Behavior Modification Treatment Research Articles

The state of the science on synchronous video‐conferencing interventions for care partners of persons with dementia

AbstractBackgroundThe need for effective clinical interventions to prevent the potentially deleterious health impact of providing unpaid care to friends and family members with Alzheimer’s disease and related dementias (ADRDs) has become increasingly urgent. Synchronous video‐conferencing in which ADRD care partners interact in real time with trained healthcare professionals has emerged as an especially promising method for telehealth interventional research. Here we report on the designs and outcomes of such interventions for care partners of persons with ADRDs.MethodA scoping review was undertaken following Arksey and O’Malley’s systematic methodological framework. Articles were identified through a comprehensive search of PubMed, PsychINFO, and CINAHL. Inclusion criteria were peer reviewed, data‐based research articles published between 2015 and 2020 reporting results of synchronous video‐conferencing interventions specifically designed to address the needs of care partners of persons with ADRDs. Reviews, scale development, protocols, and case studies were excluded.ResultFull text screening of 159 articles resulted in the identification of seven articles reporting the results of six independent interventions. Included studies fell into two categories, psychoeducational behavior modification interventions delivered by nursing professionals and facilitated peer support interventions delivered by psychologists and social workers. Interventions varied based on technological mode of delivery, level of interaction among participants and between participants and interventionists, duration and frequency of sessions, and outcomes measured or described. Articles reported evidence of efficacy for decreasing care partner loneliness, depression, burden, and increasing care competence. Feasibility and acceptability of the technological interface varied between interventions, but was high overall.ConclusionBy comparing and contrasting these 6 synchronous video‐conferencing interventions, we are able support the viability of synchronous video‐conferencing as an effective mode of intervention for care partners of persons with ADRDs, and generate information to inform future research. Despite evidence that care partners need stage‐specific interventions, none of the reviewed studies were tailored to specific dementia stages, and there was a glaring lack of diversity in most study samples. Our results suggest that future research with care partners should not be limited to earth‐bound, face‐to‐face interventions, and that synchronous video‐conferencing has benefits above and beyond other approaches.

Understanding electric bike riders’ intention to violate traffic rules and accident proneness in China

As electric bicycles (e-bikes) have emerged as an important transportation mode in China in the past decade, e-bike-related accidents have increased drastically. Research suggests that the main cause of most of these accidents is traffic rule violations by e-bike riders and that some e-bike riders have a higher propensity to experience accidents (i.e., higher accident proneness) than otherwise similar individuals. To facilitate the design of safety policies, it is important to understand the factors that influence both e-bike riders’ intention to violate traffic rules and accident proneness. For this purpose, an extension of the theory of planned behavior framework (E-TPB) was developed by incorporating seven new latent psychological factors (descriptive norm, moral norm, perceived risk, self-identity, legal norm, conformity tendency, and past behavior) into the original TPB framework (O-TPB). Using self-reported survey data from over 2000 e-bike riders collected in Shanghai, China, structural equation models for the E-TPB and the O-TPB were estimated. The model estimation results show that the E-TPB provides a more intuitive explanation of e-bike riders’ intention to violate traffic rules and accident proneness and has superior predictive power compared to the O-TPB. The model estimation results also show that descriptive norm, conformity tendency, and past behavior are important factors that affect both e-bike riders’ intention to violate traffic rules and accident proneness. These findings can be used by policymakers to design safety policies such as reward programs for safe riding behavior, e-bike rider education initiatives, and behavior modification interventions to improve road safety.

