Behavior Change Interventions Research Articles (Page 1)

Access to safe water, sanitation and hygiene (WASH) is critical for health and academic performance. Yet, many schools in sub-Saharan Africa, including Ghana, face significant challenges in providing adequate WASH facilities, leading to profound implications for students' health and academic performance. This study evaluates WASH practices among pupils in basic schools in the Mfantseman Municipality, Ghana, using a mixed-method approach involving 368 pupils from 16 schools. Findings reveal that while most schools have access to water and sanitation facilities, many are partially functional or non-operational, particularly in rural areas. Although handwashing facilities are widely available, only 30.2% of pupils consistently wash their hands with soap before meals, despite higher rates (63.3%) after toilet use. The study highlights the lack of separate facilities for menstrual hygiene management, disproportionately affecting female students. These findings underscore the need for improved WASH infrastructure and behaviour change interventions. This study contributes to the literature on WASH in schools. Based on the study's findings, it is recommended that the Ghana Education Service, Teachers and Parents should ensure infrastructure improvement while implementing behaviour change interventions in the basic schools.

With the dramatic increase in the number of people with cancer, it is necessary to optimize new interventions that promote a healthy lifestyle. This study aimed to explore medical experts' experiences and perspectives regarding the acceptability and feasibility of digital behavior change interventions for Iranian cancer survivors, as well as to identify their potential benefits and barriers. We employed a mixed-methods design to capture both the breadth and depth of clinical experts' perspectives on a digital lifestyle application for cancer survivors and to facilitate triangulation. In the quantitative phase, a standardized questionnaire was administered to 30 professionals, comprising both medical and psychology experts with extensive experience working with cancer survivors. To complement these findings, semi-structured interviews were conducted with a subset of 23 experts. Quantitative analysis revealed that only a small proportion of participants had access to their patients outside of clinical visits. Nevertheless, participants broadly agreed on the feasibility of implementing digital behavior change interventions to support healthy lifestyle changes. Concerns were minimal, provided that such interventions deliver evidence-based information, integrate patient feedback, and maintain strict confidentiality. Complementary thematic analysis further highlighted digital interventions as promising tools for improving lifestyle behaviors among cancer survivors. Essential features for an effective intervention included user-friendliness, simple language, motivational and supportive design, trustworthiness, and cultural adaptability. Our findings indicate that digital behavior change interventions are generally acceptable to Iranian medical experts, provided that potential enablers are leveraged and barriers are addressed to maximize their use. Implications for cancer survivors This study highlights the potential of digital behavior change applications to support cancer survivors in adopting and maintaining healthier lifestyles, particularly in underrepresented settings such as Iran. It also provides insight into key features to improve its acceptance, beside addressing potential barriers.

Cancer survivors living in rural areas have poorer health outcomes due in part to poorer access to survivorship programs. This study evaluated the feasibility, acceptability, and preliminary efficacy of a scalable, remotely-delivered health coaching lifestyle intervention for cancer survivors. In this phase II pilot study, we recruited young and middle-aged adult cancer survivors (18-64 years) to participate in a remotely-delivered eight-week lifestyle behavior change intervention that included remote health coaching sessions (administered by trained student health coaches), remote health education videos, and a wearable activity/sleep monitor. Feasibility was measured by enrollment, retention, and attrition rates, while acceptability was assessed via a post-intervention survey. Preliminary efficacy was evaluated by changes in psychosocial mechanisms, health behaviors, and cancer-related health outcomes. Our enrollment rate (49%) fell just short of our target (50%). Our retention rate (83%) exceeded our target rate of 75%. Adherence rates also exceeded targets (75%) with 99% of remote health coaching sessions attended, 84% of educational videos viewed, and activity monitors worn on 87% of all intervention days. Acceptability rates were also high with most participants reporting the program was beneficial (90%) and that they would recommend it to others (87%). We observed medium-large effects for several secondary/exploratory outcomes including behavioral regulation skills (Cohen's d = 2.04), fatigue (d = 0.86), and global health scores (d = 0.99). No pre-post changes were observed for physical activity, diet, or sleep behaviors. Findings suggest it is feasible to deliver an acceptable remote lifestyle intervention to young and middle-aged cancer survivors. Improvements in targeted psychosocial and cancer-related health markers are promising and support the need for a larger, controlled follow-up study. These findings support the feasibility of delivering a remote, lifestyle behavior change program to young and middle-aged cancer survivors.

