Model Of Behavior Change Research Articles

A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients.

Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to identify factors that enable adherence to immunosuppressive medications among patients with SLE from racial and ethnic minority groups. Using a qualitative descriptive study design, we conducted in-depth interviews with purposefully selected (1) patients with SLE from racial and ethnic minority groups who were taking immunosuppressants and (2) lupus providers and staff. We focused on adherence facilitators, asking patients to describe approaches supporting adherence and for overcoming common adherence challenges and providers and staff to describe actions they can take to foster patient adherence. We used applied thematic analysis and categorized themes using the Capability, Opportunity, Motivation, Behavior (COM-B) model. We interviewed 12 patients (4 adherent and 8 nonadherent based on medication possession ratio) and 12 providers and staff. Although each patient described a unique set of facilitators, patients most often described social support, physical well-being, reminders, and ability to acquire medications as facilitators. Providers also commonly mentioned reminders and easy medication access as facilitators as well as patient education/communication and empowerment. Using an established behavioral change model, we categorized a breadth of adherence facilitators within each domain of the COM-B model while highlighting patients' individual approaches. Our findings suggest that an optimal adherence intervention may require a multi-modal and individually tailored approach including components from each behavioral domain-ensuring medication access (Capability) and utilizing reminders and social support (Opportunity), while coupled with internal motivation through improved communication and empowerment (Motivation).

Behavioral theories and models to enhance compliance in cardiac rehabilitation programs for acute myocardial infarction – A narrative review

Acute myocardial infarction (AMI) is a serious and common illness that affects the cardiovascular system. Its sudden onset, high fatality rate, and recurrence rate significantly impact patients’ safety and quality of life. Owing to considerable improvement in living standards, AMI has become a major cause of death and disability, seriously increasing the burden on society. The cardiac rehabilitation program, which involves a multidisciplinary approach to assist patients with daily life guidance, diet guidance, exercise guidance, disease knowledge guidance, medication guidance, psychological guidance, risk factor control guidance, and other comprehensive guidance, has been proven to play a decisive role in the recovery of patients’ cardiac function and the improvement of their quality of life. In addition, these programs help reduce treatment costs and prevent the reoccurrence of disease as well as adverse effects in cardiac patients. However, the introduction and execution of these initiatives are currently in their early stages, characterized by a gradual pace and encountering numerous challenges. Specifically, in the context of AMI, there have been documented instances of reduced engagement, adherence, and compliance with rehabilitation programs, even within industrialized nations. Diverse treatment phases and models have been designed to enhance patient care, patient participation, compliance, and effectiveness of rehabilitation programs. Participation in post-myocardial infarction management CR programs has been reported under par levels which is posing a great threat and burden on society. Various theories and models of behavioral change are proposed to improve patient participation and compliance in cardiac rehabilitation. These theories and models have been utilized in the past to improve patient health and can also improve patients’ perception, and behavior toward active participation in cardiac rehabilitation programs.

Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study.

Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis. Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk. The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.

Older Veterans' perspectives on participation in a clinical exercise program: A qualitative study of the VA Gerofit exercise program.

We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals. Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change. Active and inactive participants differed in their perspectives about how Gerofit impacted their progress toward meeting personal health goals. Active participants noted program features (e.g., schedule, staffing) as facilitators and suggested greater self-efficacy about program participation compared to inactive participants. Both groups perceived the camaraderie with other veterans as a facilitator. Exercise program features, including camaraderie, are important factors that affect the ability of older veterans to participate in exercise and achieve personal health goals.

System Identification of User Engagement in mHealth Behavioral Interventions

Digital behavior change interventions (DBCIs) such as “just-in-time” adaptive interventions (JITAIs) have demonstrated efficacy for increasing physical activity behavior. However, the effectiveness of these interventions is heavily dependent upon user engagement. Despite the inherent dynamic nature of engagement, as it varies over time based on an individual’s changing environment, context, and psychological state, the current understanding of engagement primarily comes from static snapshots of the behavior. The availability of intensive longitudinal data from JITAIs provides a unique opportunity to build and test dynamic models of behavior change from a process systems lens, relying on prediction-error methods from system identification. However, data missingness is a significant practical consideration in this process. Therefore, in this work we address missingness using a Bayesian imputation approach, which we evaluate using data from the HeartSteps II JITAI. Ultimately, the methods presented support the discovery of key factors that impact engagement behavior over time and can play an important role in the development of large-scale personalized interventions.