COVID-19 Mitigation Behaviors by Age Group — United States, April–June 2020

CDC recommends a number of mitigation behaviors to prevent the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Those behaviors include 1) covering the nose and mouth with a mask to protect others from possible infection when in public settings and when around persons who live outside of one's household or around ill household members; 2) maintaining at least 6 feet (2 meters) of distance from persons who live outside one's household, and keeping oneself distant from persons who are ill; and 3) washing hands often with soap and water for at least 20 seconds, or, if soap and water are not available, using hand sanitizer containing at least 60% alcohol (1). Age has been positively associated with mask use (2), although less is known about other recommended mitigation behaviors. Monitoring mitigation behaviors over the course of the pandemic can inform targeted communication and behavior modification strategies to slow the spread of COVID-19. The Data Foundation COVID Impact Survey collected nationally representative data on reported mitigation behaviors during April-June 2020 among adults in the United States aged ≥18 years (3). Reported use of face masks increased from 78% in April, to 83% in May, and reached 89% in June; however, other reported mitigation behaviors (e.g., hand washing, social distancing, and avoiding public or crowded places) declined marginally or remained unchanged. At each time point, the prevalence of reported mitigation behaviors was lowest among younger adults (aged 18-29 years) and highest among older adults (aged ≥60 years). Lower engagement in mitigation behaviors among younger adults might be one reason for the increased incidence of confirmed COVID-19 cases in this group, which have been shown to precede increases among those >60 years (4). These findings underscore the need to prioritize clear, targeted messaging and behavior modification interventions, especially for young adults, to encourage uptake and support maintenance of recommended mitigation behaviors to prevent the spread of COVID-19.

Smoking and drinking among patients with mental disorders: Evidence from a nationally representative Japanese survey

BackgroundNo studies to date have addressed the association of mental disorder with smoking and drinking behaviors independent of anxiety and depressive symptoms. We therefore examined this association, stratified by age and sex, to determine the target population for behavioral modification in Japan. MethodsWe analyzed data from participants aged 20-79 years without hospitalized or institutionalized status who participated in the nationwide Comprehensive Survey of Living Conditions conducted in 2016. Prevalence ratios (PRs) for current smoking, heavy daily smoking (>20 cigarettes per day), at-risk drinking (>100 g alcohol per week), and heavy drinking (>350 g) were calculated with adjustment for potential confounders. After stratification by age (20-39, 40-64, and 65-79 years) and sex, prevalence and PRs were calculated using propensity scores. ResultsFrom among 340,194 participants, 8275 (2.4%) had mental disorder. Presence of mental disorder was significantly associated with current smoking (PR=1.18, 95%CI=1.12-1.23) and heavy daily smoking (PR=1.35, 95%CI=1.21-1.50) and inversely associated with at-risk drinking (PR=0.70, 95%CI=0.66-0.75). PRs for smoking behavior were higher in women than in men and in younger adults than in the other age groups. They were particularly high in younger women (PR=1.67 for current smokers and PR=2.17 for heavy daily smokers). LimitationsOur findings were obtained from a cross-sectional study. ConclusionThis is the first evidence that the association of mental disorder with smoking behavior is independent of anxiety and depressive symptoms. Our results indicate the need for tailored behavioral modification interventions for young people with mental disorders in Japan, particularly young women.

Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study.

BackgroundOne of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care.ObjectiveWe aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care.MethodsThe first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians’ personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout).ResultsThis work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021.ConclusionsBased on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost.International Registered Report Identifier (IRRID)DERR1-10.2196/18673

An Interactive Lifestyle Medicine Curriculum for Third-Year Medical Students to Promote Student and Patient Wellness.

Although lifestyle intervention and behavior modification are effective in the prevention and treatment of chronic disease, few medical schools provide specific training in stress management, nutrition, or physical activity. While the prevalence of chronic disease rises, medical students and physicians lack sufficient knowledge and skills to promote their patients' as well as their own wellness across these domains. We developed three hour-long workshops delivered to third-year medical students. We employed interactive lectures, small-group discussions, and reflective activities to teach the pillars of lifestyle medicine. These sessions focused on knowledge and skills to advance lifestyle counseling and behavior modification interventions with patients and to promote student wellness. We assessed student satisfaction with each session as well as self-perceived knowledge, skills, and attitudes toward lifestyle medicine and behavior change before and after the curriculum. Over 2 years, 183 students participated in the workshop series. The sessions received high ratings, with a mean of 4.2 on a 5-point Likert scale. Participating in the curriculum significantly enhanced students' understanding of the connection between lifestyle factors and the health of patients and improved their confidence about counseling for behavioral change. Lifestyle medicine provides an evidence-based framework for teaching students about the impact of lifestyle modification on chronic disease. While receiving knowledge and skills to advance patient care in the domains of stress management, nutrition, and physical activity, students who completed this curriculum also had the opportunity to reflect on their own health promotion, which could mitigate professional burnout.

Psychological well-being and personality in relation to weight loss following behavioral modification intervention in obese women with polycystic ovary syndrome: a randomized controlled trial.

