Behavior Change Process Research Articles

Energy use in social housing residents in the UK and recommendations for developing energy behaviour change interventions

Abstract This paper presents a qualitative exploration of domestic energy consumption practices in the UK social housing sector, and perceived effectiveness of varying intervention techniques in motivating energy reductions. The study was conducted using a sample of N = 20 social housing residents, who had recently taken part in a ‘serious game’ energy behaviour change intervention trial, thus making them uniquely positioned to provide such insight and feedback on these issues. A series of one-on-one open-ended interview sessions was conducted in residents’ homes at the end of the intervention period, using an open-ended discussion framework. Thematic analysis revealed that residents were highly engaged with the topic of energy saving, but that several psychological barriers existed which prevented many residents from changing them behaviour. In line with the Theory of Planned Behaviour and the Norm Activation Model, these barriers included lack of awareness of the issue, action inertia, and perceived lack of behavioural control. Some residents did make savings following the trial, and our interviews provide useful insight into their decision making and behaviour change processes, including evidence for cross-contextual spillover effects, where residents made savings in other areas. However overall, the serious gaming approach did not inspire engagement from the target population, who frequently mentioned lack of time and/or desire to use overly ‘technical’ solutions for energy savings. Recommendations for ongoing intervention development are discussed, including preference for tailored non-technical visualisation tools and less time intensive versions of the game, and implications for future energy policy development are considered.

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Digging Deeper: An Object Relations Couple Therapy Update.

Over the past two decades, neurobiology research has added clarity to the process of emotional and behavioral change. In turn, this has led to endorsement of interventions that appear to be most helpful in individual and couple therapy. In addition to research on emotional dysregulation, contemporary studies have focused on the construction of meaning and its relevance to interpersonal relationships. According to Lisa Barrett, Richard Lane, and others, the brain references concepts to rapidly arrive at the most probable conclusions. Encoded experience and memory fragments guide this process and are vital in understanding partners' emotional responses. These findings support an object relations perspective that emphasizes the importance of past relational experiences that inform the present. This is particularly relevant in work with couples, as each individual's beliefs, expectations, and capacity for intimacy are invariably tied to earlier relationships. Research findings on memory reconstruction provide a basis for interventions that can add to the existing treatment approach, as it is suggested that working in a specific way with emotionally based memories has the potential to modify and reduce their predictive power and ability to unleash beliefs and behaviors that work against intimacy. The therapist who is informed by emerging neuroscience research can better uncover and actively work with memories that may be compromising a couple's relationship.

Exploring the process of travel behaviour change and mobility trajectories associated with car share adoption

Car sharing as a mobility option is proliferating in many countries. International research on car sharing has been mostly quantitative, focused primarily on impacts in terms of net cars sold or car kilometres reduced. This study explores the process of travel behaviour change associated with car share adoption and how it varies among individuals. Qualitative methods were used to investigate how lifestyle, mobility and travel choices change in response to car sharing. Focus groups (n = 5 groups) and semi-structured interviews (n = 8) were conducted with car share members in inner and middle Melbourne, Australia. In most cases, availability of car share was reported to enable and facilitate changes in travel behaviour rather than causing or initiating them. Reconsideration of car ownership was usually triggered by key life events or long-term mobility decisions (e.g. residential relocation). Car sharers were classified into five user segments depending on their mobility trajectories post joining car share: car dependents, car avoiders, car limiters, car aspirers and car sellers. Car aspirers and car sellers reported the biggest changes in car ownership and travel choices (use of a car, public transport and active modes). Car avoiders and car limiters used car share to withstand mobility stress caused by key life events. The study highlights the value of a disaggregated understanding of car share impacts. It provides specific, practical insights that will be useful for tailoring policy, plans, and marketing measures to encourage the use of car share as a lever to limit car ownership and use.