Engaging internal and external audiences to develop and promote zoo-based conservation efforts.

As place-based conservation organizations, zoos are in a central position to support individuals in making small changes in their lives that will support the protection of wildlife and their habitats. This paper describes the secondary analysis of data collected from multi-phase front-end, exploratory evaluation that informed the development of a conservation action campaign in association with a non-profit, urban zoo. In phase one, internal organization staff were invited to attend workshops during which they brainstormed potential conservation actions that they felt were important for the zoo to promote. They identified and ranked 164 unique actions. In phase two, the ranking was used to narrow down the 164 actions to 20 actions which were used to develop a survey administered to visitors who opted in to receiving online surveys from the zoo. The survey asked participants to state their interest in each of the 20 conservation actions. The Transtheoretical Model of Behavior Change informed the analysis of responses. Through this approach we identified actions that people were already doing, interested in doing, and not interested in doing. The responses from this survey were used to narrow down the list further to 10 actions used in a survey in phase three. This second survey administered to zoo visitors on grounds asked participants which of the 10 actions they would be most interested in doing, and the perceived barriers and benefits of doing them. This process allowed us to use evidence-based decision making to choose which conservation actions would resonate most with the community for our conservation action campaign. We also were able to identify values visitors held that might influence environmentally friendly behaviors. Visitors who responded to this survey tended to respond in ways that aligned with self-transcendent values. The research suggests that the campaign should focus on habitat restoration and remediation and purchasing wildlife friendly coffee and other products.

Construção e validação de conteúdo para vídeos educativos ancorado na mudança de comportamento para pessoas com diabetes

Abstract Objective: to build and validate the content of educational video scripts, focusing on behavioral changes for the self-care of people with diabetes. Method: this work was a methodological study, anchored in the transtheoretical model of behavioral change, developed between September 2021 and November 2022, involving two stages: theoretical procedures and empirical and analytical procedures. Validation was carried out by nine judges in the first round and six in the second. In data collection, a Likert-type scale was used, divided into nine criteria and subsequently analyzed based on the content validation index (above 80%) and binomial test. Results: four scripts were constructed based on the topics: self-assessment of behavior, stages of the motivation for change stage, reflections on daily behaviors, adoption of healthy habits, and relapses in the change process. The content achieved an average Validation Index of 0.93 and 1.0 in the first and second round, respectively. Conclusion: the scripts constructed constitute tools with the potential to support health education actions used with people with diabetes in an attempt to change behaviors.

PENERAPAN TRANSTHEORICAL MODEL BEHAVIORAL CHANGE TERHADAP KEPATUHAN BEROBAT PADA PASIEN MULTIDRUG RESISTANT TUBERCULOSIS DI PUSKESMAS KOTA DAN KABUPATEN JAYAPURA

Multi Drug Resistant Tuberculosis (MDR-TB) is still a global health problem. Indonesia is the 3rd country with an average of 5% cases per 100,000 population. For the Papua region, MDR-TB is still a major problem because the treatment success rate has not reached the WHO indicator (68.7%). The treatment of MDR-TB is complex and time-consuming, making patients non-compliant. Reports of low patient visits have made it possible to develop a promotive service program based on applying the Transtheoretical Model (TTM) of Behavioral Change. The TTM Model focuses on changing behavior with the main component of self-efficacy. The study aimed to determine the characteristics of patients, treatment compliance of MDR-TB patients, analyze the effect of applying the TTM behavioral change model with the level of treatment compliance of MDR-TB patients. The research method used a pre-experiment design with a one-group pre-test-post-test design. The study population was 35 patients at the city and district health centers of Jayapura. The instruments used were the Self-Efficacy For Appropriate Medication Use Scale (SEAMS) and TB Medication Adherence Scale (TBMAS). The effect test used a paired sample t-test with significance level p-value=0.05. This indicates an effect of changes in compliance behavior after being given health promotion by applying the Transtheoretical Model. Substantially, the level of adherence to taking medication in MDR-TB patients is also influenced by belief and motivation to recover. There is support from nurses at the puskesmas who often provide behavior change promotions, so patients have the strength and support of a good system that has a positive impact on increasing thoughts to achieve recovery. The importance of Increasing health promotion based on behavior change in MDR-TB patients can increase self-efficacy to recover so that it has an impact on adherence to taking medication.

