Behaviour Change Techniques Research Articles

Improving Parent-Adolescent Conversation to Promote Adolescent Sleep Health Behavior Change: An Open Trial of the Parent Behavior Change Intervention (PBC-I)

The Parent Behavior Change Intervention (PBC-I) was developed to target parent-adolescent conversations that promote adolescent health behavior change. We report on an open trial of the PBC-I. Participants were 36 parent-adolescent dyads. Adolescents received the Transdiagnostic Sleep and Circadian Intervention (TranS-C) as parents received the PBC-I. Dyads were assessed at pre- and post-intervention for parent use of behavior change techniques (BCT) and positive and negative conversational behaviors, parent-adolescent conflict, adolescent motivation for change, and adolescent sleep outcomes. From pre to post, parents used fewer total and types of BCTs, more positive communication behaviors, and less negative communication behaviors when discussing a sleep-related hot topic. From pre to post, parents reported decreased coercion and less anger intensity while adolescents reported fewer parental conflict behaviors and less quantity and anger intensity during parent-adolescent disagreement. There was a pre-to-post increase in interest/enjoyment of sleep and a decrease in effort/importance to participate in TranS-C. More positive and less negative communication was associated with select adolescent sleep outcomes. Parents rated the PBC-I as highly acceptable and perceived it as useful. These results provide preliminary evidence supporting the PBC-I improving the parent-adolescent interpersonal process, which is linked to improved adolescent sleep. The results may be relevant to conversations parents have with adolescents about a range of health behavior change.

Examining Well-Being and Healthy Lifestyle Interventions among Nursing Students Worldwide: A Scoping Review.

Purpose: The purpose of this scoping review was to identify intervention studies related to well-being and healthy lifestyles in nursing students to identify research gaps in the literature for future research. Methods: The review followed the Joanna Briggs Institute (JBI), JBI Manual for Evidence Synthesis, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Five databases were searched to retrieve the articles assessed by this review: APA PsycINFO, CINAHL Complete, PubMed, Scopus, and Web of Science. Inclusion criteria included articles with a sample population of nursing students; addressed the well-being, wellness, health, or healthy lifestyle(s) of nursing students; tested an intervention(s), lifestyle change, behavioral change interventions, or behavior change technique. Findings: Twenty-four articles were included for analysis. Three categories of interventions were found: interventions related to (1) educational and curricular strategies, (2) psychological related interventions, and (3) supportive environments. Conclusion: This review adds to the literature by identifying future interventions that can increase the well-being of nursing students. The ability to cope with the stressors of school and competing demands is essential to meet academic requirements and goals. Therefore, understanding how to address nursing student well-being is vital to the future of the nursing profession.

Evaluating the Let's Move It intervention programme theory for adolescents' physical activity: Theorized psychosocial mechanisms of behavioural changes.

Behaviour change theories have extensively been used in health behaviour change interventions and their programme theories. However, they are rarely evaluated in randomized field studies. The Let's Move It intervention targeted various psychosocial constructs to increase adolescents' physical activity. A theory-based process evaluation aiming to illuminate the trial findings as well as to test the programme theory used is conducted. Specifically, we investigate whether the intervention influenced the theorized determinants of change immediately post-intervention and after 1 year, and whether these determinants were associated with changes in physical activity. A cluster-randomized controlled trial (n = 1166). We measured theorized determinants with self-report, and physical activity (PA) with accelerometry and self-report. The effects are evaluated with repeated measures ANOVA and regression models. No changes were detected in most theorized determinants but intervention arm reported higher enactment of behaviour change techniques used during intervention immediately post-intervention and lower descriptive norms for PA throughout. Autonomous motivation was associated with PA immediately post-intervention. The lack of intervention effects may be due to many factors, for example insensitive measures, ceiling effects. However, reporting these null effects advances understanding of behaviour change processes. We introduce methodologic possibilities for future intervention programme theory evaluation efforts.

