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Extending and building on previous work on the merits of Grace Davie's theory about 'believing without belonging', this paper offers a comparative analysis of changes in the relationships between 'believing' and 'belonging' across countries. In doing so, two renditions of the theory that co-exist in Grace Davie's work are distinguished, i.e., the typically foregrounded version about a de-institutionalization of Christianity and its often unnoticed counterpart about a spiritualization of religion. Societal growth curve modelling is applied to the data of the European Values Study for twenty European countries (1981-2008) to test hypotheses derived from both theories. The findings suggest that the typically foregrounded version of a de-institutionalization of Christianity needs to be rejected, while the typically unnoticed version of a spiritualization of religion is supported by the data.

This article tests two contrasting hypotheses about changes in the electoral relevance of moral traditionalism–progressiveness, which pertains to attitudes toward matters of procreation, sexuality, and family and gender roles. While the “cultural turn” literature expects the electoral relevance of moral traditionalism to increase over time alongside that of all other cultural issues, studies inspired by secularization theory rather predict a decrease in its relevance—due to religious decline. Analyzing the data from the European Values Study (1981–2017) for 20 West European countries, we find empirical evidence for a decrease and no indication of an increase in the electoral relevance of moral traditionalism. Religious decline weakened the effect of moral traditionalism on religious and conservative voting over time due to the most traditionalist voters shifting away from these parties. Our findings, therefore, highlight the need to differentiate between different types of cultural motives behind voting choice in Western Europe.

Moral traditionalism versus progressiveness and secular authoritarianism versus libertarianism are often understood as central to the same “new” cultural cleavage in politics. Despite the often-found sizable correlations between these two cultural value divides, the present paper theorizes that this relationship is not a cross-contextual constant, but rather a specific feature of secularized contexts where moral traditionalism is relatively marginal. We test this theory by means of a two-stage statistical analysis of the data from the four waves of the European Values Study (1981–2008) for 17 Western European countries. Our findings confirm that the two value divides are most strongly connected in the most secularized contexts because the latter are least morally traditionalist. While the two cultural divides hence tend to be distinct in more religious Western-European countries, they tend to coalesce into one single “new” cultural divide in more secular ones.

Purpose of Research The ASSUSTENT application and the ASSIST brochure have been developed to support medication intake and symptom monitoring. This study aimed to evaluate patient experiences and the factors that are a barrier to or facilitate the use of these tools. Additionally, the effect of their use on Health-Related Quality of Life (HRQoL) and satisfaction with information about medication was also assessed. Methods An exploratory study with a mixed method design was performed. Patients starting or already using sunitinib were asked to use the application or the brochure for 6 months. They completed questionnaires about their experiences with the intervention, that is, the Satisfaction with Information about Medication scale (SIMS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at baseline (T0), three months (T1), and 6 months (T2) following inclusion. Patients were also asked to participate in a semi-structured interview at T2. The main study endpoint was the feasibility of the use of the application and the brochure. Results Of the 22 (65%) patients who signed the informed consent, 19 (86%) completed T0, 15 (68%) T1, and 12 (54%) T2. Twelve agreed to be interviewed. Both the application and brochure were considered user friendly and useful to manage symptoms and prepare for consultations. Patients were generally satisfied with the information about medication. The mean global HRQoL increased from 69 (T0) to 84 (T2). Conclusion As supplements to usual care, both the application and the brochure met the needs of cancer patients using sunitinib. Their use led to an increased self-efficacy in managing symptoms. The availability of the brochure adds to patient-centered care and equal access to care, and increases self-efficacy.

Cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) in combination with endocrine therapy improve the outcomes of patients with hormone-receptor (HR)-positive, HER2-negative advanced breast cancer and can be used early as first-line treatment or deferred to second-line treatment 1 , 2 , 3 , 4 , 5 , 6 – 7 . Randomized data comparing the use of CDK4/6i in the first- and second-line setting are lacking. The phase 3 SONIA trial (NCT03425838) randomized 1,050 patients who had not received previous therapy for advanced breast cancer to receive CDK4/6i in the first- or second-line setting 8 . All of the patients received the same endocrine therapy, consisting of an aromatase inhibitor for first-line treatment and fulvestrant for second-line treatment. The primary end point was defined as the time from randomization to disease progression after second-line treatment (progression-free survival 2 (PFS2)). We observed no statistically significant benefit for the use of CDK4/6i as a first-line compared with second-line treatment (median, 31.0 versus 26.8 months, respectively; hazard ratio = 0.87; 95% confidence interval = 0.74–1.03; P  = 0.10). The health-related quality of life was similar in both groups. First-line CDK4/6i use was associated with a longer CDK4/6i treatment duration compared with second-line use (median CDK4/6i treatment duration of 24.6 versus 8.1 months, respectively) and more grade ≥3 adverse events (2,763 versus 1,591, respectively). These data challenge the need for first-line use of a CDK4/6i in all patients. The phase 3 SONIA trial challenges the benefits of using cyclin-dependent kinase 4 and 6 inhibitors as a first-line compared with second-line treatment.

The article considers the potential of design as a deliberate means to change behaviour. Recent concerns address the idea of linking sustainable design both with energy efficient products, but also with encouraging desirable behaviour in product use. The term 'persuasive technology' has been coined, and Lockton, Harrison and Stanton developed a 'Design With Intent Toolkit', a set of cards giving an overview of possible persuasive strategies based on insights from various disciplines. However, it offers little guidance on when to apply each strategy. The authors look at strategies which affect desired social outcomes, noting that rather than trying to address collective concerns, some designs trigger the user's individual concerns, resulting in an outcome which is socially desirable. They distinguish between discouragement of undesirable behaviours and encouragement of preferred behaviour through a brief analysis of 6 interventions to modify risky road use. They classify types of influence as coercive, persuasive, seductive, or decisive, and propose 11 design strategies that can be assigned to these categories, giving an example of each strategy in use. They also note that for the designer to deliberately affect human behaviour by means of their design may require redefinition of the role of a designer, to include taking responsibility for shaping society.