Behavior Change Goals Research Articles

Testing the Feasibility, User Experiences, and Preliminary Effect of Conversation Cards for Adolescents © For Behavior Change and Collaborative Goal Setting in Primary Care: A Pilot Randomized Controlled Trial

Our team developed Conversation Cards for Adolescents© (CCAs), a tool to help adolescents and health care providers (HCPs) communicate and collaboratively set behavior change goals. The objectives of this pilot randomized controlled trial were to test the feasibility, user experience, and preliminary effect of using CCAs with adolescents in primary care, focusing on behavior change and collaborative goal setting among adolescents. From March 2019 to September 2022, adolescents were recruited from the Northeast Community Health Centre (Edmonton, AB). Adolescents were randomized (1:1) to one of two groups: CCA + goal setting (experimental group) or goal setting alone (control group). Data were collected from both groups at baseline and at 3-weeks post-baseline. In total, 31 adolescents completed the trial (terminated early due to COVID-19). The study demonstrated high practicality. Adolescents reported positive user experiences with CCAs, citing attractiveness, clarity, efficiency, and dependability. No group differences were detected for behavior changes at 3-weeks post-baseline (p > .05), although adolescents in the experimental group qualitatively described improved rapport and communication with HCPs. CCAs can be used practically in a primary health care setting to facilitate communication and rapport with adolescents; however, their effect in enabling behavior change should be investigated in a multi-site, larger-scale trial.

Participants in a peer-based nutrition and health program in Zimbabwe value dialogue, peer support, and tangible action: A qualitative exploration of peer group experiences.

Peer support groups are implemented globally, and viewed as cost-effective, scalable platforms for delivering health and nutrition programming. Quality is important for participation and achieving social and behavior change goals. Little research has explored the perspectives of peer group participants on quality. This manuscript describes community-based implementation research, and associated findings, which was conducted to learn how participants of a nutrition and health program define quality peer groups and how they suggest improving peer groups. In-depth interviews on experiences, benefits, and challenges were conducted with participants of health and nutrition peer groups, including group members (n = 64) and facilitators (n = 30), in three districts in Zimbabwe. Qualitative data were analyzed thematically and preliminary results were presented in six follow-up focus group discussions with interviewees to provide input on results and interpretation. Peer groups met some of participants' needs for knowledge, social support, and visible improvements in their lives and homes. Participants described generally positive experiences that sustained participation and motivated behavior change. They highlighted group dynamics, interactive facilitation, and community recognition which support the credibility and motivation of group facilitators. Implementation could be improved by strengthening family engagement and more hands-on learning for encouraging participation. Local adaptation of group activities can address influences on behavior change and increase relevance to participants' needs. The perspectives of core stakeholders are essential to understand what aspects of peer groups are most important to implement the approach with quality across contexts. Implementation research and continued monitoring to understand participant perspectives should be an integral part of all programs to ensure the application of adult learning principles and an appropriate balance between fidelity and adaptation for local relevance and engagement.

Efficacy of an mHealth-delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial.

The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months. A randomized controlled trial of 300 African American postpartum peoplewith overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support. Intervention and usual-care participants did not significantly differ in 12-month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference -0.6 kg, 95% CI: -2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (-0.6 vs. 2.4 kg, p = 0.01; difference -3.0 kg, 95% CI: -5.4 to -0.6). The intervention reduced systolic BP relative to usual care (-1.6 vs. 2.4 mm Hg, p = 0.02; difference -4.0 mm Hg, 95% CI: -7.5 to -0.5), but this effect did not extend to other cardiometabolic risk factors. Among African American postpartum people enrolled in WIC, an mHealth-delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement.

Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis

BackgroundAdherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy.MethodsSeven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis.ResultsOf 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious.ConclusionsThe overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient’s needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy.Systematic review registrationPROSPERO CRD42021267355.

The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study.

Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.

Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder

BackgroundAs the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation.MethodsUsing a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data.ResultsOf the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24–96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants’ reported use behavior.ConclusionsThe findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether.Trial registrationThe primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).

Incorporating Cardiovascular Risk Assessment into Adolescent Reproductive Health and Primary Care Visits

Study ObjectiveThis study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits. Design, Setting, and ParticipantsWe recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA.Main Outcome Measures: Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants’ perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice. ResultsAdolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants’ median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants’ median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits. ConclusionHerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics.

Macro-engagement in mHealth: Exploring user engagement beyond the screen.

