Behaviour Change Techniques Research Articles

Associations between behaviour change technique clusters and weight loss outcomes of automated digital interventions: a systematic review and meta-regression

ABSTRACT Automated digital interventions for weight loss represent a highly scalable and potentially cost-effective approach to treat obesity. However, current understanding of the active components of automated digital interventions is limited, hindering efforts to improve efficacy. Thus, the current systematic review and meta-analysis (preregistration: PROSPERO 2021-CRD42021238878) examined relationships between utilisation of behaviour change techniques (BCTs) and the efficacy of automated digital interventions for producing weight loss. Electronic database searches (December 2020 to March 2021) were used to identify trials of automated digital interventions reporting weight loss as an outcome. BCT clusters were coded using Michie’s 93-item BCT taxonomy. Mixed-effects meta-regression was used to examine moderating effects of BCT clusters and techniques on both within-group and between-group measures of weight change. One hundred and eight conditions across sixty-six trials met inclusion criteria (13,672 participants). Random-effects meta-analysis revealed a small mean post-intervention weight loss of −1.37 kg (95% CI, −1.75 to −1.00) relative to control groups. Interventions utilised a median of five BCT clusters, with goal-setting, feedback and providing instruction on behaviour being most common. Use of Reward and Threat techniques, and specifically social incentive/reward BCTs, was associated with a higher between-group difference in efficacy, although results were not robust to sensitivity analyses.

Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial

BackgroundThe effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community.MethodsA two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention.ResultsThe feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants’ compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers.ConclusionThe DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare.Trial registrationRegistered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis.

This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes. Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g). Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies. The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.

Use of Biological Feedback as a Health Behavior Change Technique in Adults: Scoping Review.

Recent advancements in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data are used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored. The purpose of this review was to (1) map the domains of research where biological feedback has been used as a behavior change technique and (2) describe how it is implemented in behavior change interventions for adults. A comprehensive systematic search strategy was used to query 5 electronic databases (Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global) in June 2021. Eligible studies were primary analyses of randomized controlled trials (RCTs) in adults that incorporated biological feedback as a behavior change technique. DistillerSR was used to manage the literature search and review. After removing 49,500 duplicates, 50,287 articles were screened and 767 articles were included. The earliest RCT was published in 1972 with a notable increase in publications after 2000. Biological feedback was most used in RCTs aimed at preventing or managing diabetes (n=233, 30.4%), cardiovascular disease (n=175, 22.8%), and obesity (n=115, 15%). Feedback was often given on multiple biomarkers and targeted multiple health behaviors. The most common biomarkers used were anthropometric measures (n=297, 38.7%), blood pressure (n=238, 31%), and glucose (n=227, 29.6%). The most targeted behaviors were diet (n=472, 61.5%), physical activity (n=417, 54.4%), and smoking reduction (n=154, 20.1%). The frequency and type of communication by which biological feedback was provided varied by the method of biomarker measurement. Of the 493 (64.3%) studies where participants self-measured their biomarker, 476 (96.6%) received feedback multiple times over the intervention and 468 (94.9%) received feedback through a biosensing device. Biological feedback is increasingly being used to motivate behavior change, particularly where relevant biomarkers can be readily assessed. Yet, the methods by which biological feedback is operationalized in intervention research varied, and its effectiveness remains unclear. This scoping review serves as the foundation for developing a guiding framework for effectively implementing biological feedback as a behavior change technique. Open Science Framework Registries; https://doi.org/10.17605/OSF.IO/YP5WAd. RR2-10.2196/32579.

The Feasibility of Make My Day-A Randomized Controlled Pilot Trial of a Stroke Prevention Program in Primary Healthcare.

Incorporating and sustaining engaging everyday activities (EEAs) in everyday life holds potential for improving health and wellbeing; thus, there is reason to explore EEAs as a behavioral change technique in stroke prevention. The aim of this study was to evaluate the feasibility of the stroke prevention program Make My Day (MMD) for people with moderate-to-high risk for stroke in a primary healthcare setting, where EEAs are utilized to promote healthy activity patterns. A randomized controlled pilot trial was designed to evaluate the feasibility of MMD. Twenty-nine persons at risk for stroke were recruited and randomized into either an intervention group (n = 14) receiving MMD or a control group (n = 15) receiving brief health advice and support with goal setting. The results suggest that MMD is feasible, with timely recruitment, overall high response rates and study completion, and sensitivity to change in key outcome measures. Moreover, the results demonstrate that the application of EEAs can be useful for promoting behavioral change in stroke prevention. Recommendations for improvements for a full-scale trial include recruiting a relevant sample, using reliability- and validity-tested outcome measures, and implementing strategies to limit missing data.