Little is known about how lifestyle affects psychological well-being in overweight women with polycystic ovary syndrome (PCOS). We investigated the effects of behavioral modification on psychological well-being and the impact of well-being and personality traits on successful weight loss. A 4-month randomized controlled trial with a 12-month follow-up at a University Hospital. Sixty-eight women with PCOS, aged 18 to 40 years with a BMI ≥27 kg/m2, were randomized (1:1) into a behavioral modification program (intervention) or minimal intervention (control). The outcome measures were the psychological well being index and the Swedish universities scales of personality. At baseline, 60% had a global psychological well being index corresponding to severe distress and 40% to moderate distress. There was no significant change in mean global well-being score at 4 months within or between groups. However, after 4 months, the intervention group expressed less anxiety (P = .035), higher general health (P = .012) and lower depressed mood (P = .033). Anxiety and general health tended to differ between groups (P = .06, respectively) favoring intervention. In the whole population, women achieving ≥5% weight loss at 12 months (n = 18) were less anxious at baseline compared to those who had not (P = .004). Personality trait-analysis showed that the weight-loss group had higher social desirability (P = .033) and lower embitterment (P = .023). Psychological well-being is severely impacted in overweight women with PCOS. Behavioral modification can positively impact dimensions of well-being, although not fully significant, compared to control treatment. Personality factors could contribute to the understanding of successful weight loss.

User Characteristics and Parenting Practices Associated with Adolescents' Initial Use of a Lifestyle Behavior Modification Intervention.

Background and Purpose: E-health interventions can provide Canadian adolescents (13-17 years old) with personalized support to help them modify their obesogenic behaviors. However, use of e-health interventions among adolescents has not been extensively examined. This study examined user characteristics and parenting practices associated with adolescents' initial use of the Aim2Be app; a health behavior modification intervention delivered through a smartphone app. Methods: A total of 371 adolescent-parent dyads completed a baseline assessment and were invited to use the Aim2Be app. Mean adolescent age was 14.9 years and 50.1% were male (n = 186). Mean adult age was 44.1 years and 34.7% were male (n = 129). Using Mplus (v.8), path analyses were completed to identify adolescent characteristics and parenting practices that were significantly associated with initial use of the app. Analyses were then stratified to explore whether these associations were confounded by parents' gender. Results: 79.2% of adolescents (n = 294) initially used the Aim2Be app. Adolescent engagement in healthy behaviors was directly associated with increased odds of using the app (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.01-1.14), whereas autonomous motivation was indirectly associated (OR = 1.02; 95% CI = 1.00-1.04). Structure parenting practices were indirectly associated with increased odds of using the app (OR = 1.02; 95% CI = 1.00-1.04). When analyses were stratified by parent's gender, differences in the associations emerged. Conclusions: Both user characteristics and parenting practices were significantly associated with adolescents' initial use of Aim2Be. These findings will help inform future e-health interventions increase user engagement by identifying the characteristics of individuals who are not accessing the intervention, as well as identifying factors of the household environment that support use.

Goal achievement and adaptive goal adjustment in a behavioral intervention for participants with prediabetes.

Participants with prediabetes were supported to achieve and maintain weight loss with a stage-based behavior change group program named PREview behavior Modification Intervention Toolbox (PREMIT). The tendency to engage in a process of goal adjustment was examined in relation to PREMIT attendance. Analyses were based on 1857 participants who had achieved ⩾8percent weight loss. Tendency to engage in a process of goal adjustment appeared not to be influenced by PREMIT attendance. Instead, results suggested that when unsure about reaching an intervention goal, participants were more likely to engage in a process of goal adjustment, possibly lessening distress due to potentially unachievable goals, either weight loss or maintenance.

Choice‐Based Reminder Cues: Findings From an mHealth Study to Improve Tuberculosis (TB) Treatment Adherence Among the Urban Poor in India

Poor treatment outcomes due to nonadherence and consequent high levels of drug resistance continue to challenge efforts to combat tuberculosis (TB) in India. Mobile health‐ or mHealth‐based reminder cues have been considered in multiple health behavior modification interventions, including TB treatment nonadherence. We conducted a quasi‐experimental study in Ahmedabad, India, to examine the effectiveness of mHealth‐based reminder cues customized to meet diverse patient needs. Results from this experiment indicate that the potential of customized mHealth reminder cues may remain unrealized unless addressed in conjunction with the multifaceted drivers of TB treatment nonadherence. The perspective we present here has broad relevance for future mHealth studies, especially in interpreting challenges that arise within resource‐scarce settings of the urban poor and prevent them from adhering to recommended TB treatment regimens.

