Behavior Change Theory Research Articles

Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial

Background and AimsPost-colonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK’s National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted Mean Number of Polyps (aMNP), as a key performance indicator, improved endoscopists’ performance. Feedback was delivered via a theory-informed evidence-based audit and feedback intervention. MethodsThis multicentre, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial (NED-APRIQOT) randomised NHS endoscopy centres to intervention or control. Intervention-arm endoscopists were emailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behaviour change theory. The primary outcome was endoscopists’ aMNP during the 9-month intervention. ResultsFrom November 2020-July 2021, 541 endoscopists across 36 centres (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-months post-intervention period. Comparing intervention-arm to control-arm endoscopists during the intervention period: aMNP was non-significantly higher (7%, 95% confidence interval (CI) -1% to 14%; p=0·08). Unadjusted MNP (10%, 95%CI 1-20%) and polyp detection rate (PDR) (10%, 95%CI 4-16%) were significantly higher. Differences were not maintained in the post-intervention period. In the intervention-arm, endoscopists accessing NED-APRIQOT webpages had higher aMNP than those who did not (118 vs 102 aMNP, p=0.03). ConclusionAlthough our automated feedback intervention did not increase aMNP significantly in the intervention period; MNP and PDR did significantly improve. Engaged endoscopists benefited most and improvements were not maintained post-intervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback.www.isrctn.org ISRCTN11126923

An Exploration of Internet Addiction and Physical Activity Intervention Strategies for Adolescents

This paper summarizes the application of physical exercise in intervening adolescent Internet addiction and its theoretical basis. First, it analyzes the individual psychological characteristics of adolescent Internet addiction, social environmental factors, and the influence of family and educational background. Subsequently, the psychological perspectives of physical exercise, behavioral change theory, and the psychological mechanisms of Internet addiction were explored. On this basis, strategies and methods of physical activity interventions are discussed in detail, including the development of exercise prescription, the selection of exercise type and intensity, and the importance of individualized and long-term interventions. This paper aims to provide theoretical guidance and practical suggestions for researchers and practitioners in related fields, in order to promote the healthy growth of adolescents and the effective intervention of Internet addiction.

Effectiveness of DialBetesPlus, a self-management support system for diabetic kidney disease: Randomized controlled trial

We evaluated the effectiveness of a mobile health (mHealth) intervention for diabetic kidney disease patients by conducting a 12-month randomized controlled trial among 126 type 2 diabetes mellitus patients with moderately increased albuminuria (urinary albumin-to-creatinine ratio (UACR): 30-299 mg/g creatinine) recruited from eight clinical sites in Japan. Using a Theory of Planned Behavior (TPB) behavior change theory framework, the intervention provides patients detailed information in order to improve patient control over exercise and dietary behaviors. In addition to standard care, the intervention group received DialBetesPlus, a self-management support system allowing patients to monitor exercise, blood glucose, diet, blood pressure, and body weight via a smartphone application. The primary outcome, change in UACR after 12 months (used as a surrogate measure of renal function), was 28.8% better than the control group’s change (P = 0.029). Secondary outcomes also improved in the intervention group, including a 0.32-point better change in HbA1c percentage (P = 0.041). These improvements persisted when models were adjusted to account for the impacts of coadministration of drugs targeting albuminuria (GLP-1 receptor agonists, SGLT-2 inhibitors, ACE inhibitors, and ARBs) (UACR: −32.3% [95% CI: −49.2%, −9.8%] between-group difference in change, P = 0.008). Exploratory multivariate regression analysis suggests that the improvements were primarily due to levels of exercise. This is the first trial to show that a lifestyle intervention via mHealth achieved a clinically-significant improvement in moderately increased albuminuria.

Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research.

