Application of an Adapted Behaviour Change Wheel to Assistance Dog Puppy Raising: A Proposed Raiser-Centred Support Program

Beyond puppy selection—considering the role of puppy raisers in bringing out the best in assistance dog puppies

Socialisation, training, and help-seeking – Specific puppy raising practices that predict desirable behaviours in trainee assistance dog puppies

Assistance dogs are beneficial; however, accessing one can be challenging due to the time, cost, and high failure rates associated with training. A major factor contributing to a high failure rate appears to be the competency of volunteer puppy raisers (PRs), with returning PRs typically more effective than first-time PRs. However, there remains a gap in the literature dedicated to examining PRs' experiences and how they are affected by the raising programs. This study analysed two groups of PRs (N = 16) from the same university-based program in different Australian regions (i.e., one regional and one suburban). Semi-structured interviews were conducted and analysed both inductively and deductively. The inductive approach identified four major themes that helped to understand the PRs experiences throughout the program: expectations as a PR, organisational and environmental support and suitability, the intensity of PR workload, and practical support. The deductive analysis identified four functions of volunteerism relevant to PRs' motivations: altruism (values), egoism (enhancement), interacting with others (social), and learning new skills (understanding). Overall, the results obtained from the two groups were consistent with past findings suggesting the benefits of organisational and practical support. These findings further develop our understanding of how to enhance puppy-raising experiences.

Simple SummaryPuppy raisers (or foster families) are volunteers who care for assistance dog puppies until they are ready to learn how to help people with a disability. During this period, some puppies develop behaviours unsuitable for assistance roles and end up changing careers or being rehomed as pets, which is wasteful. Puppy raisers control the early experiences of their puppies, and they vary in their puppy-raising outcomes, but we do not know what specifically helps some puppy raisers produce puppies that are behaviourally suitable for an assistance role. In this study, we interviewed 17 people from seven countries who were either experienced puppy raisers or provider program staff, or both. Their responses suggested several individual factors (expectations, competency, perseverance and passion) and social factors (informational and emotional supports), in addition to the puppies’ characteristics, that influenced the experiences and perceived effectiveness of their puppy-raising practices. These factors are also evident in other well-established areas of research (e.g., education, volunteerism, social support, and organisational performance). We propose recommendations for assistance dog organisations based on those relevant frameworks, which focus on enhancing puppy raisers’ competency, positive experiences, and program retention.Assistance dog puppies live with their raisers for up to 16 months before entering advanced training and, hopefully, becoming qualified to help people with a disability. Almost half of the puppies fail to meet the behavioural standards required for assistance dogs, and some puppy raisers produce more behaviourally favourable puppies than others. It is unclear what factors influence puppy-raising practice quality. To understand this, we interviewed 17 participants, including experienced puppy raisers (n = 8), provider organisation staff (n = 4), and those who have served both as puppy raisers and staff (n = 5). Results of a thematic analysis suggest three groups of influencing factors, namely intrapersonal factors, social support, and puppy characteristics. Intrapersonal factors such as expectations, competency, perseverance and passion were reported to influence puppy raisers’ experiences, puppy-raising quality, and continuity of service. Contextual factors such as availability of social support (informational and emotional supports) and less-demanding puppies both led to positive puppy-raising experiences, while the former also contributed to puppy raisers’ perceptions of competency. Future research should quantitatively examine the interrelationships of these factors concerning puppies’ behavioural development. Meanwhile, organisations could consider these factors when developing their recruitment and puppy-raiser support programs.

