Behavior Change Tools Research Articles

Introducing innovative policy instrument to reduce antibiotics use. Relevant evidence from Bulgaria

Abstract Background of the public health challenge Excessive individual consumption of antibiotics (ABs) increases global antimicrobial resistance (AMR). Therefore, shaping consumers’ behaviors towards responsible ABs use is an essential strategy in the battle with the silent pandemic of AMR. The EU One Health (OH) Action Plan against AMR targets making Europe a best-practice region. Overall consumption of ABs in the EU decreased significantly, especially during the COVID-19 pandemic. Bulgaria is the only EU country that has reported an annual increase in ABs use during this period (ECDC data). A growing part of Bulgarians, believe that ‘ABs kill viruses’ and is unaware that ‘unnecessary use of ABs makes them ineffective’ (Eurobarometer 2022). This limited understanding of adequate ABs use resulted in counterproductive behaviors that demand change. Introducing innovative policy instrument as a tool for behavioral change: Undeniably, drug prescription monitoring has the potential to change consumers’ behaviors. In October 2023 mandatory electronic prescribing (e-Rx) for ABs was introduced in Bulgaria at a primary healthcare level. Consequently, there was an observed decline exceeding 30% in ABs sales (IQVIA Bulgaria data), evidencing a reduction in ABs consumption. However, there were negative reactions by the stakeholders, due to time-consuming procedures, nonoptimal IT infrastructure, etc., and that led to e-Rx-moratorium. Finally, in April 2024, the e-Rx is sustainably introduced. Conclusions Legislative measures, like e-Rx, can hinder the chaotic use of ABs. Moreover, Bulgarians need to reflect on their behaviors and values of solidarity which OH offers. Herewith, a multidisciplinary team of academic educators unite their OH efforts in raising awareness related to AMR and the rational use of ABs. Years of national endeavors toward healthcare digitalisation led to the introduction of e-Rx for ABs in Bulgaria. Research will prove its relevance for the rest of Europe. Key messages • To the European community: The introduction of the innovative policy tool (e-Rx for antibiotics) in Bulgaria is a significant national effort in making Europe a best-practice region regarding AMR. • To the Bulgarian society: Antibiotics are not bonbons! Responsible ABs use of every one of us can contribute to the EU efforts to manage AMR. In the context of AMR, every person is a stakeholder.

How to Encourage Continuous Use of Fitness Apps among Female Users?

The proportion of women engaging in insufficient physical activity is higher than that of men, and they may face greater barriers. Fitness apps, as effective tools for behavior change, can significantly promote active physical activity among women. Notably, women constitute over 60% of fitness app users. However, few studies have focused on the reasons behind the continuous use of fitness apps by female users. This study investigates the impact of different perceived values on the satisfaction and continuance intention of female fitness app users. A total of 395 female fitness app users from Guangzhou, China, participated in this study. The results indicate that hedonic value (β = 0.190, p < 0.001), utilitarian value (β = 0.171, p = 0.007), and health value (β = 0.440, p < 0.001) significantly and positively influence the satisfaction of female fitness app users. However, only utilitarian value (β = 0.135, p = 0.018) and health value (β = 0.436, p < 0.001) have a significant positive impact on the continuance intention, while hedonic value (β = 0.028, p = 0.547) does not. Additionally, satisfaction mediates the relationship between utilitarian and health values and continuance intention. Therefore, the design of fitness apps should prioritize helping female users achieve utilitarian and health values rather than overemphasizing hedonic-value-related content.

Shaping health behaviors beyond reality: A full body illusion to experience the consequences of unhealthy snacking

Addressing the rising obesity prevalence, a Virtual Reality full-body illusion as a novel approach to obesity prevention is examined, allowing individuals to experience ownership of a virtual body (VBO). Although never tested, an immersive experience of a virtual self that suffers from the consequences of an unhealthy lifestyle, like an overweight body, may motivate health behaviors to avoid these consequences. Hence, the study aimed to investigate 1) whether experiencing the consequences of unhealthy snacking could increase healthy snacking intentions and -intake; 2) perceived threat as potential mechanisms of this effect; and 3) potential facilitators and inhibitors of VBO (i.e., avatar body size, visuotactile stimulation/VTS and facial similarity), and whether these factors could enhance effects on perceived threat, healthy snacking intentions and -intake.Employing a 2 (Experiencing consequences: yes vs. no) ×2 (VTS: congruent vs. incongruent) ×2 (Facial similarity: similar vs. generic) between-subjects design (N = 229), findings revealed that experiencing consequences increased individuals’ healthy snacking intentions and healthy snack intake, but only through perceived severity. Furthermore, embodying an overweight avatar inhibited VBO, while congruent VTS facilitated VBO. The study provides valuable insights into the Virtual Reality experiences, paving the way for innovative research avenues in health communication and behavior change tools.