Diabetes prevention at scale: narrative review of findings and lessons from the DIPLOMA evaluation of the NHS Diabetes Prevention Programme in England.

The Diabetes Prevention Programme is a large-scale, England-wide behaviour change programme for people at high risk of progressing to type 2 diabetes. We summarise the findings of our six-year DIPLOMA evaluation of its implementation and impact and highlight insights for future programmes. Using qualitative interviews, document analysis, observation, surveys and large dataset analysis, eight interlinked work packages considered: equity of access; implementation; service delivery and fidelity; programme outcomes; comparative effectiveness and cost-effectiveness in reducing diabetes incidence; and patient decision making and experience. Delivery of the NHS-DPP encountered barriers across many aspects of the programme, and we identified inequalities in terms of the areas, organisations and patient populations most likely to engage with the programme. There was some loss of fidelity at all stages from commissioning to participant understanding. Despite these challenges there was evidence of significant reductions in diabetes incidence at individual and population levels. The programme was cost-effective even within a short time-period. Despite the challenge of translating research evidence into routine NHS delivery at scale, our findings suggest that an individual-level approach to prevention of type 2 diabetes in a 'high-risk' population was more effective than usual care. By embedding evaluation with programme delivery and working closely with the NHS DPP team, we provided actionable insights for improving communications with potential participants, supporting primary care referral, honing the delivery model with better provider relationships and more patient choice, increasing understanding of behaviour change techniques, and enriching the educational and health coaching content.

Development of an implementation strategy for routine collection of generic patient reported outcome measures: a qualitative study in multidisciplinary community rehabilitation

Purpose To explore staff perceptions of barriers and enablers towards implementing the EQ-5D-5L in community rehabilitation, and develop a theory-informed implementation approach for routine administration of generic patient-reported outcome measures (PROMs) using implementation science frameworks. Materials and methods A qualitative study was conducted at three sites. Multidisciplinary rehabilitation staff completed individual semi-structured interviews, which were transcribed and coded against the Theoretical Domains Framework (TDF). We identified and selected potentially effective behaviour change techniques using the Behavior Change Wheel. Hypothetical strategies were operationalised. Results Twenty-one interviews were conducted, and four themes emerged: (1) The Impact of PROMs on patient centered-care; (2) Considerations for validity of PROMs; (3) Service-level impact of embedding PROMs; (4) Practical issues of embedding PROMs within the service. Barriers and enablers were mapped to seven of the TDF domains; relating most to clinicians’ “belief about consequences”, “reinforcement”, and “environmental context and resources”. Five hypothetical strategies were developed to overcome identified barriers and strengthen enablers. Key behaviour change techniques underpinning the strategies include: restructuring the physical environment, incentivisation, persuasion and education, enablement, and, social support. Conclusions Our implementation approach highlights the importance of automating processes, engaging site champions, routinely reporting, and using PROM data to inform service provision.

Beach recreationists perceive a lack of knowledge about shorebirds’ needs as a constraint to walking around shorebird flocks