Simple SummaryRaisers volunteer to raise and manage an assistance dog puppy for about a year and typically receive instructions for a wide range of puppy raising tasks from a host organisation. Those tasks vary among organisations, although the literature suggests that raisers should provide frequent socialisation and consistent training to their puppy, and engage in effective learning to improve their own practices. As those tasks are heavily embedded in the raisers’ daily lives, it is not easy to determine if any factors could affect their puppy raising. In this study, we interviewed eight puppy raisers monthly during their participation in an 11-month puppy raising program based at a university campus. Raisers thought that their puppies received more socialisation when they had more availability or someone else to share this responsibility with them, or when the puppies behaved well. Raisers could train their puppy more consistently when they had been prepared to deal with different scenarios occurring during their daily activities. While raisers found that some learning methods suited them better, they generally appreciated opportunities to learn, seek help from, and practise with other raisers. We hope these findings will inform development and evaluation of future programs aimed at improving practices and experiences of raisers.Many assistance dog providers use volunteer raisers to manage each puppy’s learning and daily experiences, which partly determines the puppy’s behavioural development. Therefore, it is important that raisers engage in recommended practices. Three common recommendations from the literature include frequent socialisation and consistent training for the puppies, and effective training for the raisers. However, what facilitates or hinders raisers’ engagement in these practices remains unclear. To understand this, we interviewed eight raisers (three men and five women) every month during their year-long puppy raising program, and pseudo-randomly selected 16 from 48 interviews for data analysis. Thematic analyses revealed several facilitating and/or hindering factors corresponding to each of the three recommended practices. Frequent socialisation was influenced by the raisers’ availability, sharing of puppy raising responsibility with others, support from their workplace, and the puppy’s behaviours (e.g., soiling indoors, jumping). Consistent training was challenged by the presence of everyday distractors, accessibility to timely advice, perceived judgement from others, and the puppy’s undesirable behaviours. Effective learning was facilitated by having information available in raisers’ preferred learning modality, opportunities for peer-learning, and willingness to seek help. Future research should examine these factors quantitatively, which will enable more robust evaluation of programs aimed at supporting puppy raisers.

How Theory Can Influence Hearing Aid Use

BackgroundMedication adherence is an important but highly complex set of behaviors, which for life-threatening and infectious diseases such as HIV carry critical consequences for individual and public health. There is growing evidence that mobile phone text messaging interventions (mHealth) connecting providers with patients positively impact medication adherence, particularly two-way engagement platforms that require bidirectional communication versus one-way in which responses are not mandatory. However, mechanisms of action have not been well defined. The Behavior Change Wheel is a comprehensive framework for behavior change that includes an all-encompassing model of behavior known as Capability Opportunity Motivation-Behavior and is complemented by a taxonomy of behavior change techniques. Evaluating mHealth interventions for medication adherence using these tools could provide useful insights that may contribute to optimizing their integration into the healthcare system and successful scaling-up.ObjectiveThis study aimed to help address the current knowledge gap regarding how two-way mHealth interventions for medication adherence may work by applying the Behavior Change Wheel to characterize WelTel: an interactive digital health outreach platform with robust evidence for improving adherence to antiretroviral therapy.MethodsTo characterize how WelTel may promote medication adherence, we applied the Behavior Change Wheel to systematically (1) generate a behavioral diagnosis through mapping known antiretroviral therapy adherence barriers onto the Capability Opportunity Motivation-Behavior model of behavior, (2) specify the behavior change techniques that WelTel delivers, (3) link identified behavior change techniques to corresponding intervention functions of the Behavior Change Wheel, and (4) connect these behavior change techniques and intervention functions to respective Capability Opportunity Motivation-Behavior influences on behavior to determine potential mechanisms of action.ResultsOur evaluation of WelTel using the Behavior Change Wheel suggests that most of its impact is delivered primarily through its personalized communication component, in which 8 different behavior change techniques were identified and linked with 5 intervention functions (environmental restructuring, enablement, education, persuasion, and training). Its mechanisms of action in promoting antiretroviral therapy adherence may involve addressing all Capability Opportunity Motivation-Behavior influences on behavior (physical and psychological capability, physical and social opportunity, reflective and automatic motivation).ConclusionsSystematically unpacking the potential active ingredients of effective interventions facilitates the creation and implementation of more parsimonious, tailored, and targeted approaches. Evaluating WelTel using the Behavior Change Wheel has provided valuable insights into how and why such interactive two-way mHealth interventions may produce greater impact than one-way in addressing both nonintentional and intentional forms of nonadherence. The application of the Behavior Change Wheel for evidence synthesis across mHealth interventions targeting various conditions would contribute to strengthening the knowledge base regarding how they may work to impact medication adherence behavior.

