Behaviour Change Techniques Research Articles

Elaborating the knowledge structure and emerging research trends of physical activity for multiple sclerosis: A bibliometric analysis from 1994 to 2023

BackgroundMultiple sclerosis is a common inflammatory neurological disease among young adults and is the tenth leading cause of the global burden of disease. Existing common treatments such as pharmacological and palliative therapies do not control the neurodegenerative process or cure multiple sclerosis. Numerous epidemiological surveys, randomised controlled trials, and systematic reviews with meta-analyses support the effects of physical activity on health-related outcomes among patients with multiple sclerosis. Moreover, bibliometric analysis can provide a broad evidence synthesis beyond systematic reviews and meta-analyses, allowing researchers and other stakeholders to obtain a one-stop overview of this research field. Therefore, this bibliometric analysis aims to provide insight into the knowledge structure of the field of physical activity for multiple sclerosis over the past three decades, and to predict emerging research trends. MethodsThis study strictly complied with step-by-step guidelines of bibliometric analysis, combining performance analysis and science mapping. Four indexes from the Web of Science Core Collection were selected as data sources, and articles and review articles in the field of physical activity for multiple sclerosis from 1994 to 2023 were included in this analysis. Mircrosoft Excel, RStudio, VOSviewer 1.6.20, and CiteSpace 6.3.R1 (64-bit) Advanced were used to perform performance analysis and science mapping. ResultsOver the past three decades, this field published a total of 1,271 documents, with the scientific output showing a rapid upward trend over the past two decades. Robbert W Motl was the most prolific author in this field, with a total of 300 publications. The USA contributed nearly half of the publications in this field (549 documents), and the University of Illinois System was the institution with the highest number of publications (222 documents). Multiple Sclerosis and Related Disorders was the journal that published the highest number of documents in this field (117 documents), while more than a third of this field's publications were included in the category: Clinical Neurology (438 documents). The Reference co-citation analysis identified three main research trends, including shifts in research methodology, changes in health outcomes in randomised controlled trials, and shifts in different types of physical activity interventions. Combining the results from reference co-citation analysis and citation burst analysis, the combination of behaviour change technique and telerehabilitation may be the emerging research trend. ConclusionThis bibliometric analysis identifies rapid growth in the field of physical activity for multiple sclerosis over the past two decades. Moreover, the combination of performance analysis and science mapping provides insight into knowledge structure in this field and informed future research trends for researchers and the relevant stakeholders.

A Theory and Evidence-Informed e-Cycling Intervention for Individuals Diagnosed With Cancer: Development Study.

Physical activity engagement following a cancer diagnosis is positively associated with survival, reduced risk of disease recurrence, and reduced cancer-specific and all-cause mortality. However, rates of physical activity engagement are low among individuals diagnosed with and being treated for breast cancer or prostate cancer. The purpose of this study was to describe the systematic process of developing an e-cycling intervention aimed at increasing physical activity among individuals living with prostate cancer or breast cancer and outline the key components to be implemented. The Medical Research Council guidance for developing complex interventions and the Behaviour Change Wheel were used to guide intervention development. Information was gathered from the literature and through discussions with end users to understand factors influencing e-cycling. These factors were mapped onto the Theoretical Domains Framework to identify potential mechanisms of action. Behavior change techniques were selected from theory and evidence to develop intervention content. Interested parties, including cycling instructors, end users, and behavior change experts, reviewed and refined the intervention. Anticipated barriers and facilitators to e-cycling engagement were mapped onto 11 of the 14 domains of the Theoretical Domains Framework. A total of 23 behavior change techniques were selected to target these domains over 4 one-to-one e-cycling sessions delivered by trained cycling instructors in the community. Cycling instructors were provided a 3-hour classroom training session on delivering the intervention and a 3-hour practical session with feedback. The outcome of this work is a theory and evidence-informed intervention aimed at promoting e-cycling behavior among individuals being treated for breast cancer or prostate cancer, which is currently being implemented and evaluated. Transparent intervention development and reporting of content is important for comprehensively examining intervention implementation. The implementation of this intervention package is currently being evaluated in a pilot randomized controlled trial. If the intervention is found to be effective and the content and delivery are acceptable, this intervention will form a basis for the development of e-cycling interventions in other survivors of cancer. ISRCTN Registry ISRCTN39112034 https://www.isrctn.com/ISRCTN39112034; and IRSCTN Registry ISRCTN42852156; https://www.isrctn.com/ISRCTN42852156.

