Multimodal health behaviour-changing interventions for children living with obesity and their parents.

Introduction: Optimised secondary prevention strategies that include lifestyle change are recommended after stroke. While multiple systematic reviews (SRs) address behaviour change interventions, intervention definitions, and associated outcomes differ between reviews. This overview of reviews addresses the pressing need to synthesise high-level evidence for lifestyle-based behavioural and/or self-management interventions to reduce risk in stroke secondary prevention in a structured, consistent way. Methods: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were applied to meta-analyses, demonstrating statistically significant effect sizes to establish the certainty of existing evidence. Electronic databases MEDLINE, Embase, Epistemonikos, and the Cochrane Library of Systematic Reviews were systematically searched, current to March 2023. Results: Fifteen SRs were identified following screening, with moderate overlap of primary studies demonstrated (5.84% degree of corrected covered area). Interventions identified could be broadly categorised as multimodal; behavioural change; self-management; psychological talk therapies, albeit with overlap between some theoretical domains. Seventy-two meta-analyses addressing twenty-one preventive outcomes of interest were reported. Best-evidence synthesis identifies that for primary outcomes of mortality and future cardiovascular events post-stroke, moderate certainty GRADE evidence supports multimodal interventions to reduce cardiac events, with no available evidence for outcomes of mortality (all-cause or cardiovascular) or recurrent stroke events. For secondary outcomes addressing risk-reducing behaviours, best-evidence synthesis identifies moderate certainty GRADE evidence for multimodal lifestyle-based interventions to increase physical activity participation, and low certainty GRADE evidence for behavioural change interventions to improve healthy eating post-stroke. Similarly, low certainty GRADE evidence supports self-management interventions to improve preventive medication adherence. For mood self-management post-stroke, moderate GRADE evidence supports psychological therapies for remission and/or reduction of depression and low/very low certainty GRADE evidence for reduction of psychological distress and anxiety. Best-evidence for outcomes addressing proxy physiological measures identified low GRADE evidence supporting multimodal interventions to improve blood pressure, waist circumference, and LDL cholesterol. Conclusion: Effective strategies to redress risk-related health behaviours are required in stroke survivors to complement current pharmacological secondary prevention. Inclusion of multimodal interventions and psychological talk therapies in evidence-based stroke secondary prevention programmes is warranted given the moderate GRADE of evidence that supports their role in risk reduction. Given the overlap in primary studies across reviews, often with overlapping theoretical domains between broad intervention categories, further research is required to identify optimal intervention behavioural change theories and techniques employed in behavioural/self-management interventions.

ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service...

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that significantly limits physical activity, adversely affecting the quality of life and overall health outcomes for affected individuals. This systematic review and meta-analysis aim to evaluate the effectiveness of behavior change interventions (BCIs) designed to increase physical activity among adults with COPD. A comprehensive literature search was conducted across major databases, identifying studies that employed BCIs, including motivational interviewing, self-monitoring techniques, and technology-based support, to facilitate engagement in physical activity. A total of seven studies met the inclusion criteria and were synthesized to explore the impact of these interventions on physical activity levels and health-related quality of life. Findings revealed that multimodal interventions, combining exercise promotion with behavioral coaching and psychological support, resulted in statistically significant increases in physical activity levels (Cohen's d range: 0.39 to 0.74) compared to control groups. Moreover, interventions that incorporated ongoing support exhibited better sustainability of physical activity gains over time. This study underscores the importance of individualized, multidimensional strategies in promoting physical activity among COPD patients, suggesting that the integration of BCIs in clinical practice can enhance health outcomes and quality of life. Further research is warranted to establish standardization in intervention approaches and to identify the most effective components of BCIs within diverse patient populations.

