerebellar functional connectivity: higher M1 [GABA] relates to a decreased M1-Cerebellar connectivity, resulting in greater retention. These findings showed anatomical, neurochemical and behavioural specificity: As expected, no relationship was found between retention and a control metabolite, M1 [Glutamate], as well as retention and connectivity change between control regions and no relationship was found between M1 [GABA] and behaviour in a control condition. The implication of a mechanistic link from neurochemistry to retention significantly advances our understanding of population variability in retention behaviour and provides a crucial step towards developing therapeutic interventions to restore motor abilities.

Anatomically precise relationship between specific amygdala connections and selective markers of mental well-being in humans

There has been increasing interest in using neuroimaging measures to predict psychiatric disorders. However, predictions usually rely on large numbers of brain connections and large disorder heterogeneity, thus lacking both anatomical and behavioural specificity, preventing the advancement of targeted interventions. Here, we address both challenges. First, using resting-state functional MRI, we parcellated the amygdala, a region implicated in mood disorders but difficult to image with high fidelity, into seven nuclei. Next, a questionnaire factor analysis provided four sub-clinical latent behaviours frequently found in anxious-depressive individuals, such as negative emotions and sleep problems. Finally, for each latent behaviour, we identified the most predictive connections between individual amygdala nuclei and highly specific regions of interest e.g. dorsal raphe nucleus in the brainstem or medial prefrontal cortical regions. A small number of distinct connections predicted behaviours, providing unprecedented levels of specificity, in humans, for relating mental well-being to precise anatomical connections.

Successful Explanations Start with Accurate Descriptions: Questionnaire Items as Personality Markers for More Accurate Predictions

Personality–outcome associations, typically represented using the Big Five personality domains, are ubiquitous, but often weak and possibly driven by the constituents of these domains. We hypothesized that representing the associations using personality questionnaire items (as markers for personality nuances) could increase prediction strength. Using the National Child Development Study ( N = 8719), we predicted 40 diverse outcomes from both the Big Five domains and their 50 items. Models were trained (using penalized regression) and applied for prediction in independent sample partitions (with 100 permutations). Item models tended to out–predict Big Five models (explaining on average 30% more variance), regardless of outcomes’ independently rated breadth versus behavioural specificity. Moreover, the predictive power of Big Five domains per se was at least partly inflated by the unique variance of their constituent items, especially for generally more predictable outcomes. Removing the Big Five variance from items marginally reduced their predictive power. These findings are consistent with the possibility that the associations of personality with outcomes often pertain to (potentially large numbers of) specific behavioural, cognitive, affective, and motivational characteristics represented by single questionnaire items rather than to the broader (underlying) traits that these items are ostensibly indicators of. This may also have implications for personality–based interventions. Copyright © 2018 European Association of Personality Psychology

Human infancy and parenting in global perspective: specificity

We address three long-standing fundamental questions about early human development and parental caregiving within a specificity framework using data from 796 infant–mother dyads from 11 societies worldwide. Adopting a cross-society view opens a vista on universal biological origins of, and contextual influences on, infant behaviours and parenting practices. We asked: how do infant behaviours and parenting practices vary across societies? How do infant behaviours relate to other infant behaviours, and how do parent practices relate to other parent practices? Are infant behaviours and parent practices related to one another? Behaviours of firstborn five-month infants and parenting practices of their mothers were microanalysed from videorecords of extensive naturally occurring interactions in the home. In accord with behavioural specificity, biological expectations and cultural influences, we find that infants and mothers from diverse societies exhibit mean-level society differences in their behaviours and practices; domains of infant behaviours generally do not cohere, nor do domains of maternal practices; and only specific infant behaviours and mother practices correspond. Few relations were moderated by society.

Pragmatic Nihilism: How a Theory of Nothing Can Help Health Psychology Progress

Health psychology aims to explain and change a wide variety of behaviours, and to this end has developed a plethora of theories. Several attempts have been undertaken to build integrative theories, and some even strive for a Theory of Everything. We argue against these efforts, arguing that instead, adopting a stance that may be called ‘pragmatic nihilism’ is more fruitful in the endeavour to understand and change specific health behaviours.The first tenet of pragmatic nihilism is that psychological variables, those defined in our health psychology theories, are usefully considered as metaphors rather than referring to entities that exist in the mind. As a consequence, the second tenet emphasizes theories’ definitions and guidelines for the operationalisation of those variables. The third tenet of pragmatic nihilism is that each operationalisation represents a cross section of a variety of dimensions, such as behavioural specificity and duration of the behaviour, and most importantly, psychological aggregation level. Any operationalisation thus represents a number of implicit or explicit choices regarding these dimensions.These three tenets of pragmatic nihilism have two implications. First, they provide a foundation that enables integrating theories in a more flexible and accurate manner than made possible by integrative theories. Second, this perspective emphasizes the importance of operationalisations, underlining the importance of investing in the careful development of measurement instruments, and thorough and extensive reporting of the specifics and performance on those measurement instruments as well as disclosure of the instruments themselves.