Behavior Change Theory Research Articles

Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis.

There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness. This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions. Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability. In-person and remotely delivered rehabilitation interventions. Adult cancer survivors. Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT). Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios. While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness. Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

Development of a behaviour change intervention for improving physical activity amongst stroke survivors with physical disabilities: a co-design approach

BackgroundStroke survivors face many barriers to physical activity (PA). Solving physical inactivity after stroke requires a “systems-based” approach. We aimed to develop a complex intervention targeted at improving PA after stroke in Singapore using behaviour change theory and a co-design approach involving multiple stakeholders.MethodsWe carried out the intervention development in three phases: i. preparation phase, ii. co-design phase, and iii. intervention refinement phase. During the preparation phase, we conducted surveys (n = 38 stroke survivors, 71 physiotherapists and 35 exercise professionals) and interviews (n = 19 stroke survivors) to understand the factors influencing PA after stroke. The co-design phase consisted of two-co-design workshops held in August 2022 and were attended by 13 stroke survivors and 4 caregivers. Relevant domains of the Theoretical Domains Framework (TDF) and items in the Template for Intervention Description and Replication (TIDieR) checklist guided the discussion topics in the first co-design workshop. Solution prototypes such as exercise videos, arm and leg straps and information resources were shown in the second co-design workshop to gather feedback. In the intervention refinement phase, eight healthcare professionals from various sectors participated in two virtual Zoom meetings in August 2023, and used the Acceptability, Practicability, Effectiveness, Affordability, Spillover effects and Equity (APEASE) grid to rate the active ingredients in the complex intervention by considering the current healthcare landscape in terms of resources and manpower.ResultsStroke survivors and caregivers want a personalised PA program, stroke-specific PA opportunities and information resources, medical clearance, advice and help from healthcare professionals skilled in stroke care, face-to-face sessions at preferred exercise spaces, and access to adaptive equipment. A complex intervention consisting of 21 behaviour change techniques, 6 intervention functions and 8 options was developed.ConclusionsUsing behaviour change theory and a co-design approach involving multiple stakeholders, a complex intervention was developed to target physical inactivity after stroke. The intervention titled MOTIVATE is currently being tested in a type 1 hybrid effectiveness-implementation trial.

Clinical investigation into risk factors for delirium post-cardiac surgery and its implications for nursing intervention guided by behavior change theory

BackgroundThis study explores the factors contributing to the occurrence of delirium following cardiac surgery and devises nursing strategies rooted in behavior change theory.MethodsA cohort of 320 cardiac surgery patients was selected, categorized into two groups: 93 cases where postoperative delirium (POD) was anticipated, and 227 cases where it was not. Preoperative, intraoperative, and postoperative factors of POD were scrutinized using single-factor analysis, while binary logistic regression analysis was employed to pinpoint risk factors.ResultsAmong the 320 patients, 93 displayed POD symptoms post-surgery, yielding an incidence of 29.06%. Preoperative univariate analysis disclosed significant differences in gender, age, smoking, hypertension, and diabetes (P < 0.05). Intraoperatively, significant differences were noted in the American Society of Anesthesiologists (ASA) anesthesia grade (II, III, and IV), surgery time, cardiopulmonary bypass duration, and aortic occlusion duration (P < 0.05). Post-surgery, significant differences were observed in the duration of Intensive Care Unit (ICU) stay, mechanical ventilation time, and visual analogue scale (VAS) scores (P < 0.05). Multivariate Logistic regression identified surgery time (OR = 2.334, P < 0.001), ICU admission duration (OR = 1.457, P < 0.001), mechanical ventilation time (OR = 1.235, P = 0.004), and VAS scores (OR = 2.986, P < 0.001) as independent risk factors for POD. ROC curve analysis indicated higher sensitivity and specificity in predicting POD with surgery time, ICU stay duration, mechanical ventilation time, and VAS scores.ConclusionIrrespective of the surgical intervention type, surgery time, ICU stay duration, mechanical ventilation time, and VAS scores are recognized as risk factors for POD in cardiac surgery patients. Hence, continuous patient monitoring and early intervention tailored to specific risk factors are essential in clinical practice to mitigate POD incidence.