Individual interventions, collective lessons: Developing mid-range theory on women's groups to improve health.

Interventions with women's groups have been widely implemented to improve health outcomes in low- and middle-income settings, particularly India. While there is a large evidence base on the effectiveness of single interventions, it is challenging to predict whether a women's group intervention delivered in one setting can be expected to work in another. We applied realist principles to develop and refine a mid-range theory on the effectiveness of women's groups interventions, summarised key lessons for implementation, and reflected on the process. We synthesised primary data from several interventions in India, a systematic review, and an analysis of behaviour change techniques. We developed mid-range theories across three areas: maternal and newborn health, nutrition, and violence against women, as well as an overarching mid-range theory on how women's groups can improve health. Our overarching mid-range theory suggested that effective interventions should: build group or community capabilities; focus on health outcomes relevant to group members; and approach health issues modifiable through women's individual or collective actions. We identified four key lessons for future interventions with women's groups, including the importance of skilled and remunerated facilitation, sufficient intensity, supply-side strengthening, and the need to adapt delivery during scale up while maintaining fidelity to intervention theory. Our experience demonstrated the feasibility of developing mid-range theory from a combination of evidence and insights from practice. It also underscored the importance of community engagement and ongoing research to 'thicken' mid-range theories to design effective and scalable women's groups interventions in India and similar settings.

Behavior change techniques to increase physical activity among older adults living in long-term care facilities: A systematic review.

Despite the health benefits of physical activity, many older adults living in long-term care facilities lead sedentary lifestyles and do not meet minimum physical activity recommendations. Determining the behavior change techniques (BCTs) used in physical activity interventions can help us understand the underlying mechanisms by which behavioral change is achieved. The purpose of this systematic review was to identify and evaluate BCTs in physical activity interventions for the elderly residents. Six electronic databases were searched and 15 eligible studies were retained. Nine promising BCTs associated with physical activity promotion among elderly residents were identified: credible source, social support (unspecified), goal setting (outcome), goal setting (behavior), demonstration of the behavior, instruction on how to perform a behavior, self-monitoring of behavior, self-monitoring of outcome(s) of behavior, and adding objects to the environment. Future research is encouraged to select and tailor these BCTs to the specific needs and preferences of the target population.

Promising behavior change techniques for climate-friendly behavior change - a systematic review.

Besides societal and governmental actions to mitigate greenhouse gases, individual behavioral changes are also urgently needed to limit global temperature rise. However, these individual changes have proven to be difficult to achieve in the general population. We conducted a systematic review in five electronic databases with the aim of systematically depicting the content of interventions that promote climate-friendly behavior in individuals and households in high- and upper-middle-income countries. We included 25 studies. The analyses included identification of the used Behavior Change Techniques (BCTs) and comparison of their promise ratio. Across our three outcome categories energy consumption, water consumption, and mobility the most frequently used BCT categories are not the ones that are most promising in terms of behavior change. Based on these results, our recommendation for climate change mitigation interventions is to include components that provide concrete instructions on how to perform the desired behavior (shaping knowledge), setting goals and commitments (goals and planning), substituting undesired behavior, and practicing desired behavior (repetition and substitution). Other reviews with similar aims use different wordings, definitions, or degrees of detail in their intervention component labelling which makes it difficult to compare the results. We recommend to use a standardized classification system, like the BCT taxonomy in combination with the promise ratio, which this study has shown to be a suitable tool to classify applied intervention techniques and give an indication of successful techniques.