Prevalence of risk factors for non-communicable diseases in a rural population of Bangladesh: a cross-sectional study

BackgroundNon-communicable diseases (NCDs) account for 67% of annual deaths in Bangladesh. Behavioural and clinical risk factors such as high blood pressure, high blood glucose concentrations, dietary habits, physical inactivity, tobacco use, and alcohol consumption contribute to the prevalence of NCDs. In this study, we aim to estimate the prevalence of NCD risk factors and relevant characteristics in rural adult residents of Bangladesh. MethodsIn this cross-sectional survey, we included participants aged 18 years and older who resided in Parbatipur subdistrict of Bangladesh. We used a modified WHO STEPS tool to collect data. Additionally, questions were included on hypertension and diabetes within the questionnaire to evaluate participants' knowledge about NCDs and health-care-seeking practice. Standard bowl, teaspoon, and show cards were shown to respondents while asking about fruit, vegetables, salt, tobacco, and alcohol consumption. We used calibrated instruments to measure blood pressure, height, weight, and waist-hip circumference and asked respondents to self-report information about diabetes and lipid profile. To calculate the prevalence of hypertension, we considered participants with a previous diagnosis of hypertension and also those who had diastolic blood pressure ≥90 mm Hg or systolic blood pressure ≥140 mm Hg, or both, measured during the study. We used STATA (version 13.0) for data analysis. FindingsBetween Nov 17 and Dec 4, 2018, we collected data from 421 participants; median age was 41·9 years (SD 15·7) and 50·1% of participants (n=211) were women. Nearly half (41·6%) of respondents had hypertension. Self-reported prevalence of diabetes and high cholesterol was 4·3% and 1·0% respectively. Prevalence of physiological risk factors such as overweight (BMI 25·0–29·9 kg/m2), obesity (BMI ≥30 kg/m2), high waist circumference (≥100 cm for men and ≥90 cm for women), and high waist-hip ratio (≥0·90 for men and ≥0·80 for women) were 32·5%, 10·5%, 11·6%, and 87·4%, respectively. Other risk factors included smoking or consumption of smokeless tobaccos, or both (49·9%), inadequate physical activity (56·3%), inadequate consumption of fruits and vegetables (76·0%), and intake of extra salt in food (35·1%). Although most respondents had heard about hypertension (93·1%) and diabetes (94·3%), knowledge and practice of NCD prevention were found to be poor. Regarding the risk factors of developing hypertension and diabetes, most respondents mentioned that they did not know (46·8% and 64·4%, respectively) about this. InterpretationEven in a rural setting, lifestyle and dietary habits may be responsible for the high prevalence of NCDs that hinders people's quality of life and productivity. A comprehensive behaviour modification intervention should be undertaken by the public and private sectors to address the reduction of risk factors for NCDs. A limitation of this study was that it took place in the harvesting season when respondents were mostly busy and anxious about collecting their crops. FundingMasters dissertation funded by BRAC James P Grant School of Public Health, BRAC University.

Cardiovascular Outcomes of Diet Counseling

Context: The leading cause of death in the U.S. is heart disease with obesity as the major correlate and, some believe, Cause: Obesity is caused by eating behaviors. The U.S. Preventive Services Task Force notes the need for, yet absence of, randomized controlled trials of behavior modification interventions for cardiovascular disease endpoints. Objectives: To modify habitual dietary behaviors with counseling, to assess retention of the resulting habits, and to compare cardiovascular effects of such modifications under diets differing in fat content. Design: One-year randomized controlled trial of three diet behavior interventions for cardiovascular and behavioral end-points with intermediate surrogate end-points enabling intent-to-treat analysis. Setting: Prairie States private cardiology practice. Participants: One hundred and twenty referrals screened for: cardiovascular co-morbidity, heart medication, and informed agreement. Intervention: One hour of diet protocol initial individual instruction and one half-hour of individual self-efficacy counseling every six weeks thereafter for one year. Main outcome measures: The primary cardiovascular measure was SPECT device measured physiologic coronary blood flow. Retention of modified habits was assessed with four-month post-study measurement of changes in Respiratory Quotient as a menu selection index and in Body Mass Index as a portion control index. Surrogate endpoints were weight, BMI, lipids and other standard blood chemistry indices. Results: Participant attrition, zero. Changes in coronary blood flow were correlated with diet protocol, R (95%CI)=0.48 to 0.69, p=2.4 x 10-12. Ischemia improved significantly under a lowered fat protocol and worsened significantly under lowered carbohydrate conditions. Surrogate endpoints, weight and blood chemistry, showed similar correlations, p<10-11. Four months post-study, lowered fat dieters had retained their intervention modified behaviors while lowered carbohydrate and vegan dieters had changed, R (95%CI)=0.53 to 0.74, p=2.5 x 10-14 for portion control and R (95%CI)=0.76 to 0.88, p<2.2 x 10-16 for menu selection.