Development of a toolkit to help parents/caregivers manage feeding problems in autistic children: A protocol for a realist synthesis and toolkit co-design.

Many autistic children have feeding problems, typically eating a limited range of foods. Feeding problems affect quality of life, health, and development. Research suggests that parents are often unsure when to or whether to seek help. When they do, local provision of help across the UK is often lacking. A toolkit could offer a tailored, accessible, and scalable early intervention to support parents. We aim to develop the blueprint of a toolkit to help parents/caregivers manage feeding problems in their autistic children. Medical Research Council guidance on developing complex interventions informs three successive work packages: Realist review: a literature search and analysis using realist theory of logic to construct programme theory(s) in line with RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidance.Realist evaluation: interviews of three groups: autistic children, young people and adults (experts), parents/caregivers of autistic children (parents), and professionals who help parents manage feeding problems (professionals) across the UK. Analysis of verbatim interview transcripts using realist theory of logic to refine programme theory(s).Co-design of the toolkit blueprint: behaviour change theory applied to the programme theory(s) will generate candidate components for the online tool. A blueprint (a detailed textual outline) will be co-designed. A participatory research team of experts, parents, and professionals will be involved in each work package. Where consensus is needed it will be reached by asynchronous nominal group technique. A PPI (public and patient involvement) advisory group of experts and parents will ensure the project is relevant, respectful, and accessible. Findings of each step will be disseminated via journal publications, conferences, social media, as well as PPI-co-produced webinars and a dissemination event. On completion, this project will provide the foundation for the subsequent development and refinement of the prototype toolkit.

Effectiveness of environmental conservation measures practised in the Full Gospel churches of Kenya Embu Evurore District, Kenya

This study assessed the effectiveness of environmental conservation measures practised by the congregants of the Full Gospel Churches of Kenya in the Embu Evurore District. The environment in Embu Evurore District is degraded despite the conservation practices of the congregants. The study objective was to assess the effectiveness of the environmental conservation measures practised in the Full Gospel Churches of Kenya Embu Evurore District. The study was guided by Behaviour change theory, which states that an individual is a victim of their environment. A descriptive research design was used to collect, analyse, and interpret information. The study was carried out in the five local churches in Embu Evurore District. The study population was obtained through a sampling technique. The leaders were selected through purposive sampling. A sample of congregants was arrived at through random sampling. The study instruments were questionnaires for the congregants and interview schedules for the leaders. An observation schedule was used to identify the environmental conservation practices in Embu Evurore District. The data was analysed using tables, charts and graphs. The study found that while some environmental conservation measures have been effective, others have had limited impact. The study also found that some congregants caused environmental degradation. The findings of the study add knowledge to Eco- Theology. They benefit church leaders by adding insight to their policy formulation and decision-making concerning environment conservation. The findings of this study will sensitise the congregants to improve their methods of environmental conservation.

Influence of the teachings and practices of Full Gospel Churches of Kenya on environmental conservation: A case of Embu Evurore District, Kenya

This study sought to evaluate the ways in which the church worshipers practice the teachings on environmental conservation in the Full Gospel Churches in Embu Evurore District, Kenya. Despite the Full Gospel Church's teachings on environmental conservation, there is prevalent environmental degradation in Embu Evurore District, Kenya. This study was guided by behaviour change theory, which states that an individual is a victim of their environment. Descriptive formats were used to collect information, analyse, compare and interpret data. The study targeted the five local churches in Embu Evurore District. A Sample population was obtained through a random sampling technique. The findings of the study led to the conclusion that worshipers' awareness of the practices of environmental conservation influenced how they practised environmental conservation. The study also found out that there were worshippers who were unaware of the conservation measures. The findings of the study contribute to religious knowledge in Eco-Theology. The findings of this study are beneficial to church leaders as they add insight to policy formulation and decision-making on environmental conservation. The findings of this study will sensitise the worshippers to proper practices in environmental conservation.