Protocol for a feasibility randomised controlled trial of the 'Outdoor' mobility intervention for older adults after hip fracture.

A high proportion of patients do not regain outdoor mobility after hip fracture. Rehabilitation explicitly targeting outdoor mobility is needed to enable these older adults to recover activities which they value most. The overarching aim of this study is to determine the feasibility of a randomised controlled trial which aims to assess the clinical- and cost-effectiveness of an intervention designed to enable recovery of outdoor mobility among older adults after hip fracture (the OUTDOOR intervention). This is a protocol for a multi-centre pragmatic parallel group (allocation ratio 1:1) randomised controlled assessor-blinded feasibility trial. Adults aged 60 years or more, admitted to hospital from- and planned discharge to- home, with self-reported outdoor mobility in the three-months pre-fracture, surgically treated for hip fracture, and who are able to consent and participate, are eligible. Individuals who require two or more people to support mobility on discharge will be excluded. Screening and consent (or consent to contact) will take place in hospital. Baseline assessment and randomisation will follow discharge from hospital. Participants will then receive usual care (delivered by physiotherapy, occupational therapy, or therapy assistants), or usual care plus the OUTDOOR intervention. The OUTDOOR intervention includes a goal-orientated outdoor mobility programme (supported by up to six in-person visits), therapist-led motivational dialogue (supported by up to four telephone calls), supported by a past-patient led video where recovery experiences are shared, and support to transition to independent ongoing recovery. Therapists delivering the OUTDOOR intervention (distinct from those supporting usual care) will receive training in motivational interviewing and behaviour change techniques. Baseline demographics will be collected. Patient reported outcome measures including health related quality of life, activities of daily living, pain, community mobility, falls related self-efficacy, resource use, readmissions, and mortality will be collected at baseline, 6-weeks, 12-weeks, and 6-months (for those enrolled early in the trial) post-randomisation. Exercise adherence (6- and 12- weeks) and intervention acceptability (12-weeks) will be collected. A subset of 20 participants will also support accelerometery data collection for 10 days at each time point. The trial findings will be disseminated to patients and the public, health professionals and researchers through publications, presentations and social media channels. The trial has been registered at ISRCTN16147125. 3.0.

Long COVID Brain Fog Treatment: Findings from a Pilot Randomized Controlled Trial of Constraint-Induced Cognitive Therapy.

Long COVID brain fog is often disabling. Yet, no empirically-supported treatments exist. This study's objectives were to evaluate feasibility and efficacy, provisionally, of a new rehabilitation approach, Constraint-Induced Cognitive Therapy (CICT), for post-COVID-19 cognitive sequelae. Sixteen community-residents ≥ 3-months post-COVID-19 infection with mild cognitive impairment and dysfunction in instrumental activities of daily living (IADL) were enrolled. Participants were randomized to Immediate-CICT or treatment-as-usual (TAU) with crossover to CICT. CICT combined behavior change techniques modified from Constraint-Induced Movement Therapy with Speed of Processing Training, a computerized cognitive-training program. CICT was deemed feasible if (a) ≥80% of participants completed treatment, (b) the same found treatment highly satisfying and at most moderately difficult, and (c) <2 study-related, serious adverse-events occurred. The primary outcome was IADL performance in daily life (Canadian Occupational Performance Measure). Employment status and brain fog (Mental Clutter Scale) were also assessed. Fourteen completed Immediate-CICT (n=7) or TAU (n=7); two withdrew from TAU before their second testing session. Completers were [M (SD)]: 10 (7) months post-COVID; 51 (13) years old; 10 females, 4 males; 1 African American, 13 European American. All the feasibility benchmarks were met. Immediate-CICT, relative to TAU, produced very large improvements in IADL performance (M=3.7 points, p<.001, d=2.6) and brain fog (M=-4 points, p<.001, d=-2.9). Four of five non-retired Immediate-CICT participants returned-to-work post-treatment; no TAU participants did, p=.048. CICT has promise for reducing brain fog, improving IADL, and promoting returning-to-work in adults with Long COVID. Findings warrant a large-scale RCT with an active-comparison group.

