Behavior Change Interventions Research Articles

Understanding delays in chronic limb-threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours.

Patients in the community with suspected Chronic limb-threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Semi-structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory-driven behaviour change interventions to reduce delays in CLTI pathways.

'ThinkCancer!' - Randomised feasibility trial of a novel practice-based early cancer diagnosis intervention.

UK cancer deaths remain high; primary care is key for earlier cancer diagnosis as half of avoidable delays occur here. Improvement is possible through lower referral thresholds, better guideline adherence, and better safety netting systems. Few interventions target whole practice teams. We developed a novel whole practice team intervention to address this. To test the feasibility and acceptability of a novel, complex behavioural intervention 'ThinkCancer!' for assessment in a subsequent Phase III trial. Pragmatic, superiority pilot RCT with an embedded process evaluation and feasibility economic analysis in Welsh general practices. Clinical outcome data were collected from practices (the unit of randomisation). Practice characteristics and cancer safety netting systems were assessed. Individual practice staff completed evaluation and feedback forms, and qualitative interviews. The intervention was adapted and refined. Trial recruitment and workshop deliveries took place between March 2020 to May 2021. Trial progression criteria for recruitment, intervention fidelity and routine data collection were met. Staff-level fidelity, retention and individual level data collection processes were reviewed and amended. Interviews highlighted positive participant views on all aspects of the intervention. All practices set out to liberalise referral thresholds appropriately, implement guidelines, and address safety netting plans in detail. 'ThinkCancer!' appears feasible and acceptable; the new iteration of the workshops was completed, and the Phase III trial has been funded to assess the effectiveness and cost effectiveness of this novel professional behaviour change intervention. Delivery at scale to multiple practices will likely improve fidelity and reach.

Determinants of behaviour and their efficacy as targets of behavioural change interventions

Determinants of behaviour and their efficacy as targets of behavioural change interventions

Abstract PO5-12-02: Landscape analysis of oncology nutrition research among patients being treated for breast cancer

Abstract The American Institute for Cancer Research/World Cancer Research Fund and the American Cancer Society regularly conduct systematic reviews on the evidence supporting nutrition interventions during cancer treatment. These reviews have found that the evidence to support clinical oncology nutrition practice guidelines is limited. It is unclear how many oncology nutrition studies are currently being conducted, especially among patients being treated for breast cancer. The goal of this project was to conduct a landscape analysis of nutrition research being conducted among breast cancer patients over the past 10 years. Methods: This analysis was part of a larger effort to describe the oncology nutrition research landscape for all cancer sites. Searches of ClinicalTrials.gov were performed on 1/8/2023 using the following search terms/combinations: “cancer AND nutrition”, “cancer nutrition”, “oncology AND nutrition”, “diet AND cancer”, “cancer, oncology, neoplasms, nutrition, diet”. Search results were downloaded as .csv files and uploaded to RStudio for merging and data cleaning (elimination of duplicates, and exclusion of studies registered in ClinicalTrials.gov before 1/1/2013 or after 12/31/2022). The resulting harmonized dataset was then uploaded to REDCap, and each entry was reviewed for eligibility by one of the authors. To be included in this landscape analysis, studies must have included data collection from patients who were actively receiving cancer treatment at the time of the study and the study had to be first posted to ClinicalTrials.gov between 1/1/2013 and 12/31/2022. Studies were excluded if they: 1) focused on the role of diet in primary cancer prevention, 2) focused on cancer survivors who had completed primary treatment for their cancers. Following eligibility review, the study datafile was returned to RStudio for further cleaning and analysis. Results: The initial ClinicalTrials.gov search identified 4,345 unique study listings. After review, 1,267 studies met the inclusion criteria, of which 132 (10.4%) studies were specific to breast cancer (117 intervention studies and 15 observational studies). Among breast cancer studies, reasons for exclusion were: study focused on diet/nutrition in the prevention of a primary cancer diagnosis (n=40), study participants had already completed their cancer treatment (n=128), study did not include a diet/nutrition intervention or assessment (n=31). The largest number of breast cancer specific studies were based in the United States (n=55, 41.6%), Italy (n=11, 8.3%), France (n=10, 7.6%) and Canada (n=9, 6.8%). Dietary supplement interventions were the most common type of intervention (n=50 studies, 42.7%), followed by behavior change interventions (n=22, 18.8%), diet in relation to a drug intervention (n=25, 21.4%), diet in relation to a device/procedure/radiation intervention (n=16, 14%), fasting/time-restricted feeding studies (n=13, 11.1%) and ketogenic diet interventions (n=3, 2.6%). Changes in weight or body composition (n=52, 39.4%), quality of life (n=45, 34.1%), adverse events (n=24, 18.2%), survival (n=20, 15,2%) and fatigue (n=17, 12.9%) were the most common outcome measures. Sixteen (12.1%) studies were supported by NIH funding and 9 (6.8%) studies were industry funded, although the majority (n=124, 93.9%) reported funding from “other” sources. Of the 41 studies that started between 2013-2017 (five years prior to the January 2023 ClinicalTrials.gov search), only 21 (51.2%) were listed as being “completed” and of those, only 7 were listed as “has results”. Conclusion: More research is needed to support evidence-based supportive care guidelines for oncology nutrition interventions during breast cancer treatment. Efforts should be made to support researchers in completing studies and disseminating research findings. Citation Format: Kim Robien, Heather Wopat. Landscape analysis of oncology nutrition research among patients being treated for breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-02.

Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial

BackgroundA significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of “I’m an Active Hero” (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children.MethodsTwo preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms.ResultsThe preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial.ConclusionThe IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.

Abstract PO4-11-09: Feasibility of physical activity behaviour change for women living with metastatic breast cancer, a randomised controlled trial

Abstract Background Physical activity benefits women living with metastatic breast cancer by improving outcomes such as physical function, health-related quality of life and fatigue. These findings have been reported within well-resourced trials that involve exercise equipment and supervision. Home or community-based settings, however, may be preferable and more accessible. This trial evaluated the feasibility of a remotely delivered behaviour change intervention for increasing physical activity for women living with metastatic breast cancer, and evaluated the program’s efficacy. Methods A 12-week randomised controlled trial was conducted in which 20 women living with metastatic breast cancer were recruited from a metropolitan outpatient cancer clinic. Inclusion criteria were over 18 years old, English speaking, ambulatory, and not regularly active at time of recruitment. Participants were randomised 1:1 to an intervention or attention control group. Both groups received a recommendation for 150 minutes of physical activity, a wrist-worn activity monitor, a physical activity diary, and nine phone or video call sessions (six weekly, three fortnightly). The intervention group received individualised behaviour change advice on topics such as physical activity benefits, motivation, barriers and social support; the attention control group received a recurring symptom questionnaire and no behavioural advice. Feasibility outcomes included recruitment, dropout and session adherence rates, and acceptability of methods was evaluated with an interview at trial completion. Baseline and 12-week outcomes included: i) physical activity minutes measured with a 5-day Actigraph wear, ii) 6-minute walk distance, iii) 30-second sit-to-stands, iv) questionnaires for self-reported physical activity, health-related quality of life, fatigue, behavioural factors (stage of change, self-efficacy, decisional balance, processes of change, social support), and patient-specific function. Questionnaires were measured again at 18 weeks. Results Recruitment, baseline measures and within-trial sessions are completed; 12 and 18-week measures will conclude late August. Thirty-two women were approached to enrol the target sample of 20, with exclusion reasons being disinterest (n=5), health problems (n=4), loss of contact (n=2) and already physically active (n=1). Median age was 62 years (IQR: 60-69), and median time since metastatic diagnosis was 4 years (IQR: 1-5). Twelve women had bone metastases, and ten had a musculoskeletal comorbidity. Session delivery through video or phone calls were equally preferred (n=10 each). Participants completed 84% of the sessions, with reasons for missed sessions consisting of forgetting (55%), feeling unwell (24%), IT problems (7%), holiday (7%), and work commitments (7%). Median session duration for the intervention group was 23 minutes (IQR: 20-28), and control group was 17 minutes (IQR: 14-21). The preferred type of physical activity was predominantly walking, and no adverse events were reported. Four women dropped out after loss of contact. Compared to age-matched normative values, baseline outcomes varied: actigraphy-measured physical activity was low (median: 68 minutes/day, IQR: 45-88), self-reported physical activity was high (median: 289 MET-minutes/day, IQR: 52-728), 6-minute walk distance was equal (median: 529m, IQR: 416-579), 30-second sit-to-stands were low (median: 11, IQR: 8-14), health-related quality of life was high (median: 80, IQR: 70-100), and fatigue was equal (median: 30, IQR 20-40). Conclusions Women living with metastatic breast cancer were generally receptive of the trial, and recruitment, dropout and session adherence rates were positive. The women who dropped out were more physically active, physically functional and/or rated higher on the questionnaires, indicating that the trial may be more suited to those with limited physical activity experience. Citation Format: Mark Liu, Sharon Kilbreath, Elizabeth Dylke, Jasmine Yee, Jane Beith. Feasibility of physical activity behaviour change for women living with metastatic breast cancer, a randomised controlled trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-09.

