This visual overview of evidence examines the intention–physical activity (I–PA) gap, where positive intentions often fail to translate into behavior, a central challenge in physical activity (PA) promotion. Although intentions are necessary precursors to PA, nearly half of individuals with positive intentions do not follow through, underscoring the importance of identifying predictors of successful intention enactment for theory and practice. Evidence highlights reflective processes (i.e., affective judgments and self-efficacy/perceived control), regulatory processes (i.e., planning and self-monitoring), and reflexive processes (i.e., habit and identity) as key predictors of intention translation. Interventions targeting these constructs as mechanisms of action (MoAs) show small to medium effects on PA, but progress is limited by heterogeneity in behavior-change technique (BCT) application and under-examination of some MoAs. Closing the I–PA gap requires strengthening behavioral regulation, supporting positive affect, and aligning behavior with identity. By synthesizing theory and evidence across four figures, this review illustrates the role of intention in behavioral theories, the I–PA gap, I–PA moderators, and a logic model aligning BCTs with MoAs, offering practical guidance for researchers and practitioners. Future research using sustained experimental designs, including factorial studies, which precisely link BCTs to MoAs will be essential for developing interventions to close the gap between intentions and sustained PA.

A randomized controlled trial of wearable accelerometer-based feedback and behavior change techniques to increase physical activity and reduce sedentary behavior in older women.

Sewer misconnection: Recommendations for increasing sewer connections in low-income urban communities in Dhaka, Bangladesh.

Behaviour change interventions that increase human papillomavirus (HPV) vaccine uptake in school children have been identified, but not which behaviour change techniques (BCTs) make them effective, or whether interventions are best targeted towards adolescents or their parent/carer(s). We aimed to assess the efficacy of behaviour change interventions to increase HPV vaccination compared to usual care according to BCTs implemented, and to identify whether parent/carer(s), adolescents or both are the optimal intervention target population. We searched Central, Embase, Medline and Eric databases from 1st September 2008 to 17th July 2023 for randomised controlled trials (RCTs) reporting on HPV vaccine uptake following behaviour change interventions. We coded BCTs in interventions using the BCT taxonomy (v1). Random-effects meta-analyses and subgroup analyses were performed with data from studies that provided count data on HPV vaccine uptake by BCTs implemented and intervention target population. One thousand three hundred sixty-three unique records were identified, of which eight were eligible for inclusion. Implementing any behaviour change intervention was associated with a borderline significant increase in HPV vaccine uptake (OR 1.2 95% CI 1.0 to 1.4), interventions that implemented 'Instruction on how to perform the behaviour' (BCT 4.1) and 'Information about health consequences' (BCT 5.1) were not associated with increased HPV vaccine uptake (OR 1.7 95% CI 0.8 to 3.5), but analysis of two interventions implementing 'Adding objects to the environment' (BCT 12.5) in addition showed that this combination may be associated with significantly greater HPV vaccination (OR 13.6 95% CI 3.9 to 46.5). We found that interventions targeting parent/carer(s)-only were associated with a small significant increase in HPV vaccine uptake (OR 1.3 95% CI 1.1 to 1.5), but adolescent-only or parent/carer(s) and adolescent targeted interventions were not. To our knowledge this is the first systematic review and meta-analysis to quantify the efficacy of behaviour change interventions to increase HPV vaccine uptake according to BCTs implemented. We have demonstrated that implementing any behaviour change intervention marginally increases HPV vaccine uptake, and have identified a combination of BCTs that may be associated with significantly increased HPV vaccine uptake. Our work provides compelling evidence that public health interventions must be specific and evidence-based and calls for the implementation of changes to usual care in school-based vaccination programmes.