Barriers and Facilitators to Binge-Watching Using the Theoretical Domains Framework

Using the Theoretical Domains Framework (TDF), this rapid review coded the barriers and facilitators to binge-watching and identified corresponding behaviour change techniques (BCTs) for intervention purposes. Twenty-nine studies reporting influences on binge-watching fulfilled the inclusion criteria and passed quality appraisal checks. Data were extracted and coded accordingly, as informed by the TDF. Findings indicate that most facilitators focused on the goals of binge-watching, such as escapism, and the social influences, such as companionship, while most barriers related to behavioural regulation, such as self-control and self-regulation. BCTs included ‘Goal setting (outcome)’, ‘Social comparison’, and ‘Self-monitoring of behaviour’. Results suggest intervention strategies targeting facilitators to binge-watching by incorporating the identified BCTs may succeed in inhibiting binge-watching behaviours. However, accounting for the intensity of binge-watching was not an objective of the present review; therefore, future research should take into account the varying levels of engagement in binge-watching when developing interventions.

Alcohol- and drug-impaired e-scooter riding: exploring countermeasures from Australia, Belgium, New Zealand, and Norway

This article explores the emerging problem of drug- and alcohol-impaired e-scooter riding. Fifteen government and e-scooter hire firm professionals from four jurisdictions (Australia, Belgium, New Zealand, Norway) described and assessed countermeasures designed to deter drug- and alcohol-impaired riding. Government professionals were from local/municipal councils, state and national departments of transport, and policing organisations. We used Braun and Clarke’s (Qual Res Psychol 18(3):328–352, 2020.https://doi.org/10.1080/14780887.2020.1769238) six-step method of thematic analysis and the NVivo qualitative analysis software system to analyse the interviews. All participants said traditional police enforcement is ineffective because laws and regulations are underdeveloped, and police have limited resources for patrols. Thematic analysis grouped countermeasures into four themes: enforcement, education, encouragement, and the road environment. Third-party policing initiatives show promise. For example, local/municipal councils required e-scooter hire firms to ban e-scooters from areas that sell alcohol through GPS-based geofencing. However, geofencing and other regulatory controls do not extend to privately owned e-scooters, a growing sector in the market. Other countermeasures used a combination of education and behavioural change techniques (BCTs) to encourage compliance. For example, innovative nudge methods (a type of BCT) have potential to change dangerous riding behaviours by targeting riding norms. However, participants said some people will continue to ride under the influence of alcohol or drugs either because they are addicted to substances or exhibit high-risk behaviours. Government should therefore adopt laws and regulations that build a more forgiving road environment, based on the safe system approach, to limit injuries when crashes occur.

Physical activity maintenance in colorectal cancer survivors after an exercise intervention applying behaviour change techniques: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis is to determine the long-term effect of combined physical activity (PA) and behaviour change techniques (BCT) interventions in PA maintenance of colorectal cancer survivors (CRCS) and identify the most frequent BCT implemented in them. PRISMA recommendations were followed. Databases were searched for randomized controlled trials up to October 2023. Studies in which CRCS completed a PA intervention based on any Theoretical Model of Behaviour Change (TMBC) and a subsequent follow-up period were included. Between-group differences at baseline and after follow-up were pooled for meta-analysis. BCT codification was performed using the BCT taxonomy v1. Methodological quality and evidence certainty were also assessed. Five studies involving 906 CRCS met the inclusion criteria. PA interventions applying BCT showed a significant change with a small positive effect (pooled SMD = 0.22 (0.09, 0.35)) on the PA after a follow-up period between 3 and 12months. Twenty-two different BCTs were identified (mean 17.2, range 15-19) of which 12 were common across all interventions. PA and BCT interventions have been found to be effective in improving the long-term maintenance of PA in CRCS. Further studies with higher methodological quality are needed to confirm these findings. Aerobic exercise, pedometers, PA diaries and educational materials seem to be important aspects to achieve sustainable adherence to an active lifestyle over time. Supervision, access to fitness areas and applying some BCT appear to be differentiating features to obtain more successful PA maintenance.

