Behavior Change Theory Research Articles

The impact of COVID-19 related regulations and restrictions on mobility and potential for sustained climate mitigation across the Netherlands, Sweden and the UK: a data-based commentary

Human behaviour change is necessary to meet targets set by the Paris Agreement to mitigate climate change. Restrictions and regulations put in place globally to mitigate the spread of COVID-19 during 2020 have had a substantial impact on everyday life, including many carbon-intensive behaviours such as transportation. Changes to transportation behaviour may reduce carbon emissions. Behaviour change theory can offer perspective on the drivers and influences of behaviour and shape recommendations for how policy-makers can capitalise on any observed behaviour changes that may mitigate climate change. For this commentary, we aimed to describe changes in data relating to transportation behaviours concerning working from home during the COVID-19 pandemic across the Netherlands, Sweden and the UK. We display these identified changes in a concept map, suggesting links between the changes in behaviour and levels of carbon emissions. We consider these changes in relation to a comprehensive and easy to understand model of behaviour, the Opportunity, Motivation Behaviour (COM-B) model, to understand the capabilities, opportunities and behaviours related to the observed behaviour changes and potential policy to mitigate climate change. There is now an opportunity for policy-makers to increase the likelihood of maintaining pro-environmental behaviour changes by providing opportunities, improving capabilities and maintaining motivation for these behaviours.

Social norms, cues and improved communication to influence behaviour change of smokers

ABSTRACT This paper presents a qualitative research study to explore how social pressures contribute to normative behaviour of adult smokers. Drawing from theories of social learning, behaviour change and cognitive dissonance from a literature review, the research questions are framed in an empirical social perspective by giving attention to social cues to study smokers and their behaviour changes. The findings reveal that despite media communications from government agencies and public bodies about the dangers of smoking and health risks, ignoring or defying such messages are linked to deeply embedded reasons of smokers’ social norms, cognitive factors and addiction to nicotine. Exploring dissonance behaviour in smokers provides in-depth insights into their feelings and attitudes towards smoking restrictions. Participants in the research sample were found to experience acts of social and cultural stigmatisation when smoking bans reinforce negative feelings of non-smokers toward smokers. The paper concludes that messages and images communicated about inducing behaviour change in smokers from government and public sector organisations should seek to foster social inclusion with policies to support behaviour change in smokers.

Moving Away from Coercion: Social Justice and Behavior Change in Disability Services

The use of coercion to alter behavior in persons with intellectual and other developmental disabilities has a long history. Despite the work of leaders in the development of Positive Behaviour Support (PBS), the use of chemical, mechanical, physical or personal, and environmental restraints continues, resulting in traumatization, physical and emotional harm, and in some instances, death. When coercion is used, the trust between people breaks down, and the lack of trust is reinforced by the power differentials present when coercion occurs. Social justice provides an avenue for rebalancing power and regaining trust, but people affected by disabilities have historically been excluded from theories of social justice and, in some cases, do not fall within the definition of what it means to be a person in the paradigms put forth by a number of different authors. The term non-coercive has been used in an attempt to reframe behavior change theories and practices, but this term describes the absence of negative circumstances and interventions, rather than the presence of positive and affirming interactions which improve the quality of life of all stakeholders.

The correlates of physical activity during COVID-19 pandemic among Indonesian young adults: A longitudinal study.

BACKGROUND:Social distancing policy during the COVID-19 pandemic may affect physical activity levels. This study aimed to compare physical activity levels before and during the pandemic and to explore physical activity correlates among Indonesian young adults.MATERIALS AND METHODS:This longitudinal study was conducted before the pandemic (n = 141) in September 2019 and was followed by an online follow-up survey during the pandemic (79% response rate) in September 2020. Physical activity was measured using the global physical activity questionnaire and was classified into “sufficient” and “insufficient.” The potential correlates of physical activity were constructs from social-cognitive theory and health belief model. Those were measured using a validated questionnaire in the follow-up survey. Physical activity levels before and during pandemics were compared using the Wilcoxon signed-rank test. Simple logistic regressions were used to assess the relationships between each potential correlate and physical activity status during the pandemic.RESULTS:Physical activity levels decreased significantly during the pandemic, mostly in the work-related domain. Participants with favorable physical activity-related constructs were more likely to be physically active. The odds ratio ranged from 3.41 (95% confidence interval [CI] = 1.15–10.11) in participants with higher self-efficacy to 4.50 (95% CI = 1.44–14.06) in those with higher outcome expectations of physical activity.CONCLUSION:A significant decline in physical activity during the COVID-19 pandemic among Indonesian young adults was confirmed. The application of behavioral change theories for explaining physical activity status during the pandemic in this population is also supported. It is recommended to incorporate these constructs to develop physical activity interventions in this target population.

