Support Behavior Change Research Articles

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial.

Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. DERR1-10.2196/56562.

Human Capital and Climate Change

Abstract Addressing climate change requires individual behavior change and voter support for proclimate policies, yet surprisingly little is known about how to achieve these outcomes. In this paper, we estimate causal effects of additional education on pro-climate outcomes using new compulsory schooling law data across 20 European countries. We analyze effects on proclimate beliefs and behaviors, as well as novel data on policy preferences and voting for green parties. Results show that a year of education substantially increases pro-climate beliefs, behaviors, and policy preferences.

Assessing the Quality and Behavior Change Potential of Vaping Cessation Apps: Systematic Search and Assessment.

An increasing number of people are using vapes (e-cigarettes), and with growing evidence of associated harms, there is a need for acceptable cessation support and interventions. Smartphone apps for health and well-being have increased in popularity and use. Limited published literature assesses the potential of apps to support vaping cessation. A systematic search of vaping cessation apps currently available in Australia for iOS and Android platforms was conducted. Apps were assessed against established health app assessment tools for quality and behavior change potential. A systematic search through the Australian Apple iTunes and Google Play stores was conducted using the search terms "vape"; "vaping"; "e-cigarette"; and "cessation," "quit," or "quitting" in May 2023. Only apps that encouraged the cessation of vaping were included. App descriptions were reviewed to determine if they were relevant for inclusion in this study, and relevant apps were downloaded onto the appropriate mobile device for review. The Mobile App Rating Scale (MARS) was used to rate the quality (engagement, functionality, aesthetics, and information) of the apps using an overall score out of 5. The App Behavior Change Scale (ABACUS) was used to assess the behavior change potential of each app using a score out of 21. An initial search of the app stores yielded 220 Android apps and 124 iOS apps. Screening against the inclusion criteria left 20 iOS apps and 10 Android apps for review. Six apps were available on both operating systems, and these were downloaded, reviewed, and reported separately for each operating system. The average MARS score for all apps assessed in this review was 3.1 (SD 0.41) out of 5. The reviewed apps overall performed well for the MARS elements relating to functionality, such as ease of use and navigation, but had the lowest scores for information-related elements, such as credibility. The number of ABACUS behavior change features per app ranged from 0 to 19 out of 21, with a mean of 8.9 (SD 4.51). The apps commonly included information-related features, such as requesting baseline information. The least common behavior change features were those relating to goal-setting, such as asking about the user's willingness for behavior change and providing feedback on current actions in comparison to future goals. The identified vaping cessation apps had moderate levels of quality and some behavior change components. Future vaping cessation apps could benefit from including more features that are known to support behavior change, such as goal-setting, to improve the potential benefit of these apps to support people to stop vaping. As guidelines for vaping cessation continue to be established, future apps need to reference these in their development.

Is the NHS low-calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification.

Obesity and Type 2 Diabetes Mellitus (T2DM) are chronic conditions with significant personal, societal, and economic impacts. Expanding on existing trial evidence, the NHS piloted a 52-week low-calorie diet programme for T2DM, delivered by private providers using total diet replacement products and behaviour change support. This study aimed to determine the extent to which providers and coaches adhered to the service specification outlined by NHS England. An observational qualitative study was conducted to examine the delivery of both one-to-one and group-based delivery of programme sessions. Observations of 122 sessions across eight programme delivery samples and two service providers were completed. Adherence to the service specification was stronger for those outcomes that were easily measurable, such as weight and blood glucose, while less tangible elements of the specification, such as empowering service users, and person-centred delivery were less consistently observed. One-to-one sessions were more successful in their person-centred delivery, and the skills of the coaches delivering the sessions had a strong impact on adherence to the specification. Overall, the results show that there was variability by provider and delivery mode in the extent to which sessions of the NHS Low-Calorie Diet Programme reflected the intended service specification. In subsequent programmes it is recommended that one-to-one sessions are used, with accompanying peer support, and that providers improve standardised training and quality assurance to ensure specification adherence.