Behavioral change interventions, theories, and techniques to reduce physical inactivity and sedentary behavior in the general population: a scoping review

BackgroundWorldwide, physical inactivity (PIA) and sedentary behavior (SB) are recognized as significant challenges hindering the achievement of the United Nations (UN) sustainable development goals (SDGs). PIA and SB are responsible for 1.6 million deaths attributed to non-communicable diseases (NCDs). The World Health Organization (WHO) has urged governments to implement interventions informed by behavioral theories aimed at reducing PIA and SB. However, limited attention has been given to the range of theories, techniques, and contextual conditions underlying the design of behavioral theories. To this end, we set out to map these interventions, their levels of action, their mode of delivery, and how extensively they apply behavioral theories, constructs, and techniques.MethodsFollowing the scoping review methodology of Arksey and O’Malley (2005), we included peer-reviewed articles on behavioral theories interventions centered on PIA and SB, published between 2010 and 2023 in Arabic, French, and English in four databases (Scopus, Web of Science [WoS], PubMed, and Google Scholar). We adopted a framework thematic analysis based on the upper-level ontology of behavior theories interventions, Behavioral theories taxonomies, and the first version (V1) taxonomy of behavior change techniques(BCTs).ResultsWe included 29 studies out of 1,173 that were initially screened/searched. The majority of interventions were individually focused (n = 15). Few studies have addressed interpersonal levels (n = 6) or organizational levels (n = 6). Only two interventions can be described as systemic (i.e., addressing the individual, interpersonal, organizational, and institutional factors)(n = 2). Most behavior change interventions use four theories: The Social cognitive theory (SCT), the socioecological model (SEM), SDT, and the transtheoretical model (TTM). Most behavior change interventions (BCIS) involve goal setting, social support, and action planning with various degrees of theoretical use (intensive [n = 15], moderate [n = 11], or low [n = 3]).Discussion and conclusionOur review suggests the need to develop systemic and complementary interventions that entail the micro-, meso- and macro-level barriers to behavioral changes. Theory informed BCI need to integrate synergistic BCTs into models that use micro-, meso- and macro-level theories to determine behavioral change. Future interventions need to appropriately use a mix of behavioral theories and BCTs to address the systemic nature of behavioral change as well as the heterogeneity of contexts and targeted populations.

Expert consensus on multilevel implementation hypotheses to promote the uptake of youth care guidelines: a Delphi study

BackgroundThe implementation of youth care guidelines remains a complex process. Several evidence–based frameworks aid the identification and specification of implementation determinants and strategies. However, the influence of specific strategies on certain determinants remains unclear. Therefore, we need to clarify which active ingredients of strategies, known as behaviour change techniques (BCTs), elicit behaviour change and improve implementation outcomes. With this knowledge, we are able to formulate evidence–based implementation hypotheses. An implementation hypothesis details how determinants and in turn, implementation outcomes might be influenced by specific implementation strategies and their BCTs. We aimed to identify (1) determinants relevant to the implementation of youth care guidelines and (2) feasible and potentially effective implementation hypotheses.MethodsA four–round online modified Delphi study was conducted. In the first round, experts rated the implementation determinants based on their relevance. Next, experts formulated implementation hypotheses by connecting BCTs and implementation strategies to determinants and were asked to provide a rationale for their choices. In round three, the experts reconsidered and finalised their hypotheses based on an anonymous overview of all formulated hypotheses, including rationales. Finally, the experts rated the implementation hypotheses based on their potential effectiveness and feasibility.ResultsFourteen experts completed the first, second, and third rounds, with 11 completed the final round. Guideline promotion, mandatory education, presence of an implementation leader, poor management support, knowledge regarding guideline use, and a lack of communication skills were reported as most relevant determinants. In total, 46 hypotheses were formulated, ranging from 6 to 9 per determinant. For each determinant, we provide an overview of the implementation hypotheses that were most commonly deemed feasible and potentially effective.ConclusionThis study offers valuable insights into youth care guideline implementation by systematically identifying relevant determinants and formulating hypotheses based on expert input. Determinants related to engagement and to knowledge and skills were found to be relevant to youth care guideline implementation. This study offers a set of hypotheses that could help organisations, policymakers, and professionals guide the implementation process of youth care guidelines to ultimately improve implementation outcomes. The effectiveness of these hypotheses in practice remains to be assessed.