Communication Strategy Analysis of COVID-19 Pandemic’s Public Service Announcement (PSA) Production

Communication through media is one of the most important aspects if a country faces a health crisis such as a pandemic. One of the mediums that are often used is via the production of public service announcements or PSA. PSA is a short video lasting between 30 to 120 seconds, communicating to large-scale audiences for social behaviour changes. However, certain PSA will be considered a failure if the audience ignores or does not understand the message. When Malaysia faces a health crisis such as the COVID-19 pandemic, the PSA barely emphasises the aspects of behavioural balance, message recall, and the aesthetic of message presentation. Thus, this paper aims to discuss the mode of presentation and styles in 30 public service announcements related to COVID-19 in MyHealth’s YouTube channel under the Ministry of Health Malaysia (MOH) from January to June 2020. The preliminary finding shows that most PSAs used 2D animation production techniques by representing the real scenarios and situations faced by the Malaysian to facilitate the audience's understanding of the message. Overall, PSA's presentation style on COVID-19 in Malaysia emphasises the balance between the importance of message and communication strategy with five phases in the theory of audience behavioural change. Keywords: Public service announcement, media production, crisis communication, pandemic, COVID-19.

The Experiences of People with Diabetes during COVID-19 Pandemic Lockdown.

Little is known about the theoretical foundation underling the response of people with diabetes managing their everyday routines during COVID-19 pandemic lockdown. Aim: To explore the experience of people with diabetes during COVID-19 pandemic lockdown in light of the risk perception, response and behavioral change theories. Method: A qualitative descriptive design was employed, and Braun and Clark’s six step analysis were used for thematic analysis. Semi-structured interviews were conducted online using Zoom Videos Communication. Result: Five themes were defined as follows: (1) perceived the threat and faced their fears, (2) appraised the damage, (3) identified the challenges, (4) modified their routine, and (5) identified the strengths that facilitate the efficacy of their response. There were eight sub-themes within the themes. Conclusion: The results of this study may provide an opportunity for nurses to reflect on issues highlighted by the patients regarding more effective communication, knowledge and skill development for people to support self-care during national emergencies.

A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Protocol Development for an Expert System to Provide Adaptive User Feedback.

BackgroundBipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can improve outcomes. However, access to therapy is limited. Smartphones and other technologies can increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as alerts to providers to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions.ObjectiveTo contribute to and support the improvement and dissemination of technology-based mental health interventions, we provide a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder.MethodsInformation from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system.ResultsDecision points determining the timing of intervention option adaptation were selected to occur daily and weekly based on self-report data for medication adherence, sleep duration, routine, and wellness levels. These data were selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable thresholds were developed based on existing literature regarding bipolar disorder clinical status and psychiatrist feedback. To address the need for treatment adaptation with varying clinical statuses, decision rules for a clinical status state machine were developed using self-reported wellness rating data. Clinical status from this state machine was incorporated into hierarchal decision tables that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building and utilizing support, and keeping a regular routine, as well as determinants underlying engagement in these target behaviors as follows: attitudes and perceptions, knowledge, support, evaluation, and planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms, and engaging with psychiatric providers.ConclusionsAdaptive mental health technologies have the potential to enhance the self-management of mental health disorders. The need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems.

Journey to Transplant: Developing a social support network counselling intervention to improve kidney transplantation.