A novel 'whole day' approach that could motivate the public to be more physically active is termed Snacktivity™. Consistent with guidance, the Snacktivity™ approach encourages the public to accumulate ≥ 150min of physical activity in short 2-5-min 'activity snacks' of moderate-vigorous intensity physical activity throughout the day/week. Snacktivity™ also promotes muscle-strengthening activity twice per week. Following completion of research to co-design and develop the Snacktivity™ approach, the aim of this trial is to assess the effectiveness and cost-effectiveness of a Snacktivity™ intervention to increase physical activity and reduce future risk of disease in the population, compared with usual care. A multi-centre, two-arm, individually randomised, parallel group, superiority trial, with an economic evaluation, will be conducted in 966 physically inactive adults. Participants will be recruited from National Health Service Trusts and organisations and non-National HealthService settings (e.g. community groups and social media). Participants will be individually randomized (1:1) to the Snacktivity™ intervention group or a usual care comparator group. The Snacktivity intervention involves two main components; a brief 5-min consultation about the principles and purpose of Snacktivity™; and access to technology support (mobile phone app called the SnackApp, linked to a Fitbit activity device (Versa 4)) that through behavioural change techniques promote self-monitoring of physical activity, habit formation, action planning and feedback on the number of activity snacks completed each day. The primary outcome is the difference in average minutes of moderate-vigorous physical activity between the groups at 12-months follow up, measured using a wrist worn accelerometer. Secondary outcomes include accelerometer-assessed average minutes per day of light, moderate, and vigorous intensity physical activity, time sedentary, weight and psychological health outcomes, at 12month follow-up. Innovative interventions such as Snacktivity™, that aim to support the public to increase their physical activity each day are required. Findings could inform future public health guidance and public health messaging that seeks to raise awareness in the population of the potential benefits of Snacktivity™ for health. ISRCTN: 12390945. Registered on 22 March, 2024.

Clear communication is essential for the effective uptake of public health interventions promoting protective behaviours for respiratory infection control. The emergence of novel infectious diseases, particularly the COVID-19 pandemic, has highlighted the need for rapid adaptation of established and new behavioural practices. However, there remains limited knowledge concerning effective strategies for disseminating risk-reduction information and predicting population responses. This systematic review and meta-analysis (PROSPERO: CRD42020198874) assessed the effectiveness of these interventions using behavioural science frameworks, including MINDSPACE contextual influencers and behaviour change techniques (BCTs), to identify key components and mechanisms of action (MoAs). Twenty-four full-text articles, comprising 36 randomised controlled trials (RCTs) across 11 countries, were included via electronic databases (MEDLINE, EMBASE, PsycINFO, Scopus) and other sources (grey literature, Google Scholar, and reference lists) searched to March 2022. Here, we show that interventions mainly target social distancing, mask wearing, hand washing, and various behavioural intentions and actual behaviours, using a median of three-arm study designs with passive comparators. Interventions include a median of two contextual influencers and four BCTs. Behaviour intention is the most frequently applied mechanism of action. Study quality is moderate. Narrative synthesis of 16 full-texts (26 RCTs) shows significant effects, while network meta-analysis of 16 full-texts (21 RCTs) indicates that prosocial messages, particularly those referencing loved ones, are effective in reducing the risk of respiratory infections (d = 0.09; 95% CrI=0.06-0.14; CINeMA: Low). Although further research is needed, the review provides insight into designing public health messages that effectively improve protective behaviours for respiratory infection control.