THE USE, QUALITY AND EFFECTIVENESS OF PELVIC EXAMINATION IN PRIMARY CARE FOR THE DETECTION OF GYNAECOLOGICAL CANCER

Introduction: Pelvic examinations are vital for timely detection of gynecological cancers in primary care, yet discomfort can deter some women from seeking them. General practitioners face challenges in managing intimacy during exams, impacting their skills and confidence. Understanding these complexities using behavior change models like COM-B can aid in developing interventions to enhance pelvic examination uptake and address barriers in primary care settings for early cancer detection. A systematic review aims to consolidate qualitative studies on GPs' perceptions and experiences regarding pelvic exams, focusing on their role, barriers, and factors influencing GP behavior. Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: The search produced 18 results. After looking at the titles and summaries, we found 10 papers that fit our criteria. At first, we excluded several articles because they were written in review style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included a cross sectional study, randomized control trial, and several guidelines. Conclusion: Understanding and predicting healthcare provider behavior in gynecological examinations is complex. The Theory of Planned Behavior provided some insights into intentions but didn't fully explain actual behaviors, which were influenced by external factors like workload. Recommendations suggest tailored approaches for high-risk groups and aligning pelvic exams with cervical screening intervals. However, concerns arise from potential overuse of exams and the impact of fee-for-service payments. More comprehensive research is needed to guide noncervical malignancy screenings and comprehend the various factors influencing healthcare provider behavior in these clinical practices.

Co-Design of a Reusable Learning Object (RLO) to Address Caregiver Responsive Infant Feeding Behaviours (CRIB) to Prevent Childhood Obesity: A Mixed-Method Protocol.

Responsive infant feeding is a key strategy for childhood obesity prevention. Responsive feeding involves caregivers responding to infant hunger and satiety cues in a timely and developmentally appropriate manner. There is a dearth of evidence-based information and guidance for caregivers on how to responsively feed their infants. The aim of this research is to co-design a Reusable Learning Object (RLO) and guidance infographic to improve caregiver awareness, understanding and use of responsive infant feeding behaviours. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change and the Aim, Storyboarding, Populate specification, Implement media, Review and release prototype, and Evaluate (ASPIRE) approach for digital intervention co-design will be utilised. Four co-design workshops with caregivers of infants and healthcare professionals (HCPs) will determine priority RLO content. Content analysis will enable RLO development and process reporting. Formative and summative surveys will be conducted to evaluate the usability of the RLO, its impact on caregivers and its potential implementation into NHS care pathways. The output will be a RLO on responsive feeding for caregivers and an infographic for HCPs/support workers which will contribute to a future obesity prevention intervention. The findings will be disseminated to stakeholders and submitted for publication in a peer-reviewed journal.

MAINTENANCE OF HEALTH BEHAVIOR CHANGE: RECOMMENDATIONS FOR FUTURE RESEARCH

Abstract Modifying poor health behaviors can enhance function, improve quality-of-life, and reduce morbidity and mortality among older adults. However, achieving and sustaining behavior change can be difficult. A growing body of research suggest that initiation and maintenance are unique constructs within health behavior change; each requiring unique skills and each associated with unique outcomes. Although some leading health behavior change models (e.g., Transtheoretical Model of Change) include maintenance as a construct, maintenance is often overlooked in the scientific literature. As part of a NIA Research Centers Collaborative Network (RCCN) pilot award, this project utilized a series of qualitative activities to explore the concept of maintenance and identify future recommendations for advancing the field. Three unique listening sessions were conducted with clinician-researchers (1 group) and community-based service organizations (2 groups). An interdisciplinary expert think tank was then convened to reflect on key findings. All sessions were conducted virtually; transcripts were reviewed using a priori themes with additional themes generated by an open coding approach. Major themes included the following: (1) To date, there is no consensus definition of maintenance nor is there agreement on maintenance across behaviors. (2) Few behavior change models consider how health behaviors must shift to accommodate for age-related changes in cognition and/or physical function. (3) Existing funding mechanisms and timelines may not allow sufficient follow-up periods to examine maintenance over time. (4) Although the terms maintenance and sustainment are used interchangeably, community leaders emphasized the importance of sustaining health promotion programs in order to enable maintenance to occur.

