Behavior Change Programs Research Articles

Assessing the affordability of nutrient‐adequate diets

AbstractThe cost and affordability of least‐cost healthy diets by time and place are increasingly used as a proxy for access to nutrient‐adequate diets. Recent work has focused on the nutrient requirements of individuals, although most food and antipoverty programs target whole households. This raises the question of how the cost of a nutrient‐adequate diet can be measured for an entire household. This study identifies upper and lower bounds on the feasibility, cost, and affordability of meeting all household members' nutrient requirements using 2013–2017 survey data from Malawi. Findings show only a minority of households can afford the nutrient‐adequate diet at either bound, with 20% of households able to afford the (upper bound) shared diets and 38% the individualized (lower bound) diets. Individualized diets are more frequently feasible with locally available foods (90% vs. 60% of the time) and exhibit more moderate seasonal fluctuation. To meet all members' needs, a shared diet requires a more nutrient‐dense combination of foods that is more costly and exhibits more seasonality in diet cost than any one food group or the individualized diets. The findings further help adjudicate the extent to which nutritional behavioral change programs versus broader agricultural and food policies can be relied upon to improve individual access to healthy diets.

Impact of social reintegration activities on the detainee's behavior according to age, length of detention and recidivism

Annotation: This article brings to the fore the importance of detainees ’participation in social reintegration programs for behavior change. It is also considered to determine a correlation between the personality traits of detainees and age, length of detention and recidivism. Thus, the statistical results obtained by the Anova test and the Pearson correlation test are consistent with other similar studies, which highlight the personality traits of adult detainees such as M. Bulten and S. Maruna, but also with studies that observed the types of coping at the level of detainees with different personality patterns made by J. L. Ireland and C. L. Power.

Cultural Tailoring of Electronic Behavior Change Interventions for African Americans

The purpose of this study was to seek the views of African Americans about the unique factors on which to culturally tailor when designing electronic behavior change interventions. Ethnic-specific focus groups were held to obtain and compare responses of African Americans and non-Hispanic Caucasians enrolled in a cardiovascular disease prevention behavior change program (N = 21). Results of a thematic analysis indicated considerable heterogeneity in desired tailoring factors among both African Americans and Caucasians.

Domestic and family violence behaviour change programs: An examination of gendered and non-gendered frameworks

This article sets out to examine the dichotomous frameworks used to inform domestic and family violence (DFV) behaviour change programs (BCPs). Based on a Rapid Evidence Assessment (REA) methodology, we consider what works and what does not work in the delivery of Domestic and Family Violence programs through a gendered and non-gendered framework. This methodology was selected as it supports a balanced assessment of existing published research in the area, allowing for the current knowledge base to be critically examined. As a result, the REA revealed both the strengths and weaknesses of traditional gendered approaches focusing on the Duluth Model and non-gendered therapeutic approaches focusing on Cognitive Behaviour Therapy (CBT). Yet, while strengths and weaknesses can be seen in both the “violence as gendered” and “violence as non-gendered” paradigms, a case is made for only delivering BCPs within a non-gendered framework.

Peer Group Support Intervention to Reduce Cardiovascular Disease Risk for African American Men According to Life's Simple 7 in Faith-Based Communities.

Adverse cardiovascular health disparities persist for African American men. Although changing health behaviors is perhaps one of the most effective methods to prevent cardiovascular disease (CVD)-related deaths, previous behavior change programs targeting single or multiple CVD risk factors in target groups have had mixed success. The purpose of this pilot study was to determine whether a multi-faceted peer group intervention model based on American Heart Association's Life's Simple 7 was feasible, safe, acceptable, and efficacious in producing meaningful risk reduction for African American men. A convenience sample of 24 African American men with at least one CVD risk factor participated quasi-experimental study having peer intervention vs. nonequivalent comparison groups, with pretest-posttests at two church sites in Minneapolis, MN (MPLS) and Washington, D.C. (DC). Feasibility, safety, acceptability, and potential efficacy were assessed by examining completion of peer group sessions, adverse events, attendance, attrition, within and between-group changes in measures using nonparametric statistics. All twenty-four men completed the study with no study-related adverse symptoms and medical events. The peer groups had moderate to high attendance, and the peer program evaluation was highly positive among participants. Between baseline and 6-months, there were significant differences between the intervention and the comparison group in cholesterol levels and weights (p = .041, p = .034, respectively) at one site (DC). There were no significant between-group changes at the other site (MPLS). The multi-faceted peer support intervention was feasible, acceptable, and shown to have potential efficacy to reduce CVD risk for highly motivated African American men. Future studies with a larger sample size are needed to test the effectiveness of this intervention model to reduce CVD risk among African American men.