A Systematic Review of Interventions That Aim to Reduce Implicit and Explicit Weight Biases among Fitness Professionals

Despite the high prevalence of weight bias among fitness professionals, few resources are currently available to educate fitness professionals about weight bias and no systematic review of weight bias interventions has been conducted among this population. This paper therefore reviewed extant weight bias interventions for fitness professionals to inform future weight bias-reduction initiatives. Seven reports comprising six studies were identified from inception until April 2024. Findings showed small to large improvements in explicit weight bias, particularly on the weight control/blame component. No improvements were observed in implicit weight bias. The results show an urgent need to bridge the gap between the resources currently available in the fitness industry and those developed by the scientific community and to develop novel multifaceted interventions that draw from multiple theories of attitude and behavior change to effectively tackle weight bias among fitness professionals.

What is needed to address psychosocial hazards in road transport? Using implementation science to understand the gaps

Work-related psychosocial hazards have a significant influence on the development of musculoskeletal and mental health disorders (MSDs and MHDs). This study used behavioural change theory to guide understanding of barriers and enablers for leaders working in the Heavy Vehicle Road Transport industry, to address workplace psychosocial hazards. The findings will be used to inform design of a future intervention to support leaders to more effectively address these hazards. Principal results and major conclusions: A higher number of barriers than enablers were identified. The most prevalent barriers were inadequate knowledge and interpersonal skills, and environmental context and inadequate resources, and the most prevalent enabler was risk management. The findings extend previous evidence by providing more specific detail regarding requirements for addressing psychosocial hazards. Further, the findings identified there is a need to improve the capability, opportunity and motivation of leaders to enable them to more effectively address psychosocial hazards.

Effects of different intensity resistance training on fat level, energy intake, and appetite among overweight and obese female college students

This study examines how different intensity resistance exercises impact fat, energy intake, and appetite regulation in overweight and obese female college students in Jiangsu Province, China. This study used a randomized controlled trial (RCT) design that investigates resistance training intensity-target result causation. The study determines the impact of High-Intensity Interval Training (HIIT) and Moderate-Intensity Resistance Training (MIRT) on body composition, fat level/body composition, and muscle mass them. In Jiangsu Province, China, 515 overweight and obese female college students aged 18–25 were sampled. Intervention groups were assigned randomly to campus recruits based on demographic and anthropometric. This study demonstrated significant correlations between resistance training intensity, body composition, diet, and appetite regulation in overweight and obese colleagues. MIRT and HIIT outperformed Control in weight loss and diet and used valid measures like DEXA (Dual-Energy X-ray Absorptiometry), blood tests and food diaries to regulate appetite hormones. Increased protein and muscle mass minimize resistance exercise intensity-metabolic consequences. The study analyzes these impacts to show how exercise intensity, food, and metabolic health are interconnected. These findings help build evidence-based obesity prevention and treatment strategies for this demographic. Healthcare providers, legislators, and university stakeholders use this study to tackle college student obesity. The results suggest that campus wellness initiatives should focus on resistance exercise and diet to combat obesity. This research promotes exercise science and health behavior change theory for cross-cultural lifestyle interventions.