DEFINING AND CHARACTERIZING MAINTENANCE: RESULTS FROM A LITERATURE REVIEW

Abstract Leading models of health behavior change define maintenance as sustainment of the target behavior over time. Although behavior change interventions for physical activity have shown to be effective in older adults, maintenance of activity levels after an active intervention period is rarely examined. This literature review aimed to identify the following: (1) frequency with which maintenance is described and measured in the scientific literature; (2) intervention techniques utilized to promote maintenance; and (3) common barriers and facilitators to maintenance. Systematic searches of electronic databases (Embase, CINAHL, PubMed) identified 20 eligible studies (conducted in United States, single component physical activity intervention with 1+ follow-up period(s) beyond post-treatment assessment). Six studies reported maintenance in the title and only 8 included a theoretical model or framework [Social Cognitive Theory (N=5), Theoretical Domains Framework (N=1), Attribution Theory (N=1), Three-Level Hierarchical Framework (N=1)]. No studies defined maintenance. The majority of studies (N=16) provided only 1 follow-up after the post-treatment assessment (range: 4 weeks – 18 months). One-half of studies described specific intervention strategies to support maintenance, including goal-setting, personalized feedback, and social support. Six studies described barriers, including costs, aversion to activity or environment, low motivation, time constraints, and self-efficacy. Only two studies reported facilitators to maintenance, including knowledge, confidence, self-efficacy, and social support. These findings highlight the gap in health behavior scientific literature addressing maintenance of physical activity behaviors following structured interventions for older adults.

Applying the transtheoretical model of health behavior change: using calendars for hypertension management in elderly individuals during the COVID-19 pandemic in Phrae Province, Thailand

Hypertension is a persistent global public health concern, particularly affecting elderly individuals and is further compounded by the challenges posed by the COVID-19 pandemic. Innovative interventions are essential to effectively manage blood pressure in this vulnerable demographic group. This quasi-experimental study implemented a calendar-based intervention among 84 elderly individuals in Phrae Province, Thailand. The intervention integrated dietary recommendations, physical activity guidelines, and hypertension education. Over eight weeks, the intervention group exhibited a significant reduction in systolic blood pressure (6.59 mmHg) and diastolic blood pressure (2.52 mmHg) levels (p-value<0.05), contrasting with the comparison group's increase. The calendar-based program effectively enhanced hypertension knowledge, empowering participants to make informed health decisions. The study's holistic approach, grounded in health behavior change models, effectively promoted hypertension awareness and facilitated healthier lifestyles. Results suggest the calendar-based program's suitability for elderly individuals at high risk of hypertension, especially during the COVID-19 pandemic, due to its cost-effectiveness and accessibility. This research underscores the potential of calendar-based interventions in supporting blood pressure management among elderly populations, with broader implications for public health strategies, especially during challenging circumstances such as pandemics.

SOCIALIZATION MODELS OF WASTE MANAGEMENT IN RURAL COMMUNITIES (A CASE STUDY OF THE COMMUNITY OF CILELES JATINANGOR)

Waste is basically materials intentionally or unintentionally discarded as the product of human activities or natural processes. The handling and management of waste are increasingly more complex and complicated as its volume, types, and composition are more and more complex. Optimizing waste management needs an active role of the community to reduce, sort, and recycle the waste. However, the participation of the community in waste management often presents a complex challenge because it involves cultural, social, and economic factors. The community empowerment was conducted in Cileles Village, Jatinangor. Its proximate location to the center of education and economy gives Cileles Village the potential for the development of sustainable waste management. However, up to the present time, waste management in the village still faces some obstacles, such as the lack of infrastructure and the lack of the community’s motivation for sorting their waste. The result of this community service activity indicates that the community has a positive perception of waste and an awareness of waste management. However, the perception has not materialized in the community's daily behavior in managing their waste. For this reason, Socialization models of waste management have been carried out with participation, behavior change, and collaboration models.