Digital behaviour change intervention for weight loss maintenance in adults with obesity: a feasibility pilot study of eCHANGE

ABSTRACT Successful weight maintenance after weight loss is challenging. Digital interventions may facilitate behaviour change to prevent weight regain, however little is known about the acceptance and use of digital interventions in support of weight maintenance. This mixed methods study aims to evaluate user experiences, system use, and preliminary efficacy of eCHANGE, an application based self-management intervention for weight loss maintenance. A 3-month multi-site single group feasibility pilot study was conducted among adults (N = 60) with BMI ≥30 kg/m2, aiming to maintain weight after weight loss of ≥8%. User experiences and system use were examined through validated questionnaires, system use log data, and individual interviews (n = 15). Preliminary efficacy testing included body weight and patient reported outcome measures. Participants rated eCHANGE usability and usefulness as good in support of weight maintenance, with variation in usage. Analysis indicated that higher behavioural engagement scores were statistically significantly associated with frequency of technology usage. Weight loss was maintained by 83% of the participants at 3-months (i.e. defined as weight change of <3% of baseline body weight (kg)). Digital interventions, combining persuasive system design principles and behaviour change techniques, supporting self-regulation and maintenance of health behaviours, have the potential to facilitate weight maintenance after weight loss. Trial Registration: ClinicalTrials.gov NCT04537988 https://clinicaltrials.gov/ct2/show/NCT04537988

Data-Driven Implementation Strategy to Optimise Clinician Behaviour Change at Scale in Complex Clinical Environments: A Multicentre Emergency Care Study.

To develop an evidence-driven, behaviour change focused strategy to maximise implementation and uptake of HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) in 30 Australian rural, regional and metropolitan emergency departments. An embedded, mixed-methods study. This study is the first phase of a step-wedge cluster randomised control trial of HIRAID involving over 1300 emergency nurses. Concurrent quantitative and qualitative data were collected via an electronic survey sent to all nurses to identify preliminary barriers and enablers to HIRAID implementation. The survey was informed by the Theoretical Domains Framework, which is a synthesis of behavioural change theories that applies the science of intervention implementation in health care to effect change. Quantitative data were analysed using descriptive statistics and qualitative data with inductive content analysis. Data were then integrated to generate barriers and enablers to HIRAID implementation which were mapped to the Theoretical Domains Framework. Corresponding intervention functions and Behaviour Change techniques were selected and an overarching implementation strategy was developed through stakeholder consultation and application of the APEASE criteria (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety and Equity). Six barriers to HIRAID implementation were identified by 670 respondents (response rate ~58%) representing all 30 sites: (i) lack of knowledge about HIRAID; (ii) high workload, (iii) lack of belief anything would change; (iv) not suitable for workplace; (v), uncertainty about what to do and (vi) lack of support or time for education. The three enablers were as follows: (i) willingness to learn and adopt something new; (ii) recognition of the need for something new and (iii) wanting to do what is best for patient care. The 10 corresponding domains were mapped to seven intervention functions, 21 behaviour change techniques and 45 mechanisms. The major components of the implementation strategy were a scaffolded education programme, clinical support and environmental modifications. A systematic process guided by the behaviour change wheel resulted in the generation of a multifaceted implementation strategy to implement HIRAID across rural, regional and metropolitan emergency departments. Implementation fidelity, reach and impact now require evaluation. HIRAID emergency nursing assessment framework reduced clinical deterioration relating to emergency care and improved self-confidence and documentation in emergency departments in pilot studies. Successful implementation of any intervention in the emergency department is notoriously difficult due to workload unpredictability, the undifferentiated nature of patients and high staff turnover. Key barriers and enablers were identified, and a successful implementation strategy was developed. This study uses theoretical frameworks to identify barriers and enablers to develop a data-driven, behavioural-focused implementation strategy to optimise the uptake of HIRAID in geographically diverse emergency departments which can be used to inform future implementation efforts involving emergency nurses. The CROSS reporting method (Supporting Information S3) was used to adhere to EQUATOR guidelines. No Patient or Public Contribution. Australian New Zealand; Clinical Trials Registry (ANZCTR) number: ACTRN12621001456842, registered 25/10/2021.

Effect of Behavior-change Interventions on Daily Physical Activity in Patients with Intermittent Claudication: The OPTIMA Systematic Review with Meta-Analysis.

