***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine if lifestyle improved at a short term through an intervention to involve patients in cardiovascular risk management by the practice nurse . METHODS The IMPALA study ( 2006 , the Netherl and s ) was a cluster-r and omised controlled trial involving 25 general practice s and 615 patients who were eligible for cardiovascular risk management . The intervention consisted of ( 1 ) individual 10-year cardiovascular risk assessment , ( 2 ) risk communication , ( 3 ) use of a decision aid and ( 4 ) adapted motivational interviewing , applied by practice nurses in two consultations . Outcomes were smoking , alcohol , diet , physical activity and the secondary outcomes risk perception , anxiety , confidence about the decision and satisfaction with the communication , measured at baseline and after 12 weeks . RESULTS Patients of both groups improved their lifestyle , but no relevant significant differences between the groups were found . Intervention group patients improved in terms of the appropriateness of risk perception , although not significantly . Intervention group patients improved significantly in terms of appropriateness of anxiety and were more satisfied with the communication compared to control group patients . CONCLUSION The intervention seems to have improved the patients ' risk perception , anxiety and satisfaction with the communication , which are important conditions for shared decision making . However , we found no additional effect of the intervention on lifestyle Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care . A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines . Further , the review recommended the use of theory in the development of implementation interventions . A clinical practice guideline for the management of acute low-back pain has been developed in Australia ( 2003 ) . Acute low-back pain is a common condition , has a high burden , and there is some indication of an evidence - practice gap in the allied health setting . This provides an opportunity to develop and test a theory-based implementation intervention which , if effective , may provide benefits for patients with this condition . Aims This study aims to estimate the effectiveness of a theory-based intervention  to increase allied health practitioners ' ( physiotherapists and chiropractors in Victoria , Australia ) compliance with a clinical practice guideline for acute non-specific low back pain ( LBP ) , compared with providing practitioners with a printed copy of the guideline . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray  , and improving mean level of disability for patients three months post-onset of acute LBP . Methods The design of the study is a cluster r and omised trial . Restricted r and omisation was used to r and omise 210 practice s ( clusters ) to an intervention or control group . Practitioners in the control group received a printed copy of the guideline . Practitioners in the intervention group received a theory-based intervention developed to address prospect ively identified barriers to practitioner compliance with the guideline . The intervention primarily consisted of an educational symposium .  Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period , three months post the intervention symposia , are eligible for inclusion . Sample size calculations are based on recruiting between 15 to 40 patients per practice . Outcome assessors will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12609001022257 ( date registered 25th November 2009 OBJECTIVE The aim of this study was to explore beliefs and attitudes about refusing health screening in general practice . METHODS In 1991 , in Ebeltoft , Denmark people aged between 30 and 50 years were invited to participate in a 5-year r and omized , controlled , population -based project testing the value of health screenings and health discussion s in general practice . In 1994 , non- participants who declined the offered  health screening but expressed willingness to be contacted in the future were asked to participate in a qualitative interview . They were drawn by stratified purpose ful sampling which reflected variation in perceived health , body mass index , age and sex . The sample comprised six men and 12 women RESULTS Some had not participated because they were busy , felt healthy or had recently been examined . The non- participants emphasized the limitations of health screening and did not want possible risk factors to be revealed , or their feeling of good health to be disturbed . They stressed the individual 's own responsibility for maintaining good health and believed that a positive attitude promoted health . They would contact their GP if they had symptoms . CONCLUSION Non- participants have rational views on risk factor testing and on their own responsibility for maintaining health . Non-attendance was due to a conscious choice which included consulting their own GP A r and omized trial was conducted in five general practice s in and around Aylesbury , Buckinghamshire to assess the motivational effect of cholesterol measurement on compliance with advice to reduce dietary fat intake and to stop smoking . The advice was given by practice nurses during health checks for cardiovascular risk factors . A total of 578 patients were recruited to the study and r and omized into two groups . Both groups were given the same advice and were followed up after a median of three months , but the intervention group was also given immediate feedback on their cholesterol concentration . Follow up was completed for 88.2 % of subjects , and those who were not followed up were assumed not to have changed their behaviour . The mean fall in total cholesterol at follow up was 0.11 mmol l-1 ( 95 % confidence interval 0.03 to 0.18 ) in the intervention group who were told their cholesterol result and 0.02 mmol l-1 ( 95 % CI -0.06 to 0.10 ) in the control group who were not . The proportion of smokers who were not smoking at follow up was 10.7 % and 10.1 % in the two groups , respectively . Patients in the intervention group with an initial total cholesterol level of 6.50 mmol l-1 or greater showed a mean fall of 6.2 % in cholesterol level whereas those with an initial cholesterol level of less than 5.20 mmol l-1 experienced a mean increase of 3.6 % , but as differences of this magnitude were also seen in the control group they probably reflect regression to the mean rather than an effect of knowledge of cholesterol level . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES The aim of the present study was to test two brief planning interventions design ed to encourage cardiac patients to engage in regular physical exercise following discharge from rehabilitation . The interventions comprised action plans on ( a ) when , where , and how to act , and ( b ) coping plans on how to deal with anticipated barriers . DESIGN AND METHOD An experimental longitudinal trial was conducted to test two interventions that either focused on action planning alone , or on a combination of action planning and coping planning . A total of 211 participants completed assessment s at baseline and 2 months after discharge . Participants were r and omly assigned to either one of the intervention groups or a st and ard-care control group . RESULTS Participants in the combined planning group did significantly more physical exercise 2 months post-discharge than those in the other groups . CONCLUSIONS The theoretical distinction between action planning and coping planning as introduced in the present study has proven useful in explaining changes in health-related behaviour . The combined planning intervention can be applied in the context of cardiac rehabilitation programmes Objectives To provide insight into factors that contribute to the anxiety reported in a quantitative study of the psychological effect of screening for type 2 diabetes . To explore expectations of and reactions to the screening experience of patients with positive , negative , and intermediate results . Design Prospect i ve qualitative interview study of patients attending a screening programme for type 2 diabetes . Setting Seven general practice s in the ADDITION ( Cambridge ) trial in the east of Engl and . Participants 23 participants ( aged 50 - 69 ) attending different stages in the screening process . Results Participants ' perceptions changed as they progressed through the screening programme ; the stepwise process seemed to help them adjust psychologically . The first screening test was typically considered unimportant and was attended with no thought about its implication s. By the final diagnostic test , type 2 diabetes was considered a strong possibility , albeit a “ mild ” form . After diagnosis , people with screen detected type 2 diabetes tended to downplay its importance and talked confidently about their plans to control it . Participants with intermediate results seemed uncertain about their diagnosis , and those who screened negative were largely unaware of their remaining high risk . Conclusions This study helps in underst and ing the limited psychological impact of screening for type 2 diabetes quantified previously , in particular by the quantitative sub study of ADDITION ( Cambridge ) . The findings have implication s for implementing such a screening programme in terms of timing and content OBJECTIVE To assess the feasibility of a lifestyle intervention , focusing on diet and activity , in adults participating in cardiovascular screening . METHODS The 12-week lifestyle intervention comprised three personalised counselling sessions plus telephone contact . Outcome data were collected by anthropometry , activity monitoring and lifestyle question naires . Acceptability of study measures was assessed by question naire and the intervention delivery by in-depth interviews . RESULTS Between June 2008 and March 2009 , 75 ( 62 % ) of 121 eligible individuals were recruited from Tayside , Scotl and . R and omisation was to intervention ( IV ) ( n=55 ) or comparison group ( CG ) ( n=20 ) . Retention was 99 % across both groups . In the IV group , 63 % increased moderate-vigorous activity by ≥ 30 minutes/week , 82 % successfully maintained or lost weight ( mean loss 1.1 kg , and 2.6 cm waist circumference ) and 85 % reported eating five portions of fruit and vegetables compared with 56 % at baseline . No behaviour changes were detected in the CG . Feedback highlighted the value of lifestyle " checks , " realising that current habits were sub-optimal , receiving personalised advice on specific behaviours , and feeling " healthier " through participation . CONCLUSIONS HealthForce was feasible to deliver and implement , acceptable to participants , and associated with reported changes in health behaviours over a 12-week period Evidence -based medicine is crucial to contemporary healthcare . It is dependent on systematic review methodology modelled on an arguably inadequate hierarchy of evidence . There has been a significant increase in medical and health research using qualitative and mixed method design s. The perspective taken in this article is that we need to broaden our evidence base if we are to fully take account of issues of context , acceptability and feasibility in the development and implementation of healthcare interventions . One way of doing this is to use a range of methods that better fit the different aspects of intervention development and implementation . Methods for the systematic review of evidence , other than r and omised-controlled trials , are available and there is a readiness to incorporate these other types of evidence into good- practice guidance , but we need a clear methodology to translate these advances in research into the world of policy 
    Output:
    
A conceptual model was generated illustrating combinations of factors that produce cues to (in)action .
This model demonstrated interrelationships between individual ( beliefs and knowledge ) and societal ( social influences , role and identity , context ) factors .
Several intervention points were highlighted where factors could be manipulated to produce favourable cues to action .