Motivations of pedestrians for safe use of highway crossing: an application of the behaviour change model COM-B in Bangladesh

Motivations of pedestrians for safe use of highway crossing: an application of the behaviour change model COM-B in Bangladesh

A qualitative exploration of behaviour change and maintenance experience in people with overweight or obesity in a dietary intervention.

This qualitative study aimed to explore the experiences of participants who were enrolled in 6-month controlled weight loss interventions with 2-month follow-up to better understand the process of behaviour change and maintenance. Fifteen participants who completed or dropped out from either a daily energy restriction or intermittent fasting group were recruited using maximum variation purposive sampling. In-depth, semi-structured interviews were conducted at the 2-month follow-up phase. All interviews were transcribed and analysed using thematic analysis, guided by behaviour change models including transtheoretical model, social cognitive theory and integrated model of change. Participants following both diets showed similar behaviour change patterns. Their first motivations were mostly external and relied on 'accountability' to adhere to the diet when initiating the dietary changes. Participants highlighted the importance of frequent reviews and monitoring in assisting their adherence. This feedback system promoted the development of self-efficacy and internalised motivation to encourage an 'ownership'. Participants who transitioned successfully from relying on accountability to take 'ownership' of the intervention were more capable of tackling challenges and tailoring their diet to form a new routine for long-term maintenance. External motivations were key to initiate while internalised motivations were more important to sustain the behaviour change. Health professionals can assist this process through routine monitoring and feedback processes in clinical practice.

P57: The ENGAGED study: dementia prevention co-design for people living with depression

Background:People living with depression are at increased risk of poor health outcomes, including dementia. Interventions to reduce dementia risk (dementia risk reduction (DRR)), include physical activity, diet and vascular health interventions. These can also benefit depressive symptoms and broader health, making DRR an important part of holistic mental health care for depression. However, enabling engagement and adherence, and embedding interventions in mental health clinician practice are ongoing challenges that limit the impact of interventions and implementation in clinical practice. Improved intervention tailoring and new approaches to intervention design and implementation are urgently needed. Co-design approaches have been shown to improve engagement and the impact of complex interventions in diverse fields, but have not previously been used in DRR.Objective:The ENGAGED study will examine DRR intervention needs specifically for people living with depression, then co-design a tailored DRR intervention for use in mental health clinical settings.Methods:The study will adapt a co-design model for mental health settings that emphasizes lived-expertise, and incorporate processes and evidence from behavioral science. Participants will include middle-aged and older people living with depression, and mental health clinicians.Semi-structured interviews with both participant groups will examine unmet intervention needs. Illuminated shared experiences and themes will be explored further through focus group discussions to develop consensus intervention priorities. They will also be analyzed to produce a contextualized model of relevant behavior change. Participants and researchers will then work together to co-design intervention components and refine prototypes. Finally, mixed methods survey will evaluate the co- design process and participant experiences.Results:This study will provide two key outputs to enhance future intervention tailoring and engagement: 1.1) a pragmatic blueprint for DRR intervention with people experiencing depression across diverse mental health clinical settings, ready for evaluation and implementation2.2) a model of DRR behavior change that is specified to this population.Evaluation findings will support methods development for applying co-design to cognitive and mental health research.Conclusion:This research addresses the need for new approaches to tailored, integrated mental, physical and cognitive healthcare for people living with depression that emphasize stakeholder expertise and engagement to facilitate holistic support.

P102: Supporting Informal Carers to Undertake Regular Physical Activity from Home: a Co-design and Prototype Development Study of a novel app, “CareFit”

Background:Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.Objective:The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.Methods:We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.Results:Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.Conclusions:Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.