Effects of a digital intervention on physical activity in adults: A randomized controlled trial in a large-scale sample

BackgroundPhysical inactivity is associated with health risks, contributing to various diseases and all-cause mortality. Despite recommendations for regular physical activity (PA), many adults remain inactive, influenced by socioeconomic and environmental factors. Digital interventions, particularly web-based PA programs, offer promising possibilities to promote PA across populations. These programs vary in their effectiveness, reflecting differences in design, user engagement, and behavior change techniques employed. ObjectiveThis study evaluates the effectiveness of the 12-week multimodal web-based TKFitnessCoach. The PA online program is part of the TK-HealthCoach. This study investigates the program's impact on self-reported PA levels, goal attainment, healthrelated quality of life, body weight, and eating behavior, comparing an interactive personalized web-based intervention and non-interactive web-based health information. MethodsIn a randomized controlled trial (RCT), participants were allocated to either the intervention group (IG), receiving access to the interactive TK-FitnessCoach, or the control group (CG) that was provided a static website with evidence-based information on PA. The study targeted a German-speaking adult population interested in improving health behavior. Data was assessed at T0 (beginning of the study), T1 (postintervention), T2, 6 months, and T3, 12 months follow-ups, focusing on self-reported PA at T3 and on various secondary outcomes. ResultsWe achieved equally distributed sociodemographics in both the IG and the CG with a mean age of 42.8 (IG), resp. 43.1 years (CG), and female participants of 76.1 % (IG), resp. 74.7 % (CG). PA at baseline was 277.9 min/week in the IG and 273.3 min/week in the CG. Both, the IG (n = 1153 in the Intention-to-treat (ITT) dataset) and CG (n = 1177 in the ITT dataset) exhibited significant increases in PA over time (IG(T3-T0) = 72.92 min/week; CG(T3-T0) = 74.12 min/week).However, the study did not find significant differences in the effectiveness of the interactive TK-FitnessCoach compared to the non-interactive control in terms of improving PA and related health outcomes. The intensity of using the TK-FitnessCoach was not associated with PA. ConclusionsBoth programs were effective in promoting PA among adults, with no significant differences observed between the two RCT groups. This highlights the potential of digital interventions in addressing physical inactivity, suggesting that the effectiveness of such programs may not solely depend on their interactivity but also on the quality and relevance of the information provided. Further research is needed to explore optimization strategies for such interventions, especially for persons with low PA, including user engagement, behavior change techniques, and the integration of objective PA tracking methods. Trial registrationGerman Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249.

Sexual activity (re-)engagement following spinal cord injury: Identifying behavior change targets for intervention development.