ContextKidney transplant is superior to dialysis for the treatment of end‐stage kidney disease, but accessing transplant requires high patient engagement to overcome barriers. We sought to develop an educational counselling intervention for patients along with their social support networks to help patients access the waiting list.MethodsUtilizing an Intervention Mapping approach, we established a conceptual framework to develop a behavioural intervention that can be reproduced across kidney transplant centres. The approach includes needs assessment, identifying behavioural determinants and process objectives and integrating targeted behavioural change theory.ResultsThe Intervention Mapping process resulted in the development of a group counselling session, titled Journey to Transplant (JtT). This intervention was designed for kidney transplant candidates along with members of their social support networks and guided by a transplant healthcare professional. The session begins with standardized educational information to improve knowledge and normalize emotional barriers to transplant. This education is followed by a tailored counselling intervention, including the presentation of the individual patient's calculated likely outcomes on the kidney transplant waiting list. Finally, JtT incorporates patient and support network goal setting to address the specific barriers for that patient in accessing kidney transplantation.ConclusionA systematic Intervention Mapping approach to develop the JtT intervention helps ensure the intervention is efficacious, acceptable and feasible for transplant centres to implement. JtT engages the patient's social support network, targeting known barriers to transplant and utilizing established behaviour change theory to motivate concrete actions to improve the likelihood of kidney transplantation.Patient or Public ContributionThis study includes a patient and family advisory committee comprised of kidney transplant candidates and their family members to guide the final language and content of the intervention guide, and the conduct of the implementation and pilot testing of the intervention. However, patients and family members were not involved in the intervention mapping development process itself described in this manuscript, which was informed by focus group data from patient and family study participants.

Reducing salt intake: a systematic review and meta-analysis of behavior change interventions in adults.

ContextProlonged high salt (sodium) intake can increase the risk of hypertension and cardiovascular disease. Behavioral interventions may help reduce sodium intake at the population level.ObjectiveThe effectiveness of behavior change interventions to reduce sodium intake in adults was investigated in this systematic review and meta-analysis.Data sourceThe PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and EMBASE databases were searched.Data extractionNarrative synthesis and random-effects meta-analyses were used to determine intervention efficacy. A total of 61 trials (46 controlled trials and 15 quasi-experimental studies) were included.ResultsBehavior change interventions resulted in significant improvements in salt consumption behavior (eg, decrease in purchase of salty foods; increase in use of salt substitutes), leading to reductions in sodium intake as measured by urinary sodium in 32 trials (N = 7840 participants; mean difference, –486.19 mg/d [95%CI, –669.44 to –302.95]; P < 0.001; I2 = 92%) and dietary sodium in 19 trials (N = 3750 participants; mean difference –399.86 mg/d [95%CI, –581.51 to –218.20]; P < 0.001; I2 = 96%), equivalent to a reduction of >1 g of salt intake daily. Effects were not significantly different based on baseline sodium intakes, blood pressure status, disease status, the use of behavior change theories, or the main method of intervention delivery (ie, online vs face-to-face).ConclusionBehavior change interventions are effective at improving salt consumption practices and appear to reduce salt intake by >1 g/d.Systematic Review RegistrationPROSPERO registration no. CRD42020185639.

Exercise Training for Multiple Sclerosis: A Narrative Review of History, Benefits, Safety, Guidelines, and Promotion.

Background: There have been significant advances in the medical treatment and management of multiple sclerosis pathogenesis, relapse and disease progression over the past 30 years. There have been advancements in the symptomatic treatment of multiple sclerosis, including management of secondary multiple sclerosis expressions such as walking, cognitive dysfunction, fatigue and depression. Scientific evidence and expert opinion suggest that exercise may be the single most effective non-pharmacological symptomatic treatment for multiple sclerosis. This article presents the historical context of exercise training within the multidisciplinary management of multiple sclerosis. We guide neurologists and healthcare providers on the recommended prescription of exercise and practical, theoretical methods to overcome barriers to exercise. Method: We undertook a critical search of the historical and current literature regarding exercise and multiple sclerosis from the viewpoint of exercise promotion by neurologists and the multidisciplinary care team. Results: We highlight the ever-strengthening body of research indicating that exercise is safe and effective for improving symptoms of multiple sclerosis. Further, exercise training may be necessary for reducing disease progression. Conclusion: We seek to encourage neurologists and specialists in multidisciplinary healthcare teams to prescribe and promote exercise at diagnosis and across all stages of the disease trajectory using prescriptive guidelines as part of comprehensive MS care. Available tools include clinical education to dispel any historical myths related to exercise in multiple sclerosis, clinical exercise guidelines and behaviour change theory to overcome patients barriers to exercise.

The Brief Attitudes Survey for Interprofessional Collaborative Learning: The Design, Reliability, and Validation of a New Instrument.