Abstract A005: The development of a bioethically sensitive education video: Addressing the barriers to African Americans’ and Hispanics’ participation in clinical and genomic research through digital animation

Abstract Introduction: Research advances on effective methods to prevent, diagnose and treat cancer continue to emerge through clinical and genomic research. To ensure the results from these research studies help those who need it most, a diverse population needs to enroll. Despite guidance from authorities, such as the National Institutes of Health, most clinical trial and genomic research participants identify as White. At the participant level, mistrust of research, unawareness of research opportunities and gaps in bioethical knowledge about clinical trials and genomic research remain proven barriers to participating, especially among African Americans (AA) and Hispanics. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of AA and Hispanics in research. Methods: Members from the NCI-funded Partnerships to Advance Cancer Health Equity (PACHE) including experts from the community, healthcare, biomedical research and public health, such as oncologists, cancer geneticists, behavioral scientists and bioethicists collaborated on all phases. A design lab with experience synthesizing complex health messages into brief animations was contracted. The goal was to utilize existing educational resources from the National Cancer Institute and the National Human Genome Research Institute to create a tailored message to address AA's and Hispanics’ beliefs, values and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the animated video. Results: Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. In the last two steps, the video was presented to family members of cancer patients, cancer survivors and community members who provided quantitative and qualitative feedback which informed further edits. The final animated video is approximately five minutes in length and covers several topics including the goal of clinical research, disparities in clinical trials and genomic research participation, genomic research regulations and the purpose of a biobank. Supporting imagery to emphasize specific concepts, such as racial disparities in research, was dispersed throughout the video. A voiceover emphasized key bioethical concepts, including how research participation is safe and voluntary. When possible, characters were designed to resemble the targeted viewing audience. Discussion: Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials. Future research will evaluate the efficacy of the video through a multi-level framework in real-world settings. Citation Format: Victoria Churchill, Yu-Mei Schoenberger, Vivian L Carter, Windy Dean-Colomb, Roland Matthews, Desiree Rivers, Stephen O Sodeke, Jamirah Chevrin, Brian Rivers. The development of a bioethically sensitive education video: Addressing the barriers to African Americans’ and Hispanics’ participation in clinical and genomic research through digital animation [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A005.

Designing EXercise for Cognitive hEalth in depression and anxiety: the EXCEL study

AbstractBackgroundPhysical inactivity significantly contributes to chronic disease burden, including increasing dementia risk. Physical activity (PA) can benefit cognitive health for groups at high‐risk of dementia, such as people experiencing cognitive concerns (including mild cognitive impairment and subjective cognitive decline), and mental health symptoms. However, understanding how to best enable people with co‐occurring cognitive and mental health concerns to increase PA for dementia risk reduction (DRR) remains challenging for researchers, resulting in lower adherence in clinical trials and limiting the impact of implementation in clinical practice. The EXCEL PA implementation study incorporated design approaches from behavioral science that were novel to DRR, to improve intervention tailoring and engagement. We report findings from the first phase of EXCEL, which aimed to understand PA behavior change needs in this population and identify unique intervention tailoring requirements to enable more effective engagement.MethodThe study used the Capability, Opportunity and Motivation (COM‐B) model of behavior change as an organizing framework. Middle‐aged and older people (aged 45 – 85 years) experiencing subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and mild‐moderate depression or anxiety were interviewed. Themes from semi‐structured interviews examining PA and DRR perspectives were triangulated with findings from published PA intervention trials to identify convergent and complementary themes. Integrated findings were mapped to the study framework to develop a specified, contextualized model of key factors influencing PA behavior change and matched intervention approaches.ResultData from 21 interviews and 24 relevant papers were included. Identified areas requiring behavior change support in the target population that have not been emphasized in theory or previous interventions included:• Emotional regulation• Turning intentions into action despite distractions or barriers• Confidence in existing skills, including to overcome barriers and regulate emotionThese aligned with and extended COM‐B and provided a model to guide the EXCEL intervention.ConclusionThis novel model used behavioral science methods to tailor an intervention for people experiencing cognitive concerns and depression or anxiety, supporting improved PA engagement and impact for an at‐risk population (see Ellis et al. AAIC‐23, submitted, for trial results).