While ChatGPT has shown promise in health domains, its application in smoking cessation, particularly in non-English contexts, remains underexplored. This study assessed the consistency, specificity, and inclusion of behavior change techniques in ChatGPT-4's advice for smoking-related queries in Traditional Chinese across three phases. ChatGPT-4 was accessed via Azure OpenAI Services (temperature: 0.7, Top P: 0.95). Phase 1 assessed consistency by generating 10 responses to identical smoking-related questions, measured using the Jaccard coefficient. Phase 2 evaluated specificity using 12 smoking-related vignettes, tailored to age, readiness to quit, and nicotine dependence, through Jaccard distances and alignment to the 2008 U.S. Clinical Practice Guideline. In Phase 3, 20 detailed smoking-related vignettes were analyzed for inclusion of behavior change techniques, the responses were also analyzed qualitatively. Two independent coders performed analysis in each phase, discrepancies were resolved by a third coder. Substantial agreement was observed between coders (Kappa = 0.63-1.00). ChatGPT-4 provided advice in Traditional Chinese with opening, bullet-point recommendations, and concluding. In Phase 1, the median Jaccard coefficient was 0.50, indicating moderate consistency. In Phase 2, specificity was higher for readiness to quit (0.58) and age (0.44) compared to nicotine dependence (0.40). Phase 3 identified 17 unique behavior change techniques, averaging 10 per response. Qualitative analysis found ChatGPT-4's advice was somewhat tailored but lacked sufficient detail or contextual appropriateness. ChatGPT-4 demonstrated moderate consistency, specificity, and inclusion of evidence-based content in its Traditional Chinese cessation advice. Improvements are needed to better adhere to cessation guidelines and enhance contextual relevance.

ABSTRACT The value–action gap in sustainable clothing consumption reflects a disconnect between consumers' sustainable values and actions. As global clothing consumption rises, garment lifespans decrease, increasing textile waste. Addressing this requires practical interventions to engage consumers in practices like extending garment lifetimes and responsible disposal of non‐reusable textiles. This study applied the Design for Sustainable Behaviour model in combination with selected behaviour change techniques (BCTs) in a workshop intervention aiming to bridge this gap. Pre‐post‐test surveys analysed the relationships between BCTs, participants' behavioural intentions and self‐reported behaviour. Results showed statistically significant associations between specific BCTs, such as environmental education, behaviour comparison and skill‐building, and participants' intentions to reuse or repair garments. However, no such associations were found for responsible disposal intentions. While we observed a reduction in the value–action gap over time, intention did not significantly predict long‐term behaviour, indicating a persistent intention‐behaviour gap. This research contributes to the literature by demonstrating how BCTs can be applied and evaluated in real‐world interventions related to clothing consumption. It also highlights the importance of tailoring techniques to the behavioural context and cautions against over‐reliance on intention as a predictor of sustainable action. Findings inform the design of future interventions targeting post‐use clothing practices.

Adherence to weight management is an essential indicator of weight management success. However, the conceptualization and operationalization of adherence show substantial variability, posing limitations for research, surveillance efforts, policy formulation, and comparisons across studies. This study aimed to identify in the literature of weight management interventions for people with obesity and overweight: (a) adherence definitions, (b) adherence components, (c) adherence metrics and measurement methods, and (d) behavior change techniques used to enhance it. A scoping review was conducted following PRISMA-ScR guidelines. A comprehensive search strategy was used (Web of Science, PubMed/MEDLINE, Scopus, and Cochrane). A total of 182 papers were included. Findings from the data synthesis showed variability in the definition, operationalization, and measurement of adherence across studies. The most frequent components of adherence in the context of weight management included (1) adherence to dietary behaviors, (2) adherence to physical activity, (3) attendance at intervention sessions, (4) self-monitoring of weight, (5) adherence to exercise, (6) adherence to medication, (7) attrition, (8) retention, and (9) dropout. The WHO's definition and framework to operationalize adherence are recommended, with modifications adjusted to the specific weight management context, as well as the use of standardized measurement metrics. Furthermore, behavior change techniques associated with adherence were summarized, with self-monitoring behavior and social support reported as strategies to improve adherence.