Continuous glucose monitoring (CGM) is increasingly being used within precision health interventions to motivate behaviour change. However, there is considerable variability and complexity in the design of behaviour change interventions that incorporate CGM-based biofeedback, making it challenging to disentangle the intervention components that are driving intervention effects. The objective of this review is to identify the behaviour change techniques and mechanisms of action commonly implemented alongside CGM-based biofeedback. We conducted secondary analyses of a scoping review to identify health behaviour interventions (RCTs) that provided CGM-based biofeedback to promote behaviour change in adults. Two researchers applied the 93-item Behaviour Change Techniques (BCT) Taxonomy (v1) to independently code intervention content in all trial arms (i.e., intervention and comparison arms) dependent upon their targeted behaviour of CGM use, glucometer use, diet, physical activity, or medication adherence. BCTs were analysed individually and according to their corresponding category. We performed univariate linear regression analyses to examine whether the presence of individual BCTs and target behaviours influenced pre-post changes in HbA1c within CGM-based intervention arms. Thirty-one RCTs comprising 35 intervention arms and 29 comparison arms were included. Theory was reported in 4 studies (13%), most commonly Self-Efficacy Theory. Mechanisms of action (MoAs) were specified in 5 studies (16%), typically targeting beliefs about capabilities. We identified 40 (of 93 possible) unique BCTs, with intervention arms employing an average of 7.1 BCTs (SD: 4.8) compared to 5.3 BCTs (SD: 4.3) in comparison arms. The most frequently implemented BCT categories in CGM-based biofeedback interventions were 'Feedback and monitoring' (n = 35/35, 100%), 'Shaping knowledge' (n = 28/35, 80%), and 'Social support' (n = 22/35, 63%). Commonly used BCTs supporting CGM use and promoting dietary and physical activity changes included 'Biofeedback' (n = 35/35; 100%), 'Instruction on how to perform the behaviour' (n = 19/35; 54%), and 'Credible source' (n = 14/35; 40%). Univariate linear regressions did not identify any individual BCTs or targeted behaviours that significantly moderated HbA1c outcomes. RCTs using CGM to change behaviour in adult populations include a range of BCTs, focusing predominantly on BCTs that support the implementation of CGM itself. Future research should examine whether BCTs operate through distinct MoAs when supporting CGM uptake and use versus when promoting broader health behaviour change in conjunction with CGM-based biofeedback.

Hearing loss is a prevalent condition that impacts on social, mental and physical health, and has a significant economic burden. Hearing aids can improve the quality of life for those living with hearing loss; however, low and inconsistent use remains common. Within the National Health Service (NHS), follow-up care for new hearing aid users is highly variable and often lacks structure, which may contribute to low use. The FAMOUS trial investigates whether a structured care model for follow-up, combined with evidence-based behaviour change interventions, improves hearing aid use compared to usual care. FAMOUS is a multi-centre, two-arm parallel-group cluster randomised controlled trial (CRCT) with integral internal pilot, economic, and process evaluations. The trial involves 36 NHS audiology services and compares two types of follow-up for new adult hearing aid users: structured care, which includes personalised action plans, early monitoring, and routine follow-up at 6weeks post-fitting, to usual care, which includes the offer of a follow-up 6-12weeks after fitting. Recruitment is conducted through participating services over 3 months, with pseudo-anonymised routine data collected from electronic medical records of all patients who attend. Consent and outcomes are then collected from patients at 12weeks post-fitting. For patients who provide consent to future contact, the primary outcome (self-reported daily hearing aid use) is collected at 12months post-fitting. Secondary outcomes (quality-of-life (QoL), hearing-related disability, and economic measures) are collected at both timepoints. Qualitative interviews with a subset of patients and hearing professionals in the intervention arm will assess the acceptability and implementation of the intervention. Statistical analyses, including mixed-effects regression modelling, will be conducted under an intention-to-treat framework. FAMOUS addresses a critical evidence gap regarding the potential benefits of follow-up care for new hearing aid users. If the intervention is successful, it can be rolled out nationally using existing facilities with limited impact on resources, identified in the economic analysis, and would improve hearing aid use and quality of life for those living with hearing loss. Prospectively registered with the International Standard Randomised Controlled Trial Number (ISRCTN) 10589817.Date of registration: 01/09/2022.