Navigating The Escalating Climate Crisis: Comprehensive Policy Responses And Collaborative Global Action For A Sustainable Future

The escalating climate crisis has become one of the greatest challenges of this century, having far-reaching negative impacts on the environment, human health, food security, and the global economy. The response to this crisis requires a deep understanding of the dynamics of climate change, as well as comprehensive and collaborative policies and actions at the global level. Therefore, it is important to evaluate and identify effective strategies to mitigate the impacts of climate change and move towards a sustainable future. This research aims to explore comprehensive policy responses and collaborative global action to navigate the climate crisis toward a sustainable future. The research method used is qualitative, by collecting and analyzing data from relevant research results and previous studies. The results of this research found that efforts to overcome the climate crisis require a comprehensive approach, involving strong international cooperation and synergy between development policies. Transitioning to clean energy, sustainable management of natural resources, and increasing community resilience to the impacts of climate change were identified as key strategies. Education and increasing public awareness are also important elements in supporting behavior change and community participation. Technology and innovation play a vital role in creating efficient and sustainable solutions. Finally, adequate funding and innovative funding mechanisms are needed to support the effective implementation of climate policies and initiatives.

Exercise and behaviour change support for individuals living with and beyond cancer: Interim results and program satisfaction of the EXCEL study

PurposeExamine the impact of the EXercise for Cancer to Enhance Living Well's (EXCEL) 10–12-week exercise and behaviour change support intervention on secondary effectiveness outcomes, including patient-reported outcomes, physical function, and program satisfaction. MethodsIndividuals with cancer up to 3 years post treatment with any tumour type were eligible. Outcomes were measured at baseline and immediately following the 10–12-week intervention. Patient-reported outcomes included participant characteristics, overall well-being, cognition, fatigue, symptom severity, exercise barrier self-efficacy, and program satisfaction. Physical function included shoulder flexion, 30-s sit to stand, sit and reach, 2-min step test or 6-min walk test (in-person only), and single leg balance. Wilcoxon signed-rank tests were used to assess changes in patient-reported outcomes and physical function assessments from baseline to 12-weeks. ResultsA total of 804 participants enrolled in the study in the first 2.5-years, with 699 completing the intervention. Wilcoxon signed rank tests and Rosenthal coefficients (r) showed significant (p ​< ​0.05) small improvements in well-being (r ​= ​0.10), fatigue (r ​= ​0.25), symptom severity (r ​= ​0.17), and self-efficacy (r ​= ​0.11). Significant (p ​< ​0.01) moderate to large improvements were observed for the 30-s sit to stand (r ​= ​0.54), sit and reach (left: r ​= ​0.46; right: r ​= ​0.41), 2-min step test (r ​= ​0.66), 6-min walk test (r ​= ​0.52), and single leg balance (left: r ​= ​0.32; right: r ​= ​0.34) assessments. Participants reported high satisfaction with program staff (average ​= ​4.5/5) and that the program was beneficial and enjoyable (average ​= ​4.6/5). ConclusionEXCEL's group-based exercise program with behaviour change support, delivered in an online supervised setting to individuals living with cancer, may improve patient-reported outcomes and physical function and is associated with high participant satisfaction.

Effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program for hip osteoarthritis – protocol for the Better Hip randomised controlled trial

BackgroundHip osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Self-management is vital with education, exercise and weight loss core recommended treatments. However, evidence-practice gaps exist, and service models that increase patient accessibility to clinicians who can support lifestyle management are needed. The primary aim of this study is to determine the effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program (Better Hip) on the primary outcomes of hip pain on walking and physical function at 6 months, compared with an information-only control for people with hip OA.MethodsA two-arm, parallel-design, superiority pragmatic randomised controlled trial. 212 members from a health insurance fund aged 45 years and over, with painful hip OA will be recruited. Participants will be randomly allocated to receive: i) Better Hip; or ii) web-based information only (control). Participants randomised to the Better Hip program will have six videoconferencing physiotherapist consultations for education about OA, prescription of individualised home-based strengthening and physical activity programs, behaviour change support, and facilitation of other self-management strategies. Those with a body mass index > 27 kg/m2, aged < 80 years and no specific health conditions, will also be offered six videoconferencing dietitian consultations to undertake a weight loss program. Participants in the control group will be provided with similar educational information about managing hip OA via a custom website. All participants will be reassessed at 6 and 12 months. Primary outcomes are hip pain on walking and physical function. Secondary outcomes include measures of pain; hip function; weight; health-related quality of life; physical activity levels; global change in hip problem; willingness to undergo hip replacement surgery; rates of hip replacement; and use of oral pain medications. A health economic evaluation at 12 months will be conducted and reported separately.DiscussionFindings will determine whether a telehealth-delivered clinician-supported lifestyle management program including education, exercise/physical activity and, for those with overweight or obesity, weight loss, is more effective than information only in people with hip OA. Results will inform the implementation of such programs to increase access to core recommended treatments.Trial registrationAustralia New Zealand Clinical Trials Registry (ACTRN12622000461796).

What does it mean to be engaged with digital health interventions? A qualitative study into the experiences of engaged users and the views of professionals.

Digital health interventions (DHIs) hold promise for influencing health behaviors positively, but their widespread implementation and effectiveness remain limited. Engagement is crucial for DHI effectiveness, yet its conceptualization is debated. This qualitative study explores engagement from user and professional perspectives. Twenty self-proclaimed engaged health app users participated in semistructured interviews, and 13 professionals working with DHIs completed an online survey. Interviews with health app users revealed three key components of their sense of engagement: behavioral, cognitive, and affective. Behavioral engagement includes routine, effortless, and dynamic usage; emphasizing the importance of the quality of fit between user and technology over frequency of use. Cognitive engagement encompasses the technology's utility as a tool for supporting behavior change, providing new insights, and enhancing motivation. Affective engagement involves enjoying progress, deriving pleasure from using the technology, and identifying with the technology. Notably, participants exhibited varying emphasis on these components. Professionals, in a parallel inquiry, agreed on the relevance of behavior, cognition, and affect in defining engagement. In their understanding, behavioral engagement is often associated with adherence and frequency of use, while cognitive engagement emphasizes understanding, motivation, and achieving cognitive outcomes. Affective engagement, although diverse, is recognized as a critical dimension. In addition, it was noticeable that users and professionals perceived microengagement (with the DHI) and macroengagement (with the target behavior) as interconnected. To conclude, this study contributes a nuanced understanding of the multifaceted nature of engagement, informing future measurement of the concept, DHI design, and implementation strategies for improved user experiences and outcomes.

Improving cardiovascular health in patients with an abdominal aortic aneurysm: development of the cardiovascular risk reduction in patients with aneurysms (CRISP) behaviour change intervention

BackgroundAbdominal aortic aneurysm (AAA) is an important cardiovascular health problem. Ultrasound screening is proven to reduce AAA mortality and programmes have been implemented in some healthcare systems. Those who are identified as having a small AAA in screening enter into a surveillance programme to monitor AAA size. Individuals in AAA surveillance are at elevated risk of cardiovascular events, which is not currently addressed sufficiently. We aimed to develop a simple intervention to reduce cardiovascular risk, which could be embedded in AAA surveillance pathways.MethodsIntervention mapping methods were used to co-develop the intervention with individuals with AAA, families/carers, and healthcare staff. We identified “targets for change” by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We conducted a series of workshops to identify barriers to and facilitators of change and used taxonomies of behaviour change theories and techniques to match intervention strategies to each target. Further stakeholder involvement work helped refine the intervention.ResultsThe developed intervention focusses on assessment and individually tailored discussion of risk factors, exchanging information, building motivation and action planning, followed by review of progress and problem-solving. Workbooks covering physical activity, diet, stress management, alcohol, smoking, blood pressure and mental health are provided to support behaviour change. The intervention is facilitated by trained healthcare professionals during the patient’s AAA screening appointment for the duration that they are in surveillance.DiscussionThe developed intervention will now be tested to assess whether it can be integrated with the current AAA screening programme. The developed intervention is a novel approach to reducing cardiovascular disease in the AAA population, it is also the first intervention which tries to do this in this population.Trial registrationInternational Clinical Trial Registration: ISRCTN93993995.

Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: a 12-week randomised controlled feasibility trial.

This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2-1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: -153, 245) increase in MVPA, 1·7 kg (95 % CI: -3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.

The path towards an HIV-free generation: engaging adolescent boys and young men (ABYM) in sub-Saharan Africa from lessons learned and future directions

ABSTRACT This paper highlights the pressing need to address the HIV epidemic among adolescent boys and young men (ABYM) in sub-Saharan Africa. Despite progress in HIV prevention, ABYM still experience low diagnosis rates, treatment adherence, and linkage to care. The paper emphasizes ABYM’s vulnerability due to societal norms, limited healthcare access, and economic pressures. It calls for gender-responsive interventions, including comprehensive sexual education, youth-friendly health services, community engagement, and targeted outreach. Comprehensive sexual education is pivotal in HIV prevention for ABYM, providing them with age-appropriate sexual health knowledge and safer sexual practices to reduce HIV incidence. Harmful masculine norms must be countered to promote respectful relationships, benefiting boys, men, and their partners. Inadequate access to youth-friendly health services hampers HIV prevention. Establishing spaces with confidential, non-judgmental care offering testing, counselling, circumcision, and provision of pre-exposure prophylaxis (PrEP) is essential, especially considering ABYM’s unique clinic experiences. Engaging communities, leaders, educators, and peers combats stigma and discrimination. ABYM’s input in intervention design, targeted outreach, and innovative technology enhances effectiveness of HIV prevention programmes. Economic factors should also be addressed. Comprehensive multi-sectoral interventions, including conditional cash transfers, effective for AGYW, could benefit ABYM. Addressing structural factors alongside behaviour change and social support is key.

Cli-fi videos can increase charitable donations: experimental evidence from the United Kingdom.

Recent research has begun to investigate if climate fiction, or cli-fi, can increase people's support for pro-climate initiatives. Emerging evidence focuses on whether cli-fi stories affect people's self-reported emotions, attitudes, and intentions. Few studies, however, examine the effect of such stories on revealed behavior, and whether the cli-fi story medium, i.e., whether stories are presented in text, audio, or audio-visual format, matters. We investigate the causal effect of cli-fi stories, and the medium through which they are communicated (textual, audio, or audio-visual) on self-reported support for climate policy, individual and collective action intentions, and a revealed measure of charitable donations. In a pre-registered online experiment (n = 1,085 UK adults), participants were randomly assigned to one of 5 conditions - to read scientific information about climate change (scientific information condition), read a story unrelated to the environment (control), read a cli-fi story in which a protagonist took intentional pro-environmental actions (fiction text), listen to the same cli-fi story in audio format (fiction audio), or watch an animation of the cli-fi story (fiction video). When comparing the fiction-text, fact-text, and control conditions, we found that cli-fi stories are not always more effective than alternative climate communications: participants in the fact-text condition reported higher support for climate policies, and intentions of taking individual environmental actions, and negative feelings of sadness, disappointment, and guilt, compared to the text-based control and cli-fi text condition. When comparing the cli-fi media format, we found that cli-fi videos were most effective in increasing pro-environmental charitable donations in an incentivized choice task, and self-reported feelings of happiness, hope, and inspiration. The findings show that scientific information about the climate and climate-fiction have an important place in the climate communications toolkit and can offer distinct pathways to enhance support for policy and behavioral change. Communicators seeking to inspire individual pro-environmental actions can consider telling cli-fi stories in video, which may be more compelling. And communicators seeking to enhance public support for societal changes, via climate policies, may benefit from disseminating scientific information about climate change.