Metabolic comorbidities such as obesity, diabetes, hypertension, and dyslipidemia are common to multiple sclerosis (MS) and are associated with negative outcomes of the disease. Dietary intervention has the potential to improve MS co-morbidities; thus, it is a high priority for people livingwith MS to self-manage their disease. The present review aimed to summarize the recent evidence on the impacts of combining dietary modification with nutrition education and counseling on managing metabolic comorbidity markers in MS. Evidence suggests important roles for tailored dietary change strategies and nutrition education and counseling in managing metabolic comorbiditiesfor MS. There is also indirect evidence suggesting a relationship between dietary fiber, the gut microbiome, and improved metabolic markers in MS, highlighting the need for more research in this area. For people livingwith MS, addressing both barriers and facilitators to dietary changes through behavior change techniques can help them achieve sustainable and tailored dietary behavior changes. Thiswillsupport person-centered care, ultimately improving metabolic comorbidity outcomes. Metabolic comorbidities in MS are considered modifiable diseases that can be prevented and managed by changes in dietary behavior. However, the impact of targeted dietary interventions on mitigating MS-related metabolic comorbidities remains inadequately explored. Therefore, this review has provided insights into recommendations to inform future best practices in MS. Further well-designed studies based on tailored dietary strategies applying behavior change theories are needed to address the underlying determinants of dietary practice in this population.

A Nutrition-Focused Approach During Continuous Glucose Monitoring Initiation in People With Type 2 Diabetes: Using a Theoretical Framework to Unite Continuous Glucose Monitoring and Food Choices.

Continuous glucose monitoring (CGM) has transformed diabetes care, yet opportunities for further innovations still exist. Some research suggests CGM could be an ideal tool to guide food choices and other healthy lifestyle behaviors, especially for people with type 2 diabetes (T2D). Behavior change theories can be used to understand and describe how CGM users make food-related decisions, which could ultimately lead to the design of more tailored and effective interventions. In this commentary, we describe what it looks like to use the behavior change wheel-a theory-based intervention development framework-to design an intervention for people with T2D who will use CGM data to guide food choices aligned with evidence-based nutrition recommendations. Such frameworks may be beneficial when designing or evaluating future technology-focused behavior change interventions.

An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial.

Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. RR2-10.2196/20534.

“No changes, but I become more positive mentally”: A mixed-methods study of the impact of a combined SEL and MBP on behavior change and academic achievement among Chinese adolescents

This mixed-methods study aimed to investigate students' perspectives regarding their behavioral and academic changes following an 8-week combined intervention of Social and Emotional Learning (SEL) and Mindfulness-Based Program (MBP). A total of 552 teenagers (mean age = 13.03, SD = 0.50, 47.5% females) from an urban Chinese private school participated, with 184 participants randomly assigned to each condition (taught, self-help, and active control groups). Paired-sample t-tests were employed to examine changes within groups, while General Linear Models compared academic achievement changes among the three groups. Despite finding no significant improvement statistically on academic achievement, some students attributed their improved academic performance to the course. Thematic analysis was conducted on 115 written responses and 4 focus group interviews from the taught group. The analysis revealed several key themes among the Chinese population, including no changes, state change, attitude change, and behavior change. These themes were consistent with the theoretical foundations of Mindfulness-based Cognitive Therapy (MBCT) and aligned with previous qualitative research on Western adolescents. The study highlights the benefits of techniques and cognitive change in facilitating behavioral change and offers practical suggestions for supporting students in behaviour regulation. It also underscores qualitative research's role in detailing these practices' effects on behavior and academic performance. Furthermore, a proposed model aligns with established behavioral change theories, providing a practical visual aid for teachers. This study offers a comprehensive framework for future research on the theoretical constructs of MBPs and provides practical suggestions for supporting students in behavior regulation.

Effect of Educational Intervention on Reducing Mobile Phone Addiction: Application of Transtheoretical Model

Background: Mobile phone addiction (MPA) among students leads to significant psychological changes. Therefore, modifying mobile phone usage (MPU) patterns using behavioral change theories and models can be beneficial. The transtheoretical model (TTM) is commonly employed in the field of addictive behaviors. Objectives: This study aimed to assess the effect of an intervention based on TTM on MPA in female primary school students. Methods: This experimental study included 72 students (36 participants in each group) randomly selected from girls' primary schools in Bushehr. The data collection tool comprised a questionnaire covering demographic factors, stage of changes, decisional balance (DC), self-efficacy (SE), excessive mobile phone use, and an MPA questionnaire. The training was conducted through motivational interview sessions: Two for participants in the preparation stage and three for those in the pre-contemplation and contemplation stages, utilizing the constructs of the TTM. After 3 months, the collected data were analyzed using SPSS software with a significance level of less than 0.05. Results: The findings indicated similarities between the two groups before the study. Following the intervention, the training led to a significant increase in the mean score of SE and DC distribution count of excessive MPU (P = 0.013) and stage of change (P < 0.001) over time between the two groups. Mobile phone addiction significantly decreased in the intervention group three months after training (P < 0.001). Conclusions: Education based on TTM can effectively reduce MPA in students.

Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review.

The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. This study aims to synthesize qualitative insights into opioid users' acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users.

Precision feedback: A conceptual model.

When performance data are provided as feedback to healthcare professionals, they may use it to significantly improve care quality. However, the question of how to provide effective feedback remains unanswered, as decades of evidence have produced a consistent pattern of effects-with wide variation. From a coaching perspective, feedback is often based on a learner's objectives and goals. Furthermore, when coaches provide feedback, it is ideally informed by their understanding of the learner's needs and motivation. We anticipate that a "coaching"-informed approach to feedback may improve its effectiveness in two ways. First, by aligning feedback with healthcare professionals' chosen goals and objectives, and second, by enabling large-scale feedback systems to use new types of data to learn what kind of performance information is motivating in general. Our objective is to propose a conceptual model of precision feedback to support these anticipated enhancements to feedback interventions. We iteratively represented models of feedback's influence from theories of motivation and behavior change, visualization, and human-computer interaction. Through cycles of discussion and reflection, application to clinical examples, and software development, we implemented and refined the models in a software application to generate precision feedback messages from performance data for anesthesia providers. We propose that precision feedback is feedback that is prioritized according to its motivational potential for a specific recipient. We identified three factors that influence motivational potential: (1) the motivating information in a recipient's performance data, (2) the surprisingness of the motivating information, and (3) a recipient's preferences for motivating information and its visual display. We propose a model of precision feedback that is aligned with leading theories of feedback interventions to support learning about the success of feedback interventions. We plan to evaluate this model in a randomized controlled trial of a precision feedback system that enhances feedback emails to anesthesia providers.

The impact of social media interventions on eating behaviours and diet in adolescents and young adults: a mixed methods systematic review protocol

IntroductionAdolescents and young adults are susceptible population when it comes to healthy eating and dietary behaviours. The increasing use of social media by this age group presents a unique opportunity...

What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework.

Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore. Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements. Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences). In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.

A systematic review of artificial intelligence-powered (AI-powered) chatbot intervention for managing chronic illness

Background Utilizing artificial intelligence (AI) in chatbots, especially for chronic diseases, has become increasingly prevalent. These AI-powered chatbots serve as crucial tools for enhancing patient communication, addressing the rising prevalence of chronic conditions, and meeting the growing demand for supportive healthcare applications. However, there is a notable gap in comprehensive reviews evaluating the impact of AI-powered chatbot interventions in healthcare within academic literature. This study aimed to assess user satisfaction, intervention efficacy, and the specific characteristics and AI architectures of chatbot systems designed for chronic diseases. Method A thorough exploration of the existing literature was undertaken by employing diverse databases such as PubMed MEDLINE, CINAHL, EMBASE, PsycINFO, ACM Digital Library and Scopus. The studies incorporated in this analysis encompassed primary research that employed chatbots or other forms of AI architecture in the context of preventing, treating or rehabilitating chronic diseases. The assessment of bias risk was conducted using Risk of 2.0 Tools. Results Seven hundred and eighty-four results were obtained, and subsequently, eight studies were found to align with the inclusion criteria. The intervention methods encompassed health education (n = 3), behaviour change theory (n = 1), stress and coping (n = 1), cognitive behavioural therapy (n = 2) and self-care behaviour (n = 1). The research provided valuable insights into the effectiveness and user-friendliness of AI-powered chatbots in handling various chronic conditions. Overall, users showed favourable acceptance of these chatbots for self-managing chronic illnesses. Conclusions The reviewed studies suggest promising acceptance of AI-powered chatbots for self-managing chronic conditions. However, limited evidence on their efficacy due to insufficient technical documentation calls for future studies to provide detailed descriptions and prioritize patient safety. These chatbots employ natural language processing and multimodal interaction. Subsequent research should focus on evidence-based evaluations, facilitating comparisons across diverse chronic health conditions.