RECOMMENDATIONS These recommendations pertain to the management of weight over the reproductive years for adult women living with obesity (i.e. body mass index ≥30 kg/m2) with a singleton pregnancy, who are ≥18 years of age and do not have pre-existing diabetes or gestational diabetes. General advice. We recommend that healthcare providers (HCPs) should discuss weight management targets specific to the reproductive years with adult women living with obesity: pre-conception weight loss (Level 3, Grade C); gestational weight gain of 5 - 9 kg over the entire pregnancy (Level 4, Grade D); and postpartum weight loss of – at minimum – gestational weight gain (Level 3, Grade C), to reduce the risk of adverse outcomes in the current or a future pregnancy. Combined behaviour change interventions. HCPs should offer behaviour change interventions, including both nutrition and physical activity, to adult women living with obesity who are considering a pregnancy (Level 3, Grade C), who are pregnant (Level 2a, Grade B) and who are postpartum (Level 1a, Grade A),[16] in order to achieve weight targets. Nutrition counselling alone. We recommend that HCPs encourage and support pregnant women with obesity to consume foods consistent with a healthy dietary pattern in order to meet their target gestational weight gain (Level 3, Grade C). Physical activity counselling alone. We recommend that HCPs encourage and support pregnant women with obesity who do not have contraindications to exercise during pregnancy to engage in at least 150 minutes per week of moderate-intensity physical activity to assist in the management of gestational weight gain (Level 3, Grade C). Pharmacotherapy. HCPs should not prescribe metformin for managing gestational weight gain in women with obesity (Level 1b, Grade A). We suggest no weight management medications during pregnancy or breastfeeding (Level 4, Grade D). Breastfeeding. We recommend that women with obesity be offered additional breastfeeding support owing to decreased rates of initiation and continuation (Level 3, Grade C).

The increasing livestock demand in developing countries raises concerns about endemic zoonotic diseases, such as bovine tuberculosis (bTB). Farmer behaviors and social contexts drive transmission, necessitating behavior change interventions. An epidemiological field survey was conducted to assess artificial insemination (AI) use and bTB incidence among dairy farmers in Madagascar, combined with socioeconomic interviews with 114 farmers in Malagasy from 2021 to 2022. A probit regression model analyzed farm-level bTB infection status as the dependent variable. AI was used by 14.1% (15 households), with 93.3% (14 households) employing natural bull mating. The herd-level bTB prevalence was 41.2% (50 cows), and 41.6% (47 households) owned at least one bTB-positive cow. AI use increased the risk of bTB, likely due to inadequate cleaning of AI equipment. Despite AI’s potential to improve productivity, improper implementation may increase the risk of bTB. These findings underscore the need for enhanced farmer education on bTB prevention and proper sanitation of AI equipment.

Dynamic Modeling and System Identification of User Engagement in mHealth Interventions using a Bayesian Approach for Missing Data Imputation.

ObjectivesTo showcase the planning and optimization processes involved in developing a digital behaviour change intervention through the example of a self‐management support tool for young people with acne (‘Acne Care Online’).DesignFollowing Medical Research Council guidance, a theory, evidence, and person‐based approach was employed, drawing on existing evidence, stakeholder expertise, health psychology theory, and qualitative methods to underpin intervention content, structure and functionality.MethodsSystematic reviews of literature concerning acne help‐seeking and treatment adherence, theoretical understandings of health‐related behaviour, guidance from public contributors, and interviews with young people with acne (n = 24), their parents/carers (n = 8) and healthcare professionals (n = 18), informed the intervention's guiding principles and logic model. Draft intervention content was then developed by a multidisciplinary study team including public contributors and health professionals, and optimized through 53 think‐aloud interviews with intended users.ResultsThe development process created Acne Care Online ready for trial evaluation. It also provided insights into self‐management challenges amongst this group – including their reluctance to consult, and misconceptions about treatments that hinder effective management (e.g., using products with no active ingredients, concerns about side effects, and unrealistic expectations). Acne Care Online appeared engaging, informative and relevant, with early feedback from health professionals suggesting it could be integrated into current healthcare practice.ConclusionsThis study provides insights into theory and person‐informed development processes for behaviour change interventions. Here, the acceptability and perceived value of Acne Care Online was evidenced. The work also provides important insights for clinicians managing young people seeking support for acne.