The growing threat of antimicrobial resistance has led to efforts to improve the responsible use of antimicrobials (antimicrobial stewardship - AMS). AMS education and training is essential for providing healthcare professionals with the knowledge and skills required to change prescribing behaviours, but the design and delivery of education and training varies, and it is unclear what content, and methods make for more effective education and training. The aim of this systematic review was to apply behavioural science frameworks to specify the content of AMS education and training interventions in hospital settings to determine 'what works' and to evaluate their effectiveness and cost-effectiveness. We searched MEDLINE, EMBASE, and CENTRAL and hand searched studies included in a previous Cochrane review for studies published from January 2015 to February 2025. We applied behavioural science frameworks (Action, Actor, Context, Target and Time framework, Behaviour Change Wheel and Behaviour Change Technique Taxonomy) to code intervention descriptions and supplementary materials from published papers into target behaviours, modes of delivery and behaviour change strategies used. Meta-regressions were used to explore the (cost-)effectiveness of different target behaviours, modalities, and behaviour change strategies on reducing antibiotic consumption. Of the 1845 studies identified, 64 were included in the review and 26 included in the meta-regression. Education/training was more effective in reducing antibiotic consumption when delivered face-to-face (β= -2.65, 95% CI: -5.23 to -0.07, k = 21). In total, 29 behaviour change techniques were identified across interventions, with no individual behaviour change technique associated with reduced antibiotic consumption. Interventions using the broad intervention types of modelling (Providing an example for people to aspire to or imitate) (β= -2.23 (95% CI: -4.27 to -0.18) and restriction (Using rules to reduce the opportunity to engage in the target behaviour or to increase the target behaviour by reducing the opportunity to engage in competing behaviours) (β = 2.95 (95% CI: 1.10 to 4.79) had significant effects on antibiotic consumption. Our results suggest that AMS education and training interventions may be more effective when they focus on modelling and appropriate restriction, and when delivered in-person. However, more evidence is needed from well-designed studies that explicitly report intervention content, to enable firmer conclusions about the specific elements involved in effective AMS education and training.

Women's initial preferences for self-sampling tests at home for cervical cancer screening in the UK: A mixed-methods analysis of demographic and behavioural factors.

PurposeCommunity behaviour change interventions are a promising strategy for addressing unhealthy eating and physical activity behaviours in underserved populations. This review explores these interventions' characteristics by focusing on behaviour change techniques, evaluates their behaviour change effectiveness and examines participant experiences.MethodsA mixed‐methods rapid review was conducted. Five databases and the grey literature were searched and supplemented by hand searching. Results were screened, assessed for methodological quality and data extracted using the Behaviour Change Techniques Ontology. A convergent segregated approach was used to synthesize the results.ResultsTwenty‐one studies were included. Commonly used behaviour change techniques were social support, guidance on how to perform the behaviour and monitoring. Intervention effects on healthy eating and physical activity behaviour change were small, but outcomes that measured influences on behaviour change (e.g., social support) improved. Participants reported largely positive experiences, mostly attributed to the intervention's tailoring to the target population's contexts and the engagement and expertise of those who delivered the intervention.ConclusionsEvidence of direct behaviour change remains limited; there is stronger evidence for improvements in factors that influence behaviour change. Qualitative evidence highlights the value of tailoring interventions to participants' lives and using relatable, knowledgeable sources for delivery. This could enhance engagement and contribute to improved outcomes over time. Further research is needed on how contextual tailoring is implemented and how the characteristics of those delivering interventions influence effectiveness and experience. Findings support the potential of community‐centred approaches, but long‐term evaluations in underserved contexts are needed.