While digital technology holds great promise for health and well-being, some users feel sceptical about the time they spend online and how they use their mobile devices. This attitude could hamper uptake of digital health technologies and engagement with them. This study uses the concept of macro-engagement as a starting point to investigate how users of digital behaviour change interventions (DBCIs) engage with their behaviour change goals beyond the screens of their tools. Thirty semi-structured interviews were conducted with individuals who take part in behaviour change processes in different ways (i.e. mental health professionals, digital health experts and users of DBCIs). A qualitative analysis of their data through a grounded theory approach highlighted a wide array of offscreen behaviors and strategies that complement a behavior change process offscreen. Furthermore, implications for designing technology that encourages progressive non-reliance on DBCI usage are drawn out.

Digital health coaching to improve patient preparedness for elective lower limb arthroplasty: a quality improvement project

Major surgery carries high risks with comorbidities, frailty and health risk behaviours meaning patients are often unprepared for the physiological insult. Since 2018, the Prepwell programme at South Tees Hospitals...

Participant characteristics, modifiable dementia risk, and associated goal setting within a large online, multi‐domain, risk factor management program (BetterBrains) to delay cognitive decline

AbstractBackgroundIn 40% of cases, dementia can be attributed to potentially modifiable risk factors (RFs) such as poor vascular health, poor sleep, low mood, and low social/cognitive engagement.1 BetterBrains (betterbrains.org.au) is a prospective, blinded endpoint, 24‐month randomised controlled trial to test the effectiveness of an online, person‐centred, RF management program in delaying cognitive decline2 in middle‐aged adults (40‐70 years) with a family history of dementia.MethodAssessment of RFs in vascular health, social/cognitive engagement, mood, and sleep are conducted and participants with risk in at‐least 1 domain are enrolled. The primary outcome is favourable cognitive performance at 24‐months, defined as the absence of decline on at least one out of four cognitive tests. All participants (control/intervention) receive educational blogposts. Intervention participants also receive at least six person‐centred telehealth consults with a “BetterBrains coach” trained in motivational interviewing to set and achieve goals to reduce identified RFs.ResultTo date, 599 participants have been enrolled in BetterBrains. Blinded baseline descriptive analyses revealed high trial acceptability, with &lt;3% of participants who completed baseline withdrawing from the trial. Participants who completed RF assessment (n = 459) were mostly female (80%), aged 59.4 years, and have 15.2 years of education on average. Risk in all domains is most common (29.6%), followed by risk in social/cognitive engagement, sleep, and vascular health (16.9%) (Fig 1). Of those randomised, behaviour change goals (n = 429 goals) most commonly target vascular RFs (e.g., increasing physical activity, lowering blood pressure/cholesterol) (41%) and low levels of social/cognitive engagement (e.g., attending community/social groups, learning a language) (26.1%), mapping closely to the most common modifiable RFs (Fig 1).ConclusionLow attrition rates indicates high acceptability of the BetterBrains methodology. However, the current sample consists mostly of younger adult females with high educational attainment. There is high co‐occurrence of modifiable RFs in the sample, consistent with observations of clustering of RFs in adult populations.3,4 When categorised, personalised behaviour change goals occurred most commonly within the vascular health and social/cognitive engagement domains, aligning with prescriptive components used in previous lifestyle prevention trials.4 Variation in modifiable RF profiles confirms the validity of a personalised, multidisciplinary approach.

Development, Implementation, and Process Evaluation of Bukhali: An Intervention from Preconception to Early Childhood

The Healthy Life Trajectories Initiative, an international consortium developed in partnership with the World Health Organization, is addressing childhood obesity from a life-course perspective. It hypothesises that an integrated complex intervention from preconception, through pregnancy, infancy and early childhood, will reduce childhood adiposity and non-communicable disease risk, and improve child development. As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali randomised controlled trial is being conducted with 18–28-year-old women in Soweto, where young women face numerous challenges to their physical and mental health. The aims of this paper were to describe the intervention development process (including adaptations), intervention components, and process evaluation; and to highlight key lessons learned. Intervention materials have been developed according to the life-course stages: preconception (Bukhali), pregnancy (Bukhali Baby), infancy (Bukhali Nana; birth—2 years), and early childhood (Bukhali Mntwana, 2–5 years). The intervention is delivered by community health workers, and includes the provision of health literacy resources, multi-micronutrient supplementation, in-person health screening, services and referral, nutrition risk support, SMS-reminders and telephonic contacts to assist with behaviour change goals. A key adaption is the incorporation of principles of trauma-information care, given the mental health challenges faced by participants. The Bukhali process evaluation is focussing on context, implementation and mechanisms of impact, using a mixed methods approach. Although the completion of the trial is still a number of years away, the documentation of the intervention development process and process evaluation of the trial can provide lessons for the development, implementation, and evaluation of such complex life-course trials.