Co-designing an intervention using the COM-B model to change an eating behaviour in people living with achalasia

BackgroundAchalasia is a rare motility disorder affecting the oesophagus, leading to difficulties with eating and drinking. Participants in previous studies reported that they needed more social, clinical and behavioural support in the long-term management of achalasia. This study, therefore aimed to 1) identify the most challenging eating behaviour for people living with achalasia and 2) co-design a behaviour change intervention to help address the challenges they experience.MethodsThis study used a qualitative approach involving online focus groups. The COM-B model was the theoretical framework, with behaviour change techniques (BCTs) as the active ingredients that target a mixture of capability, opportunity and/or motivation. Three focus groups were undertaken to obtain a range of input from different people living with achalasia. Participants in this study identified the target behaviour, prioritised the different BCTs which most resonated with them to design an intervention and decided on the mode of delivery. The research team analysed the techniques that helped participants with their eating behaviour using the COM-B model as a framework to create the intervention.ResultsThe 24 participants in this study identified “eating in a social setting” as the target behaviour for the intervention. A workbook that can be personalised by the individual was the most suitable intervention. The workbook structure aligns with the constructs of the COM-B model. It includes reflection, activities and goal-setting sections based on what was indicated to be useful for the majority of the participants. Key techniques to overcome the challenges with eating in a social setting included social support, regulation to reduce negative emotions, goals and planning.ConclusionUsing a focus group approach with the COM-B model as the theoretical framework, the participants in this study developed an intervention to support people living with achalasia. In order to achieve long-term behaviour change, engagement with a personalised workbook could facilitate eating in a social setting. Future work will need to pilot the workbook to ensure it can support people to improve their quality of life and complement the ongoing care they receive from health services.

A feasibility study to assess a co-designed behaviour change intervention to support people living with achalasia