Understanding Attitudes towards Reducing Meat Consumption for Environmental Reasons. A Qualitative Synthesis Review

Meat-based diets are the norm in Western societies. This is a problem because meat production is a major contributor to global warming and environmental degradation. Despite the urgency to reduce meat consumption, quantitative studies have shown that there is only a small minority of consumers aware of the meat environmental impact, willing to halt or reduce meat intake for ecological reasons, or who have already stopped or reduced meat consumption because of environmental concerns. We conducted a qualitative synthesis reviewing studies that looked at attitudes towards changing meat consumption. Our focus was on the behavioral change process: Awareness, willingness, and change, aiming to enhance the current understanding of people’s attitudes towards reducing meat consumption due to environmental concerns. The studies reviewed show that consumer awareness is hindered by beliefs about food, meat, and personal behavior. Nutrition, health, and taste were found to be both enablers and barriers with regard to willingness. Vegetarians and vegans perceive the environment as simply another reason, among others, to maintain a meatless diet. Based on these results, we offer recommendations for future dietary public health interventions, and for future research endeavors on this topic. This review employed a meta-aggregative approach and partially followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence.

Workshop: Behaviour change and knowledge translation: The unlocked potential to improve people’s health

Abstract Background Despite the complexities of modern healthcare it remains the case that human behaviour plays a critical role in health outcomes and in the efficacy of most treatments. We know that people get sick because of unhealthy behaviours. We know that the success of most healthcare interventions is highly dependent on patients’ willingness to adhere to self-care activities such as taking medications or performing self-examinations. Over the last decades well-validated, cost-effective behavioural medicine interventions have been developed. The field has contributed to strategies in health education, with techniques for modifying behaviour, and enhancing motivation and learning for health. More recently, multilevel intervention models, including environmental and policy variables, are being increasingly proposed and tested. Yet, for several reasons, only few such interventions have been translated into policy recommendations or implemented successfully in clinical practice. Through highlighting critical gaps in knowledge translation that can be addressed by integrating modern theoretical and methodological approaches across disciplines we hope to contribute to the development of effective and implementable behaviour change interventions for optimal population and individual health and well-being. Aim The aim of this workshop is to broaden our understanding of measures that have originated from behavioural sciences and have a lot to offer to public health. This workshop also seeks to contribute to capacity building in knowledge translation and evidence-informed decision-making in public health. Workshop structure The workshop will consist of five presentations providing an overview of topical issues in the field of behaviour change and knowledge translation, followed by an interactive audience discussion. The first presentations will introduce the most recent challenges in knowledge translation from the WHO/Europe perspective. The second presentation will discuss the possibilities of using behaviour change principles in the development and adoption of health policies showcasing the Canada’s newly adopted Food Guide. The third presentation will highlight the challenges in tackling physician’s ability to effectively conduct behaviour change counselling with their patients in the context of chronic disease prevention. The fourth presentation will make the link between the knowledge translation theory and practice, using the Behaviour Change Wheel theory. The fifth presentation will introduce the free academic meta-search engine - Motrial, which has a great potential in evaluating the randomized controlled trials and fuelling meta-analyses and systematic reviews in return of better quality. Further to the reflexion on the current knowledge base, an audience discussion will give attendees the opportunity to share their opinions regarding challenges and opportunities in knowledge translation to improve people’s health and well-being. Key messages Policy development and adoption can be considered as a behaviour change process. The application of behaviour change principles to the policy process may lead to greater stakeholder engagement and faster policy implementation.