The adoption of mobile health (mHealth) technologies among older adults remains significantly lower than in younger populations, despite their potential to promote healthier lifestyles and mitigate age-related health risks. This study aims to explore the perspectives of retirement-age adults on mHealth interventions, identifying factors that influence their adoption, such as persuasive elements in the app design and psychological techniques. A qualitative focus group study was conducted with 19 Spanish participants recruited from urban community settings in Madrid, Spain (mean age 61.5 years; 15/19, 79% women). Participants discussed their attitudes, barriers, and preferences for mHealth tools. Focus groups were recorded, transcribed, and coded using an iterative process to ensure rigorous data analysis. An abductive approach was followed, using the persuasive design principles framework and the behavior change techniques' taxonomy, and representing any theme outside those frameworks. Participants expressed generally positive attitudes toward mHealth tools, favoring intuitive, user-friendly designs that are minimally time-demanding. However, significant barriers also emerged, such as low digital literacy and concerns about technology dependence. Key design preferences (persuasive design principles) and psychological techniques (behavior change techniques) were deemed beneficial, with preferred features such as tailored and meaningful goal-setting, self-monitoring, positive feedback (eg, congratulating messages after achieving a goal; social rewards), and a moderated use of notifications and prompts. Participants also stressed the importance of age-appropriate recommendations (eg, suggested diets for their age and characteristics) and design (eg, accessible, easy-to-use interfaces and human-like communication). Additionally, some preferences appeared to be culturally grounded (eg, rejection of anglicisms and the desire for locally relevant content, such as suggested activities specific to Madrid). Social support mechanisms, such as group activities and peer interactions through mHealth, were seen as critical for fostering motivation and engagement. mHealth interventions for this population should offer accessible and easy-to-use interfaces along with initial tutorials, facilitating an easy onboarding to overcome low digital literacy, thereby enhancing both usability and initial adoption. Furthermore, by providing meaningful, tailored content (eg, personalized diets and goals) and social features that foster peer connection (eg, user chats or organized activities), these tools may better support sustained engagement over time.

Many mobile health (mHealth) apps focus on promoting physical activity (PA) and healthy eating (HE). However, there is limited empirical evidence regarding their effectiveness in initiating and sustaining behavior change, particularly among children and adolescents. Considering that behavior is influenced by social contexts, it is essential to take core settings like family dynamics into account when designing mHealth apps. The purpose of this study was to further develop and refine the SMARTFAMILY (SF) app targeting PA and HE in a collective family-based setting by enhancing design and usability, as well as by adding gamification aspects, health literacy, and just-in-time adaptive interventions to the first version of the app. The SF2.0 app, based on behavior change theories and techniques, was developed, implemented, and evaluated. The app was used in a collective family setting, with family members using it individually and cooperatively. In a cluster-randomized controlled trial, the intervention group (IG) used the app for 3 consecutive weeks, while the control group (CG) received no treatment. Primary outcomes included PA measured through self-reports and accelerometry, as well as self-reported fruit and vegetable intake (FVI) for HE. Secondary outcomes included intrinsic motivation, behavior-specific self-efficacy, and the Family Health Climate. A follow-up assessment (T2) was conducted 4 weeks after the postmeasurement (T1) to assess intervention effects. Multilevel analyses were performed in R (R Foundation for Statistical Computing), considering the hierarchical structure of individuals (level 1) within families (level 2). Overall, 55 families (28 CG, 105/209; 27 IG, 104/209 participants) were recruited for the study. In total, 3 families (3 CG, n=12) chose to drop out of the study due to personal reasons before T0. Overall, no evidence for meaningful and statistically significant increases in PA was observed in favor of the IG of our physically active sample. However, the app elucidated positive effects in favor of the IG for FVI diary (T0-T1; P=.03), joint PA (T0-T1; P=.02 and T0-T2; P<.001), and joint family meals (T0-T1; P=.004). The SF2.0 trial evaluated an mHealth intervention designed to promote PA and HE within families. Despite incorporating a theoretical foundation, several behavior change techniques based on family life, and gamification and just-in-time adaptive intervention features, the intervention did not significantly increase PA levels among physically active participants. FVI, joint PA, and joint meals were improved within the IG. Previous studies on digital health interventions have produced mixed results, and family-based mHealth interventions remain rare, with limited focus on whole-family behavior and randomized controlled trials. To enhance intervention effectiveness, future app development could consider incorporating even more advanced features and should focus on inactive participants. Further research is needed to better understand intervention engagement and tailor mHealth approaches for primary prevention efforts. German Clinical Trials Register DRKS00010415; https://www.drks.de/search/en/trial/DRKS00010415. RR2-10.2196/20534.