Abstract Introduction Achalasia is a rare oesophageal condition that affects the motility of the oesophageal body and the relaxation of the lower oesophageal sphincter. Even the most effective treatments are unlikely to be curative. The main goal of medical treatments and interventions are mitigation of symptoms. The medical interventions are pharmacologic, endoscopic and surgical treatments to achieve symptom relief. As all medical treatments only help to alleviate symptoms, it is important for people living with achalasia to use non-pharmacological interventions to manage their condition. Aim This study aimed to evaluate the feasibility of recruitment and assess the acceptability of a co-designed behaviour change intervention, targeting eating in a social setting for people living with achalasia. Methods The mixed-method study used pre- and post-intervention questionnaires and semi-structured post-intervention interviews. Achalasia Action (a UK-based support group) emailed members the study information and participants contacted the researcher to take part. The intervention was a workbook designed collaboratively by the researchers and people living with achalasia, with strategies built on the COM-B model (Capability, Opportunity, Motivation).[1] Participants were given up to two months to complete the workbook. The interview was optional and it was an opportunity for participants to give further feedback on the intervention. Quantitative measures were subjected to descriptive analysis reporting recruitment and retention rates, and self-reported changes in eating behaviours. Qualitative data were analysed descriptively using the APEASE criteria (Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity).[2] Results The study aimed to recruit 20 participants, and this target was achieved, resulting in a 100% recruitment rate. However, the post-intervention questionnaires were completed by only 10 participants, indicating a 50% retention rate from baseline. Quantitative measures demonstrated an improvement in confidence and enjoyment levels while eating in a social setting post-intervention and a decrease in symptoms such as pain, regurgitation, stress and anxiety. Qualitative feedback (n=5) on the intervention described enhanced social support and improved symptom management of achalasia in a social setting. Furthermore, the intervention met the APEASE criteria, indicating its usability and acceptability. Conclusion The recruitment success of this study underscores the feasibility of involving people living with achalasia in intervention research. However, with a retention rate of only 50% at follow-up, it is evident that future studies should consider recruiting a larger baseline sample to ensure the target is achieved. The study acknowledges that the sample size was small and limits the generalisability of the findings. However, this is a characteristic typical of feasibility studies; therefore, the study is designed to assess the feasibility of recruitment and implementing a co-designed intervention rather than drawing conclusions on its efficacy. The positive outcomes of the co-designed intervention highlights the importance of user involvement in developing interventions. The intervention demonstrated the potential to support people living with achalasia in eating in a social setting. The co-designed intervention has significant practical implications by providing healthcare professionals and support groups with a feasible, effective method to enhance the social eating experience of people living with achalasia, potentially improving their overall quality of life.

Linking Cardiac Psychology and Cardiovascular Medicine via Self-Determination Theory and Shared Decision-Making.

Despite considerable progress in recent years, research in cardiac psychology is not widely translated into routine practice by clinical cardiologists or clinical health psychologists. Self-determination theory (SDT), which addresses how basic psychological needs of autonomy, competence, and relatedness contribute to the internalization of motivation, may help bridge this research-practice gap through its application to shared decision-making (SDM). This narrative review discusses the following: (a) brief background information on SDT and SDM, (b) the application of SDT to health behavior change and cardiology interventions, and (c) how SDT and SDM may be merged using a dissemination and implementation (D&I) framework. We address barriers to implementing SDM in cardiology, how SDM and SDT address the need for respect of patient autonomy, and how SDT can enhance D&I of SDM interventions through its focus on autonomy, competence, and relatedness and its consideration of other constructs that facilitate the internalization of motivation.

Reducing risk behaviours after stroke: An overview of reviews interrogating primary study data using the Theoretical Domains Framework.

Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking. Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes. From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence). Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.

A Nutrition-Focused Approach During Continuous Glucose Monitoring Initiation in People With Type 2 Diabetes: Using a Theoretical Framework to Unite Continuous Glucose Monitoring and Food Choices.

Continuous glucose monitoring (CGM) has transformed diabetes care, yet opportunities for further innovations still exist. Some research suggests CGM could be an ideal tool to guide food choices and other healthy lifestyle behaviors, especially for people with type 2 diabetes (T2D). Behavior change theories can be used to understand and describe how CGM users make food-related decisions, which could ultimately lead to the design of more tailored and effective interventions. In this commentary, we describe what it looks like to use the behavior change wheel-a theory-based intervention development framework-to design an intervention for people with T2D who will use CGM data to guide food choices aligned with evidence-based nutrition recommendations. Such frameworks may be beneficial when designing or evaluating future technology-focused behavior change interventions.

Patent Applications as Glimpses into the Sociotechnical Imaginary: Ethical Speculation on the Imagined Futures of Emotion AI for Mental Health Monitoring and Detection