The physical health nurse consultant and mental health consumer: An important therapeutic partnership.

People diagnosed with mental illness (hereon referred to as consumers) experience a disproportionately lower life expectancy of up 30 years compared to the general population. Systemic issues such as diagnostic overshadowing and stigma from healthcare professionals have inhibited the development of positive therapeutic partnerships that enable consumers to seek and engage support for their physical health concerns. Consumers have called for healthcare professionals to skillfully develop and prioritize therapeutic partnerships whilst coordinating and providing physical healthcare. The aim of this qualitative descriptive research was to explore consumer views and experiences of their interactions with a specialist mental health nursing role, the Physical Health Nurse Consultant. Semi-structured interviews were conducted with 14 consumers from a large public Community Mental Health Service in the Australian Capital Territory. Interviews were transcribed and thematically analysed. Therapeutic partnerships were an overarching theme identified from the data and included three sub-themes: personal attributes of the Physical Health Nurse Consultant; behaviour change engagement strategies; and impact of the therapeutic partnership. Consumers described the personal and professional attributes of the Physical Health Nurse Consultant that enabled the establishment and maintenance of their highly valued therapeutic partnership. This therapeutic partnership was perceived to positively impact their personal and clinical outcomes. With increasing support from consumers, clinical practice settings should move towards embedding a Physical Health Nurse Consultant role in routine practice. Further research exploring the co-development of health behaviour change goals and, barriers and facilitators experienced by the consumers regarding the Physical Health Nurse Consultant is required to further role development.

A social robot-based platform for health behavior change toward prevention of childhood obesity

Childhood obesity is a major public health challenge which is linked with the occurrence of diseases such as diabetes and cancer. The COVID-19 pandemic has forced changes to the lifestyle behaviors of children, thereby making the risk of developing obesity even greater. Novel preventive tools and approaches are required to fight childhood obesity. We present a social robot-based platform which utilizes an interactive motivational strategy in communication with children, collects self-reports through the touch of tangible objects, and processes behavioral data, aiming to: (a) screen and assess the behaviors of children in the dimensions of physical activity, diet, and education, and (b) recommend individualized goals for health behavior change. The platform was integrated through a microservice architecture within a multi-component system targeting childhood obesity prevention. The platform was evaluated in an experimental study with 30 children aged 9–12 years in a real-life school setting, showing children’s acceptance to use it, and an 80% success rate in achieving weekly personal health goals recommended by the social robot-based platform. The results provide preliminary evidence on the implementation feasibility and potential of the social robot-based platform toward the betterment of children’s health behaviors in the context of childhood obesity prevention. Further rigorous longer-term studies are required.

Implementation of Healthy Conversation Skills to support behaviour change in the Bukhali trial in Soweto, South Africa: A process evaluation

BackgroundTo address the need for preconception health interventions in low- and middle-income countries, the Healthy Life Trajectories Initiative (HeLTI) was launched in Soweto, South Africa to optimise young women's physical and mental health to establish healthier trajectories for themselves and, where relevant, the next generation. As part of HeLTI trial, the Bukhali intervention utilises the Healthy Conversation Skills (HCS) approach to promote behaviour change with 18–28-year-old women. The aim of this article is to report on the process evaluation of implementing HCS, to identify implementation challenges, and make recommendations for HCS adaptations. MethodsData were collected from intervention session records (participants’ response to setting behaviour change goals, community health workers (CHWs) impression of their HCS use; n ​= ​7418), individual in-depth interviews with participants (n ​= ​35), focus groups (3) and debrief sessions (13) with CHWs who deliver the intervention. ResultsThe findings indicated that the HCS approach was not implemented as originally intended. Challenges were reported regarding participants' willingness to set behaviour change goals, and prioritise health and health behaviour change, as well as participants’ exposure to trauma, influencing their ability to prioritise health behaviour change. While CHWs were able to identify strengths of the HCS approach, there were challenges with contextual adaptation, especially using HCS in a multilingual setting such as Soweto. Recommendations for contextual adaptations of the HCS approach in Soweto, South Africa include simplification of certain HCS tools, language adaptions for a multilingual setting, adapting training to fit in with time constraints of a trial, and adopting a trauma-informed perspective to health behaviour change. ConclusionsThis article extends our understanding of challenges to health behaviour change for young women in a low-income setting, highlighting the role of trauma, and the need for a trauma-informed perspective to understand behaviour change in this context.(PACTR201903750173871, Registered March 27, 2019).

