Proof of concept trial for a new theory-based intervention to promote child and adult behavior change

Christopher J Armitage,Peter Callery,Tanya Walsh,Jeanette Mooney,Stephanie Tierney

doi:10.1007/s10865-019-00061-0

Abstract

Interventions to change children’s behavior typically target adults or children, but rarely both. The aims were to: (a) evaluate acceptability and feasibility of an innovative theory-based intervention designed to change both child and adult behavior, and (b) generate effect sizes for a definitive randomized controlled trial. The oral health of sixty children aged 5–9 years with a repaired cleft lip and/or palate was assessed before randomization to one of three conditions: (a) control group, (b) intervention group in which children and adults were asked to form implementation intentions, or (c) intervention plus booster group in which adults were additionally sent a reminder about the implementation intentions they and their children formed. Oral health assessments were repeated at 6-month follow-up alongside exit interviews. The procedures proved popular and participants exposed to the intervention additionally reported believing that forming implementation intentions was effective. Descriptive statistics generally showed oral health improvements across all conditions, although the effects were more marked in the intervention plus booster condition, where plaque improved by 44.53%, gingivitis improved by 20.00% and free sugar consumption improved by 8.92% (vs. 6.43% improvement, 15.00% deterioration and 15.58% improvement in the control group, respectively). Data collection procedures were acceptable and the intervention feasible. The effect sizes suggest that the intervention plus booster condition has sufficient promise to proceed to a fully-powered randomized controlled trial. The intervention has the potential to be adapted to tackle other child health behaviors and to be deployed at scale.

Highlights

The leading causes of morbidity and mortality, such as cardiovascular disease and cancer, can be prevented through changes in key behaviors such as increasing physical activity, improving dietary intake, limiting alcohol consumption and stopping/not starting smoking (Global Burden of Disease Collaboration, 2015)
The oral health of sixty children aged 5–9 years with a repaired cleft lip and/or palate was assessed before randomization to one of three conditions: (a) control group, (b) intervention group in which children and adults were asked to form implementation intentions, or (c) intervention plus booster group in which adults were sent a reminder about the implementation intentions they and their children formed
Descriptive statistics generally showed oral health improvements across all conditions, the effects were more marked in the intervention plus booster condition, where plaque improved by 44.53%, gingivitis improved by 20.00% and free sugar consumption improved by 8.92%

Summary

Introduction

The leading causes of morbidity and mortality, such as cardiovascular disease and cancer, can be prevented through changes in key behaviors such as increasing physical activity, improving dietary intake, limiting alcohol consumption and stopping/not starting smoking (Global Burden of Disease Collaboration, 2015). The few interventions designed to change children’s behavior are typically targeted at adults (e.g., parents, teachers) or children (e.g., Nixon et al, 2012), but rarely both adults and children simultaneously. It is clear that for many of the domains in which behavior change is important, the majority of people are already motivated to change (e.g., 68% of US smokers want to quit completely, Centers for Disease Control, 2017). This means that, in addition to considering ways to motivate people, researchers are paying increasing attention to behavior change interventions that will ensure people’s existing good intentions are effectively translated into relevant behavior change. Implementation intentions differ from other concepts found in models of behavior change (e.g., capabilities, opportunities, and motivations, see Michie et al, 2014) in so far as implementation intentions can be used to deliver multiple techniques (e.g., valued self-identities, Armitage et al, 2011; self-incentives, Brown et al, 2018) that bring about changes in behavior via changes in constructs such as capabilities, opportunities and motivations (Michie et al, 2014)

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