Abstract Walking through shorebird flocks can have negative impacts on shorebird populations. Understanding human behavior is essential for minimizing disturbance. As such, we used a mixed methods approach consisting of phone interviews and a survey to explore (1) recreationists’ perceived benefits and constraints to voluntarily walk around shorebird flocks, (2) recreationists’ intentions to walk around shorebird flocks, (3) differences in behavioral intention by sociodemographic variables, and (4) differences in norms, benefits, and constraints among recreationists who intend to walk around flocks and recreationists who do not intend to walk around flocks. We found that perceived benefits to walking around flocks were maintaining undisturbed conditions for shorebirds and reducing harm to people and their dogs, whereas perceived constraints related to a lack of knowledge about shorebirds’ needs. The majority of recreationists were willing to walk around flocks, rather than through them. Intention to walk around flocks can vary by sociodemographic groups. Recreationists who intended to walk around flocks had stronger personal and social norms than recreationists who did not intend to walk around flocks. Recreationists who intended to walk around flocks generally agreed more strongly that maintaining undisturbed conditions for shorebirds and reduced harm to people and their dogs were benefits, compared to participants who did not intend to walk around flocks. Recreationists who did not intend to walk around flocks agreed more strongly that a lack of knowledge about shorebirds’ needs was a constraint compared to participants who intended to walk around flocks. Our findings could be used in the strategy development phase of a community-based social marketing campaign (CBSM) aimed at encouraging recreationists to voluntarily walk around shorebird flocks. Using behavior change techniques, benefits uncovered in this study can be emphasized and constraints uncovered in this study can be reduced for the purpose of promoting less disturbance to shorebirds.

A Systematic Review of the Effectiveness of Brief Health Behaviour Change Interventions on Service Users Accessing the Third and Social Economy Sector

There are well-established relationships between socioeconomic status (SES) and all aspects of health. Brief interventions offer a cost-effective method to target health behaviours, helping to reduce these health inequalities. Furthermore, the third and social economy (TSE) sector, which encompasses all not-for-profit groups and organisations that operate outside of the family, household, and government, offers access to those of lower SES and a motivated workforce with established relationships with service users. The aim of this systematic review was to investigate the effectiveness of brief interventions targeting health behaviours and their social determinants, when delivered within TSE settings or by TSE service providers (PROSPERO registration number: CRD42022301969). Eight databases were searched for brief health behaviour change interventions lasting under 30 minutes per session, delivered by volunteers within the TSE sector or delivered within the TSE sector provided by or within a TSE, from all possible publication dates to February 2022. Behaviours relating to smoking, diet, alcohol, physical activity, housing, or finance were included. Narrative synthesis and Cochrane risk of bias tools were applied. Eight eligible studies were identified, most measuring smoking behaviour and with a considerable risk of bias. Only one study was set both within a TSE setting and delivered by TSE providers. The most common behaviour change techniques applied were the provision of information on both the consequences of the behaviour and further support. Brief interventions showed a minimal, if any, reduction in smoking behaviour and cholesterol levels, with more intensive interventions resulting in a far greater improvement in smoking, diet, and physical activity behaviours than brief intervention. This study highlighted a lack of research on brief interventions within the TSE sector, particularly for alcohol consumption. More qualitative research is needed to explore the feasibility and acceptability of brief interventions within the TSE settings. Limitations are discussed, including the high risk of bias of included studies and the exclusion of mental health.

182 Pharmacists’ opinions on deprescribing Fall Risk Increasing Drugs in older people

Abstract Background Falls are prevalent in older adults and can be associated with medication use. Pharmacists play a role in deprescribing Fall Risk Increasing Drugs (FRIDs) and fall prevention. The aim of this study was to explore the factors that prevent or influence the process of deprescribing of FRIDs in older adults, from a pharmacist’s point of view. Methods Individual online semi-structured interviews, involving clinical pharmacists (CPs) who work with older adults in hospitals, were conducted. The interviews were steered by an interview guide based on the Theoretical Domains Framework (TDF) and interviews continued until saturation. The transcripts were coded using NVivo 12. Challenges and enablers were matched with possible behavioural change techniques, to identify potential future intervention strategies. Results Twelve senior CPs participated in the study (11 female and 1 male; years of practice range 5–30 years). Common challenges included: deprescribing FRIDs not being prioritised by medical teams; medication review is time-consuming; written recommendations to doctors not always read/actioned; fear of withdrawal symptoms; and follow up on patients after discharge is difficult. Deprescribing enablers included: building good team relationships, the belief that medication review is a shared responsibility, verbal being the most effective method of communication, medication review being a core part of pharmacists’ workload, and having the opportunity to review medication and monitor during the inpatient stay. Conclusion Work environment challenges and concerns about safety after discharge were considered significant barriers to deprescribing FRIDs in hospitals. Involving pharmacists in multidisciplinary teams in hospitals may facilitate deprescribing.