Adequate hand hygiene practices throughout the continuum of care of maternal and newborn health are essential for infection prevention. However, the hand hygiene compliance of facility-based birth attendants, parents and other caregivers along this continuum is low and behavioural-science informed interventions targeting the range of caregivers in both the healthcare facility and home environments are scarce. We assessed the limited efficacy of a novel multimodal behaviour change intervention, delivered at the facility, to improve the hand hygiene practices among midwives and caregivers during childbirth through the return to the home environment. The 6-month intervention was implemented in 4 of 8 purposively selected facilities and included environmental restructuring, hand hygiene infrastructure provision, cues and reminders, and participatory training. In this controlled before-and-after study, the hand hygiene practices of all caregivers present along the care continuum of 99 women and newborns were directly observed. Direct observations took place during three time periods; labour, delivery and immediate aftercare in the facility delivery room, postnatal care in the facility ward and in the home environment within the first 48 h following discharge. Multilevel logistic regression models, adjusted for baseline measures, assessed differences in hand hygiene practices between intervention and control facilities. The intervention was associated with increased odds of improved practice of birth attendants during birth and newborn care in the delivery room (Adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.7, 7.7), and that of parental and non-parental caregivers prior to newborn care in the post-natal care ward (AOR = 9.2; CI = 1.3, 66.2); however, the absolute magnitude of improvements was limited. Intervention effects were not presented for the home environment due COVID-19 related restrictions on observation duration at endline which resulted in too low observation numbers to warrant testing. Our results suggest the potential of a facility-based multimodal behaviour change intervention to improve hand hygiene practices that are critical to maternal and neonatal infection along the continuum of care.

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite extensive evidence supporting its efficacy and multiple clinical practice guidelines recommending its provision, very few eligible stroke survivors receive mCIMT internationally. A multi-modal behaviour change intervention, guided by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel, was implemented across a large early-supported discharge (ESD) rehabilitation service in Perth, Australia, to increase delivery of mCIMT within existing resources. As part of this iterative implementation process, qualitative data from stroke survivors, carers, clinicians and managers informed program adaptations to support sustained mCIMT delivery. This study aimed to evaluate the process of implementing mCIMT across the seven sites of this ESD service. This mixed methods process evaluation was guided by the RE-AIM QuEST framework. Data collection included patient file audits (conducted twice over six-month periods) (N = 540), clinician training attendance records, interviews with stroke survivors and carers (N = 25), and focus groups with clinicians and managers (N = 24). Quantitative data were analysed descriptively. Qualitative data were analysed using reflexive thematic analysis and mapped to the Capability, Opportunity, Motivation- Behaviour model for interviews and TDF for focus groups. Reach: 31% of all stroke survivors admitted to the ESD service, including 80% of those with an UL impairment, were eligible for mCIMT. Twenty-eight facilitated workshops were conducted across all sites (four per site). Clinicians reported that the behaviour change intervention improved their knowledge, skills and confidence to identify suitable stroke survivors and deliver mCIMT programs. Adoption: 17% of eligible stroke survivors were offered mCIMT and 11% received it (Audit 1). 7/9 programs were delivered with protocol fidelity. Adaptations included ongoing/booster training sessions and resource refinement. Maintenance: 34% of eligible stroke survivors were offered mCIMT, with 26% receiving it, and all programs adhered to the protocol (Audit 2). mCIMT was feasibly and acceptably integrated into the ESD service, demonstrating that complex interventions can be implemented within existing resources. However, concerns persist regarding sustained delivery. Future research should investigate long-term sustainability and target policy-level change to ensure stroke survivors consistently receive evidence-based interventions.

Health technology reassessment (HTR) is a process to manage existing health technologies to ensure ongoing optimal use. A model to guide HTR was developed; however, there is limited practical experience. This paper addresses this knowledge gap through the completion of a multi-phase HTR of red blood cell (RBC) transfusion practices in the intensive care unit (ICU). The HTR consisted of three phases and here we report on the final phase: the development, implementation, and evaluation of behavior change interventions aimed at addressing inappropriate RBC transfusions in an ICU. The interventions, comprised of group education and audit and feedback, were co-designed and implemented with clinical leaders. The intervention was evaluated through a controlled before-and-after pilot feasibility study. The primary outcome was the proportion of potentially inappropriate RBC transfusions (i.e., with a pre-transfusion hemoglobin of 70 g/L or more). There was marked variability in the monthly proportion of potentially inappropriate RBC transfusions. Relative to the pre-intervention phase, there was no significant difference in the proportion of potentially inappropriate RBC transfusions post-intervention. Lessons from this work include the importance of early and meaningful engagement of clinical leaders; tailoring the intervention modalities; and, efficient access to data through an electronic clinical information system. It was feasible to design, implement, and evaluate a tailored, multi-modal behavior change intervention in this small-scale pilot study. However, early evaluation of the intervention revealed no change in technology use leading to reflection on the important question of how the HTR model needs to be improved.