The study aimed to synthesize evidence of daily physical activity (PA) following Behavior-change technique (BCT)-based interventions compared to any control in individuals with peripheral arterial disease/intermittent claudication (PAD/IC); and examine the relationship between BCTs and daily PA. Systematic search of 11 databases from inception to 30/11/2022 was conducted, plus weekly email alerts of new literature until 31/8/2023. Studies comparing BCT-based interventions with any control were included. Primary analysis involved a pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane-RoB-2 and ROBINS-I tools. Certainty of evidence was evaluated with the GRADE system. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Outcome measures were short-term (<6 months) change in daily PA, and maintenance of the daily PA (6 months or longer) reported as standardized mean differences (SMDs) with 95% confidence intervals (95%CIs). Forty-one studies (4,339 patients; 26 RCTs/3,357 patients; 15 non-RCTs/982 patients; study mean age 60.3 to 73.8, 29.5% female) were included. Eleven RCTs (15 comparisons, 952 participants) suggested that BCT-based interventions increased daily PA in the short term compared to non-SET [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ∼473 steps/day] with high certainty. Evidence of maintenance of daily PA (≥6 months) is unclear [increase of 0.12 SMD (95%CI: -0.04 to 0.29); ∼288 steps/day; 6RCTs, 8 comparisons, 899 participants], with moderate certainty. For daily PA, compared to SET it was inconclusive both for < 6months change [-0.13 SMD, 95%CI: -0.43 to 0.16); 3RCTs, 269 participants; low certainty] and ≥6months [-0.04 SMD, 95%CI: -0.55 to 0.47); 1 RCT, 89 participants; very low certainty]. It was unclear whether the number of BCTs or any BCT domain were independently related to an increase in PA. BCT-based interventions improve short-term daily PA in people with PAD/IC compared to non-SET controls. Evidence for maintenance of the improved PA at 6 months or longer and comparison with SET is uncertain. BCT-based interventions are effective choices for enhancing daily PA in PAD/IC.

Developing films to support vaccine-hesitant, ethnically diverse parents’ decision-making about the human papillomavirus (HPV) vaccine: a codesign study

ObjectiveTo illustrate an evidence-, theory- and person-based approach to codesign the COMMUNICATE films that support parental decision-making about the human papillomavirus (HPV) vaccine for their teenagers.DesignCodesign study.SettingLocalities covered by two...

Content, Behaviour Change Techniques, and Quality of Postpartum Depression Apps to Be Recommended by Midwives: Systematic Search and Evaluation.

Postpartum depression is a public health problem that affects a considerable percentage of women. Despite the proliferation of related apps, there are limited data available on the best apps to prevent postpartum depression. We identified which apps available in Spanish could be recommended by midwives based on their content, quality, and behaviour change techniques, as a complementary tool for preventing postpartum depression in women. A systematic search was performed to identify apps available on iOS App Store and Google Play, which were used to replicate how patients' access "postpartum depression prevention" apps. Apps' quality, behaviour change potential, and contents were assessed. A total of 1408 apps were identified, of which 7 were retrieved for assessment (0.5%). The mean objective and subject quality were 3.1 (SD = 1.01) and 2.7 (SD = 1.27), respectively. A total of 24 topics were identified. The mean ABACUS score was 6.6 (SD = 3.64), and the mean number of topics addressed by the apps was 9.9 (SD = 5.90). The results of the present study suggest that a specific free app is not available in Spanish for the prevention of postpartum depression, and only a small percentage of free apps should be recommended based on their quality, BCTs, and contents. The systematic review protocol was not registered.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions.

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

Effectiveness of a Just-In-Time Adaptive App to Increase Daily Steps: An RCT

IntroductionAddressing the public health problem of physical inactivity, this study evaluates “SNapp”, a just-in-time adaptive app intervention to promote walking through dynamically tailored coaching content. It assesses SNapp's impact on daily steps and how users’ perceptions regarding ease of use and usefulness moderated its effectiveness. Study designSNapp was evaluated in an RCT from February 2021 to May 2022. Analyses were conducted in November 2022. Setting/participants176 adults (76% female, mean age of 56 years) were randomized to a control group receiving a step counter app (n = 89) or an intervention group receiving the app plus coaching content (n = 87). InterventionSNapp's coaching content encompasses individually tailored feedback on step counts and advice to engage in more walking, taking preferences regarding behavior change techniques into account. Additionally, SNapp provides contextualized content calling attention to suitable walking locations in the user's environment. Main outcome measuresThe primary outcome was daily step count as recorded by the step counter app. User perceptions regarding ease of use and usefulness were assessed via survey at 3-month follow-up. ResultsMixed models indicated that the intervention did not significantly impact step counts on average over time (B = -202.30, 95% CI = -889.7, 485.1), with the coefficient indicating that the intervention group walked fewer steps per day on average, though this difference was not statistically significant. Perceived ease of use did not moderate the intervention effect (B group x perceived ease of use = 38.60, 90% CI = -276.5, 353.7). Perceived usefulness significantly moderated the intervention effect (B group x perceived usefulness = 344.38, 90% CI = 40.4, 648.3). ConclusionsSNapp increased steps only in users who deemed the app useful, underscoring the importance of user perceptions in app-based interventions. Trial registrationThis trial was preregistered in the Dutch Trial Register (NL7064).