Enhancing cyber security behavior: an internal social marketing approach

PurposeUnderstanding the behavioral change process of system users to adopt safe security practices is important to the success of an organization’s cybersecurity program. This study aims to explore how the 7Ps (product, price, promotion, place, physical evidence, process and people) marketing mix, as part of an internal social marketing approach, can be used to gain an understanding of employees’ interactions within an organization’s cybersecurity environment. This understanding could inform the design of servicescapes and behavioral infrastructure to promote and maintain cybersecurity compliance.Design/methodology/approachThis study adopted an inductive qualitative approach using in-depth interviews with employees in several Vietnamese organizations. Discussions were centered on employee experiences and their perceptions of cybersecurity initiatives, as well as the impact of initiatives on compliance behavior. Responses were then categorized under the 7Ps marketing mix framework.FindingsThe study shows that assessing a cybersecurity program using the 7P mix enables the systematic capture of users’ security compliance and acceptance of IT systems. Additionally, understanding the interactions between system elements permits the design of behavioral infrastructure to enhance security efforts. Results also show that user engagement is essential in developing secure systems. User engagement requires developing shared objectives, localized communications, co-designing of efficient processes and understanding the “pain points” of security compliance. The knowledge developed from this research provides a framework for those managing cybersecurity systems and enables the design human-centered systems conducive to compliance.Originality/valueThe study is one of the first to use a cross-disciplinary social marketing approach to examine how employees experience and comply with security initiatives. Previous studies have mostly focused on determinants of compliance behavior without providing a clear platform for management action. Internal social marketing using 7Ps provides a simple but innovative approach to reexamine existing compliance approaches. Findings from the study could leverage proven successful marketing techniques to promote security compliance.

Development of an Evidence-based Nutritional Intervention Protocol for Adolescent Athletes.

Effective nutritional intervention can help reduce the risk of nutritional problems and improve athletic performance in adolescents. The five A's (assess, advise, agree, assist, and arrange) model is widely used as the theoretical framework for advice on nutrition, smoking, drinking, and physical activity and it recommends that practitioners in primary health care promote behavior change to facilitate positive outcomes. This model has also been useful in understanding the underlying processes of behavior change. This study aimed to develop both a novel evidence-based nutritional intervention protocol, rooted in sound nutritional theory, and a customizable nutritional intervention program to support sustainable healthy eating, enhance nutrient intake, and improve athletic performance in adolescent athletes. In this study, we adapted the 5 A's behavioral change model and motivational interview to develop a theoretical framework to help adolescent athletes change their behavior and achieve their goals. During each step of the 5 A's protocol, a customized nutritional intervention protocol was developed by nutrition experts for each of adolescent athletes. Each plan was developed to improve the eating habits of adolescent athletes through group education and counseling. All nutritional counseling sessions were designed to enable participants to apply nutritional knowledge and practical action plans to their training and competition conditions to enable each of them to achieve individual athletic goals and facilitate self-management. A theoretical and evidence-based nutritional intervention protocol was developed to identify and address obstacles to healthy dietary habits in adolescent athletes. This could be used as the basis for further studies aimed at improving nutrient intake and athletic performance in adolescent athletes.

Efficacy of Osteoporosis Prevention Smartphone App.

The Striving to be Strong study tested the efficacy of a multifaceted, theory-based, complex osteoporosis prevention smartphone application (app). We hypothesized use of the app would improve bone mineral density and trabecular bone scores. The study was a three-group, prospective, repeated-measure, longitudinal randomized trial. Baseline sample consisted of 290 healthy women between 40 and 60 years of age. Participants were randomly assigned to one of three groups: "Striving," a dynamically tailored, person-centered app; "Boning Up," a standardized osteoporosis-education e-book; and "Wait List," a participant's choice of intervention in the final 3 months of the 12-month study. Participants had or were provided a smart phone. Bone mineral density and trabecular bone scores were measured using dual-energy X-ray absorptiometry at baseline and 12 months. To assess engagement in health behavior change processes, ecological momentary assessments were administered via text messaging during the 12 months participants actively used the app. The final sample reflects an 89.6% retention rate. There were decreases in bone mineral density over time but not among the three groups. The percentage of bone density lost over 12 months was lower than expected. Trabecular bone scores were not different over time or by group but improved across all three groups. Small but positive results were observed across all groups, suggesting one or more aspects of participation might have affected outcomes, including dissemination of the intervention across groups, retention without participation, ecological momentary assessments functioning as both an intervention and measure, and selective engagement in research-based recommendations.