Some Interventions to Shift Meta-Norms Are Effective for Changing Behaviors in Low- and Middle-Income Countries: A Rapid Systematic Review.

Social-norms approaches are increasingly included in behavior-change programming. Recent reviews categorize a large number of norms-shifting programs but do not synthesize evidence about effectiveness. To inform the design of social and behavior-change programs in low- and middle-income countries in response to time-sensitive demands, this rapid systematic review examines the evidence for the effectiveness of interventions that use norms-based approaches to change behavior. Nine indexes and eight websites were electronically searched for both systematic reviews and primary studies. s and full texts were screened to include: documents published in 2010 and later; documents evaluating the effectiveness of programs that include norms-based approaches; documents measuring behavioral outcomes; and documents employing quantitative analysis of concurrent treatment and comparison groups. Data collected include participant age cohort, program name and duration, scope of norms, intervention activities, category of behavioral outcome, and statement of findings for the main behavioral outcome(s). Primary studies were appraised based on identification strategy. Search and screening yielded 7 systematic reviews and 29 primary studies covering 28 programs. Across the primary studies, the programs are highly heterogeneous, and the findings are mixed, with some strong positive effects and many marginal or null effects on behavior change. Taken together, the evidence shows that meta-norms-based approaches can be part of effective programs but do not assure that programs will change behaviors. Program designers can draw some general conclusions from this review but can also use it to locate specific studies relevant to their evidence needs.

71-LB: Real-World Evidence of Arabic Digital Therapeutics for People Living with Type 2 Diabetes in Qatar

Background: Around 17% of people in Qatar live with diabetes. This study reports on the impact of an Arabic digital therapeutics product, named Droobi Health™ (DH) on glycemic control in patients with T2DM. Methods: DH provides participant with a 16-week digital behavior change program tailored for people with T2DM. The programs are based on DSME content and AADE7 guidelines for T2DM, with the content localized to be culturally relevant. The DH app gives participants access to chat with a real-human CDE, tracking tools for blood glucose, weight, food intake, and physical activity, and weekly lessons. Participants at primary healthcare centers with T2DM and a starting A1c equal to or greater than 8% were provided the DH intervention. A post-intervention A1C was measured after three months. This study presents results from 633 participants who completed follow-up A1c. Results: The mean pre and post-intervention A1c for 633 participants was 9.67% and 8.76% respectively, showing a mean reduction of 0.91% (95% CI 0.73%-1.09%, P≤0.001) . For women, the use of DH was associated with a statistically significant A1c reduction of 0.73% (95% CI 0.42%-1.04%, P≤0.001) . For men, the use of DH was associated with a statistically significant A1c reduction of 0.99% (95% CI 0.75%-1.21%, P≤0.001) . Conclusion: Based on the results, participants have improved glycemic control outcomes, particularly male participants, underscoring DH’s potential to deliver a clinically effective intervention for people with T2DM in Qatar and across the Middle East. Disclosure N. Jandali: Stock/Shareholder; Droobi LLC. R. Saad: Employee; Droobi LLC.

PENERAPAN THEORY OF PLANNED BEHAVIOR DALAM PEMBERIAN ASI EKSKLUSIF DI KECAMATAN TAROKAN

Introduction: The achievement of exclusive breastfeeding in Kediri Regency 2020 is only 13%, in the Tarokan District area there are several villages which are still below the national target of 40%. The mother's role is very dominant in achieving the target of exclusive breastfeeding. This study aims to determine the behavior of mothers in exclusive breastfeeding using the theory of planned behavior. Method: Quantitative research, observational analytic methods, cross-sectional approach. The research location is in the Tarokan District, carried out from 1 to 20 December 2021 using a simple random sampling technique. Independent Variables: Attitude, Subjective Norm, Behavioral Control. Intervening Variable: Intention, Dependent Variable: Behavior using path analysis. Result: Goodness of Fit CMIN = 0.020, probability = 0.888, GFI=1,000, CFI=1,000, NFI=1,000, TLI=1.009, IFI=1.001, RFI=1,000, AGFI=0.999, RMSEA=0.000, PGFI=0.067. Path coefficient of attitude with intention (β=0.754) (p-value=0.000), (CR=14.871). Subjective norm with intention (β=0.130), (p-value=0.000), (CR=3.374). Behavioral control with intention (β=0.126), (p-value=0.000), (CR=3.429). Intention with behavior (β=0,269), (p-value=0.000), (CR=3.176) Attitude with behavior (β=0.637), (p-value=0.000), (CR=9,198). Behavioral control with behavior (β=0.098), (p-value=0.000), (CR=3.292), attitude through intention towards behavior (0.8325) and behavior control over behavior through intention (0.1505). Discussion: The development of research on health behavior needs to be carried out by further researchers so that they can explore in more depth changes in behavior change in order to plan health behavior change programs in order to improve government programs in the health sector