BackgroundImproving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.MethodsA systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity.ResultsNineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity.ConclusionsInterventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

Event Abstract Back to Event Development of Virtual Traveller: A behaviour change intervention to increase physical activity during primary school lessons Emma Norris1*, Nicola Shelton1, Sandra Dunsmuir2, Oliver Duke-Williams3 and Emmanuel Stamatakis1, 4 1 University College London, Department of Epidemiology & Public Health, United Kingdom 2 University College London, Department of Clinical Educational and Health Psychology, United Kingdom 3 University College London, Department of Information Studies, United Kingdom 4 University of Sydney, Charles Perkins Centre, Australia Background Children spend a large amount of their time in obligatory seated school lessons, with notable effects on health and cognitive outcomes. A common issue reported by teachers is a lack of time to incorporate physical activity into the school day alongside academic pressures. As such, emerging research is attempting to convert educational time from sedentary to active via physically active lessons. However this existing research does not utilise Behaviour Change concepts, making comparability and replicability difficult (Norris, Shelton, Dunsmuir, Duke-Williams, & Stamatakis, 2015a). The Virtual Traveller programme is the first to test Virtual Field Trips (VFTs) as physically active lessons. These utilise existing classroom interactive whiteboards to integrate globe-based educational content with related physical movements. Aim(s) This research aimed to develop a 6-week ‘Virtual Traveller’ intervention based around the Behaviour Change Wheel and Behaviour Change Techniques Method / Results Three sources of data were used to inform the intervention development process: the existing research literature on school-based physical activity interventions, teacher interviews (N=12) and pupil focus groups (N=18) and an experimental feasibility study (N=85; Norris, Shelton, Dunsmuir, Duke-Williams, & Stamatakis, 2015b). The Behaviour Change Wheel was used as a framework to guide synthesis of evidence into the resulting intervention. Potential appropriate Behaviour Change Techniques were reviewed and embedded within the intervention. Conclusions The resulting 6-week Virtual Traveller programme with a 3-month follow-up period is currently in its final stages of evaluation in ten Greater London primary schools. Using the Behaviour Change Wheel and Behaviour Change Techniques allows development of replicable health interventions in applied settings such as schools. Acknowledgements Thank you to all the schools, teachers and pupils that made this research possible. References Norris, E., Shelton, N., Dunsmuir, S., Duke-Williams, O., & Stamatakis, E. (2015a). Physically active lessons as physical activity and educational interventions: A systematic review of methods and results. Preventive Medicine, 72(0), 116-125. doi: http://dx.doi.org/10.1016/j.ypmed.2014.12.027 Norris, E., Shelton, N., Dunsmuir, S., Duke-Williams, O., & Stamatakis, E. (2015b). Virtual Field Trips as physically active lessons for primary-school children: A pilot study. BMC Public Health, 15, 366. doi: 10.1186/s12889-015-1706-5 Keywords: physical activity, primary school children, Intervention Studies, interactive whiteboard, student engagement Conference: 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016. Presentation Type: Oral presentation Citation: Norris E, Shelton N, Dunsmuir S, Duke-Williams O and Stamatakis E (2016). Development of Virtual Traveller: A behaviour change intervention to increase physical activity during primary school lessons. Front. Public Health. Conference Abstract: 2nd Behaviour Change Conference: Digital Health and Wellbeing. doi: 10.3389/conf.FPUBH.2016.01.00052 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Dec 2015; Published Online: 09 Jan 2016. * Correspondence: Miss. Emma Norris, University College London, Department of Epidemiology & Public Health, London, United Kingdom, e.norris.11@ucl.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Emma Norris Nicola Shelton Sandra Dunsmuir Oliver Duke-Williams Emmanuel Stamatakis Google Emma Norris Nicola Shelton Sandra Dunsmuir Oliver Duke-Williams Emmanuel Stamatakis Google Scholar Emma Norris Nicola Shelton Sandra Dunsmuir Oliver Duke-Williams Emmanuel Stamatakis PubMed Emma Norris Nicola Shelton Sandra Dunsmuir Oliver Duke-Williams Emmanuel Stamatakis Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Changing behaviour: Role of theories and techniques in increasing physical activity in non-specific low back pain patients