106 Older adults’ perspectives on participation in a community arts-based programme (Music and Movement for Health): a qualitative study

Abstract Background Ireland, like most counties worldwide, has an ageing population. It is estimated that there will be greater than one million older adults by 2031, demonstrating an increase from 13% (2015) to 20% of the overall population. Physical inactivity, which increases with age, is associated with greater multimorbidity, mortality and economic burden. Arts-based exercise programmes are an emerging area of preventative healthcare. The aim of this study was to explore the opinions and experiences of older adults on Music and Movement for Health (MMH), a tailored arts-based exercise programme. Methods An embedded qualitative study was conducted among older adults who participated in MMH. Data were collected through four focus groups (n = 33) and telephone interviews (n = 5). Data were analysed inductively using thematic analysis. Results Three overarching themes were developed; ‘Encouraging Exercise Through the Arts’, ‘Socialising in the Community: Experiences and Influences’, and ‘Coming to Terms with Retirement’, with a total of six subthemes. Participants recognised that MMH was a novel and unique programme and were attracted to MMH due to an interest in music and dance. The behaviour change techniques facilitated exercise habit formation. Through MMH, participants were able to interact with others in the community and, for some, this led to new connections within the group. Finally, the findings highlight the experiences of participants who stated they faced significant changes to their lives following retirement; however, participating in MMH provided structure to their lives. Conclusion The inclusion of music and dance into an exercise class was desirable to many older adults and promoted exercise habit formation. Overall, MMH appears to be an enjoyable programme which had positive perceived effects on mental and physical health. MMH is a unique evidence-based programme designed with input from key stakeholders, and community-dwelling older adults can potentially benefit from this intervention across the country.

Glycaemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass—study protocol for a randomized controlled trial

BackgroundApplying technology through the use of the Internet and mobile phones can help provide education and trained peer support for patients with diabetes after coronary artery bypass (CABG). We are conducting a randomized controlled trial to evaluate the efficacy and feasibility of mobile-based coaching intervention in improving risk-factor control and secondary prevention in patients with diabetes after CABG.MethodsThe glycaemic control using miniprogram-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDE ME) study is a multi-centre, randomized controlled trial of mobile intervention versus standard treatment with 6 months follow-up conducted in 2 hospitals in China. The interventions are education and a reminder system based on the WeChat mini-program. Participants in the intervention groups receive 180 videos (including lines) about secondary prevention education for 6 months as well as the standard treatment. Behavioural change techniques, such as prompting barrier identification, motivational skills, and goal setting, are employed. A total sample size of 820 patients would be adequate for the GUIDE ME study. The primary outcome is the change of glycaemic haemoglobin (HbA1c) at 6 months. Secondary outcomes include a change in the proportions of patients achieving HbA1c, fasting blood glucose, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C) and medication adherence.DiscussionThis trial is the first to investigate the efficacy of mobile phone WeChat-based video coaching and medication reminder mini-program system to improve self-management in patients with diabetes and coronary heart disease (CHD) after CABG and has the potential to be applied in resource-limited settings across diverse populations. If successful, such mobile intervention could be used and scaled up to improve care for this high-risk group of patients.Trial registrationClinicalTrials, NCT04192409. Registered on December 10, 2019.

Evaluating a WeChat-Based Health Behavioral Digital Intervention for Patients With Hypertension: Protocol for a Randomized Controlled Trial.