This study used the behavior change wheel to identify the priority behavioral factors for a tailored intervention to support (re-)engagement in sexual activity following a spinal cord injury (SCI). Forty-eight semistructured interviews were conducted with participants from three outpatient/carer/clinician populations in the United Kingdom: people living with SCI, their partners/spouses, and healthcare professionals working in SCI rehabilitation. To identify potential strategies to facilitate (re-)engagement in sexual activity, the behavior change wheel (BCW) and behavior change technique taxonomy Version 1 were applied to code behavior change techniques (BCTs) present in interview transcripts. Six intervention functions, three policy categories, and 21 BCTs were identified as primary targets for interventions to support sexual (re-)engagement post-SCI. Increasing physical-related skills and training would promote physical capability, while sex-related knowledge and the understanding of sex-related health consequences would elevate psychological capability. A supportive healthcare team, alongside peer support and targeted environmental resources about sexual activity/well-being facilitate physical and social opportunities for sex. Motivation to (re-)engage in sexual activity comprised goal-driven reflective motivation to enhance beliefs about capabilities, and automatic motivation via emotional support and reward-based reinforcement. This study outlines the key BCW and theoretically-derived intervention targets which now provide the foundation for innovative future interventions in SCI and sexual activity. Targeting these highly specific BCTs increases the likelihood that sexual satisfaction can become universally accessible after SCI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Decoding behaviour change techniques in opioid deprescribing strategies following major surgery: a systematic review of interventions to reduce postoperative opioid use

Background and objectivesMethodsA structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting...

Enhancing making every contact count (MECC) training and delivery for the third and social economy (TSE) sector: a strategic behavioural analysis

Objective To enhance Making Every Contact Count (MECC, an opportunistic approach to health promotion), training in the Third and Social Economy (TSE, all groups and organisations primarily working towards social justice, outside of the government or household) by examining the degree to which the behavioural content of MECC training tackled significant factors influencing MECC delivery. Methods and Measures A strategic behavioural analysis design. Semi-structured interviews with service providers (n = 15) and users (n = 5) were coded for barriers and facilitators of MECC delivery using the Theoretical Domains Framework (TDF). Existing MECC training was coded for behaviour change techniques (BCTs) and intervention functions (IFs). The degree to which BCTs and IFs addressed the key TDF domains of influences on MECC delivery in the TSE were examined using prespecified tools. Results Seven key TDF domains of influences in MECC delivery were identified. Overall, only 9/31 linked BCTs were utilised within MECC training, with percentage utilisation of relevant BCTs for each domain ranging from 0% to 66.7%. Training adequately addressed 2/7 key domains. Conclusion The TSE and healthcare share many common key TDF domains, although there are differences in how each are relevant. Limitations and recommendations for MECC training are discussed.

Improving Movement Behavior in People after Stroke with the RISE Intervention: A Randomized Multiple Baseline Study.

Objective: High amounts of sedentary behavior increase the risk of cardiovascular disease. This study aimed to determine the preliminary effectiveness and feasibility of the RISE intervention to support community-dwelling people with stroke, who are highly sedentary, to reduce and interrupt sedentary time. Additionally, the added value of including participatory support was determined. Methods: A randomized, multiple-baseline study was conducted including 14 participants. All received the RISE intervention, a 15-week blended behavioral intervention in which a primary care physiotherapist provided personalized coaching in the home setting by using behavior-change techniques and the RISE eCoaching system, including an activity monitor and app to provide real time feedback. Half of the participants (randomly allocated) received participatory support from someone from their social network (e.g., partner or close friend) who joined them in the intervention. Preliminary effectiveness was determined with significant changes in total sedentary time and fragmentation (interruption) of sedentary time using a randomization test. Feasibility was assessed by adherence with the intervention protocol, safety, and satisfaction with the intervention. Results: Participants significantly reduced total sedentary time (p = 0.01) by 1.3 h on average and increased their fragmentation (p < 0.01). Subgroup analyses showed significant improvements in both outcomes only in the group with participatory support. Thirteen (92.9%) participants completed the intervention, no related adverse events occurred, and the reported participant satisfaction was sufficient. Conclusions: The RISE intervention appears promising to support people with stroke who are highly sedentary to reduce and interrupt their sedentary time. Participatory support appears to contribute to greater results. Trial registration: ISRCTN international trial registry, 10694741.