EFFECTIVENESS OF BEHAVIOR MODIFICATION COGNITIVE APPROACH WITH RELAXATION TECHNIQUE THROUGH GROUP SETTINGS TO REDUCE AGGRESSIVE BEHAVIOR

Facts in the field show that there are very high levels of aggressive behavior in students. Aggressive behavior is an aggressive action that is intentionally done to hurt others and is done repeatedly. The main objective in this study is to reveal the effectiveness of the Cognitive Behavioral Modification approach with Relaxation Techniques through Group Settings to reduce students' aggressive behavior. This type of research is experimental research. Pre experimental design models using the One Group Pretest Posttest Design. The subjects of this study were 10 students of SMP UNP Laboratory Development who have very high aggressive behavior. Data collection methods use a scale of aggressive behavior. Data analysis using Wilcoxon test and descriptive data analysis. From the results of the pretest Aggressive behavior scale there are 1 student in the high category and 9 students in the very high category. The results of the posttests of 10 students after being given cognitive behavioral modification treatment changed the average of students' aggressive behavior and were in the low category. Wilcoxon test results showed an average of T count = 0, 005 <T_table = 0.005. The results showed that there were differences in students' aggressive behavior before and after participating in the activity. So cognitive behavioral modification is effective to reduce students' aggressive behavior.

Prevalence of Elevated and Hypertension among Secondary School Students in Ghana

Introduction: Worldwide prevalence of hypertension in 2014 was 22% and is expected to increase.Prevalence of hypertension has been on the increase among adolescentsworldwide that persist during adulthood and has become a major public health problem. However, few studies on hypertension has been studied among secondary school students in Ghana. Materials and Methods: A cross sectional study design was conducted among 14-19-year-old secondary school students in two districts of Ghana. A validated self-administered questionnaire was used to collect data on socio-demographic characteristics, blood pressure, physical activity, weight and height. Two blood pressure measurements were taken for each student with Omron HBP-1100 automated BP (blood pressure) monitor while weight and height were taken with Tanita Model HD 309 and Seca body Meter Model 208 respectively. Data was analyzed with SPSS version 22 with descriptive statistics such as means, frequencies and percentages. Chi-Square test and Logistic regression were also utilized. Results: Prevalence of hypertension and elevated was 24.4%. There were 11.0% students who were overweight while2.2% were obese. Approximately 34.6% of the students were physically inactive. The independent variables in the logistics regression for hypertension was body mass index and physical activity. Conclusion:Risk factors of hypertension are increasing among students. A behavioral modification intervention should be implemented in secondary schools to reduce risk factors of hypertension among the students.

The effect of weight loss and weight gain on blood pressure in children and adolescents with obesity.

Obesity in childhood is a profound risk factor for hypertension, and weight loss has positive effects on blood pressure (BP). However, the expected effect size on BP from weight reduction in children with obesity is insufficiently described. Therefore, the aim was to investigate the association between changes of degree of obesity and BP levels. This prospective cohort study examined subjects receiving behavioral lifestyle modification treatment who were registered in the Swedish national registry for treatment of childhood obesity (BORIS). A total of 5279 obese subjects (51.3% boys) had repeated BP measurements. The average follow-up time was 32 months. Degree of obesity was expressed as BMI standard deviation score (SDS) and BP as BP SDS. The mean age at treatment initiation was 10.3 years. The prevalence of hypertensive BP was 15.3% for systolic and 5.5% for diastolic pressure. Both systolic and diastolic BP SDS decreased when a lower BMI SDS was achieved; systolic BP SDS decreased 0.41 [0.33-0.49] and diastolic BP SDS decreased 0.26 [0.20-0.32] per BMI SDS unit reduction. The impact of BMI SDS reduction on BP SDS was greater in subjects with hypertensive levels at treatment initiation, but behavioral modification was an insufficient treatment for 27% of them. Obesity treatment failure increased the risk of developing hypertensive levels; HR = 1.81 [1.38-2.37] (systolic BP) HR = 3.82 [2.34-6.24] (diastolic BP), per unit increase in BMI SDS. Weight loss is a key factor for hypertension prevention and treatment in children with obesity. However, its limited effect suggests that additional pharmacological antihypertensive treatment more readily should be considered.