Investigating the effect of peer-led educational intervention on behaviors related to pubertal health and its determinants in high school girls of Genaveh, Iran: Application of social cognitive theory

Background Empowering adolescents in the field of puberty health is one of the important goals of public health programs. The present study was carried out with the aim of determining the effect of peer-led training on puberty-related behavior and its determinants using social cognitive theory. Methods: A total of 245 teenage girls were randomly divided into two groups: the intervention group and the comparison group. The questionnaire measuring puberty-related behavior and its determinants was self-administered and completed before and 2 months after training in the two groups. One session for parents, four sessions for peer educators, and four sessions for participants were conducted for 1 month. Results: In the intervention group, unlike the comparison group, the mean scores of knowledge, outcome expectations, self-efficacy, self-control, social support, and behavior increased significantly after training (p <0.05). Based on regression analysis, outcome expectations and social support were the main determinants of puberty-related behavior (adjusted R2 = 0.464). Conclusion: The findings of this study support the effectiveness of the peer-led educational intervention based on social cognitive theory in the improvement of puberty-related behavior and its determinants, which can be used in the design of puberty-related health promotion programs. Further research to assess the longer-term outcomes and to examine other theories of behavior change are suggested.

The Adaptive Physical Activity Study for Stroke: A Feasibility Sequential Multiple Assignment Randomized Trial

Abstract Background Between 1990 and 2017, stroke cases nearly doubled, ranking as the second leading cause of death and disability globally. Inadequate physical activity (PA) is a leading risk factor. Recent guidelines advise stroke survivors to follow population-based PA guidelines. Given stroke heterogeneity personalised PA interventions are recommended. Therefore, this study used a Sequential Multiple-Assignment Randomized Trial (SMART) design to develop an adaptive mHealth intervention to improve PA post-stroke. Methods This SMART is in progress, with recruitment completed and follow-up data ending November 2024. A 12-week intervention programme was developed incorporating public patient involvement (PPI), empirical evidence and behavioural change theory to increase participation in Structured Exercise (SE), Lifestyle Physical Activity (LPA), or both. The study enrolled 54 ambulatory, community-dwelling people who were randomly assigned to either SE or LPA treatment groups. Participants used Fitbit Inspire 2 devices to monitor step counts and set personalized weekly step goals. At six weeks post-randomisation, participants were evaluated and classified as responders or non-responders based on their step count target achievement. Non-responders were re-randomized to switch treatments or augment their current regime with an additional intervention. Responders maintained their original treatment protocol. Primary outcomes address recruitment, retention and adherence rates. Secondary outcomes encompass overall health. Results Preliminary results include 54 participants (56% male) aged 51.58 (± 15.12) with Ischaemic (44%), Haemorrhagic (28%) or unknown (28%) stroke type at baseline. The mean weekly step was 7046 (±3797) while the mean Fatigue Severity Scale score was 38.02 (± 14.60). Participants had a mean Hospital Anxiety and Depression Scale score of 12.33 (± 6.98). Additionally, the mean Stroke Specific Quality of Life was 155.04 (58.84). Conclusion This is the first trial to use a SMART to design an adaptive intervention post-stroke internationally. Findings will inform the development of a PA intervention and subsequently will be evaluated against treatment as usual in a definitive trial.

Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

BackgroundIt remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.MethodsStudies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.ResultsThirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.ConclusionOur systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.

Evaluating the Let's Move It intervention programme theory for adolescents' physical activity: Theorized psychosocial mechanisms of behavioural changes.

Behaviour change theories have extensively been used in health behaviour change interventions and their programme theories. However, they are rarely evaluated in randomized field studies. The Let's Move It intervention targeted various psychosocial constructs to increase adolescents' physical activity. A theory-based process evaluation aiming to illuminate the trial findings as well as to test the programme theory used is conducted. Specifically, we investigate whether the intervention influenced the theorized determinants of change immediately post-intervention and after 1 year, and whether these determinants were associated with changes in physical activity. A cluster-randomized controlled trial (n = 1166). We measured theorized determinants with self-report, and physical activity (PA) with accelerometry and self-report. The effects are evaluated with repeated measures ANOVA and regression models. No changes were detected in most theorized determinants but intervention arm reported higher enactment of behaviour change techniques used during intervention immediately post-intervention and lower descriptive norms for PA throughout. Autonomous motivation was associated with PA immediately post-intervention. The lack of intervention effects may be due to many factors, for example insensitive measures, ceiling effects. However, reporting these null effects advances understanding of behaviour change processes. We introduce methodologic possibilities for future intervention programme theory evaluation efforts.