Using evidence-based co-design to develop a hybrid delivered exercise intervention that aims to increase confidence to exercise in people with haemophilia.

Due to advances in treatments, people with haemophilia (PWH) are living longer. They are not as active as the general population due to joint damage and lack confidence to be active due to concerns about further bleeds and pain. There is a need to facilitate healthy aging through promotion of physical activity (PA) and exercise. Changing patient beliefs and increasing physical literacy and confidence to move are thought to be key to helping PWH become more active. This paper describes the development of an exercise and behaviour change intervention to improve confidence to exercise in PWH. The 4-stage Medical Research Council framework for complex intervention development was used. Stakeholders included 17 PWH and 7 physiotherapists working in haemophilia. Seven online focus group meetings were held. The final intervention is a hybrid 12-week physiotherapist led progressive exercise programme. Classes are 45 min including Pilates, High intensity interval training and balance elements, together with discussion sessions focusing on PA recommendations, the types and benefits of different exercise styles and the effects of PA, together with the effects of aging for PWH. The COM-B model of behaviour change was used to develop the intervention. Co-design helps to produce an intervention that understands the stakeholders needs. Through this process the intervention developed to incorporate not only increasing PA but also confidence to exercise. The use of behaviour change theory identified the behaviour techniques included in the intervention and aims to increase physical literacy in this population.

Implementation Evaluation of an Early Notification Care Bundle for Patients with Hip Fracture (eHIP)

Introduction: Hip fracture in older adults results in significant mortality and is one of the costliest fall-related injuries. The Australian Commission for Quality and Safety in Health Care hip fracture clinical care standards consolidate the best available evidence for managing this patient group; however, uptake is variable. The aim of this study was to evaluate the implementation and effectiveness of a multidisciplinary early activation mechanism and bundle of care (eHIP) on patient and health service outcomes. Methods: This controlled pre- and post-test study was conducted from June 2019–June 2021 at a large regional hospital in Australia. We hypothesised that eHIP would result in at least 50% of hip fracture patients receiving six or more components of the ACSQHC Hip Fracture Clinical Care Standard. Secondary outcomes include hospital-acquired complication rates and acute treatment costs. Results: There were 565 cases included for analysis. After implementation of eHIP (the post-period), 88% of patients received a correct activation of the eHIP pathway, sustained over 12 months. The proportion of patients receiving the primary outcome of six or more components increased from 36% to 49%. Care at presentation (pain and cognitive assessment) increased by 23%, and unrestricted mobilisation within 24 h improved by 10%. Prescription of appropriate analgesia improved 10-fold (5.2–57%), and patients receiving the gold standard fascia iliaca block increased from 68% to 88%. Acute treatment costs did not significantly change. Discussion/Conclusion: eHIP, a hip fracture care program incorporating evidence-based behaviour change theory, resulted in sustained improvements to patient care as recommended by the ACSQHC Hip Fracture Clinical Care Standard.

Parental decision making about safer sleep practices: A qualitative study of the perspectives of families with additional health and social care needs.

Despite a decline in Sudden Unexpected Death in Infancy in the UK since 2004, inequalities have widened with higher rates among families from deprived backgrounds and those known to child protection services. Almost all cases involve parents who had engaged in unsafe sleeping practices despite awareness of safer sleeping advice. To understand the perspectives surrounding safer sleep of families supported by statutory child protection agencies, and use behavior change theory to inform how approaches to providing safer sleep advice to these families may be modified. We interviewed 14 mothers, 2 fathers and one grandmother, who had recent contact with child protection services in northeast England. In-depth, semi-structured interviews, with purposive sampling. The COM-B model (Capability, Opportunity, and Motivation) structured our analysis. Parents described how anxiety, sleep deprivation, settling infants, illness, and a desire to bond with infants influence their decision making about sleep. Parents valued credible, trusted sources and understanding how safer sleep practices protect infants. Responses to questions about 'out of routine' situations suggested social pressures surrounding routines and 'good parenting' may preclude parents from acknowledging risks and planning for these situations. Open conversations tailored to the needs of families, focused upon understanding why and when parent(s) do or do not follow safer sleep guidance seem a promising way of promoting safer sleep practices. Safer sleep discussions with these families are likely to be best delivered as part of wider infant care by professionals who have an established and continuing trusting relationship with parents. While advice and information should be provided by any professional in contact with the family with the necessary expertise, sensitive conversations around sleeping practices, particularly co-sleeping, may be more easily facilitated by professionals where the statutory responsibility for safeguarding is less apparent.