Hypertension is the most prevalent chronic condition and a significant risk factor for cardiovascular and kidney diseases. The efficacy of health behavioral interventions in blood pressure (BP) control has been demonstrated by a large and expanding body of literature, with "adherence" playing a crucial role. WeChat is the most common social communication mobile app in China, and it has been shown to be an acceptable delivery platform for delivering health interventions. The WeChat-based health behavioral digital intervention program (WHBDIP) showed high feasibility and efficacy. However, the results regarding BP improvement between the WHBDIP and control groups were inconsistent. The objective of this study is to develop a WHBDIP and assess its efficacy in controlling BP and improving adherence among patients with hypertension. A 2-arm, parallel-group, and randomized trial design was used. Patients older than 60 years and with hypertension were randomly assigned to either the control group or the experimental group, which received a 12-week intervention. The program, primarily developed based on the Behavior Change Wheel (BCW) theory, offers health education on exercise, diet, BP monitoring, and medicine adherence (MA). It also includes other behavior interventions guided by an intervention manual, incorporating behavior change techniques (BCTs). The primary outcomes encompass BP and adherence indicators, while the secondary outcomes encompass cardiovascular function indicators, body composition indicators, learning performance, satisfaction, and acceptability. The exercise and blood pressure monitoring adherence (BPMA) indicators for the WHBDIP group were assessed weekly via WeChat during the initial 3 months, while other outcome data for both groups will be collected at the baseline assessment phase, 3 months after the intervention, and 1 year after the program. The trial will assess the efficacy of WHBDIP for patients with hypertension (N=68). The WHBDIP seeks to enhance participants' knowledge of healthy behaviors and assist patients in developing positive health behaviors to improve their health outcomes. Patient recruitment for individuals with hypertension commenced on September 5, 2022, and concluded on September 19, 2022. The 3-month intervention and phased data collection were finalized in January 2023. Data analysis will commence in August 2023, and the final 1-year health outcome results will be collected in September 2023. A successful WHBDIP will establish the management mode as a feasible approach for hypertension management in the community. Additionally, it will pave the way for the development of related mobile health programs. Chinese Clinical Trial Registry ChiCTR2200062643; https://tinyurl.com/mwyv67wk. PRR1-10.2196/46883.

O.4.2-11 Effects of habit formation interventions on physical activity habit strength: meta-analysis and meta-regression

Abstract Background Interventions aimed at promoting physical activity (PA) behavior through habit formation pathways are gaining popularity, as they differ from conventional interventions that rely on intention pathways. Past research has established a positive correlation between PA habits and behavior. However, the efficacy of current interventions designed to form PA habits and improve PA automaticity is not yet fully ascertained. Additionally, the intervention components that significantly impact the effectiveness of these interventions are yet to be determined. Methods We conducted a search of three databases (PubMed, Embase, and Cochrane Library) from January 2000 to December 2022, with a focus on interventions for developing PA habits. Two independent authors conducted paper selection, quality assessment, data extraction, and coding of behavior change techniques (BCTs). The effect size of interventions was calculated using standardized mean difference. Subgroup analyses were carried out based on follow-up duration, delivery method, sample characteristics, and theory. Furthermore, we employed meta-regression to investigate the association between BCTs and PA habits. Results Ten eligible studies with relatively high quality were included in the final data set. Characteristics of studies varied in intervention sample and delivery way. The habit formation interventions significantly increased PA habit (SMD=0.31, 95% CI 0.14 - 0.48, P&amp;lt;.001) compared to the control groups. Subgroup analysis demonstrated that the duration of follow-up≤12 weeks have a higher effect size on PA habit than the duration &amp;gt; 12 weeks. Meta-regression revealed that problem solving has a significant positive association with effectiveness improvement (β = 0.36, 95% CI 0.17–0.55), while social reward is linked with a reduction in effectiveness (β = -0.40, 95% CI -0.74–0.06). Conclusions Our findings reveal that habit formation interventions are effective in fostering PA habit. Future studies could leverage the insights form this study to optimize the intervention design and achieve better effectiveness.

O.5.2-5 Piloting a text message intervention to increase physical activity and exercise after post-stroke rehabilitation: the KATS study (Keeping Active with Texting after Stroke)