Promoting passenger behaviour change with provision of occupancy information to help moderate train overcrowding: A cognitive work analysis approach

Passengers' travel behaviour is one of the significant factors affecting train overcrowding. Train occupancy information has been introduced as a tool to stimulate passengers' behaviour change to ease in-vehicle crowding. However, there are limitations to this strategy as it often fails to consider other elements in the complex rail system that influence behaviour. This research provides insights to service providers to promote passenger behaviour change by revealing the behavioural constraints in the environment. Cognitive Work Analysis (CWA) was applied to systematically analyse passengers’ behaviour and related constraints in the environment. Specifically, Work Domain Analysis (WDA) and Social Organisation and Cooperation Analysis (SOCA) were conducted and presented in the forms of Abstraction Hierarchy (AH) and Contextual Activity Template (CAT). Results showed that a wide range of informational, navigational and physical support alongside provision of occupancy information could better encourage passengers to select and use less busy carriages and trains. Behaviour change goals are likely to be achieved more effectively when the constraints of the system are better understood.

Abstract 041: Effect Of Personalized Feedback Messages On Adherence To The Dietary, Physical Activity And Weight Loss Goals- The Smarter RCT

Background: A core component of standard behavior treatment for weight loss is establishing goals for caloric restriction and weekly minutes of physical activity (PA). Adherence to these behavior change goals is essential for successful weight loss outcomes. The aim of this paper is to examine adherence to the behavior change goals in the two treatment conditions: Self-Monitoring plus personalized Feedback (SM+FB) or SM alone. Methods: We conducted a single-site, two-arm randomized controlled trial from August 2018 to March 2021. Adults (N=502) 18 years of age or over with body mass index (BMI) 27-43 kg/m 2 were randomized with equal allocation to SM+FB (n=251) or SM (n=251). Feedback messages were sent daily for diet and every other day for PA. Adherence to the dietary and PA goals were defined as: 1) for diet the number of days one was adherent to the calorie goal (i.e., between 80% and 120% with the wide range due to the lack of precision in self-reported food intake) and 2) for PA the percentage of minutes of fairly and very active minutes per week meeting the PA goal of at least 150 minutes for fairly and very active minutes based on the Fitbit Charge 2™. Associations between treatment assignment and adherence to the dietary and PA goals were examined using linear mixed modeling with intention-to-treat method. Results: The sample (N=502) was mostly white (84%, 423 of 502), female (79%, 399 of 502) and on average 45.0±14.4 years of age and BMI of 33.7±4.0 kg/m 2 . Study retention at 12 months was 79%. The trajectory of change in adherence to the dietary goal was non-linear over 12 months (b=-.18, 95% CI [-.20, -.17]; b 2 =.006, 95% CI [.005, .007]; b 3 =-.0001, 95% CI [-.00007, -.00006], all P&lt;.0001). The rate of decline over time in adherence to the diet goal was nonlinear and different by treatment (b trt*time = .03, 95% CI [.01, .06]; b trt*time*time = -.002, 95% CI [-.003, -.001]; b trt*time*time*time = .00003, 95% CI [.00002, .00004], all P&lt;.05) Notably, the effect of treatment (b= .41, 95% CI [.10, .72], P=.009) on adherence to the dietary goal was significant. Additionally, the effects of time with polynomial contrasts showed declining curvilinear trajectories of change in the PA goal over 12 months (b=-1.75, 95% CI [-2.57, -0.92], b 2 =.08, 95% CI [.04, .11], b 3 =-.001, 95% CI [-.002, -.001], all P&lt;.0001). The rate of decline over time in adherence to the PA goal was non-linear and different by treatment (b trt*time = -.80, 95% CI [-1.40, -.20]; b trt*time*time = .02, 95% CI [.004, -.03], all P&lt;.05); the effect of treatment on adherence to the PA goal was not significant (b= 19.07, 95% CI [-3.86, 42.01], P = .103). Conclusions: In this study, adherence to the dietary and PA goals was associated with daily FB, which may be related to the frequency of the feedback messages. Further studies are needed to determine the best dose of tailored feedback messages to achieve sustained adherence to the prescribed behavior change goals.

Impact of a brief training on motivational interviewing and the 5A's approach on weight-related counseling practices of pediatricians.