Technology-Supported Behavior Change-Applying Design Thinking to mHealth Application Development.

Non-communicable diseases are the leading cause of global deaths. The risk of their development and progression is increased by modifiable behavioral risk factors. Yet, despite the known benefits of primary and secondary prevention, people often do not follow recommendations for a healthier lifestyle. To this end, mobile health (mHealth) applications offer features for behavioral interventions. Yet, reported user engagement is often low. The objective of the work presented in this article is thus to evaluate the suitability of Design Thinking (DT) as a means to inform the development of an mHealth application that helps increase long-term engagement, and consequently supports individuals in sustainably changing their lifestyle. Applying the DT approach, key user needs and challenges were investigated and used to design a first low-fidelity mHealth application prototype. Think-Aloud analysis, task completion, and post-test interviews were then used to evaluate the prototype and generate early-stage insights. Subsequently, a structured, retrospective analysis of this process, evaluating the insight-generation potential of each step in the DT process cycle, was used to reflect on its suitability to inform mHealth application development. The respective results highlight (1) the distinct value of the DT method, particularly in the early stages of a development project; (2) the strong need for interdisciplinary collaboration in such projects, so as to capture realistic end-user requirements and improve the overall effectiveness of the application design; and (3) the significance of integrating behavioral change theories into the design of mHealth applications, in order to promote long-term engagement.

Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study

BackgroundLung cancer is the leading cause of cancer death in the United States. Lung cancer screening (LCS) decreases lung cancer mortality. Emergency department (ED) patients are at disproportionately high risk for lung cancer. The ED, therefore, is an optimal environment for interventions to promote LCS. ObjectivesDemonstrate the operational feasibility of identifying ED patients in need of LCS, referring them to LCS services, deploying a text message intervention to promote LCS, and conducting follow-up to determine LCS uptake. MethodsWe conducted a randomized clinical trial to determine the feasibility and provide estimates of the preliminary efficacies of 1) basic referral for LCS and 2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of LCS among ED patients. Participants aged 50 to 80, identified as eligible for LCS, were randomized to study arms and followed up at 150 days to assess interval LCS uptake (primary outcome), barriers to screening, and perceptions of the study interventions. ResultsA total of 303 patients were surveyed, with 198 identified as eligible for LCS and subsequently randomized. Results indicated that 24% of participants with follow-up data received LCS (11% of the total randomized sample). Rates of screening at follow-up were similar across study arms. The intervention significantly improved normative perceptions of LCS (p = 0.015; Cohen's d = 0.45). ConclusionThis pilot study demonstrates the feasibility of ED-based interventions to increase uptake of LCS among ED patients. A scalable ED-based intervention that increases LCS uptake could reduce lung cancer mortality.

Implementation of a Frailty Care Bundle (FCB) Targeting Mobilisation, Nutrition and Cognitive Engagement to Reduce Hospital Associated Decline in Older Orthopaedic Trauma Patients: Pretest-Posttest Intervention Study.

To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline. We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models. We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count. It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention. ISRCTN registry: ISRCTN15145850 (https://doi.org/10.1186/ISRCTN15145850).

Feasibility study of a multimodal prehabilitation programme in women receiving neoadjuvant therapy for breast cancer in a major cancer hospital: a protocol

IntroductionNeoadjuvant therapy has become a standard treatment for patients with stage II/III HER2 positive and triple negative breast cancer, and in well-selected patients with locally advanced and borderline resectable high...