Abstract Purpose After stroke rehabilitation, people feel abandoned by services and struggle to undertake physical activities to support recovery and health. Text messaging interventions can reach many people at low cost but have not been used widely after stroke. This study pilot-tested a text message intervention (KATS) to promote post-rehabilitation activity. Methods We developed KATS using: formative research on post-stroke activity; stakeholder engagement (people with stroke and rehabilitation therapists) to identify priorities; the Health Action Process Approach to structure the behaviour change intervention; and stakeholder review before pre-testing. KATS components included: increasing motivation; goal setting and planning; self-monitoring; coping planning; and maintaining regular activity. KATS comprised 95 messages, delivered by computer programme, over 12 weeks. Text messages explained and modelled KATS components using Behaviour Change Techniques effective for changing health behaviours. Messages used conversational language to encourage engagement, some asked questions on current activities. Quotes from survivors modelled behaviours, providing encouragement and authenticity. Some messages were personalised to include participants’ names. We piloted KATS with community-dwelling stroke survivors, using mid and end-of-intervention interviews to explore experiences of KATS. We analysed qualitative data using Normalisation Process Theory to examine how participants made sense of KATS and embedded it in everyday activities. Results Following piloting, from 24 interviews with 12 participants, we derived four analytical themes: (1) Making sense of KATS: Timing and complementarity in the rehabilitation journey; (2) Engaging with KATS: Connection and identification with others; (3) Making KATS work: flexibility and tailorable guidance; (4) Appraising the worth of KATS: encouragement and friendliness. Participants differentiated KATS from current rehabilitation practice, finding it relevant, fitting, and worthwhile. They reported variations in engagement with behaviour change techniques, but participants could tailor KATS use, making it work for them in different ways. Conclusions KATS was seen as useful and acceptable to stroke survivors. Perceived benefits went beyond promoting physical activity, to feeling supported and connected. Future research will test effectivenes of KATS in promoting physical activities and explore associations with functional, social and emotional secondary outcomes. The study illustrates the importance of co-design in interventions for clinical populations. Funder Scottish Government Chief Scientist Office.

O.4.3-7 Mothers’ experiences of supporting their daughter to be physically active: a qualitative analysis

Abstract Purpose Girls are more at risk of non-communicable diseases associated with insufficient levels of physical activity (PA). Maternal support plays an important role in girl’s PA. Yet little is known about how mothers provide support to keep their daughters active. The aim of this study was to explore mothers’ experiences of supporting their daughter to be physically active. Methods A qualitative study with semi-structured interviews was conducted with a purposive sample of mothers (n = 29) of girls (Mean age =10.9 years; SD = 0.6). Reflexive Thematic Analysis was used to analyse the data, with themes/subthemes mapped to the relevant domains of the Theoretical Domains Framework (TDF). Results Most mothers recognised the importance of supporting their daughter to be active. Themes highlighted how a mother’s identity and confidence in supporting their daughter to be active influenced supportive behaviours. Social interactions played an important role in facilitating or inhibiting how a mother supports her daughter. The circumstances of a mother’s environment and her perceptions of her daughter’s attitudes towards PA influenced the type of support mothers provided. Conclusion The findings advance our understanding of maternal PA support behaviours which will inform strategies to enhance maternal PA support with the ultimate goal of improving girls’ participation in PA. Future research should explore the appropriate behaviour change techniques for maternal PA support and involve mothers in the co-design process to develop interventions that are more feasible, acceptable and implementable.

O.5.1-3 Co-creation of an active transportation promotion intervention: a concept mapping study

Abstract Purpose Active transportation (AT) is an efficient way to increase daily physical activity and reduce pollution from the transportation sector. Mhealth has contributed to behavior change in fields like physical activity and has been explored to encourage AT. Most interventions, however, did not incorporate evidence-based behavior change techniques and were not co-created with potential users. We aim to understand how AT can be promoted via mhealth intervention by using a bottom-up participatory approach. Methods Concept mapping was done online via GroupWisdom platform, with the public of Alpes-Maritimes County, France. Participants were asked to brainstorm, sort, and rate ideas about mobile app features to encourage AT. Multidimensional scaling algorithm and hierarchical cluster analysis were used to create visual cluster maps to illustrate the participants’ conceptual thinking of the topic. We compared the data by participants’ age, education, and typical transportation mode to understand how different groups perceived each idea and clusters. Results Participants generated 44 unique ideas that they believe would encourage AT behaviors. Six themes emerged, from highest to lowest cluster rating: Infrastructure (n = 9 ideas) and Itinerary (n = 9 ideas), which were consistently rated across groups; Contact with government (n = 4 ideas); Data (n = 12 ideas), with the most number of ideas generated; App usability (n = 6 ideas); and Legislation and code of conduct (n = 4 ideas), with the least number of ideas. Conclusions Our findings showed various ways AT can be promoted. Even though the participants were asked about mobile apps features, they quickly pointed out ideas unrelated to mobile apps. The built environment and infrastructure are clearly the most important factors to promote AT, for our participants. However, they have also identified other soft measures like information, participation in decision making, and social aspects that can contribute to behavior change and support sustainable and healthy modes of transportation. Therefore, a systemic and multifaceted approach is recommended to promote AT. Support/Funding Source This work was supported by the French government, managed by the Agence Nationale de la Recherche under the project Investissements d'Avenir UCAJEDI with the reference n° ANR-15-IDEX-01.