221 - Preconception lifestyle interventions for women – a systematic review and meta-analysis of intervention characteristics and behaviour change techniques

221 - Preconception lifestyle interventions for women – a systematic review and meta-analysis of intervention characteristics and behaviour change techniques

Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis

Interventions supporting parents of young children often target parenting or parental mental health separately. Multi-component parenting and parental mental health interventions have the potential to improve parenting practices, mental health, and early childhood development. We aimed to examine their impact on child and parent outcomes. In this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science Core Collection, APA PsycINFO, CINAHL Complete, the Cochrane Central Register of Controlled Trials, and the Global Health Database from inception to Jan 23, 2024. Eligible studies were randomised controlled trials of interventions explicitly targeting parenting behaviours and parental mental health antenatally or in children's first 3 years of life. Screening, extraction, and quality assessment were done independently by two authors. Primary outcomes were cognitive and social-emotional functioning in children and depressive symptoms in parents, meta-analysed as standardised mean differences (SMDs), relative to control. This study is registered with PROSPERO, CRD42022302848. We found 5843 records. After screening 2636 (45·1%) titles and abstracts, we manually identified and screened three additional articles and excluded 2177 records. After screening 462 full-length articles, 25 articles, representing a sample size of 8520 children and caregivers, were included. At baseline, mean caregiver age was 27·7 years (SD 5·9) and mean child age (excluding those enrolled during pregnancy) was 14·4 months (8·0). Interventions lasted a mean of 14 months (SD 11) and used a mean of 3·7 behaviour change techniques (2·0). Most interventions dedicated more time to parenting behaviours than to parental mental health. We found significant intervention effects on children's cognitive (SMD 0·19 [95% CI 0·04 to 0·34]; I2=69%) and social-emotional (0·26 [0·17 to 0·34]; I2=47%) outcomes but not on depressive symptoms in female caregivers (-0·18 [-0·36 to 0·002]; I2=86%) relative to control conditions. Risk of bias across studies was moderate, and we found heterogeneity across results. Multi-component parenting and mental health interventions had a positive effect on child cognitive and social-emotional outcomes, but not on depressive symptoms in parents, suggesting that other factors might contribute to positive ECD outcomes. Interventions might lack adequate focus on mental health to make a discernible impact, highlighting a need for future studies to differentiate and assess contributions of parenting and mental health components to understand independent and collective effects on family outcomes. Canadian Institutes of Health Research.

S14 Physical activity promotion in healthcare settings: Designing and implementing physical activity referral schemes

Abstract Purpose This symposium will share findings, expertise and experiences from different countries on the design and implementation of physical activity referral schemes (PARS). Description Physical activity promotion by healthcare professionals is a key strategy to increase population physical activity levels. This strategy has been outlined in the World Health Organisation’s (WHO) ‘Global Action Plan on Physical Activity’ (GAPPA) and the ‘Physical activity strategy for the WHO European Region 2016-2025‘. PARS are a promising intervention that allow healthcare professionals to advocate for physical activity and integrate its promotion into routine clinical care. PARS are a heterogeneous group of interventions. Simpler PARS, for example, may consist only of a written description, while more complex PARS might include different healthcare professionals working together systematically, applying several behaviour change techniques in combination with physical activity practice, to connect patients to community resources. There is currently no consensus on the optimal PARS approach and implementation strategies. Implementers need specific knowledge, skills and methods; however, implementation is also influenced by structural and context-related factors in the healthcare system. Accordingly, a successful implementation of PARS needs co-productive capacity building within healthcare systems and proper support for healthcare professionals. The symposium includes four contributions (3 research-oriented and 1 practise-oriented) related to the design and implementation of PARS in different countries. 1) EUPAP Feasibility Study. Practice transfer of a HEPA prescription model to other nine EU countries. From theory to practice. Sebastià Mas-Alòs 2) The association of physical activity referral scheme’ components with physical activity level, scheme uptake and adherence rates: a systematic review, meta-analysis with meta-regression. Wolfgang Geidl 3) The adoption and implementation of a physical activity referral pathway integrated into a major U.S. health system. Mark Stoutenberg 4) Designing a physical activity pathway in healthcare model for Irish Health Services. Sarah O’Brien This symposium will provide guidance on the development of PARS and future successful implementation in other healthcare settings.

Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review.

To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.

Automated information extraction for behavioural interventions: evaluation and reflections on interdisciplinary AI development

Background The HBCP knowledge system identifies and extracts entities from randomised controlled trials of behaviour change interventions organised by a behaviour change intervention ontology (BCIO) to populate: 1) an outcome prediction tool; and 2) a research browser tool. This knowledge system requires automated information extraction algorithms to query and interpret evidence from behaviour change intervention (BCI) reports. This paper reports the results of an evaluation of the automated information extraction and reflects on the results in relation to the challenges of interdisciplinary working and collaboration. Methods The evaluation used a dataset of 117 previously unseen BCI reports to assess its performance. The automatically extracted information was compared to the full text PDF by trained annotators on essential BCIO entities required for the outcome prediction tool and research browser tool and whether the extracted information was assigned to the correct arm of the randomised trial. Essential entities were the outcome value, a selection of the most common Behaviour Change Techniques (BCTs), the mode of intervention delivery, and key population characteristics. Results The evaluation found an outcome value present in 53.85% (n=63) of the output from the information extraction system but it never extracted both the correct outcome values (interventions and control arms) and assigned them to the correct study arms (intervention and control). Although 84.62% (n=99) of the papers contained information relevant to Behaviour Change Techniques (BCTs), the information extraction algorithm correctly extracted only 58.59% (n=58) of BCTs. Conclusions The evaluation found that the information extraction algorithm did not extract the outcome values and key BCIO entities correctly against the correct arms in any of the papers in our sample, making it unsuitable for deployment in the outcome prediction and research browser tools. Several challenges with working in interdisciplinary teams were identified and discussed along with lessons learned for future work.

Tackling unmanaged oropharyngeal dysphagia in primary care: a behavioural science realist review of interventions

IntroductionOropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care,...

Older adults’ perceptions and experiences of engaging in web- and mobile-based physical activity interventions: A systematic review and qualitative meta-synthesis

BackgroundWeb- and mobile-based physical activity interventions effectively promote physical and mental health among older adults, but participation and adherence are suboptimal. MethodsThis qualitative review used the mega-aggregation approach. Searches were conducted in five databases from the earliest to November 2023. Quality assessment and data extraction used JBI tools. Data synthesis used the COM-B model as a guide. ResultsSixteen sub-themes were identified from the eight studies and categorized into the COM-B model. Sub‑themes were physical and psychological changes, digital skills and knowledge, older adult-friendly design, integration into daily routines, social influence, family engagement and support, health benefits and impairments, accessibility and flexibility, low cost, visibility and interaction, instructions and feedback, personalization and progression, incentives, self-efficacy, visual cues, self-monitoring. DiscussionWeb- and mobile-based interventions motivate older adults to engage in physical activity, but modifications are necessary. This includes age-appropriate interfaces and contents, tailored behavioral change techniques, and family engagement.

A cross-sectional study assessing modifications to the delivery of a multi-component implementation strategy (the Get Outside, Get Active program) to improve child physical activity in early childhood education and care services.