This paper describes the development and validation of a new questionnaire designed to measure and investigate attitudes towards interprofessional education (IPE) among health professions students. After a thorough literature review and survey of prior instruments, we created an instrument built around a single construct domain: attitudes toward interprofessional collaborative learning. Through a rigorous design methodology rooted in behavior change theory and an iterative question development process, we launched the 11-item “Brief Attitudes Survey for Interprofessional Collaborative Learning” (BASIC-L). Implemented as part of a “toolbox” for assessing the progress of learners in IPE, the questionnaire was then administered to a large cohort of medical and nursing students. Its reliability, validity, and fit with our one-domain model were evaluated via thorough psychometric analysis, including computation of reliability coefficients and a Rasch analysis. These analyses indicate strong reliability, validity, and fit of the questions with our one-domain model. The analyses also included assessment for any sources of measurement error, which were not significant. The BASIC-L appears to be a useful, valid, and reliable instrument for the assessment of attitudes toward interprofessional collaborative learning among students in the health professions, especially as part of a larger multidimensional assessment process.

Limited evidence exists on determinants of physiotherapists' adherence to high value interventions in nonspecific low back pain management: A scoping review.

Examining the emerging body of evidence investigating what drives physiotherapist's clinical decisions in the management of low back pain can guide future research into identifying barriers and facilitators of their adherence to evidence recommended interventions. To establish the body of evidence regarding factors that improve or hinder physiotherapists' adherence to high-value interventions on the management of non-specific low back pain. Scoping review. We conducted a Scoping review by searching MEDLINE, CINAHL, and SPORTDiscus databases on 13 February 2021. Two reviewers independently screened the retrieved literature and selected articles for inclusion. We included quantitative research that investigated an association between physiotherapists' personal characteristics or setting related characteristics with their clinical management of patients with non-specific low back pain. Twelve studies reported in 13 publications were included. The majority of the studies were conducted in high-income countries including, the United States, Canada and UK. Twenty-six factors were investigated as potentially influencing physiotherapists' adherence to high value interventions in low back pain management. The most commonly examined physiotherapists' attributes were educational qualification that is postgraduate or certification course (58%, N=7 studies), years of experience (41%, N=5 studies), and beliefs and attitude about low back pain (41%, N=5 studies). Work setting (N=4) and workload (N=3) were frequently investigated setting related factors. Currently, there is limited evidence available to understand determinants controlling practice behaviours of physiotherapists' management of nonspecific low back pain. Future researches conceptualized within contemporary theories of clinician behaviour change and models of knowledge translation are needed.

The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study.

To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.

Lifestyle in Female Teachers: Educational Intervention Based on Self-Efficacy Theory in the South of Fars Province, Iran.

Introduction Today, improving lifestyles and promoting health are basic needs for human society. The main goal in promoting health is to achieve healthy lifestyle behaviors, and self-efficacy is one of the factors influencing people's lifestyle. Therefore, the impact of educational intervention based on self-efficacy theory on improving lifestyles of the female teachers in Galledar was investigated. Method This study was a semiexperimental study with educational intervention with a control group that was performed on 120 teachers in Galledar. Data collection tools included demographic information questionnaires, health-promoting lifestyle questionnaires, and Sherry's self-efficacy questionnaire. Data were analyzed using SPSS 25 software. Result The mean age and standard deviation of teachers in the control and intervention groups were 33.40 ± 5.68 and 32.83 ± 6.46 years, respectively. Health-promoting lifestyle variables are significant correlation with self-efficacy and overall lifestyle index. Six dimensions which consisted of spiritual growth and self-actualization, health responsibility, interpersonal relationships, stress management, exercise and physical activity, and nutrition showed significant statistical differences before and after educational intervention (P = 0.001). Conclusion Due to the sensitive role of teachers as an effective human force in the development and evolution of society and their students' role modeling, the authorities should formulate policies, regulate educational interventions, and design strategies for promoting self-efficacy beliefs and promoting a healthy lifestyle for all teachers. We suggest that other methods and theories of behavior change be used in future studies to promote a healthy lifestyle.

Learning from the COVID-19 pandemic to combat climate change: comparing drivers of individual action in global crises

The COVID-19 pandemic and climate change are two global crises that require collective action. Yet, the inertia typically associated with behavior change to limit climate change stands in contrast to the speed associated with behavior change to stop the spread of COVID-19. Identifying the roots of these differences can help us stimulate climate-friendly behaviors. We assessed the extent to which a number of theory-based drivers underlie behaviors aiming to counter COVID-19 and climate change with an online survey (N = 534). We focused on the role of a number of drivers derived from prominent behavior change theories and meta-analyses in the field, namely, personal threat, threat to close others, threat to vulnerable others, fear, participative efficacy, injunctive and descriptive social norms, and governmental policy perceptions. We investigated (1) what drivers people perceived as most important to engage in behaviors that limit the spread of the COVID-19 pandemic and climate change and (2) the strength of the associations between these drivers and engaging in behaviors that limit the spread of the pandemic and climate change. Results highlight three key drivers for climate change action: changing perceptions of governmental policy and perceptions of threat to close others and priming participative efficacy beliefs.