Exploring the use of ChatGPT as a virtual health coach for chronic disease management.

ChatGPT has been widely researched for its potential in gealthcare applications. However, its efficcy as a virtual health coach is one of the important areas, which can significantly contribute to the sustainablility in healthcare operations, especially in managing critical illnesses. Therefore, this study aims to analyze the use of ChatGPT as a virtual health coach for chronic disease managemet. This study used a quasi-experimental design because ChatGPT is a relatively new technology and few people have experience with it. Patients who were receiving care outside of the hospital were included. Semi-structured interviews were conducted after a 2-week period in which participants used ChatGPT to search for health information about chronic disease management. Thirty-nine outpatients were interviewed and thematic analysis was used to analyze the interview data. The findings suggested both opportunities and challenges of using ChatGPT as a virtual health coach for chronic disease management. The major opportunities identified included life-long learning, improved health literacy, cost-effectiveness, behavioral change support, scalability, and accessibility. The major challenges identified included limited physical examination, lack of human connection, legal and ethical complications, and lack of accuracy and reliability. ChatGPT-based technologies may serve as a supplementary or intermediate support system. However, such applications for managing chronic diseases must protect privacy and promote both short- and long-term positive outcomes.

An Exercise and Wellness Behavior Change Program for Solid Organ Transplant: A Clinical Research Protocol for the Transplant Wellness Program.

Exercise prehabilitation is an evidence-based, safe, and effective method to increase quality of life, physical fitness and function, and post-surgical outcomes in solid organ transplant (SOT) patients. However, few prehabilitation programs for SOT patients exist in practice. Furthermore, there is a lack of multimodal prehabilitation programs that include behavior change support. To address this need, the Transplant Wellness Program (TWP) was designed. The objective of the TWP is to assess both the effectiveness and implementation of a comprehensive and multimodal exercise and wellness behavior change intervention for patients undergoing kidney or liver transplant. The TWP is a hybrid effectiveness-implementation trial consisting of exercise and wellness behavior change support. Individuals who are in evaluation or listed for kidney or liver transplant in Southern Alberta, Canada. The primary outcomes of self-reported exercise and quality of life are assessed at intake, post-exercise intervention, 6 months post-intake, 12 weeks post-transplant, and annually for 5 years after program completion. Functional fitness measures will be assessed at intake, post-exercise intervention, 12 weeks post-transplant, 6 months post-intake, and 1-year post-intake. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of TWP at the individual and health care system level. Recruitment began in November 2023 and will continue until November 2028. Participants take part in a 12-week exercise intervention and are offered individualized and group behavior change support. Continued exercise support is offered through maintenance classes after the completion of the 12-week intervention. The design of the hybrid effectiveness-implementation trial with a single experimental group will not allow for comparisons to a control or usual care group, potentially impacting internal validity. Differences in number of participants between organ groups (kidney vs liver) and cohorts (pre-transplant vs post-transplant) will likely be uneven, requiring consideration when running and interpreting analyses. The TWP aims to support patients throughout the transplant journey through a multimodal and comprehensive exercise and wellness behavior change program. Results from this study will determine the effectiveness of the program and inform future scale-up and sustainability. NCT06367244.

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.