IntroductionMental health conditions are highly prevalent among adolescents, affecting one in seven individuals and accounting for 15% of the global disease burden in this age group. The promotion of health behaviours including physical activity, nutrition, and sleep, and reduction of sedentary behaviour, has been shown to significantly improve symptoms of mental health conditions in adolescents. However, addressing this public health challenge at a population level requires scalable interventions, such as mobile health (mHealth) interventions. However, the effectiveness of mHealth interventions in achieving clinically meaningful mental health improvements for adolescents with emotional, behavioural, or eating disorders remains unclear. Therefore, this systematic review and meta-analysis evaluated the effectiveness of mHealth behaviour change interventions aimed at improving physical activity (PA), sedentary behaviour (SB), nutrition, or sleep on outcomes related to emotional, behavioural, and eating disorders in adolescents.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO ID: CRD42024591285). Eight databases were searched for randomized controlled trials (RCTs) published up to September 2024. Eligible studies included participants in early (11–14 years), middle (15–17 years) and late (18–21 years) adolescence with clinical diagnosis or self-report of emotional, behavioural, or eating disorders, where interventions targeted physical activity, sedentary behaviour, nutrition, or sleep. The cochrane risk of bias 2.0 (ROB2) and cochrane grading of recommendations assessment, development and evaluation tool (GRADE) were applied. Pooled effect sizes were calculated as standardized mean differences (SMD) with 95% confidence intervals using random-effect models.ResultsNine RCTs involving 3,703 participants were analysed across emotional, behavioural, and eating disorders. The meta-analysis yielded a significant reduction in anxiety (6 Studies, 2086 participants, SMD [95% CI] = −0.19 [−0.37, −0.01], I2 = 71%, with positive effects for sleep focussed interventions as well as multimodal interventions (PA, SB, diet, sleep) and eating disorders (3 studies, 732 participants, SMD [95% CI] = −0.23 [−0.44, −0.02], I2 = 38%, with positive effects for diet and combined diet/PA interventions). In contrast, depressive (7 Studies, 1855 participants, SMD [95%CI] of −0.12 [−0.28, −0.04], I2 59%) and behavioural disorders symptoms (2 studies, 560 participants, SMD [95%CI] = −0.71 [1.77, 0.36], I2 = 95) showed no significant pooled effect. The cumulative evidence was weakened by high heterogeneity of trial design and low overall certainty of evidence as indicated by ROB2 and GRADE assessments. Across interventions, trials characterized by higher session frequency, greater intensity (e.g., more vigorous physical activity), longer duration, and hybrid delivery methods, including some face-to-face counselling were associated with larger effect sizes but reduced scalability.DiscussionThese findings suggest that mHealth interventions incorporating health behavior modifications may effectively reduce anxiety and eating disorder symptoms in adolescents. However, modest and mixed effects on depression and behavioural disorders, together with a low number of included studies, considerable heterogeneity and low certainty of evidence, underscore the need for further high-quality RCTs to evaluate long-term efficacy. Combining mHealth interventions with standard clinical care may enhance symptom improvements in adolescents.Systematic Review Registrationidentifier (CRD42024591285).

TPS12140 Background: Exercise is associated with improved survival, physical function, treatment tolerability, and quality of life in early-stage breast cancer. Prospective trials support the positive impact of exercise on cardiorespiratory fitness (CRF), physical function, and muscle mass. These same endpoints matter in metastatic breast cancer (MBC). CRF is a predictor of worse cancer- specific survival, and there is a high prevalence of physical impairment and sarcopenia in patients with MBC, both associated with worse quality of life and survival. Two previous exercise trials in those with MBC have found exercise to be not feasible or of limited benefit. These findings may be due to a heterogeneous participant population that is primarily receiving cytotoxic chemotherapy. Patients with MBC have variable disease trajectories and supportive care needs; those with indolent MBC have longer life expectancy, lower symptom burden and distinct priorities, and are well-positioned to participate in and benefit from an exercise program. The EMBody trial is focused on enrolling a homogeneous patient population with indolent, stable MBC and improving endpoints known to correlate with survival outcomes in this population. Here, we evaluate the impact of a multimodal exercise intervention on CRF, physical function, body composition, and PROs. This study will be a step toward redefining “survivorship” to extend to those living with MBC. Methods: In this prospective phase II trial (NCT05468034), 100 patients with MBC are randomized 1:1 to exercise intervention or wait-list control, stratified by baseline function. Eligible patients have no evidence of disease progression in the prior 12 months and may be receiving endocrine, targeted, immuno-, or antibody drug conjugate therapy. Patients receiving cytotoxic chemotherapy are not eligible as this subgroup did not benefit in prior trials. Target enrollment is 3-4 participants per month over 2.5 years, beginning January 2023. The virtually-delivered exercise intervention arm achieves moderate intensity exercise with oncology-certified exercise physiologists 3 days/week for 16 weeks. The 60-minute sessions include aerobic, resistance, balance and stretching exercises. The exercise arm receives informational sessions on the role of exercise in cancer and principles of habit and self-efficacy. The primary endpoint is 16 week change in CRF on a ramp treadmill test between the exercise and control arms. Secondary endpoints include change in a physical function battery, muscle mass assessed by CT scans, and PROs of fatigue and quality of life. Exploratory analysis includes behavioral modifiers of exercise adherence and effectiveness and serologic measures of inflammatory, metabolic, and immune pathway biomarkers, as well as changes in circulating tumor cells. Patients will be followed post- intervention for sustained behavior change and survival trajectory. Clinical trial information: NCT05468034 .