BackgroundPediatric primary healthcare providers are well‐positioned to provide healthy lifestyle and weight management related counseling but many lack training in evidence‐based messages and methods.ObjectivesWe assessed the impact of a brief, easy‐to‐access training for pediatric healthcare providers, (the Strong4Life Provider Training), designed to introduce/review current evidence‐based messages and methods and improve healthy weight‐related assessment and counseling practices.MethodsFollowing their well‐child visit, a convenience sample of children 12–17 years and parents of children 6–11 years (N = 121) of randomly selected Strong4Life trained (N = 15) and untrained (N = 15) pediatricians were administered a survey designed to assess the frequency, content, and patient satisfaction with weight management‐related counseling provided. Results from parents and patients of trained pediatricians (N = 62) compared to those from parents and patients of untrained pediatricians (n = 59) were compared using chi‐square tests. Generalized estimating equations were used to account for lack of independence among respondents from the same practice. P‐values less than 0.05 were considered to be statistically significant.ResultsParents/patients of trained pediatricians were more likely than those of an untrained pediatrician to report having been asked about child's consumption of fruit/vegetables, 57 (92%) versus 44 (75%), p = 0.04 and sugary drinks, 50 (81%) versus 29 (49%), p = 0.005, and their readiness for behavior change, 47 (76%) versus 29 (49%), p = 0.005, and to set a behavior change goal, 36 (59%) versus. 23 (40%), p = 0.005. Regardless of training status, physical activity, screen time, and weight status were assessed for most patients, and most were satisfied with the discussion. Few (21%) were asked about barriers to behavior change.

Leveraging emotion-behavior pathways to support environmental behavior change

Many global environmental threats are driven by human behavior and require behavioral solutions. Researchers in the environmental field have recently explored the behavioral sciences as core to changing behavior for conservation, yet leveraging human emotions remains an underused tool for behavior change compared to others like social norms. Humans experience a range of emotions that each cause distinct patterns of behavior depending on unique contexts that evolved over time; this presents an opportunity to leverage emotions to support behavior-change goals. The existing literature and models of behavior change offer minimal guidance about which specific emotions to use in which contexts and how those emotions might lead to certain behaviors. In the environmental field specifically, there have been mixed recommendations on using emotions, resulting from an incomplete understanding of the causal relationship between emotions, contexts, and environmental behaviors. We propose that adopting a functionalist approach, which describes emotions as functional states designed to produce outcomes in specific contexts, will help to unlock emotions as a tool for conservation. To demonstrate this approach, we identified fear, hope, the prospect of shame, pride, anger, and interest as particularly relevant for environmental behavior change. Based on an understanding of each emotion’s function, we developed an emotion-behavior pathway that described the expected outcome of using an emotion in a particular context. Applying these emotional-behavior pathways can allow both researchers and practitioners to advance the science of shifting environmental behavior through emotion.

Patient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores.

BackgroundCare delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors.ObjectiveThe primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps.MethodsA systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS).ResultsApp store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent paper in 2022.ConclusionsKnowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care.International Registered Report Identifier (IRRID)PRR1-10.2196/29047

Are eHealth interventions for adults who are scheduled for or have undergone bariatric surgery as effective as usual care? A systematic review.

This systematic review aimed to evaluate the effect of eHealth-delivered interventions for adults who undergo bariatric surgery on postoperative weight loss, weight loss maintenance, eating psychopathology, quality of life, depression screening, and self-efficacy. Six electronic databases were searched, with 14 studies (across 17 reports) included, involving 1633 participants. With substantial heterogeneity, qualitative descriptions have been provided. Interventions were delivered via an online program or internet modules (n = 2), telephone (n = 2), text messages (n = 2), videoconferencing (n= 3), mobile application (n = 1), and audiovisual media (n = 1). Three studies included a combination, including internet modules and telephone (n = 1), wireless fidelity scales, emails, and telephone (n = 1), and a combination of online treatment, weekly emails, and access to a private Facebook group (n = 1). All the eHealth interventions, except for one, implemented behavior change techniques, including self-monitoring, problem solving, social support, goal setting, and shaping knowledge. Both eHealth intervention and control groups lost weight across the included studies, and eHealth was found to be as effective as or more effective than the control for weight loss. Two studies measured weight loss maintenance; both eHealth and control groups regained weight in the longer term. The interventions showed significant improvement on assessment measures for eating psychopathology. In conclusion, when bariatric surgery patients have limited or no access to healthcare teams or require additional support, eHealth may be a suitable option. Future studies implementing eHealth interventions would benefit from reporting intervention components as per the behavior change techniques taxonomy and further consideration of delivering eHealth in a stepped care approach would be beneficial.