Applying the Theoretical Domains Framework to Develop an Intervention to ‘Re-implement’ Parent–Child Interaction Therapy (PCIT)

Parent–Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven ‘re-implementation’ intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) ‘Environmental Context and Resources’, specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) ‘Social/Professional Role and Identity’, with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.

Designing an evidence-based working method for medical work disability prognosis evaluation-an intervention mapping approach.

Performing evidence-based work disability prognosis evaluation (WDPE) of clients on sick leave is a difficult task for physicians. The aim was to develop a working method to support physicians in performing evidence-based WDPE and to improve WDPE quality. Intervention Mapping (IM) supplemented with elements of the Behavior Change Wheel (BCW) guided project planning for developing the working method. This approach allowed combination with other frameworks and, e.g., behavior change theories. WDPE quality challenges were analyzed on various ecological levels, e.g., the individual (i.e., the physician), interpersonal (i.e., the client) and organizational level, culminating into a multilevel logic model of the problem. Determinants that contributed to this problem, e.g., lack of physicians' knowledge on performing evidence-based WDPE, were identified. Performance objectives were formulated that could contribute to a desired change in WDPE quality. From the performance objectives and determinants (e.g., knowledge), change objectives were derived. In order to achieve these change objectives, suitable intervention functions (e.g., education) and policy categories (e.g., service provision) were identified, allowing the formulation of intervention components. Behavior change techniques (e.g., feedback on outcomes of a behavior) were selected to serve the intervention functions to deliver the desired change. This led to the conceptualization of an intervention plan. The intervention "Prognosable" is presented. It consists of a stepwise working method (SWM) for evidence-based WDPE. The SWM offers an overview of important aspects (e.g., medical condition, clients' confidence in return-to-work) to consider in individual clients' WDPE. The SWM helps physicians to identify crucial functional limitations, find and appraise evidence-based information, weigh all relevant prognostic aspects and it supports physicians to conclude with an evidence-based WDPE, tailored to the individual client. The intervention "Prognosable" was designed, which also includes an educational program and a supportive software tool to enable implementation of the SWM. IM combined with BCW elements guided the development of a SWM for evidence-based WDPE. The SWM will be delivered through an educational program for physicians supported by a digital tool. The SWM, educational program and digital tool are ready to be implemented and evaluated in practice as the intervention "Prognosable."

Just-In-Time Adaptive Intervention to Sit Less and Move More in People With Type 2 Diabetes: Protocol for a Microrandomized Trial.

Reducing sedentary behavior and increasing physical activity in people with type 2 diabetes (T2D) are associated with various positive health benefits. Just-in-time adaptive interventions offer the potential to target both of these behaviors through more contextually aware, tailored, and personalized support. We have developed a just-in-time adaptive intervention to promote sitting less and moving more in people with T2D. This paper presents the study protocol for a microrandomized trial to investigate whether motivational messages are effective in reducing time spent sitting in people with T2D and to determine what behavior change techniques are effective and in which context (eg, location, etc). We will use a 6-week microrandomized trial design. A total of 22 adults with T2D will be recruited. The intervention aims to reduce sitting time and increase time spent standing and walking and comprises a mobile app (iMove), a bespoke activity sensor called Sedentary Behavior Detector (SORD), a messaging system, and a secured database. Depending on the randomization sequence, participants will potentially receive motivational messages 5 times a day. Recruitment was initiated in October 2022. As of now, 6 participants (2 female and 4 male) have consented and enrolled in the study. Their baseline measurements have been completed, and they have started using iMove. The mean age of 6 participants is 56.8 years, and they were diagnosed with T2D for 9.4 years on average. This study will inform the optimization of digital behavior change interventions to support people with T2D Sit Less and Move More to increase daily physical activity. This study will generate new evidence about the immediate effectiveness of sedentary behavior interventions, their active ingredients, and associated factors. Australian New Zealand Clinical Trial Registry ACTRN12622000426785; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383664. DERR1-10.2196/41502.