Assessing the impact of behaviour change intervention strategies on the biosecurity knowledge, attitudes, and practices of pig producers in New South Wales, Australia.

BackgroundDeaths from alcohol-related liver disease (ARLD) are rising in the UK, representing a significant public health crisis. Effective interventions are urgently needed to reduce alcohol consumption and improve outcomes for individuals with ARLD. While behaviour change interventions (BCIs) are effective, their scalability is limited. Digital therapeutics offer a promising avenue for delivering BCIs remotely and at scale. AlcoChange, a novel digital therapeutic combining a smartphone app and digital breathalyser, delivers personalised BCIs based on patient triggers. Preliminary data suggest its potential efficacy in reducing alcohol use.MethodsThis is a multi-centre, two-arm, parallel-group, individually randomised controlled trial comparing usual care (review by a hospital Alcohol Care Team and brief intervention) with usual care plus AlcoChange in patients with ARLD.PopulationAdults aged 18 years or older with a diagnosis of ARLD (including cirrhosis, fibrosis, steatohepatitis, or recent alcoholic hepatitis) who have been advised to abstain from alcohol and intend to do so, and who have access to a smartphone.InterventionUsual care plus AlcoChange, comprising a smartphone app and digital breathalyser delivering personalised behaviour change techniques.ComparisonUsual care alone.OutcomeThe primary outcome is the proportion of patients abstinent or reporting low-risk alcohol consumption (< 14 units/week) at 180 days post-randomisation, assessed using the Timeline Follow-Back (TLFB) method. Secondary outcomes include self-reported alcohol use at various time points, liver disease severity, health-related quality of life, healthcare resource utilisation, and cost-effectiveness. Four hundred participants will be recruited from up to 18 NHS hospitals in England and randomised 1:1. A mixed-methods approach was used to develop the trial protocol, including a theory of change framework and bespoke training materials for the TLFB assessment.DiscussionThis trial will evaluate the real-world efficacy and cost-effectiveness of AlcoChange in reducing alcohol consumption and alcohol-related harm in individuals with ARLD. The study addresses the urgent need for scalable interventions to combat the rising burden of ARLD in the UK. The pragmatic design and mixed methods approach to implementation aim to enhance the generalizability and impact of the findings. The trial will provide valuable evidence to inform clinical practice and policy regarding the use of digital therapeutics for alcohol use disorder and liver disease.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09005-3.

Community and behavior maintenance: the association of community factors with behavior maintenance outcomes in people with type 2 diabetes participating in a group-based walking intervention.

Background Understanding how interventions work requires clear hypotheses, rigorous testing, and accurate reporting of links between behaviour change techniques (BCTs)—the smallest replicable active components of interventions—and mechanisms of action (MoAs), the processes through which behaviour changes. The Theory and Techniques Tool (TaTT) provides a grid of likely BCT-MoA links to guide intervention design, based on literature synthesis and expert consensus. Recently, the Behaviour Change Intervention Ontology development team introduced detailed, computer-readable lower-level ontologies for BCTs and MoAs, but limited guidance exists on integrating the BCT-MoA links proposed by the TaTT with these ontologies. This study aimed to map BCTs and MoAs from the TaTT to corresponding classes (i.e., categorisations or groupings) in the Behaviour Change Technique Ontology (BCTO) and Mechanism of Action (MoA) Ontology. Methods Three researchers mapped the classes from the BCTO onto 74 BCTs within the TaTT, using their definitions. Similarly, two researchers mapped classes from the MoA Ontology onto the 26 MoAs within the TaTT. Discrepancies were resolved through discussion with senior researchers. Subsequent updates to the BCT and MoA Ontologies necessitated a researcher updating the mappings, with the revisions being verified by the research team. Results From the BCTO, 85 BCTs were mapped to the 74 BCTs present in the TaTT, while 56 MoAs from the MoA Ontology were mapped to the 26 MoAs present in the TaTT. Subclasses of these 85 BCTs and 56 MoAs provide additional specificity and can be found by further engaging with these ontologies. Discussion Mapping the TaTT to the Behaviour Change Intervention Ontology enhances clarity and precision in selecting and reporting BCT-MoA links, enabling integration of data across frameworks. Future work should maintain these mappings as ontologies evolve and users provide more feedback and evidence on BCTs, MoAs and their links, ensuring they remain relevant and user-friendly.