O aplicativo tecnológico Playnatal como mediador da experiência turística e de lazer no destino Natal/RN, Brasil

Esse artigo busca debater o uso de tecnologias, como possibilidade de mediação das experiências turísticas e de lazer de turistas e residentes no destino Natal/RN, Brasil, a partir do aplicativo PlayNatal. Trata-se de um estudo exploratório-descritivo, de abordagem qualitativa, que usou a técnica análise temática nas avaliações deixadas pelos usuários na página do Facebook e na plataforma de downloads Play store. Conclui-se que o PlayNatal atua como uma inovadora estratégia de negócios, possibilitando a promoção da cidade do Natal/RN, enquanto destino turístico. Também apresenta possibilidades de contribuir para o processo de mudança comportamental (de turistas e residentes) com vistas na preservação de elementos simbólicos, presentes nas experiências turísticas e de lazer da cidade. Sugere-se para a necessidade de alguns ajustes, como a facilidade do acesso e do contato presencial entre residentes e turistas, nos espaços de turismo e lazer do destino Natal. 
 Palavras-chave: Experiências turísticas; Lazer; Mediação tecnológica; PlayNatal.

Designing an integrated socio-technical behaviour change system for energy saving

Stimulating households to save energy with behaviour change support systems is a challenge and an opportunity to support efforts towards more sustainable energy consumption. The approaches developed so far, often either; do not consider the underlying behaviour change process in a systematic way, or do not provide a systematic linking of design elements to findings from behaviour change literature and the design of persuasive systems. This paper discusses the design and evaluation of a holistic socio-technical behaviour change system for energy saving that combines insights from behavioural theories and the persuasive system design in a systematic way. The findings from these two streams of research are combined into an integrated socio-technical model for informing the design of a behaviour change system for energy saving, which is then implemented in a concrete system design. The developed system combines smart meter data with interactive visualisations of energy consumption and energy saving impact, gamified incentive mechanisms, energy saving recommendations and attention triggers. The system design distinguishes between a version with non-personalized energy saving tips and a version with personalized recommendations that are deployed and evaluated separately. In this paper, we present the design and evaluation results of the non-personalized system in a real-world pilot. Obtained results indicate reduced energy consumption compared to a control group and a positive change in energy knowledge in the treatment group using the system, as well as positive user feedback about the suitability of the designed system to encourage energy saving.

An Examination of Hope, Symptom Severity, and Functioning Among Combat Veterans After Participation in an Intensive Outpatient Program for PTSD

Impairment in psychosocial functioning complicates readjustment to civilian life for many combat veterans with PTSD and is related to poorer quality of life. Hope theory posits that both a sense of agency and the ability to identify pathways toward achieving a goal underlie the process of behavior change. We developed an intensive outpatient program (the HOME program) in order to help combat veterans move toward values-driven activities and improve psychosocial functioning. We hypothesized that increased hope regarding veterans’ ability to manage and recover from PTSD symptoms may facilitate improvements in functioning apart from symptom reduction. The present study examines changes in hope, psychosocial functioning, and PTSD symptoms in a sample of HOME participants (N = 33). Consistent with our hypothesis, results indicated that greater levels of hope were associated with improvements in adaptive behaviors (related to functioning) above and beyond symptom change. These preliminary findings suggest that therapeutic interventions that increase veterans’ perceptions of hope regarding recovery from PTSD may enhance psychosocial functioning. Additional research with larger samples is needed to further examine these relationships.

Sustainability of Low Carbon City Initiatives in China: A Comprehensive Literature Review

Low carbon city (LCC) has emerged as the latest sustainable urbanism strategy in China as a response to climate change impacts. Yet, minimal scholarships have explored the sustainability of the urban planning model towards understanding the complexity of the components. Using a two-step triangulation approach, this paper presents a structured overview of the LCC initiative in China as it relates to the transition to a sustainability paradigm. The data collection approach includes a comprehensive review of 238 articles on LCC to identify and categorize LCC components. Furthermore, discourse and framing analysis was used to develop and synthesize a conceptual framework for assimilating the components into four core sustainable development principles: Integration, implementation, equity, and scalability and replicability. The results indicate that LCC development in China is bias towards economic and environmental technological innovations and strategies. Additionally, several critical sustainability issues of LCC pilots were identified. These include a lack of social equity planning concerns for the most vulnerable population, dearth of social reforms that cater to lifestyle and behavioral change, top-down planning and decision-making processes, a technocratic rationalization planning approach, inconsistent LCC targets on inter-generational justice concerns, absence of an effective national “sharing and learning” city–city network system, and several barriers to implementation. We conclude that the applied theoretical and conceptual inquiry into the field of LCC is pertinent to mitigate climate change and achieve sustainable urban development.