Designing a behaviour change intervention using COM-B and the Behaviour Change Wheel: Co-designing the Healthy Gut Diet for preventing gestational diabetes.

Evidence suggests that modulating the gut microbiota during pregnancy may help prevent gestational diabetes mellitus (GDM). The Healthy Gut Diet study is a complex behaviour change intervention co-designed with women who have a lived experience of GDM. The aim of the study was to describe the development of the behaviour change dietary intervention, the Healthy Gut Diet. This study followed the process for designing behaviour change interventions using the Behaviour Change Wheel. Six researchers and 12 women with lived experience participated in online workshops to co-design the Healthy Gut Diet intervention. This included "diagnosing" the barriers and enablers to two target behaviours: eating more plant foods and eating less ultra processed/saturated fat containing foods. Content analysis of the workshop transcripts and activities was undertaken, underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Barriers and enablers to the target behaviours were described across all six COM-B components and 10 TDF domains. The intervention functions for the Healthy Gut Diet were education, enablement, environmental restructuring, persuasion and incentivisation. Forty behaviour change techniques were integrated into five modes of delivery for the Healthy Gut Diet intervention. The feasibility, acceptability and effectiveness of the Healthy Gut Diet is being tested within a randomised controlled trial. Using the Behaviour Change Wheel process in partnership with consumers resulted in a clearly described complex intervention targeting barriers and enablers of dietary behaviour change to improve the gut microbiota diversity in pregnant women.

Systematic Development of an AI Chatbot for Physical Activity Habit Formation in Prehypertension Individual Integrating Needs, Theories, and Evidence.

Prehypertension, an early stage in the development of hypertension, impacts a substantial segment of the adult population worldwide. Addressing this issue, our study introduces HabitBot, an AI-driven chatbot tailored to encourage physical activity (PA) habits among individuals with prehypertension. HabitBot combines natural language processing with multidisciplinary approaches, drawing from both theoretical frameworks and empirical studies. The chatbot development followed a systematic, five-phase process: comprehensive needs assessment, literature review on behavior change theories, analysis for selecting effective behavior change techniques (BCTs), prototype design through intervention mapping, and refining the intervention based on user feedback. The outcome includes a prototype that integrates the Health Action Process Approach and Habit Formation Theory, utilizing twelve identified BCTs effective in fostering PA habits. User feedback further refined the chatbot across multiple dimensions such as user interface, content accessibility, and privacy. HabitBot exemplifies an innovative integration of behavior change strategies with advanced language model technology, paving the way for digital health interventions in chronic disease prevention. Future studies should assess its long-term efficacy in habit formation and explore its applicability to various demographic groups.

Effect of Communication Mode on Disclosure of Nutrition Impact Symptoms During Nutrition Intervention Delivered to People With Upper Gastrointestinal Cancer.

Individuals diagnosed with upper gastrointestinal cancers experience a myriad of nutrition impact symptoms (NIS) compromise a person's ability to adequately meet their nutritional requirements leading to malnutrition, reduced quality of life and poorer survival. Electronic health (eHealth) is a potential strategy for improving the delivery of nutrition interventions by improving early and sustained access to dietitians to address both NIS and malnutrition. This study aimed to explore whether the mode of delivery affected participant disclosure of NIS during a nutrition intervention. Participants in the intervention groups received a nutrition intervention for 18 weeks from a dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Poisson regression determined the proportion of individuals who reported NIS compared between groups. Univariate and multiple regression analyses of demographic variables explored the relationship between demographics and reporting of NIS. The incidence of reporting of NIS was more than 1.8 times higher in the telephone group (n = 38) compared to the mobile group (n = 36). Telephone predicted a higher likelihood of disclosure of self-reported symptoms of fatigue, nausea, and anorexia throughout the intervention period. A trusting therapeutic relationship built on human connection is fundamental and may not be achieved with current models of mobile health technologies.