Expression of concern: Determinants of usefulness in professional behaviour change interventions: observational study of a 15-year national program.

The objective of this scoping review was to map how intervention mapping has been used to develop health promotion interventions for adults with chronic conditions. Chronic conditions present a growing burden of disease across the world, with many countries looking for novel ways of managing these conditions. Intervention mapping is a 6-step behavioral change intervention development approach that can be used to create programs or innovations for health promotion in different settings and locations. This review considered all studies that used intervention mapping to develop a health promotion intervention for adults (≥ 18 years) with a chronic condition, in any setting or location. To be included, the study had to use at least 1 of the 6 steps of intervention mapping. This scoping review followed the JBI methodology for scoping reviews. In May 2023, the databases MEDLINE (EBSCOhost), CINAHL (EBSCOhost), Allied and Complementary Medicine Database (EBSCOhost), APA PsycINFO (Ovid), Embase (Ovid), Cochrane Database of Systematic Reviews (Cochrane Library), Scopus, and Web of Science Core Collection; the trial registries Cochrane Central Register of Controlled Trials (Cochrane Library), ClinicalTrials.gov, ISRCTN Registry, Research Registry, European Union Clinical Trials Register, Australian New Zealand Clinical Trials Registry, and the Trials Register of Promoting Health Interventions; and the gray literature databases EThOS, EBSCO Open Dissertations (EBSCOhost), and Sherpa Services (OpenDOAR) were systematically searched. Title and abstract screening was conducted by 3 reviewers independently, with conflicts resolved through discussion. Full-text screening of selected studies was conducted similarly by 2 reviewers. Data were extracted by 1 reviewer using a predefined yet flexible tool developed by the reviewers. A second reviewer independently extracted the first 10% of the included studies, with any discrepancies between reviewers resolved through discussion and random checks on 10% of the remaining studies providing extra fidelity. The data are presented in tables, graphs, and diagrams, with a descriptive summary and discussion of the results. After screening, 56 studies were included in this review. Interventions were developed for 26 named chronic conditions. Steps 1, 2, and 3 were included in 55 studies (98%), step 4 was included in 48 studies (86%), step 5 was included in 30 studies (54%), and step 6 was included in 25 studies (45%). Stakeholder involvement included people with lived experience, health care professionals, experts, and community members, and was reported most often in the work group involved in conducting the research. The most common theory utilized by the included studies was the Social Cognitive Theory. Although intervention mapping was adapted by all the included studies to fit their needs, this flexibility is embraced by the authors of intervention mapping. Stakeholders were involved throughout, although less so in later steps. Theory, although regularly employed, was not always fully integrated into the developed interventions. The findings of this scoping review suggest that a dedicated intervention mapping reporting tool should be developed to improve the reporting in the literature and enable easier understanding and synthesis of future research. Future intervention developers must recognize the benefits while understanding the challenges of fully engaging with theory when developing their interventions. OSF https://osf.io/z9kdc.

Development and preliminary testing of a culturally competent behaviour change intervention framework to enhance utilisation of sexual and reproductive health services among migrant adolescents in Ghana: an intervention design

BackgroundSpecialist multidisciplinary clinics have been established to provide care for the burgeoning number of young people presenting with comorbidities related to severe obesity in childhood. Digital technology, an integral component of most young people’s lives, may enable clinics to offer accessible, ongoing support between appointments to the patients, thereby increasing the likelihood of successful health behavior change. However, while short-term engagement with technology-based behavior change interventions is good, engagement tends to decrease over time, limiting their overall impact. Little is known about the views of young people living with obesity on the role of digital technology as an adjunct to current traditional care pathways.ObjectiveThis study aims to explore the views of adolescent patients and their families on whether digital technology should be used by obesity services to support health behavior change.MethodsParticipants included patients aged between 10 and 16 years from an obesity clinic, along with their adult family members. Four focus groups and co-design workshops, facilitated by a cross-disciplinary team of clinicians, academics, and technology innovators, explored young people’s health priorities, identified the barriers to and facilitators of health behavior change, and co-designed ways in which technology could be used to support them in overcoming these barriers to achieving their health goals. Data were analyzed using inductive content analysis, with findings integrated with key co-design workshop outputs.ResultsIn total, 37 individuals participated, including 19 (51%) adolescents (n=11, 58% female) and 18 (49%) family members. The young participants, on average, were aged 13.4 (SD 1.68; range 10-16) years; the mean BMI was 36.6 (SD 0.3; range 34-47) kg/m2. The mean socioeconomic decile was 4.3 (SD 2; range 1-8). Participants did not mention weight as an important aspect of their health. Instead, mental health, sleep, and peer support were identified as the domains where patients felt they would most benefit from additional support. Addressing these aspects of health was viewed as foundational to all other aspects of health, with poor mental health, sleep, and social support reducing young people’s ability to engage in the process of health behavior change. Participants reported that technology could help provide this support as an adjunct to in-person support. Participants expressed a preference for technologies able to individually tailor content to the young person’s needs, including relatable peer-produced content. The need for support for both the young people and their family members was highlighted, along with the need to integrate in-person strategies to maintain engagement with any technological offering.ConclusionsThere is clear potential for digital technology to support the holistic health priorities of young people receiving specialist care for the comorbidities of excess weight. This study’s findings will serve as a foundation for developing innovative approaches to the use of technology to support this high-need population.