Behaviour change during dietary Type 2 diabetes remission: a longitudinal qualitative evaluation of an intervention using a very low energy diet.

To understand the process of behaviour change through the experiences of people with Type 2 diabetes engaged in an 8-month diabetes remission intervention including a 2-month weight loss phase with the use of a very low energy diet (VLED), and a 6-month, structured weight maintenance phase. Data were collected in three semi-structured interviews at baseline, week 8 (end of the weight loss phase), and month 8 (end of the weight maintenance phase). Longitudinal inductive thematic analysis was used to analyse participants' narratives and identify change over time. Eleven of 18 participants completed all three interviews. The following themes of change were identified in their narratives: (1) 'Building behavioural autonomy' as a process of growing confidence to engage in health behaviours that are independent of those of other people; (2) 'Behavioural contagion' describing how one's new health behaviours tend to affect those of other people; (3) 'From rigid to flexible restraint', reflecting the changes in attitudes and behaviours required for a successful adaptationfrom weight loss to weight maintenance; and (4) 'Shift in identity', representing changes in the participants' perceptions of themselves. This longitudinal qualitative study provided new insights into how behaviour change is experienced by people with Type 2 diabetes engaged on a weight management intervention using VLED, contributing to theoretical and practical understanding of weight management behaviours. The themes identify potential areas in which individuals can be supported in achieving dietary diabetes remission and long-term maintenance of weight loss.

Self-management Processes Used by Healthy Middle-aged Women to Change Behaviors.

The purpose of this descriptive qualitative study was to understand the processes women used to change osteoporosis prevention health behaviors. Twenty healthy, predominately white, middle-aged women engaged in an osteoporosis prevention program shared behavior change stories. Results indicated that behavior change was a highly personalized process influenced by a myriad of factors that are unique to the individual. Approaches to behavior change varied across individuals over time and were shaped by personal preferences, capacity, and past experiences. Rather than relying on a systematic approach to health behavior change, women selected and restructured aspects of research-based recommendations to match their personal needs and preferences. We identified four person-initiated behavior change processes: (a) picking and choosing, (b) doing it my way, (c) recognizing how I am doing, and (d) using prompts and feedback. Understanding the process people use to change behaviors might uniquely contribute to increasing the effectiveness of theory, research, intervention development, and clinical care.

P153 Affirming the Adolescent and Adult Framework for Ten Experiential Drivers of Behavior Change with Youth Engaged in Teen Battle Chef

Background Behavioral nutrition research uses psychosocial theories to develop interventions, with less research on the delivery of interventions. To this end, in 2018 FamilyCook Productions (FCP) developed a framework with ten experiential drivers for culinary education that may enhance motivation and facilitate sustained behavior change. Objective To conduct a secondary analysis of qualitative interviews conducted in 2016–17 with alumni of FCPs Teen Battle Chef Program (TBC) to determine whether and how the alumni discussed the ten experiential drivers. Study Design, Settings, Participants Cross-sectional study with 30 alumni (6 months to 7 years post-program) of FCP's TBC. Interviews asked about the behavior change process (e.g., current behaviors, behavior changes post-program, motivations for change, and strategies to sustain changes). Measureable Outcome/Analysis The interview transcripts were analyzed by coding text aligned with each experiential drivers in the FCP framework. The research team established definitions, topics, and phrases for each experiential driver and also established inter-rater reliability for coding the interview text to the experiencial drivers. Results All ten experiential drivers were mentioned by at least two-thirds of interviewees. Drivers most frequently mentioned were: Challenge, discussed how they were pushed out of their comfort zone; Home Environment discussed family dynamics, home kitchen facilities, and access to healthy food; Peer Support participants explained how cooking and eating together created a level playing field; Skill Building through the program participants moved from ‘student’ to ‘teacher’; Skill Reinforcement how repetition built confidence to transfer classroom experiences to their lives; and Success through weekly sense of achievement. Less frequently cited were: Collaboration valued group over individual accomplishment; Palate Development discovered new flavors: Recipe Concepts moved beyond recipe driven cooking; and Celebration had fun while learning. The drivers were often discussed together and as interrelated with each other. Conclusion It is encouraging that the experiental drivers were discussed with specificity by the TBC participants. This sets the stage for further research on how to apply the FCP framework to support sustained behavior change. Funding Self-funded.