Establishing healthy 24-hour movement behaviours early in life is crucial for long-term health. However, few preschoolers comply with the 24-hour movement behaviour guidelines. Given the pivotal role of parents in shaping children's health habits, interventions targeting parenting practices may optimise these behaviours in preschoolers. This study evaluates the effectiveness of the 'Move ARound And Get Active' (MARGA) intervention in improving preschoolers' 24-hour movement behaviour composition, guideline compliance, and parents' parenting practices. A two-armed, non-equivalent pretest-post-test control group design was conducted in Belgium. The MARGA intervention, co-created with parents, incorporated seven interactive sessions over 11 weeks, focussing on parenting practices conceptualised within the Self-Determination Theory and behaviour change methods such as planning and goal setting. Participants included preschoolers (2.5-6 years) and one parent per child (n = 141; 49 intervention, 92 control). The primary outcomes were changes in preschoolers' 24-hour movement behaviour composition and guideline compliance measured using accelerometers and proxy-reported diary. Secondary outcomes included changes in proxy-reported parents' parenting practices. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed. In addition, intervention implementation was investigated. The intervention showed no significant impact on the overall 24-hour movement behaviour composition, nor on 24h-movement behaviour guideline compliance. However, favourable intervention effects were observed for screen time guideline compliance (ITT: d = 1.5, p = 0.04, PP: d = 8.6, p = < 0.001) and combinations of screen time and physical activity (ITT: d = 1.2, p = 0.05, PP: d = 1.7, p = 0.04) or sleep (PP: d = 1.7, p = 0.05) guideline compliance. Parenting practices also improved in parents from the intervention condition compared to parents from the control condition, including setting screen time rules (ITT: d = 0.79, p = 0.01, PP: d = 1.1, p = 0.001), providing choices within sleep routines (ITT: d = 0.63, p = 0.04, PP: d = 0.68, p = 0.05), parent and preschooler performing physical activity together (PP: d = 0.76, p = 0.03) and explaining screen time rules (PP: d = 0.68, p = 0.05). Implementation scores indicated moderate engagement, with attendance rates averaging 49.7%. The intervention showed modest improvements in preschoolers' 24-hour movement behaviours and parenting practices. Extended follow-up observations might be required to capture changes in preschoolers' 24-hour movement behaviours, especially considering that the intervention targets preschoolers indirectly by first aiming to influence parents' parenting practices. ClinicalTrials.gov (ID NCT06171191).

Endocrine-disrupting chemicals (EDCs) represent a threat for the ecosystem and human health. Exposure routes include modifiable exposures, such as choice of food or cosmetics but also daily habits such as airing the room. However, current attempts to reduce modifiable exposure often rely on knowledge provision and awareness-raising campaigns. This is the case even though human behaviour, decision making and habits change have been studied for a long time, and numerous psychological theories demonstrate that the transition from awareness of a health threat to actually change daily behaviour is not straightforward. This paper calls for interventions on EDCs exposure reduction to build on solid understanding of human behaviour and use of evidence-based behaviour change techniques to achieve significant impact. We illustrate how this can be done by presenting the HYPIEND project, a multicomponent behavioural intervention designed to help pregnant women and prepubertal children (and their parents) to reduce their modifiable exposure to EDCs in these sensitive periods. HYPIEND relies on behavioural evidence-based models such as the Health Action Process Approach model, motivational interviewing techniques, and broader support through partners (for pregnant women) and the school environment (for children) through a school-wide project built on the School Wide Positive Behavioural Interventions Supports.