An evaluation of public initiatives to change behaviours that affect water quality

AbstractPollution and environmental depletion are often caused by human behaviours, where if behaviours were modified, environmental pressure could be substantially reduced. Many public programmes aim to influence people to change their unsustainable behaviours but few undertake ex post evaluations of behavioural change programmes. This paper undertakes an evaluation of a 5‐year programme to understand whether community engagement activities lead to more sustainable practices. Using a treatment and control experiment, the research investigates whether programme participants are representative of the wider population, whether participation leads to sustainable practices, whether pro‐environmental behaviours are sustained over time, and the relative effectiveness of different types of events on individual behaviours. Overall, results suggest that water engagement event participants are more likely to adopt sustainable behaviours, however attendees only represent a small cohort of the wider population, which possibly hinders a wider adoption of good practices. With respect to individual behaviours, different outcomes were detected for different behaviours, which suggests that not all behaviours were equally amenable to change. When comparing the impact of different events, events that are focused on building community ties were more successful than events with simple provision of information. Finally, new pro‐environmental behaviours tend to be abandoned after a period of time, therefore re‐engagement at regular time intervals is advised.

Key Focus Group Themes to Inform Weight Management Interventions in Deep South African Americans

ObjectiveTo understand African Americans’ perceptions, barriers, and facilitators to recruitment, enrollment, adoption, maintenance, and retention in a nutrition and physical activity promotion program. DesignFour focus groups were conducted. SettingTwo community settings located in Jackson and Hattiesburg, Mississippi. ParticipantsParticipants (n = 28) were aged 18–50 years. Main Outcome Measure(s)Barriers and facilitators associated with healthy eating, physical activity, achieving a healthy weight, and participation in a health behavior change program. AnalysisA conventional thematic content analysis approach includes data familiarization, initial code generation, initial theme generation, themes review, and team review for finalization of themes. ResultsMajor themes related to health behaviors and participation in a behavior change program were identified by participants, including time constraints, costs, social support, consistency and self-efficacy, motivation for longevity and disease prevention, physical appearance, fear of injury/pain, social norms/stigma associated with outdoor physical activity, body criticism from family members, and having empathic and validating program staff support. Conclusions and ImplicationsSeveral social determinants of health were identified as essential considerations for promoting healthy nutrition and physical activity behaviors among African American adult Mississippians. Cultural and spiritual implications were also identified. Study insights inform policy approaches for designing culturally appropriate health behavior change programs in the Deep South.

Reducing meat consumption: The influence of life course transitions, barriers and enablers, and effective strategies according to young Dutch adults

High consumption of animal-source foods, specifically meat, adversely affects human health and the environment. Dietary habits are shaped at younger ages and a reduction in meat consumption may be facilitated by the life course transitions in early adulthood, but studies are limited. This study among young Dutch adults aimed to describe their perceptions on the influence of life course transitions on meat consumption, barriers and enablers to reduce meat consumption, and strategies for reducing meat consumption. Barriers and enablers were grouped applying the COM-B model that includes capability, opportunity, and motivation. This quantitative cross-sectional study included a representative sample of 1806 young adults from two Dutch consumer panels who completed an online survey. Young adults frequently reported life course transitions, especially those related to moving house, to have decreased their meat consumption. Barriers and enablers to reduce meat consumption were identified for all three factors of the COM-B model. Important barriers included taste, perceived high prices of meat alternatives, and habits. In contrast, important enablers included care for the environment and animal welfare, enjoyment of smaller portions of meat and saving money. However, barriers and enablers largely differed by groups of meat consumption frequency. Self-perceived effective strategies for reducing meat consumption were price reduction of meat alternatives, recipes for vegetarian meals, and more attractive meat alternatives. The findings of this study are relevant for the development of targeted behaviour-change programmes including interventions in the physical and the social environment (like lowering prices and improving the offer of meat alternatives).