The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity.

BackgroundBy 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention.ObjectiveThis study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations.MethodsA pre-post single‐arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time.ResultsA total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake.ConclusionsThe findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations.

The PREVIEW Study

Abstract. Individuals at risk of Type 2 Diabetes are advised to change health habits. This study investigated how the PREMIT behavior modification intervention and its association with socio-economic variables influenced weight maintenance and habit strength in the PREVIEW study. Overweight adults with pre-diabetes were enrolled ( n = 2,224) in a multi-center RCT including a 2-month weight-loss phase and a 34-month weight-maintenance phase for those who lost ≥ 8% body weight. Initial stages of the PREMIT covered the end of weight-loss and the beginning of weight-maintenance phase (18 weeks). Cross-sectional and longitudinal data were explored. Frequent PREMIT sessions attendance, being female, and lower habit strength for poor diet were associated with lower weight re-gain. Being older and not in employment were associated with lower habit strength for physical inactivity. The PREMIT appeared to support weight loss maintenance. Younger participants, males, and those in employment appeared to struggle more with inactivity habit change and weight maintenance.

The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results.

BackgroundObesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes.ObjectiveThis study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia.MethodsQualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures.ResultsThe development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly.ConclusionsMobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered.

Does Instruction of Oral Health Behavior for Workers Improve Work Performance?—Quasi-Randomized Trial

Oral disease can cause economic loss due to impaired work performance. Therefore, improvement of oral health status and prevention of oral disease is essential among workers. The purpose of this study was to investigate whether oral health-related behavioral modification intervention influences work performance or improves oral health behavior and oral health status among Japanese workers. We quasi-randomly separated participants into the intervention group or the control group at baseline. The intervention group received intensive oral health instruction at baseline and a self-assessment every three months. Both groups received oral examinations and answered the self-questionnaire at baseline and at one-year follow-up. At follow-up, the prevalence of subjects who use fluoride toothpastes and interdental brushes/dental floss were significantly higher in the intervention group than in the control group. Three variables (tooth brushing in workplace, using fluoride toothpaste, and experience of receiving tooth brushing instruction in a dental clinic) showed significant improvement only in the intervention group. On the other hand, work performance and oral status did not significantly change in either group. Our intensive oral health-related behavioral modification intervention improved oral health behavior, but neither work performance nor oral status, among Japanese workers.

Ideating Mobile Health Behavioral Support for Compliance to Therapy for Patients with Chronic Disease: A Case Study of Atrial Fibrillation Management.

Poor patient compliance to therapy results in a worsening condition that often increases healthcare costs. In the MobiGuide project, we developed an evidence-based clinical decision-support system that delivered personalized reminders and recommendations to patients, helping to achieve higher therapy compliance. Yet compliance could still be improved and therefore building on the MobiGuide project experience, we designed a new component called the Motivational Patient Assistant (MPA) that is integrated within the MobiGuide architecture to further improve compliance. This component draws from psychological theories to provide behavioral support to improve patient engagement and thereby increasing patients' compliance. Behavior modification interventions are delivered via mobile technology at patients' home environments. Our approach was inspired by the IDEAS (Integrate, Design, Assess, and Share) framework for developing effective digital interventions to change health behavior; it goes beyond this approach by extending the Ideation phase' concepts into concrete backend architectural components and graphical user-interface designs that implement behavioral interventions. We describe in detail our ideation approach and how it was applied to design the user interface of MPA for anticoagulation therapy for the atrial fibrillation patients. We report results of a preliminary evaluation involving patients and care providers that shows the potential usefulness of the MPA for improving compliance to anticoagulation therapy.