Patent applications provide insight into how inventors imagine and legitimize uses of their imagined technologies; as part of this imagining they envision social worlds and produce sociotechnical imaginaries. Examining sociotechnical imaginaries is important for emerging technologies in high-stakes contexts such as the case of emotion AI to address mental health care. We analyzed emotion AI patent applications (N=58) filed in the U.S. concerned with monitoring and detecting emotions and/or mental health. We examined the described technologies' imagined uses and the problems they were positioned to address. We found that inventors justified emotion AI inventions as solutions to issues surrounding data accuracy, care provision and experience, patient-provider communication, emotion regulation, and preventing harms attributed to mental health causes. We then applied an ethical speculation lens to anticipate the potential implications of the promissory emotion AI-enabled futures described in patent applications. We argue that such a future is one filled with mental health conditions' (or 'non-expected' emotions') stigmatization, equating mental health with propensity for crime, and lack of data subjects' agency. By framing individuals with mental health conditions as unpredictable and not capable of exercising their own agency, emotion AI mental health patent applications propose solutions that intervene in this imagined future: intensive surveillance, an emphasis on individual responsibility over structural barriers, and decontextualized behavioral change interventions. Using ethical speculation, we articulate the consequences of these discourses, raising questions about the role of emotion AI as positive, inherent, or inevitable in health and care-related contexts. We discuss our findings' implications for patent review processes, and advocate for policy makers, researchers and technologists to refer to patent (applications) to access, evaluate and (re)consider potentially harmful sociotechnical imaginaries before they become our reality.

Effectiveness of behavior change and self-management theoretically-informed telehealth interventions for stroke secondary prevention: An overview of systematic reviews

Effectiveness of behavior change and self-management theoretically-informed telehealth interventions for stroke secondary prevention: An overview of systematic reviews

Can behavioural change interventions be used to tackle the misdiagnosis of appendicitis and improve patient outcomes?

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Piloting co-developed behaviour change interventions to reduce exposure to air pollution and improve self-reported asthma-related health.

Exposure to air pollution can exacerbate asthma with immediate and long-term health consequences. Behaviour changes can reduce exposure to air pollution, yet its 'invisible' nature often leaves individuals unaware of their exposure, complicating the identification of appropriate behaviour modifications. Moreover, making health behaviour changes can be challenging, necessitating additional support from healthcare professionals. This pilot study used personal exposure monitoring, data feedback, and co-developed behaviour change interventions with individuals with asthma, with the goal of reducing personal exposure to PM2.5 and subsequently improving asthma-related health. Twenty-eight participants conducted baseline exposure monitoring for one-week, simultaneously keeping asthma symptom and medication diaries (previously published in McCarron et al., 2023). Participants were then randomised into control (n = 8) or intervention (n = 9) groups. Intervention participants received PM2.5 exposure feedback and worked with researchers to co-develop behaviour change interventions based on a health behaviour change programme which they implemented during the follow-up monitoring week. Control group participants received no feedback or intervention during the study. All interventions focused on the home environment. Intervention group participants reduced their at-home exposure by an average of 5.7 µg/m³ over the monitoring week (-23.0 to +3.2 µg/m³), whereas the control group had a reduction of 4.7 µg/m³ (-15.6 to +0.4 µg/m³). Furthermore, intervention group participants experienced a 4.6% decrease in participant-hours with reported asthma symptoms, while the control group saw a 0.5% increase. Similarly, the intervention group's asthma-related quality of life improved compared to the control group. This pilot study investigated a novel behaviour change intervention, utilising personal exposure monitoring, data feedback, and co-developed interventions guided by a health behaviour change programme. The study aimed to reduce personal exposure to fine particulate matter (PM2.5) and improve self-reported asthma-related health. Conducting a randomised controlled trial with 28 participants, co-developed intervention successfully targeted exposure peaks within participants' home microenvironments, resulting in a reduction in at-home personal exposure to PM2.5 and improving self-reported asthma-related health. The study contributes valuable insights into the environmental exposure-health relationship and highlights the potential of the intervention for individual-level decision-making to protect human health.

Determinants of immunization defaulters among children aged 12–23 months in Ambo town, Oromia, Ethiopia: A case–control study