The Get Outside, Get Active (GOGA) program is a randomised controlled trial which tested the impact of a multi-component implementation strategy to support early childhood education and care (ECEC) services to replace indoor-only free play with indoor-outdoor-free play. This cross-sectional study aims to describe the extent and nature of modifications made to implementation strategies and Behaviour Change Techniques (BCTs) using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and to describe the fidelity of BCT delivery throughout GOGA. An audit of records was undertaken throughout the intervention delivery period in the intervention arm. GOGA included 14 standard BCTs within six implementation strategies. Modifications and BCT delivery were recorded by Health Promotion Officers via project records. Modifications were categorised according to the FRAME-IS. BCT delivery was recorded using a checklist. Forty-four ECEC services received the GOGA program. Overall, 60 modifications were recorded. According to FRAME-IS categories, most modifications related to: content; format; pragmatic or practical considerations; tailoring/tweaking/refining in nature; fidelity was inconsistent; the goal was to increase the acceptability, appropriateness, or feasibility of the implementation effort; the rationale was at the practitioner level; and were unplanned/reactive. Overall, 96.4% of standard BCTs were delivered as intended. GOGA was delivered with high fidelity to protocol as indicated by the level of BCT delivery. This article details a thorough approach to documenting modifications and provides guidance for future studies. SO WHAT?: This article contributes to the emerging evidence regarding documentation of adaptations and modifications to public health implementation interventions.

Adherence to resistance training and hypocaloric diet among persons near retirement age — A secondary data analysis of three randomized controlled trials

ObjectivesAdherence to lifestyle interventions is crucial for the treatment of obesity. However, there is little research about adherence to lifestyle interventions in persons around retirement age. The objectives of this study are (1) to identify factors associated with the adherence to resistance training and a hypocaloric diet and (2) to describe the association between adherence and changes in body composition outcome parameters. DesignThis secondary data analysis included three randomized controlled trials. Setting & participantsThe inclusion criteria of the participants were an age of 55–75 years, a BMI ≥ 25 kg/m2 and receiving both a hypocaloric diet and resistance training. All participants were residing in the community. MeasurementsAdherence to hypocaloric diet was measured through the mean dietary intake on the basis of a 3-day dietary record. If the participant consumed at least 600 kcal less than the individual caloric requirements, they were considered adherent. Adherence to resistance training was achieved if ≥67% of the recommended training sessions were attended over the course of the study periods. Results232 participants were included, 47.0% female, mean age 64.0 (±5.5) years. 80.2% adhered to resistance training and 51.3% adhered to a hypocaloric diet. Older age (Beta 0.41; 95% CI 0.05, 0.78; p = 0.028) and male sex (Beta 7.7; 95% CI 3.6, 11; p < 0.001) were associated with higher resistance training adherence. A higher BMI at baseline (Beta 6.4; 95% CI 3.6, 9.2; p < 0.001) and male sex (Beta 65; 95% CI 41, 88; p < 0.001) were associated with higher adherence to hypocaloric diet. ConclusionWe identified several associated factors (sex, age and BMI at baseline) that should be considered to promote adherence in future lifestyle intervention studies in persons around retirement age. We recommend including behavior change techniques in lifestyle interventions and consider sex-specific interventions to improve the adherence of women.

Using the behaviour change wheel to develop a tailored intervention to overcome general practitioners’ perceived barriers to referring insomnia patients to digital therapeutic sleepio

BackgroundDigital therapeutic Sleepio has proven effective in improving sleep quality and decreasing symptoms of anxiety. The National Institute for Health and Care Excellence (NICE) guidance recommends Sleepio as an alternative treatment to usual sleep hygiene education and hypnotic medications. General practitioners (GPs) play a critical role in the adoption of digital therapeutics in patient care. Previous interventions did not adopt theoretical frameworks to systematically understand GPs behaviour toward referring patients to digital therapeutics.ObjectivesThis study aimed to report the systematic and comprehensive development of an intervention to encourage GPs to refer insomnia patients to Sleepio, using the Behaviour Change Wheel (BCW).MethodsThe eight steps outlined in the BCW were followed to develop an intervention. The Capability Opportunity Motivation-Behaviour Self-Evaluation Questionnaire (COM-B-Qv1) was adopted to understand GPs perceived facilitators and barriers to refer insomnia patients to Sleepio. The Behaviour Change Technique Taxonomy Version 1 (BCTv1) was thereafter used to identify possible strategies that could be used to facilitate changes in GPs’ behaviour in relation to Sleepio.ResultsThe BCW design process resulted in the identification of five intervention functions, three policy categories and five behaviour change techniques (BCTs) as potential active components for an intervention. The intervention includes providing GPs with an orientation about using Sleepio to improve their knowledge and confidence, sending visual reminders to GPs to recommend Sleepio to their patients, providing ongoing technical support.ConclusionThe BCW can be successfully applied through a systematic process to understand the drivers of GPs’ behaviour and to develop an intervention that can encourage them to refer insomnia patients to Sleepio.