A scoping review of coaching in occupational therapy: Mapping methods, populations and outcomes.

Coaching is proposed as a core enabling skill of occupational therapy and increasingly suggested for a diverse range of health populations. In recent years, research on coaching has proliferated, emerging from within and outside of occupational therapy. Yet, concern has been raised about the absence of theoretical underpinning and diversity of descriptions of coaching in occupational therapy, as well as low-quality evidence supporting its effectiveness. The aim of this study is to map the use of coaching by occupational therapists from 2007 to 2022 to identify the populations, settings and outcomes it is applied to, differences between coaching interventions and evidence supporting its use. This systematic scoping review applied Arksey and O'Malley's five-stage methodological framework with further methodological direction using the Levac framework. There was no consumer involvement in undertaking this review. Findings from 60 research publications on coaching indicate its use with populations across the lifespan in primarily community settings to improve occupational performance, participation and self-efficacy. A wide range of coaching interventions are designed or used by occupational therapists, with Occupational Performance Coaching being the most researched (16/27, 59% of named interventions). Common elements of coaching interventions included collaborative goal setting and problem-solving; however, a lack of described theory or coaching methods persists. High-quality study designs indicate its effectiveness; however, an absence of fidelity definition or monitoring limits interpretation of many studies. The language of coaching is becoming common practice within occupational therapy, and evidence indicates effectiveness of some coaching interventions. Advances in coaching research and use by occupational therapists will be aided by an explicit statement of the theoretical basis for coaching interventions, with congruent coaching methods, mechanisms and outcomes stated. This scoping review maps the use of coaching by occupational therapists in current published research. Key aspects of coaching examined include how coaching is defined, who it is used with and how effective it is. The kinds of outcomes that coaching is intended to improve are also reported. From 633 publications, 60 research publications were fully analysed. The use of coaching by occupational therapists has grown rapidly over the past 10years. Strong evidence of its effectiveness exists for achieving the personal goals of people receiving occupational therapy when goals describe changes in everyday life activities. Coaching is being used with people across the lifespan with a variety of disabilities and chronic conditions and their caregivers/parents, most commonly parents of children with developmental issues. The key features of coaching interventions used by occupational therapists include collaborative goal setting, shared problem-solving and client-led action planning. Some elements of coaching are also used within other interventions with a wider range of methods. Coaching is believed to work by supporting an individual's self-belief that they can make changes. Theories that underpin coaching vary but commonly focus on self-determination, behaviour change and occupational therapy theory. However, many of the coaching interventions do not describe any theoretical basis nor coaching methods in detail. Future research on coaching in occupational therapy should ensure a clear explanation of the theory that underpins it, coaching methods and monitoring of how well coaching is applied.

Factors Influencing the Translation of Evidence Into Clinical Practice for Hospital Allied Health Professionals in Terms of the Domains of Behaviour Change Theory: A Systematic Review.

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Developing theoretically underpinned primary care resources for patients with asthma: an exemplar from the IMP2ART trial.

This article reports on the development of patient resources for the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme that aimed to encourage patients to attend asthma reviews (invitation letters), encourage patients to enquire about asthma action plans (posters), and equip patients with the knowledge to manage their asthma (information website). To improve supported asthma self-management in UK primary care, the IMP2ART programme developed a whole-systems approach (patient resources, professional education, and organisational strategies). Linked to behaviour change theory, we developed a range of patient resources for primary care general practices (an information website, invitation letters to invite patients for asthma reviews, and posters to encourage asthma action plan ownership). We elicited qualitative feedback on the resources from people living with asthma in the UK (n = 17). In addition, we conducted an online survey with volunteers in the UK-wide REgister for Asthma researCH (REACH) database to identify where they source asthma information, whether their information needs are met, and what information would be useful (n = 95). Following feedback gathered from the interviews and the online survey, we refined our patient resources for the IMP2ART programme. Refinements included highlighting the seriousness of asthma, enhancing trustworthiness, and including social support resources. We also made necessary colour and formatting changes to the resources. In addition, the patient resources were updated following the COVID-19 pandemic. The multi-stage development process enabled us to refine and optimise the patient resources. The IMP2ART strategy is now being tested in a UK-wide cluster RCT (ref: ISRCTN15448074).