The design of persuasive prompts to induce behavioural change through an mHealth application for people with depression

ABSTRACT The alteration of an individual's lifestyle and the adoption of healthy behaviours have been shown to be effective in combating a majority of the major symptoms of depression. While there are several mHealth applications that use behaviour change to reduce depressive symptoms, they are often not grounded in behaviour change theory and display a lack of understanding regarding the specific factors that lead to behaviour change. Therefore, there is a need to test innovative strategies to tackle the issue. One such strategy is the use of behaviour change theories to design mHealth applications that use persuasive prompts to assist in ‘prompting’ the user to adopt healthier behaviours. In this paper, we present the design of persuasive prompts and an mHealth application to induce behavioural change, followed by the results of two studies: (i) an acceptability study that tested the acceptability of the persuasive prompts and (ii) a usability study of the mHealth application. The results show that there is a significant difference in which behaviour change theories users prefer based on their level of depression and that overall, users have a positive perception of the application.

Using experience-based co-design with patients, carers and healthcare professionals to develop theory-based interventions for safer medicines use.

Experience-Based Co-Design (EBCD) is a participatory design method which was originally developed and is still primarily used as a healthcare quality improvement tool. Traditionally, EBCD has been sited within single services or settings and has yielded improvements grounded in the experiences of those delivering and receiving care. In this article we present how EBCD can be adapted to develop complex interventions, underpinned by theory, to be tested more widely within the healthcare system as part of a multi-phase, multi-site research study. We begin with an outline of co-design and the stages of EBCD. We then provide an overview of how EBCD can be assimilated into an intervention development and evaluation study, giving examples of the adaptations and research tools and methods that can be deployed. We also suggest how to appraise the resulting intervention so it is realistic and tractable in multiple sites. We describe how EBCD can be combined with different behaviour change theories and methods for intervention development and finally, we make suggestions about the skills needed for successful intervention development using EBCD. EBCD has been recognised as being a collaborative approach to improving healthcare services that puts patients and healthcare staff at the heart of initiatives and potential changes. We have demonstrated how EBCD can be integrated into a research project and how existing research approaches can be assimilated into EBCD stages. We have also suggested where behaviour change theories can be used to better understand intervention change mechanisms.

The role of health beliefs and health literacy in women's health promoting behaviours based on the health belief model: a descriptive study

BackgroundHealth literacy and health beliefs are factors that can effectively contribute to adoption of preventive behaviors among women. The present study was done to explore the role of health beliefs and health literacy in women's health promoting behaviors based on the health belief model (HBM).MethodsThe descriptive study was conducted in 2020 on 431 female students of Rafsanjan University of Medical Sciences (RUMS) who had been selected through stratified sampling. Data collection tool was a questionnaire which covered eight demographic information, 41 health literacy questions and 50 researcher-developed questions of health belief based on HBM constructs. Data were collected electronically and SPSS version 20 and independent t-test, one-way ANOVA, Pearson correlation coefficient and Multiple Linear Regression were used for data analysis at a significance level less than 0.05.ResultsThe preventive behaviors were adopted by 75.57% of the population and the total health literacy score was found to be 52.71 out of 100. According to the Multiple regression analysis, self-efficacy (β = 0.414, p = 0.001) and cues to action (β = 0.299, p = 0.001) were found to be the first and second robust predictors of behavior, respectively. Health literacy, self-efficacy, cues to action and perceived susceptibility constructs predicted 52.1% of preventive behaviors.ConclusionIt is recommended that researchers design, implement and evaluate interventions based on behavioral change theories, especially the self-efficacy theory, in order to promote women's health.

Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial.

BackgroundAlthough fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity.ObjectiveThe aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy.MethodsThe participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels.ResultsAlthough one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants.ConclusionsBoth groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity.Trial RegistrationClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537

Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review.

It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people’s intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.