Heart, Body, and Soul: Impact of Church-Based Smoking Cessation Interventions on Readiness to Quit

PurposeEvidence that lifestyle factors are associated with better outcomes in colorectal cancer (CRC) survivors highlights the need for behaviour change interventions. This study examined feasibility and acceptability, and provided an indication of behavioural impact, of a telephone-based, multimodal health behaviour intervention for CRC survivors. MethodParticipants were recruited from five London hospitals. Patients (n = 29) who had recently completed treatment for CRC participated in a 12 week intervention. Behavioural goals were to increase physical activity (PA) and fruit and vegetable (F&V) intake, and reduce consumption of red/processed meat and alcohol. Self-report measures of PA and diet were completed in all patients, supplemented by objective measures in a sub-set. ResultsUptake of the study when patients were approached by a researcher was high (72%), compared with 27% contacted by letter. Methods for identifying eligible patients were not optimal. Study completion rate was high (79%), and completers evaluated the intervention favourably. Significant improvements were observed in objectively-measured activity (+70 min/week; p = .004). Gains were seen in diet: +3 F&V portions a day (p < .001), −147 g of red meat a week (p = .013), −0.83 portions of processed meat a week (p = .002). Changes in serum vitamin levels were not statistically significant, but the small sample size provides limited power. Clinically meaningful improvement in quality of life (p < .001) was observed. ConclusionAn intervention combining print materials and telephone consultations was feasible and acceptable, and associated with improvements in PA, diet and quality of life.

Multimodal health behaviour-changing interventions for adolescents living with obesity.

Improving dietary intake during pregnancy can mitigate adverse consequences for women and their children. The effective techniques and features for supporting and sustaining dietary change during pregnancy and postpartum are minimally reported. The primary aims of this systematic review and meta-analysis were to summarise the effectiveness of dietary interventions for pregnant woman, identify which behaviour change techniques (BCTs) and intervention features were most frequently used and determine which were most effective at improving dietary intake. Six databases were searched to identify randomised control trials (RCTs) reporting on dietary intake in pregnant women over the age of sixteen, with an active intervention group compared to a control group receiving usual care or less intensive interventions. The Cochrane Risk of Bias Tool 1 was used to assess study validity. BCTs were coded by two authors using Michie et al.’s BCT taxonomy V1. A random effect model assessed intervention effects on indices of dietary quality and food groups (fruit, vegetables, grains and cereals, meat, and dairy) in relation to the use of BCTs and intervention features. Thirty- seven RCTs met the inclusion criteria. High heterogeneity was observed across intervention characteristics and measures of fidelity. Only half of the available BCTs were used, with eleven used once. The BCT category Reward and threat was successful in improving dietary quality and vegetable intake, whilst 'Action planning’ (1.4) from the category Goals and planning significantly improved dietary quality. Interventions delivered by a nutrition professional and those that included group sessions improved dietary quality more than those delivered by other health professionals, research staff, or application-delivered interventions and delivered via other modalities. Future dietary interventions during pregnancy should incorporate and report on BCTs used in the intervention. Successful design elements for improving antenatal dietary intake may include multimodal interventions delivered by nutrition professionals and the use of Rewards and Goal setting.

Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study