Fentanyl Test Strips for Harm Reduction: A Scoping Review.

High potency synthetic opioids like fentanyl have continued to replace or contaminate the supply of illicit drugs in North America, with fentanyl test strips (FTSs) often used as a harm reduction tool for overdose prevention. The available evidence to support FTS for harm reduction has yet to be summarized. A search of PubMed, Ovid Embase, and Web of Science was conducted in March 2023. A 2-stage review was conducted to screen by title and abstract and then by full text by 2 reviewers. Data were extracted from each study using a standardized template. A total of 91 articles were included, mostly from North America, predominantly reporting on FTS along with other harm reduction tools, and all conducted after 2016. No randomized controlled trials are reported. Robust evidence exists supporting the sensitivity and specificity of FTS, along with their acceptability and feasibility of use for people who use drugs and as a public health intervention. However, limited research is available on the efficacy of FTS as a harm reduction tool for behavior change, engagement in care, or overdose prevention. Though FTSs are highly sensitive and specific for point of care testing, further research is needed to assess the association of FTS use with overdose prevention. Differences in FTS efficacy likely exist between people who use opioids and nonopioid drugs, with additional investigation strongly needed. As drug testing with point-of-care immunoassays is embraced for nonfentanyl contaminants such as xylazine and benzodiazepines, increased investment in examining overdose prevention is necessary.

Adding a Brief Continuous Glucose Monitoring Intervention to the National Diabetes Prevention Program: A Multimethod Feasibility Study.

The National Diabetes Prevention Program (DPP) promotes lifestyle changes to prevent diabetes. However, only one-third of DPP participants achieve weight loss goals, and changes in diet are limited. Continuous glucose monitoring (CGM) has shown potential to raise awareness about the effects of diet and activity on glucose among people with diabetes, yet the feasibility of including CGM in behavioral interventions for people with prediabetes has not been explored. This study assessed the feasibility of adding a brief CGM intervention to the Arizona Cooperative Extension National DPP. Extension DPP participants were invited to participate in a single CGM-based education session and subsequent 10-day CGM wear period, during which participants reflected on diet and physical activity behaviors occurring prior to and after hyperglycemic events. Following the intervention, participants completed a CGM acceptability survey and participated in a focus group reflecting on facilitators and barriers to CGM use and its utility as a behavior change tool. A priori feasibility benchmarks included opt-in participation rates ≥ 50%, education session attendance ≥ 80%, acceptability scores ≥ 80%, and greater advantages than disadvantages of CGM emerging from focus groups, as analyzed using the Key Point Summary (KPS) method. Thirty-five DPP members were invited to participate; 27 (77%) consented, and 24 of 27 (89%) attended the brief CGM education session. Median survey scores indicated high acceptability of CGM (median = 5, range = 1-5), with nearly all (n = 23/24, 96%) participants believing that CGM should be offered as part of the DPP. In focus groups, participants described how CGM helped them make behavior changes to improve their glucose (e.g., reduced portion sizes, increased activity around eating events, and meditation). In conclusion, adding a single CGM-based education session and 10-day CGM wear to the DPP was feasible and acceptable. Future research will establish the efficacy of adding CGM to the DPP on participant health outcomes and behaviors.

Effect of peer health education intervention on HIV/AIDS knowledge amongst in-school adolescents in secondary schools in Imo State, Nigeria