ABSTRACT Immunization is a public health intervention to reduce morbidity and mortality among children. However, vaccination becomes more effective if the child can receive the full course of recommended vaccination doses according to the schedule. Many children fail to complete the full course of vaccination. To identify the determinants of immunization defaulters among children aged 12–23 months in Ambo town, Oromia, Ethiopia. A community-based, unmatched, case–control study was done from October 1 to 25, 2021. A simple random sampling was used to select 317 (106 cases and 211 controls). Data were collected by using a pretested and structured questionnaire. Data were coded and entered to Epi-data version 3.1 and then transported to SPSS version 21.0 for statistical analysis. Descriptive analysis like frequency, mean, and percentage was calculated. Binary and multivariable logistic regression analysis was done. Finally, variables with a p value  < .05 were considered statistically significant. Urban residences (AOR = 0.288, 95% CI, 0.146, 570), government employee (AOR = 0.179, 95% CI, 0.057, 0.565), number of family members more than four (AOR = 2.696, 95% CI, 1.143, 6.358), higher income (AOR = 0.250, 95% CI, 0.099, 0.628), attending ANC (AOR = 0..237, 95% CI, 0.107, 0.525), and good awareness (AOR = 0.070, 95% CI, 0.005, 308) were significant predictors of immunization defaulters. This study has found that urban residences, government employee by occupation, number of family members more than four, higher monthly income, and attending ANC were identified as determinants of childhood immunization defaulters. Social Behavior Change intervention programs should focus on providing health information about the importance of the vaccine and vaccine schedule. Due attention should be given for rural residents and farmers who had limited access to information and are more prone to defaulting. Policy-makers should consider those identified factors while designing intervention programs to enhance vaccination coverage.

The Health4Life e-health intervention for modifying lifestyle risk behaviours of adolescents: secondary outcomes of a cluster randomised controlled trial.

To investigate the effectiveness of a school-based multiple health behaviour change e-health intervention for modifying risk factors for chronic disease (secondary outcomes). Cluster randomised controlled trial. Students (at baseline [2019]: year 7, 11-14 years old) at 71 Australian public, independent, and Catholic schools. Health4Life: an e-health school-based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app. Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol-related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous). A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow-up survey, 5698 (85.8%) two or more follow-up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57-2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64-1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72-1.38); tobacco use frequency: relative difference, 0.03 (95% CI, -0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, -0.34 (95% CI, -1.16 to 0.49) days per 30 days; device use time: relative difference, -0.07 (95% CI, -0.29 to 0.16) hours per day. Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e-health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention. Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective).

Breaking Barriers in Behavioral Change: The Potential of AI-Driven Motivational Interviewing.

Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is Motivational Interviewing (MI), a collaborative and patient-centered counseling approach, which has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients, and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven Motivational Interviewing has the potential to offer significant improvements in adherence, and should be further explored to maximally leverage the potential of artificial intelligence for our patients.

Physical Activity Levels and Social Cognitive Theory Correlates among Adults with Crohn's Disease: Preliminary Results from a Cross-Sectional Analysis.

There is increasing research and clinical interest in physical activity (PA) as an adjuvant therapy for improving health outcomes among persons with Crohn's disease. To date, little is known regarding PA behavior and its cognitive and behavioral correlates in Crohn's disease. Thus, we assessed self-reported PA and its social cognitive theory (SCT) correlates in a sample of persons with Crohn's disease. Data on demographic and clinical characteristics, disease activity, leisure-time PA, and SCT variables were collected from 30 participants with Crohn's disease (90% White, 60% female) through an online survey. SCT variables assessed included exercise self-efficacy, social support, outcome expectations, goal setting, and planning. Analyses involved comparing PA levels and SCT survey scores using independent sample t-tests and non-parametric bivariate correlations. The majority of participants were in clinical remission (60%) and over half (57%) were classified as physically active, yet the mean PA level was lower than normative values for adults. Females (n = 18) and participants who reported previous surgery for Crohn's disease (n = 18) were almost twice as physically active as male participants and those without a history of Crohn's disease-related surgery, respectively (p's < 0.05). Overall, participants who reported greater exercise goal setting behaviors had higher levels of PA (rs = 0.34; p < 0.05). These findings highlight lower overall levels of PA in persons with Crohn's disease, and exercise goal setting represents a potential target of behavior change interventions for increasing PA in this population.

Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study.

Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant. This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150min/wk) or physically inactive (<150min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression. At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97-6.06), obesity (odds ratio = 1.79; 95% CI = 1.26-2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20-8.42), >3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17-2.13), family income of >1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48-0.90), and student status (odds ratio = 0.58; 95% CI = 0.37-0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46-0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01-2.13). This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity. In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.