ABSTRACTInsufficient physical activity is a widespread health concern, necessitating the broad implementation of evidence‐based behavior change interventions. Such evidence commonly derives from randomized controlled trials, but questions arise about who is willing to enroll and actively engage in such trials. This study investigated factors predicting engagement and retention in an online physical activity intervention for inactive parent‐child dyads. Participants were recruited from the general Finnish population and assigned to either an intervention or wait‐list control group. The intervention consisted of online materials, SMS prompts, and four online sessions. Partial least squares regression models were used to analyze autonomous motivation, parent and child gender, parental education, employment status, and recruitment source as predictors of intervention retention and engagement. Results showed that intervention retention was predicted by higher autonomous motivation, being a mother, social media recruitment, and university education. Session attendance was higher for autonomously motivated parents, fathers, parents of daughters, and university‐educated parents. These findings highlight the importance of autonomous motivation and demographic factors in intervention engagement. However, the higher engagement of already motivated participants demonstrates challenges for reaching and intervening on those who might benefit most from such programs. Future research should explore strategies to engage and retain less motivated individuals and investigate reasons behind non‐compliance to improve the effectiveness of physical activity interventions for inactive families.

Human behavior can sometimes cause harm to the behaving individual, other organisms, or their environment. Psychological science plays a crucial role in understanding and addressing these harmful behaviors by providing direction to behavior change interventions. However, the field of psychology encompasses numerous theories, and translating these theories into effective practices can be challenging. In this paper, we introduce the Goal-Directed Predictive Processing (GDPP) framework, an integrative approach that combines key principles from predictive processing and goal-directed theories. The GDPP framework bridges recent theoretical advancements with practical application, offering a user-friendly model to assist practitioners across various domains. It emphasizes assessing inference chains that underlie harmful behaviors in risk situations, mapping out alternative inference chains in relation to expected surprise and self-concept beliefs, and designing targeted interventions to influence these predictive processes. We illustrate the application of this framework in the context of harmful alcohol consumption and depressive behavior.

BackgroundPeople with chronic obstructive pulmonary disease (COPD) experience a range of limitations, which have a significant effect on their health. Self-management and pulmonary rehabilitation (PR) are key treatments for people with COPD; however, barriers often limit their uptake and adherence.ObjectiveTo overcome these barriers, a digital self-management intervention called PocketMedic (PM) was developed and evaluated in people with COPD alongside, and in addition, to PR.MethodsA total of 53 participants were recruited to 1 of 3 groups: PM and PR, PM, or PR. Data were collected at baseline and 7 weeks (after the interventions had finished). Questionnaires on health-related quality of life, self-management knowledge, and disease knowledge were collected. Multivariate analysis of variances and ANOVAs were used to analyze the data.ResultsThe analyses found that the improvements in those receiving PM were not statistically significantly different from those receiving PR, indicating that PM may replicate the benefits underpinning self-management behaviors observed in those attending PR. However, there were no additional benefits when participants received PM and PR in combination.ConclusionsPM may be a useful treatment to support COPD self-management, especially when barriers prevent people with COPD receiving traditional services such as PR. The quantitative results suggest that PM may be less beneficial when delivered alongside PR. Feedback from participants indicated that they would prefer to receive PM while they were on the waiting list for PR, to support them during this time and alleviate the apprehensions associated with attending PR. Implications, limitations, and suggestions for future research are discussed.