Data-Driven Implementation Strategy to Optimise Clinician Behaviour Change at Scale in Complex Clinical Environments: A Multicentre Emergency Care Study.

To develop an evidence-driven, behaviour change focused strategy to maximise implementation and uptake of HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) in 30 Australian rural, regional and metropolitan emergency departments. An embedded, mixed-methods study. This study is the first phase of a step-wedge cluster randomised control trial of HIRAID involving over 1300 emergency nurses. Concurrent quantitative and qualitative data were collected via an electronic survey sent to all nurses to identify preliminary barriers and enablers to HIRAID implementation. The survey was informed by the Theoretical Domains Framework, which is a synthesis of behavioural change theories that applies the science of intervention implementation in health care to effect change. Quantitative data were analysed using descriptive statistics and qualitative data with inductive content analysis. Data were then integrated to generate barriers and enablers to HIRAID implementation which were mapped to the Theoretical Domains Framework. Corresponding intervention functions and Behaviour Change techniques were selected and an overarching implementation strategy was developed through stakeholder consultation and application of the APEASE criteria (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety and Equity). Six barriers to HIRAID implementation were identified by 670 respondents (response rate ~58%) representing all 30 sites: (i) lack of knowledge about HIRAID; (ii) high workload, (iii) lack of belief anything would change; (iv) not suitable for workplace; (v), uncertainty about what to do and (vi) lack of support or time for education. The three enablers were as follows: (i) willingness to learn and adopt something new; (ii) recognition of the need for something new and (iii) wanting to do what is best for patient care. The 10 corresponding domains were mapped to seven intervention functions, 21 behaviour change techniques and 45 mechanisms. The major components of the implementation strategy were a scaffolded education programme, clinical support and environmental modifications. A systematic process guided by the behaviour change wheel resulted in the generation of a multifaceted implementation strategy to implement HIRAID across rural, regional and metropolitan emergency departments. Implementation fidelity, reach and impact now require evaluation. HIRAID emergency nursing assessment framework reduced clinical deterioration relating to emergency care and improved self-confidence and documentation in emergency departments in pilot studies. Successful implementation of any intervention in the emergency department is notoriously difficult due to workload unpredictability, the undifferentiated nature of patients and high staff turnover. Key barriers and enablers were identified, and a successful implementation strategy was developed. This study uses theoretical frameworks to identify barriers and enablers to develop a data-driven, behavioural-focused implementation strategy to optimise the uptake of HIRAID in geographically diverse emergency departments which can be used to inform future implementation efforts involving emergency nurses. The CROSS reporting method (Supporting Information S3) was used to adhere to EQUATOR guidelines. No Patient or Public Contribution. Australian New Zealand; Clinical Trials Registry (ANZCTR) number: ACTRN12621001456842, registered 25/10/2021.