Frailty is an especially significant consequence of ageing with resulting physical decline. Some studies suggest that exercise can reduce the deleterious effects of ageing and have a positive impact on functional ability and quality of life. Further research was required to determine the clinical effectiveness and cost-effectiveness of extended community-based rehabilitation for older people following acute illness or injury. The Home-based Extended Rehabilitation for Older people trial included an embedded process evaluation and compared provision of a home-based graded exercise programme plus usual care (the Home-based Older People's Exercise intervention) versus usual care alone for community-dwelling older people with frailty. Qualitative mixed-methods process evaluation incorporating non-participant observations, semistructured interviews and analysis of therapy records and participants' exercise diaries. Primary aims of the process evaluation were to explore fidelity and acceptability in intervention delivery. Data analysis was based on thematic analysis and was underpinned by Normalisation Process Theory. Data were generated in 10 community services in England. Non-participant observations of 10 staff training sessions, 61 intervention delivery sessions and 8 staff trial update sessions were completed. Semistructured interviews were conducted with 10 therapy service managers, 19 therapists and 4 therapy assistants. Thirty-five interviews were conducted with intervention participants, with some including supporting carers, and 19 with usual care only participants. There was evidence of fidelity to the intervention protocol, with no significant variation between sites. Less experienced therapists were sometimes less confident in making judgements about what exercises could be adapted and tailored to the individual while maintaining intervention fidelity. Most therapists utilised planned behaviour change techniques to engage participants and sustain their involvement in the exercise programme. Intervention acceptability was generally good, with therapy staff and participants noting potential and actual benefits of the intervention and associated physical improvements for participants completing the 24-week intervention. Usual care only participant interviews provided no evidence of engagement with or perceived benefit from community-based programmes provided by the National Health Service or private providers which were equivalent to the Home-based Older People's Exercise intervention. Therapists and therapy service managers noted the value of the Home-based Older People's Exercise intervention as an addition to existing programmes that were designed to reduce the likelihood of older people with frailty requiring hospital admission. However, they felt that embedding the intervention in routine service provision would prove to be challenging within the existing resource allocation. It was necessary to utilise convenience sampling for some of the data collection. It proved to be difficult to recruit family carers, as many participants lived alone. These issues may have impacted the extent to which participants were fully representative of the population targeted in the Home-based Extended Rehabilitation for Older people trial. Home-based Older People's Exercise was perceived to be an acceptable rehabilitation intervention, which could be utilised to extend existing home-based rehabilitation for older people living with frailty. With appropriate resource allocation, it could be delivered by therapists and appropriately trained and supervised therapy assistants in community-based rehabilitation settings. Research is needed to evaluate the effectiveness of structured, individually tailored, exercise interventions, like Home-based Older People's Exercise, within inpatient and community-based intermediate care settings, recognising the variation in delivery models across health services. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/43/07.

Returning to the workplace after inpatient medical rehabilitation poses significant challenges for many rehabilitants. When conventional rehabilitation aftercare is not available, internet-based aftercare offers an effective alternative to support rehabilitants in incorporating action and coping strategies developed during rehabilitation into daily personal and professional life. This paper presents the development and pilot testing of the internet-based self-help intervention "marena" (My Work-Related Rehabilitation Aftercare), which was designed to support rehabilitants during this complex transition.The intervention was developed in an agile, iterative process based on comprehensive literature research and expert interviews. Its features and content were continuously refined through expert feedback loops. Rehabilitants were actively involved in order to identify potential usability problems and evaluate usability and user experience.Marena includes, among other elements, task planning with pre-designed aftercare plans, a knowledge base with frequently asked questions, and established rehabilitation strategies and exercises. Marena promotes key behaviour change techniques by providing information and supporting self-monitoring and setting aftercare goals. The pilot study included n=7 participants. Usability was rated as good, achieving a System Usability Score of 75.33 (SD=6.97). User experience was assessed in the User Experience Questionnaire with an overall score of 1.02 (SD=1.07), indicating an average rating. A total of 38 usability issues were identified, with the most frequent and severe problems occurring in the areas of design and functionality.Despite some limitations, the pilot study provides valuable insights into user interactions with the intervention. The investigation identified key usability issues, which led to specific optimizations of the application. The results highlight the importance of pilot-testing internet-based interventions with future users for identifying usability-problems early on. The intervention is currently undergoing evaluation for effectiveness in a randomized controlled trial.