Preventing cardiovascular disease in at-risk patients: Protocol for a feasibility study in general practice (‘High-Risk Prevention Programme’)

Background: Cardiovascular disease (CVD) is the number one cause of death globally. Whilst initiatives such as Ireland’s ‘Chronic Disease Management Programme’ have helped in the fight against CVD, a more intensive approach may be required to meet high risk patients’ needs. The High-Risk Prevention Programme (HRPP), led by the Irish Heart Foundation, University College Dublin (UCD), and Ireland’s Health Service Executive (HSE) aims to design, deliver, and evaluate an intensive, six-week behaviour change programme among people at high risk of CVD living in Irish communities. In this paper, we aim to describe the HRPP intervention and the approach that will be used to evaluate it. Methods: The HRPP has been informed by an inclusive co-design process involving health provider and patient input, has been operating since February 2021 and will run until February 2023. Six general practices have agreed to take part in the project, and it is planned that 400 patients at high risk of CVD will participate. Participating patients attend either a practice nurse or health promotion coordinator-led six-week one-to-one consultation programme focusing on self-management of health issues. Feasibility, acceptability, and likely effectiveness will be assessed by means of a process evaluation involving quantitative survey (patient health and health behaviours assessments) at baseline and 12 months, and in-depth qualitative interviews with patients, practice nurses and general practitioners. Conclusions: Project findings will inform whether a general practice-based intervention to prevent CVD among at-risk patients is feasible, acceptable in practice, has a positive impact, and what outcome measures might form the focus of future research.

Addressing the raven food subsidy challenge by engaging restaurants to close their dumpsters.

Ravens have benefitted from resource subsidies provided by humans so much that their population has increased by over 800% in the western Mojave desert over the last 50 years. Our food waste is an especially large subsidy. Raven predation is one of the greatest threats to desert tortoise survival in the California desert. We sought to create and evaluate a behavioral change program among restaurants in Yucca Valley and Twentynine Palms, California in the western Mojave with elevated raven populations. Half of the 60 restaurants in these two communities received an intervention encouraging them to close their dumpsters while the other half served as controls with no intervention. Treatment restaurants received two in-person visits to discuss the manifold importance of dumpster closure and laminated information signs to display and extend communication to staff. We surveyed all dumpsters for open/closed status five times before the intervention and five times again 3 months after the intervention. We found a significant increase in closure rates among treatment restaurants due to the interventions, with an average of 9.5% increase toward maximum possible lid closure. Restaurants achieving 80%+ closure received "Gold Star Awards" to further stimulate community-wide behavior change by publicly recognizing and encouraging desired behaviors. We summarize dumpster closure rates from similar interventions in nearby Joshua Tree and across the Coachella Valley to illustrate how local social norms may influence behavior.

Effectiveness of a behavior change program on cardiometabolic risk factors in adult women

This study aimed to evaluate the effectiveness of a behavior change program, called Vida Ativa Melhorando a Saúde (Active Life Improving Health - VAMOS), on cardiometabolic risk factors in adult women. Study participants (> 18 years) were divided into two groups: intervention group (IG) and control group (CG). The GI participated in VAMOS, in 2016 and 2018, for three months, with 12 face-to-face meetings, once a week, for approximately 2 hours. The GC received general guidance on the importance of maintaining an active and healthy lifestyle before data collection. Both groups were evaluated at baseline and three months after the intervention. The evaluation consisted of a sociodemographic questionnaire, anthropometric measurements and blood collection to determine the biochemical profile. There was a reduction in uric acid (AU) (p <0.001) and waist circumference (WC) (p = 0.001) in the GI from pre- to post-intervention. For the other variables evaluated, no statistically significant difference was observed within and between the groups. It is concluded that the VAMOS program was effective in reducing UA and WC, important indicators of cardiovascular diseases, in adult women.

Influences of decisions to attend a national diabetes prevention programme from people living in a socioeconomically deprived area.

AimsTo explore key influences of decisions in participants from a socioeconomically deprived area to attend the Healthier You: NHS Diabetes Prevention Programme (NHSDPP). The NHSDPP is a lifestyle behaviour change programme for adults with prediabetes living in England.MethodsSemi‐structured interviews were conducted with 35 participants who had attended the initial assessment, but not yet started the NHSDPP; 23 were classified as “attenders,” 12 as “non‐attenders” after they were interviewed based on whether they had attended the first NHSDPP session or not. Transcribed interviews were analysed using inductive thematic analysis.ResultsSeven themes were derived from the data. The results demonstrate how understanding type 2 diabetes, making lifestyle changes, comparing themselves with others, having support and certain self‐perceptions can all affect individuals’ motivation to attend a diabetes prevention programme. Accessibility and practicalities also influenced both motivation and attendance.ConclusionsThis study identified a range of different influences on decisions to attend a diabetes prevention programme, which programme organisers and healthcare professionals should consider to maximise attendance. Initial communication from general practitioners (GPs) and initial assessments are key points where people's beliefs and understanding could be explored.