A qualitative study of perspectives on the acceptability and feasibility of “virtual home visits” for asthma

BackgroundAsthma home-visit programs delivered by community health workers (CHWs) are an effective way to improve asthma outcomes and cost of care, through performing home environmental inspections, delivering education and hands-on demonstrations, and providing personalized behavior change support. During the COVID-19 pandemic, many in-person asthma CHW programs have been adapted to be delivered virtually, but it is unclear whether this is acceptable or feasible for clients with asthma. This qualitative study sought to identify perspectives of prior clients of the Public Health–Seattle & King County Asthma Program on acceptability and feasibility of a hypothetical virtual asthma program.MethodsWe performed semi-structured interviews with participants speaking English, Spanish, and Somali. An a priori codebook was developed based on the Theoretical Framework of Acceptability and was revised iteratively during coding. Intra-rater reliability was established, and thematic analysis was used to determine major themes.ResultsA total of 19 individuals participated (9 speaking English, 8 Spanish, and 2 Somali). Krippendorf’s alpha was 0.848, indicating high intra-rater reliability. Our results demonstrated that many participants felt positively about the prospect of completing the program virtually, but they also expected a variety of challenges, the most important of which were lack of engagement with the CHW and lack of confidence in the accuracy of a virtual home inspection. Participants also varied widely in their comfort level with videoconferencing platforms and their access to adequate internet connectivity.ConclusionsAcceptability and feasibility of virtual programming varies widely between participants, indicating that there may be no “one-size-fits-all” approach. We present several recommendations for adapting in-person asthma home visit programs to a virtual format, including considering a hybrid approach to delivery, making concerted efforts to build rapport when using videoconferencing, and deliberately evaluating the effectiveness of new adaptations, especially if a virtual environmental assessment is attempted.

Increasing the uptake of plant-based diets: An analysis of the impact of a CO2 food label

Reducing the environmental footprint of the global food system significantly depends on shifting to more plant-based diets. However, deep-rooted eating habits and a general lack of awareness about food-related emissions hinder large-scale dietary shifts. Demand-side food policies can accelerate this transition towards plant-based diets. One policy instrument that may increase awareness of diet-related emissions and facilitate climate-friendly food consumption choices is a CO2 food label. The success of such demand-side food policies depends on socio-political and market acceptance. However, there is a lack of empirical evidence regarding the socio-political (i.e., feasibility) and market acceptance (i.e., effectiveness at changing behavioral intentions) of CO2 food labels. We also require more knowledge about the potential spillover effects of CO2 food labels on support for more ambitious demand-side food policies. The paper presents evidence from a survey experiment with a sample of Swiss residents (N = 2372) who were randomly provided with information about an established CO2 food label. The survey experiment was embedded in a cooperation throughout a larger long-term project with the second-largest Swiss retailer, which launched one of the world's first CO2 food labels in 2021. Findings show that providing information on a CO2 food label strengthens individuals' behavioral change intentions and support for a mandatory governmental CO2 food label. However, no spillover effect on support for other food policy instruments is identified, which also means that the study finds no crowding out effect by voluntary CO2 labelling initiatives on the support of governmental food policy measures. The results imply that a CO2 food label enjoys high market and socio-political acceptance.

He Rourou Whai Painga, an Aotearoa New Zealand dietary pattern for metabolic health and whānau wellbeing: protocol for a randomized controlled trial.

Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand. Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health. This study aims to test whether an intervention including a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) and behavior change science can improve the metabolic health of participants and their household/whānau. This is a multi-center, three-stage trial with two parallel group superiority randomized controlled trials (RCTs), and a longitudinal cohort study embedded within the trial design. The first RCT (RCT 1) is a comparison of the NZMedDiet pattern compared to usual diet for 12 weeks. The Behavior Change Wheel was used to select and implement strategies to support participant adherence to the NZMedDiet, such as web-based nutrition education on healthy shopping and cooking. The second (RCT 2) compares online social support to no online social support for 12 weeks, administered to participants immediately following RCT 1. The third stage is a longitudinal cohort study where all participants are followed from the beginning of their start of the active intervention for 12 months in total. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). The duration of enrolment is 12-15 months. The total recruitment target is 200 index participants and their household/whānau members who participate with them, and the primary analyses will be intention to treat on index participants. The trial will test whether the NZMedDiet pattern and behavior change support improves the cardiometabolic health of people in Aotearoa New Zealand. https://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056 (Spirit 2).