BackgroundEndometriosis is a chronic inflammatory condition experienced by approximately 10% of women worldwide. Women living with endometriosis experience multidimensional burdens often attributed to pain, fatigue, anxiety, and depression. Treatment patterns frequently focus on acute symptom management, while endometriosis is a lifelong condition. In addition, endometriosis-associated symptoms are complex, requiring multimodal treatment strategies. New complementary approaches for symptom management are needed, where further exploration of current online programs is a necessary next step. Online programs can be noninvasive and convenient, provide a sense of comfort, and are often more cost-effective than traditional in-person medicine. Mapping components within the online programs, using the behavior change ontologies, for women living with endometriosis is necessary for developing effective and long-lasting endometriosis management options.ObjectiveThe aim of this scoping review is to examine the range and nature of online cognitive-behavioral programs created to manage endometriosis-associated symptoms and to identify key behavior change techniques (BCTs) within the online programs.MethodsWe will conduct the proposed scoping review using the Arksey and O’Malley framework with an interpretive scoping review, consulting stakeholder methodology (6 stages) and referencing the Joanna Briggs Institute Evidence Synthesis Manual. The population-situation framework was used to develop our search strategy, focusing on women living with endometriosis (population) and online programs or online interventions (situation). The study must be a primary source of data, published in 2014 or later, the intervention must take place online and must seek long-term changes for symptom management. Original studies, including peer-reviewed and protocol studies, will be identified from Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL Complete, ProQuest Nursing and Allied Health Premium, EBSCOhost SPORTDiscus, and ProQuest PsycINFO. Preprints will be identified via the Web of Science Preprint Citation Index. We will also search for active clinical trials from multiple registries. EndNote (Clarivate) will be used for citation management, and Covidence (Veritas Health Innovation Ltd) software will be used for screening and extraction. Up to 5 reviewers will screen studies in Covidence using an inclusion checklist for title and abstract screening and then full-text review. Included studies will be coded to identify BCTs within the online intervention using the BCTs Taxonomy v1. Results will report on the characteristics of the included studies, the BCTs used in the online program or intervention, and the outcomes of the program. Results, including tables and the narrative, have been piloted prior to publication of this protocol using 4 studies that meet our criteria.ResultsData collection is scheduled to start in October of 2025, with results to be published by the Spring of 2026. This research is not directly funded.ConclusionsThis review will collate information about online symptom management interventions for women living with endometriosis. Findings will identify gaps that can guide future intervention development.

ABSTRACT Physical education (PE) offers a valuable opportunity to reduce physical inactivity and promote lifelong healthy habits among children and adolescents. The benefits of interventions in PE largely depend on students’ engagement with lessons. However, the mechanisms driving engagement and the behaviour change techniques (BCTs) involved remain underexplored. This scoping review, conducted in accordance with Joanna Briggs Institute methodological guidelines, aimed to map the mechanisms underlying engagement in mainstream PE among 6- to 16-year-olds in high- and upper-middle-income countries. A systematic search in CINAHL, MEDLINE, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science was completed, up to March 2025. Across 98 eligible studies, key barriers (e.g., negative peer interactions, limited teacher training, traditional curricula) and enablers (e.g., need-supportive teaching, positive peer relationships, access to resources) were coded using the 26 mechanisms of action from the Theory and Techniques Tool. Second, this tool guided the identification of potentially relevant BCTs associated with the most important mechanisms, e.g. social support, social comparison, instruction on how to perform behaviour, behavioural practice/rehearsal, graded tasks, information about others’ approval. These findings lay the groundwork for future interventions designed to enhance student engagement in PE by identifying promising behavioural strategies and key mechanisms.