Empowering consumers to PREVENT diet-related diseases through OMICS sciences (PREVENTOMICS): protocol for a parallel double-blinded randomised intervention trial to investigate biomarker-based nutrition plans for weight loss

IntroductionPersonalised nutrition holds immense potential over conventional one-size-fits-all approaches for preventing and treating diet-related diseases, such as obesity. The current study aims to examine whether a personalised nutritional plan produces...

Making every contact count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England.

Making Every Contact Count (MECC) is a national, long‐term public health strategy in England. It supports public‐facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under‐represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi‐stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi‐structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self‐reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a ‘double‐edged sword,’ in light of associated challenges such as sector‐level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long‐term sustainability challenges. The recommendations call for system‐level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom‐heard client groups.

A Nutrition Behavior Change Program Moderately Improves Minimum Diet Diversity and Handwashing Behaviors Among Tea Workers in Assam and Tamil Nadu, India.

Many workers in global supply chains remain nutritionally vulnerable despite the income they earn. The Seeds of Prosperity (SOP) program was implemented in Tamil Nadu and Assam, India, for tea supply chain workers (estate workers, small holder farmers, and farm workers). The aim was to enhance demand for diverse and nutritious foods and improve practices related to handwashing. The program used a behavior change communication approach wherein participants received weekly 1-hour group sessions with messaging on dietary diversity for 5 weeks and handwashing for 4 weeks. An impact evaluation was conducted to estimate changes in reported dietary and hygiene knowledge and behaviors among women. The study used a longitudinal quasi-experimental design in a subsample of program participants at baseline and post-intervention among both intervention and comparison. There was a small but significant increase in mean dietary diversity (DD) for all 4 worker groups (ranging from DD score changes of 0.3 to 0.7; P < .05) and in the proportion of women meeting the minimum dietary diversity in 2 of the 4 groups. Similarly, a significant increase in the mean number of handwashing moments was observed in 2 of the worker groups. An increase in home garden use was observed in 1 of the 4 worker groups. While the SOP program resulted in improvements in dietary diversity, most tea farming women still do not achieve minimum dietary diversity. Nutritious food access may be an important constraint to further improvement.

KODY, an all-of-family response to co-occurring substance use and domestic violence: protocol for a quasi-experimental intervention trial

BackgroundThe co-occurrence of domestic violence with alcohol and other drugs significantly increases the severity of abuse and violence experienced by family members. Longitudinal studies indicate that substance use is one of few predictors of men’s continued use of, or desistance from, violence. Recent developments in men’s behaviour change programs have focused on men’s attitudes and behaviour towards their children, and the exploration of interventions that address the needs of all family members. However, the research evidence is limited on the most effective elements of men’s behaviour change programs in promoting the safety and wellbeing of child and women victim survivors.This study aims to build on the existing evidence by trialling the KODY program which addresses harmful substance use by men who also perpetrate domestic violence; the safety and wellbeing of women and children; the needs of children in their own right, as well as in relationship with their mothers; and the development of an ‘all-of-family’ service response. The evaluation of these innovations, and the ramifications for policy development to support less fragmented service system responses, provide the rationale for the study.Methods/DesignA quasi-experimental design will be used to assess the primary outcomes of improving the safety and wellbeing of mothers and children whose (ex)partners and fathers respectively participate in KODY (the trial program), when compared with ‘Caring Dads standard’ (the comparison group). Psychometric tests will be administered to fathers and mothers at baseline, post-program and at 3-month follow up. Data collection will occur over three years.DiscussionBy building the evidence base about responses to co-occurring domestic violence and substance use, this study aims to develop knowledge about improving safety outcomes for women and children, and to better understand appropriate support for children in families living at the intersection of domestic violence and substance use. It is anticipated that study findings will point to the ramifications for policy development to support less fragmented service system responses.Trial registrationAn application for registration with the Australian and New Zealand Clinical Trials Registry (https://www.anzctr.org.au/) was lodged on 20 December 2021 (Request number: 383206)—prospectively registered.

Applying the theory of planned behaviour to littering prevention behaviour in a developing country (Nigeria)

Guided by the Theory of Planned Behaviour, this study investigates littering attitudes, social norms, and perceived behavioural control as predictors of the intention to prevent littering and actual littering prevention behaviour among residents of a developing country (Nigeria). The study employed a survey questionnaire to collect cross-sectional data. By applying structural equation modelling it was found that people who intend to prevent littering are also more likely to engage in actual littering prevention behaviour. At the same time, the perceived behavioural control had a significant influence on littering prevention intention. The study's findings can assist waste managers in formulating policies and interventions targeting behavioural intention and perceived behavioural control to foster littering prevention. Further, environmental managers should engage applied social and environmental psychologists or social scientists to design such behaviour change programmes.