Data Abstraction Tool for ACSRB Theory-Related Portfolio Analysis
Date:
Initials of Coder:
Grant Code:
Project title
Grant number
PI name
PI current institutional
affiliation
Received date
Cancer screening behavior(s)
Mammogram
Colonoscopy
PI training
PhD (specify):
MD
MPH
Other Masters (specify):
Other (specify):
Data analyst(s) training
Statistics
Biostatistics
PhD Other (specify):
Doctorally trained behavioral
scientist on team?
Primary behavioral aim(s)
Yes
Theory-related aim(s)
Is an aim described to test:
Pap Test
FOBT
Other(s), specify:
No
Sigmoidoscopy
Field(s):
a. A full mediation model?
b. Association between intervention and a mediator?
c. Association between a mediator and an outcome?
Yes (if yes, skip b and c)
Yes
Yes
No
No
No
Grant Code
Initials of Coder
Theory-Related Elements
1. Mention of health behavior theory by name?
Yes
No
Code 2 in Notes if cited as inappropriate – reference to a theory that was not used for the project described in the grant
Theory Name
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
a. Elaboration Likelihood Model
b. Health Belief Model
c. Precaution Adoption Process
Model
d. Precede/Proceed Planning
Model
e. Protection Motivation Theory
f. Social Cognitive Theory
g. Theory of Planned Behavior
h. Theory of Reasoned Action
i. Transtheoretical Model
j.
k.
2
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
Abstract
Theory Name
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.
w.
x.
y.
z.
3
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
2. Mention of constructs by name?
Yes
No
Code 2 in Notes if cited as inappropriate – reference to a construct that was not used for the project described in the grant
Construct Name
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
a. Attitude
b. Behavioral Intention
c. Fatalism
d. Fear
e. Knowledge
f. Outcome Expectation
g. Perceived Barrier
h. Perceived Behavioral
Control
i. Perceived Benefit
j. Perceived Severity
k. Perceived
Susceptibility, Risk
l. Physician
Recommendation
4
ACSRB Theory-Related Portfolio Analysis
Grant Code
Construct Name
Initials of Coder
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
m. Processes of Change
n. Pro/Con Decisional
Balance
o. Self-Efficacy
p. Worry
q. Stage of Change
(TTM Only)
r. Subjective Norm
s.
t.
u.
v.
w.
x.
y.
z.
5
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
Theoretical Element
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
3. Is there any effort to describe a
conceptual framework?
Yes
If yes:
Words
No
Figure
Both
a. Conceptual framework describes
which constructs relate causally to
BEHAVIOR
Yes, comprehensive
Yes, limited
No
b. Conceptual framework describes
how constructs relate causally to
EACH OTHER
Yes, comprehensive
Yes, limited
No
6
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
Theoretical Element
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
4. Rationale for choice of
specific theory or constructs
Yes, comprehensive
Yes, limited
No
5. General statement that
intervention will address
theoretical elements
Yes
No
a. Linking of theoretical
constructs to specific
intervention elements
Yes, comprehensive
Yes, limited
No
b. Linking of specific
intervention elements to
expected outcomes
Yes, comprehensive
Yes, limited
No
7
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
Theoretical Element
Abstract
Specific
Aims
Back&
Signif.
Prelim
Studies
Methods
Notes
6. Description of measurement
of constructs
Yes, all
Yes, some
No
No, only in Appendix
7. Theoretical rationale for
timing of measurement of
constructs
Yes
No
8. Theoretical rationale for
frequency of measurement of
constructs
Yes
No
9. Analysis described to test:
a.
Full mediation model
Yes
No
b.
Association between
intervention and mediator
Yes
No
c.
Association between
mediator and outcome
Yes
No
8
ACSRB Theory-Related Portfolio Analysis
Grant Code
Initials of Coder
Where intervention takes place
Heath Care Setting
Where recruitment takes place
Health Care Setting
Home
Community
Community
Describe eligible participants
Age
Sex
Male
Screening Status
Out-of-date
Other (specify):
Risk-defined Population
Yes
No
Yes
No
Female
Up-to-date
Both
Both
Racial/ethnic Sample
Study design
Randomized
Total sample size
Number of intervention points
Timing of intervention points
Number of data collection
points
Timing of data collection
points
9
ACSRB Theory-Related Portfolio Analysis
Grant Code
Unit(s) of randomization
Initials of Coder
Individual
Community
Provider
Family/Couple
Practice
Number of units randomized
Number of groups
(including control)
Data source(s)
Survey
Administrative Data
Observation
Other (specify):
Channel(s) of intervention
Print
Film/Video
Telephone
In-person
Internet/Computer
Other (specify):
10
ACSRB Theory-Related Portfolio Analysis