Medow Brite Enterprises: a growth strategy dilemma

Learning outcomes After completion of this case study, students will be able to understand about characteristics of urban poor in the city of Mumbai which will aid in understanding about other emerging markets as well, to apply Health Belief Model to help students analyse behaviour change model, to apply social marketing strategies to popularize a social marketing cause, to learn about non-traditional intermediaries and apply to promote a social marketing cause, to apply Ansoff matrix and evaluate various strategies for growth and to analyse various challenges faced by social entrepreneurs and enable learners to arrive at solutions (applicable for social entrepreneurs and marketing executives). Case overview/synopsis This case study looked at a Mumbai-based organization, Medow Brite Enterprises, which sold sanitary napkins under the brand FeelOn to women particularly from urban poor background. The protagonist Mrs Ameeta Neel Ramesh was at the helm of the organization and was stuck with a dilemma – whether to enter rural markets or focus on selling incinerators and aid in disposing used sanitary napkins which was adding to the volume of non-biodegradable waste in the city. In 2019, Ameeta made her first investment in Medow Brite. The organization had seen turbulent times during COVID-19 outbreak. However, Ameeta with her astute strategy, helped the company get back on its feet. Medow Brite instead of manufacturing started procuring quality sanitary napkins from specific vendors. In contrast to many other sanitary napkins available in the market, FeelOn had cotton sanitary napkin variant without presence of plastic in the pads. Ameeta had taken a different route for sale of her sanitary napkin, she conducted awareness sessions with the help of non-governmental organizations in various locations of Mumbai as well as Maharashtra. Post these sessions she sold her sanitary napkins among the attendees of the awareness sessions. Complexity academic level The case study can be included in marketing management course, consumer behaviour as well as social marketing courses in both undergraduate level and postgraduate level. In addition, the case study is also suitable for social entrepreneurs and marketing executives to discuss about non-traditional sales and marketing approaches, identifying unique segments and understanding behaviour change theories. Supplementary materials Teaching notes are available for educators only. Subject code CSS 8: Marketing.

Psychometric Testing of an Instrument Assessing Family Knowledge, Contemplation, Confidence and Readiness for Engaging in Early Mobilisation of Critically Ill Patients: A Multi-Site Cross-Sectional Design.

Early mobilisation is beneficial to support recovery among critically ill patients. The literature highlights the benefits of family engagement in early mobilisation, yet this practice remains underutilised. Effective implementation depends on understanding the key antecedents that influence family engagement in early mobilisation, specifically families' knowledge, contemplation, confidence and readiness. However, no measurement tools currently exist to assess these. Therefore, developing a psychometrically supported instrument is essential to understanding and enhancing families' factors influencing their engagement in early mobilisation. To develop and evaluate the psychometric properties of an instrument to assess families' knowledge, contemplation, confidence and readiness to engage in early mobilisation. A multi-site cross-sectional survey design. Based on established psychological theory (Social Cognitive Theories and Behaviour Change Theories), an item pool was developed to assess families' knowledge, contemplation, confidence and readiness to participate in early mobilisation. To psychometrically evaluate the new tool, a multi-site cross-sectional survey was undertaken from May 2020 to June 2022 across five intensive care units in Australia. Data from 370 families of critically ill patients were used to evaluate the structural, convergent and discriminant validity as well as the reliability of the new instrument. Confirmatory factor analysis indicated good model fit, supporting the proposed structure. All items displayed high standardised factor loadings except one, which improved upon freeing an error covariance. Positive inter-factor correlations were moderate to strong and were substantially lower than the square root of the average variance extracted, supporting both convergent and discriminant validity, respectively. Additionally, all subscales demonstrated well to excellent reliability. The findings provide preliminary support for the multiple types of validity evidence and the reliability of the instrument. This new instrument is suitable for use in clinical and research applications to assess families' knowledge, contemplation, confidence and readiness for their engagement in early mobilisation. Family engagement in early mobilisation activities may have multiple benefits but it is not commonly implemented in the ICU. Factors influencing family engagement in early mobilisation are poorly understood. Influential psychological theories highlight the likely importance of knowledge, contemplation, confidence and readiness. A readily available instrument designed to assess these constructs among family members is needed to deepen research understanding and guide clinical practice. The proposed instrument is designed to measure factors influencing family engagement in early mobilisation, which may support healthcare professionals and health services to identify and tailor strategies to support family engagement in early mobilisation. Recommendations for reporting the results of studies of instrument and scale development and testing was followed to report this study. Family members of adult critically ill patients participated in this study, and they provided the data through the survey.

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. This trial is registered as ISRCTN12139369. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.