The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

Conquering the Craving: Treatment to Curb Alcohol Use Disorder.

Largely underutilized in North America, the use of medications to treat alcohol dependence is frequently a successful method of reducing alcohol craving and promoting abstinence. Recovery from alcohol addiction can be a complicated process, requiring nutritional, social, psychological, spiritual, and physical aspects of healing and self-directed behavioral change. Nurses can intervene in alcohol use disorder via screening, referrals, support of medical and behavioral treatments, and spiritual care that emphasizes hope, forgiveness, and relief from shame and guilt.

Motivational and behaviour change approaches for improving diabetes management

AbstractEffective diabetes management requires both good clinical care, and good self‐management by the person with diabetes to achieve optimal health outcomes. Both diabetes‐specific behaviours, and lifestyle behaviours need to be addressed. Self‐management is challenging, due to the characteristics of diabetes, a condition which can be unpredictable, variable over the lifespan, lifelong, and often psychologically demanding, requiring knowledge, confidence, motivation and behaviour change skills to maintain optimal control.Health professionals can support people to self‐manage more effectively if they have psychological skills to promote motivation and to support behaviour change. This review summarises some of the skills needed by people with diabetes and by health professionals to support self‐management, including person‐centred working and ‘MAP’ motivational, action and prompting behaviour change techniques. The review takes a critical look at motivational and behavioural interventions and their outcomes, in the wider context of the process of behaviour change. We look at evidence for effectiveness of motivational approaches – from the perspective of the patient outcomes and health practitioner training required. We also evaluate behaviour change interventions which use ‘action‐based’ approaches, followed by suggestions for longer‐term, sustainable models of training. Copyright © 2019 John Wiley & Sons. Practical Diabetes 2019; 36 (4): 121–125

The Effectiveness of Acceptance and Commitment Therapy on Anxiety, Depression, and Stress in Patients with Spinal Cord Injuries

Background: Since the number of patients with spinal cord injuries is increasing, paying attention to these patients’ psychological problems is a priority. This study aimed to evaluate the effect of acceptance and commitment therapy on anxiety, depression, and stress in patients with spinal cord injuries. Methods: The present study had utilized a single-subject approach in the form of multiple baseline design. The samples were selected using purposive sampling based on convenience sampling method. The statistical population included all patients in Hamadan city with spinal cord injuries who referred to the Shahid Beheshti hospital in this city. The total numbers of them were 181 people in 2016. The researchers informed the patients about the research and presented them with informed consent forms. Among 50 screened patients, five patients (4 males and one female) selected and entered the treatment process: anxiety, depression, and stress measured by Depression Anxiety Stress Scales (DASS-21). Acceptance and commitment therapy conducted in 8 treatment sessions on anxiety, depression, and stress in patients with spinal cord injuries. Results: The results of the graphic and chart analysis, reliable change index (RCI) and the percentage of recovery showed that acceptance and commitment therapy affected anxiety, depression, and stress in the patients with spinal cord injuries. Conclusion: Findings indicated that acceptance and commitment therapy improved people’s mental health by working on acceptance and mindfulness processes and behavior change processes. This therapy decreased anxiety, depression, and stress in patients with spinal cord lesion.