A high quality Aotearoa New Zealand dietary pattern adapting a Mediterranean diet for metabolic health: a feasibility study

AimTo assess the feasibility of a family-based dietary intervention study using a meal kit home delivery service, in people at risk of cardio-metabolic disease.MethodsA 12-week dietary intervention feasibility study of adults (termed the index participants) at increased risk of metabolic and cardiovascular disease, enriched for Māori who are indigenous New Zealanders. The study sample also included the household/whānau members living with the index participant. All participants received a 12 week intervention using weekly home delivery of meal kits and groceries consistent with a Mediterranean dietary pattern. Outcomes were the metabolic syndrome severity score (MetSSS); feasibility and acceptability of the intervention; dietary intake; and other clinical and anthropometric measures.ResultsThere were 29 index participants recruited and in addition, 50 household/whānau members took part in the feasibility study. The mean (SD) household/whānau size was 3.45 (1.4) people, and the mean (SD) number of people in each household/whānau who participated in the study was 2.84 (1.2). The feasibility of intervention to households/whānau was proven in this context. The mean (SD) change in MetSSS was 0.03 (0.33), N = 27, P = 0.69 and there was a statistically significant decrease in body weight of 1.37 kg (95% CI 0.11 to 2.62), p = 0.034. The food deliveries were well received, the dinner kits more so than the grocery items.ConclusionIt is feasible to recruit individuals and households/whānau to a family-based dietary intervention. Use of a meal kit home delivery service to provide food which is consistent with the intervention dietary pattern was well received. This feasibility study identified improvements to be made such as nutrition behaviour change support, more variety in food provided, more recipes, and better matching of food quantity to family size.Trial registrationANZCTR—ACTRN12621000856819p registered 2.JUN.2021 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382021&isReview=true

Mobile health behaviour change support system as independent treatment tool for obesity: a randomized controlled trial

Background/ObjectivesDigital health interventions are increasingly utilized as an adjunct to face-to-face counselling in the treatment of obesity. However, previous studies have shown inconsistent efficacy when digital interventions are used as stand-alone treatment. The purpose of this study was to investigate whether a mobile health behaviour change support system (mHBCSS) is effective in weight reduction and weight loss maintenance without additional counselling. Furthermore, changes in cardiometabolic risk factors were investigated.MethodsIn this randomized controlled trial, a mHBCSS intervention was conducted for 200 volunteers with obesity (BMI 30–40 kg/m² and age 18–65 years). The study participants were randomly assigned into two groups: immediate access to mHBCSS intervention or wait-list control with access to mHBCSS after 6 months. Anthropometric and metabolic traits were also measured. The primary outcome was weight loss from the baseline to the 6-month visit.ResultsAmong 200 participants (88.5% women), mean BMI (SD) was 34.3 kg/m² (2.8) and age 46.5 years (9.5). The retention rate was 98.5% and 89.0% at the 6- and 12-month visits, respectively. At the 6-month visit, those with immediate access to mHBCSS had significantly greater weight loss (−2.5%, 95% CI −3.4 to −1.6, p < 0.001) compared with the wait-list control group (0.2%, 95% CI –0.4 to 0.9, p = 0.466; between groups p < 0.001). Weight loss was maintained until the 12-month time point in the mHBCSS group (−2.1%, 95% CI −3.3 to −0.9, p = 0.001). The usage of mHBCSS had no significant effect on metabolic traits.ConclusionThe mHBCSS as a stand-alone treatment of obesity results in weight reduction and weight loss maintenance with remarkable adherence rate. Further studies are needed to establish how to best implement the scalable and resource-efficient mHBCSS into the standard care of obesity to achieve optimal weight loss results.