Insights from psychology about the design and implementation of energy interventions using the Behaviour Change Wheel

The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine the functional mechanisms of interventions and how these characteristics can influence emergency department clinicians' behaviors related to suicide prevention care. This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behaviour Change Wheel's intervention functions. Reported outcome measures were categorized. Findings were tabulated and synthesized narratively. This review included a total of 70 sources, describing 66 different interventions. Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivization (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and organization-level barriers for a given context. The ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors; however, current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.

Issue/problem Over the past decades, researchers from many fields have built an impressive body of knowledge regarding behaviour change. However, the use of this knowledge for accurately designing/delivering/executing behaviour change programs is challenging for many public health practitioners. Description of the problem To support effective knowledge mobilization in behaviour change and to build a coherent and useful body of scientific evidence, leading researchers in behavioural sciences have developed and refined a number of tools for designing interventions. Among these tools, the Behaviour Change Wheel (BCW) was built on an impressive effort to synthetize available evidence regarding intervention development frameworks, behaviour change theories, and behaviour change techniques. However, studies highlighted some issues associated with the use of these methodological innovations. Working with our public health partners in the field of health communication, we realized that applying models such as the BCW is far from being mundane practices. To support optimal knowledge mobilization in behavioural sciences, we are developing a research agenda to understand perceptions and motivations of public health practitioners toward innovations such as the BCW and to develop and evaluate knowledge mobilization strategies. Results The initiative will contribute to the development of new scientific knowledge regarding mechanisms underlying effective knowledge mobilization in behaviour change and will further support the adoption of these evidence-based practices within the field of public health. Lessons Although rapidly adopted by the community of researchers, it is not clear whether or not public health practitioners would be as willing, or capable of using the BCW to design and deliver programs. Issues regarding knowledge mobilization in behaviour change should be addressed to improve the uptake of this knowledge in practice.

Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.

BackgroundFamilial hypercholesterolaemia (FH) is a genetic condition characterised by elevated levels of low-density lipoprotein cholesterol (LDL-C) and an increased risk of cardiovascular disease (CVD). Following dietary and physical activity guidelines could help minimise this risk but adherence is low. Interventions to target these behaviours are therefore required. A comprehensive understanding of the target behaviours and behaviour change theory should drive the process of intervention development to increase intervention effectiveness and scalability. This paper describes the application of a theoretical framework to the findings of a qualitative evidence synthesis (QES) to inform the content and delivery of an intervention to improve adherence to dietary and physical activity guidelines in individuals with FH.MethodsThe Behaviour Change Wheel (BCW) was used to guide intervention development. Factors influencing dietary and physical activity behaviours were identified from an earlier QES and mapped onto factors within the BCW. A comprehensive behavioural diagnosis of these factors was conducted through application of the theoretical domains framework (TDF). Using these data, the most appropriate intervention functions and behaviour change techniques (BCTs) for inclusion in the intervention were identified. Decision making was guided by evaluation criteria recommended by BCW guidance and feedback from individuals with FH.ResultsFactors influencing dietary and physical activity behaviours mapped onto twelve of the fourteen TDF domains, with seven intervention functions deemed suitable to target the domains’ theoretical constructs. Twenty-six BCTs were identified as being appropriate for delivery within these functions and were included in the intervention. For instance, within the enablement intervention function, the BCT problem solving was incorporated by inclusion of a ‘barriers and solutions’ section. Guided by evaluation criteria and feedback from individuals with FH, the intervention will be delivered as an hour-long family-based appointment, followed up with four telephone calls.ConclusionsThe novel application of the BCW and TDF to the results of a QES has enabled the development of a theory and evidence informed behaviour change intervention. This systematic approach facilitates evaluation of the intervention as part of an ongoing feasibility trial. The transparent approach taken can be used to guide intervention development by researchers in other fields.