BackgroundPeer education is an approach to health promotion in which community members are supported to promote health-enhancing change among their peers. The study assessed the effect of peer health education on HIV/AIDS knowledge amongst in-school adolescents in secondary schools in Imo State.MethodsThis was an intervention study carried out among 296 and 287 in-school adolescents aged 15 to 19 years attending Akwakuma Girls Secondary School and Federal Government Girls College Owerri Imo State respectively. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using semi-structured questionnaires. The study utilized a quasi-experimental study design. The chi-square test and McNemar’s test were used to test the hypothesis with a significance level of p ≤ 0.05.ResultsThe result from the study revealed that the majority (73%) of the respondents at Akwakuma Girls Secondary School (test group) had poor knowledge of HIV/AIDS mode of transmission and prevention at baseline. The overall good knowledge of respondents in the test group improved from 27 to 81% after the intervention. 36% of the respondents in the control group had good knowledge at baseline, the knowledge of 64% of them with poor knowledge at baseline were compared post-test to those in the test group who also had poor knowledge at baseline. The knowledge of only 27.7% of those in the control group increased post-test while the remaining 72.3% still had poor knowledge. The result of the inter-school comparison using Chi-square revealed that the p-value was statistically significant. Intra-school comparison using McNemar’s test revealed a statistical significance for all questions in the test group, while none was positively significant in the control group.ConclusionsPeer health education improved the knowledge of the students at Akwakuma Girls Secondary School which was very low at the baseline. The knowledge of the students in the control group with poor knowledge at baseline didn’t increase post-study. Peer health education should be strengthened and expanded as one of the tools for behavior change among adolescents. There should be more focus on adolescents for HIV-targeted prevention.

Nurses’ and clients’ perspectives after engagement in the co-designing of solutions to improve provider-client relationships in maternal and child healthcare: a human-centered design study in rural Tanzania

BackgroundThere has been a persistent increase in clients’ dissatisfaction with providers’ competencies in maternal and child healthcare (MCH). Existing interventions have failed to address the complexity of provider-client relationships. Therefore, targeted, contextualized innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation are needed. The study team adopted a co-design strategy as part of Human- Centered Design (HCD) approach, where MCH nurses, clients, and stakeholders partnered to design an intervention package to improve provider-client relationships in rural Tanzania.ObjectiveThis paper explored nurses’, clients’, and MCH stakeholders’ perspectives following participation in a co-design stage of the HCD study to generate interventions to strengthen nurse-client relationships in Shinyanga Region.MethodsA qualitative descriptive design was used. Thirty semi-structured key informant interviews were conducted in the Swahili language with purposefully selected nurses, clients, and MCH stakeholders. The inclusion criterion was participation in consultative workshops to co-design an intervention package to strengthen nurse-client relationships. Data were transcribed and translated simultaneously, managed using NVivo, and analyzed thematically.ResultsThree main themes were developed from the analysis, encompassing key learnings from engagement in the co-design process, the potential benefits of co-designing interventions, and co-designing as a tool for behavior change and personal commitment. The key learnings from participation in the co-design process included the acknowledgment that both nurses and clients contributed to tensions within their relationships. Additionally, it was recognized that the benefits of a good nurse-client relationship extend beyond nurses and clients to the health sector. Furthermore, it was learned that improving nurse-client relationships requires interventions targeting nurses, clients, and the health sector. Co-designing was considered beneficial as it offers a promising strategy for designing effective and impactful solutions for addressing many challenges facing the health sector beyond interpersonal relationships. This is because co-designing is regarded as innovative, simple, and friendly, bringing together parties and end-users impacted by the problem to generate feasible and acceptable interventions that contribute to enhanced satisfaction. Furthermore, co-designing was described as facilitating the co-learning of new skills and knowledge among participants. Additionally, co-designing was regarded as a tool for behavior change and personal commitment, influencing changes in participants’ own behaviors and cementing a commitment to change their practices even before the implementation of the generated solutions.ConclusionEnd-users’ perspectives after engagement in the co-design process suggest it provides a novel entry point for strengthening provider-client relationships and addressing other health sector challenges. Researchers and interventionists should consider embracing co-design and the HCD approach in general to address health service delivery challenges.

How to have healthy conversations: Contemporary Evidence and Behaviour Change Tools in support of Delivering Better (Oral) Health.

The aim of this paper is to provide dental professionals with insight into how the science of behaviour change can be used to support patients to change their oral health behaviours. The paper describes how the fourth version of Delivering Better Oral Health (DBOHv4) published in November 2021, brings together the theory plus key principles and practical tools in Chapter 3 "Behaviour change", to help front-line clinicians achieve the best effect. DBOH is freely available to all online at gov.uk and is a key resource for dental teams for the prevention of oral diseases.

OptimalMe Program: A Mixed Method Investigation into the Engagement and Acceptability of a Preconception Digital Health Lifestyle Intervention with Individual Coaching for Women's Health and Behaviour Change.

Preconception interventions, specifically addressing general health, lifestyle behaviours and weight management, are limited despite their importance in optimising women's health. The objective of this study is to evaluate the engagement and acceptability of OptimalMe, a digital preconception intervention. Participants, (n = 298) Australian women aged 18-44 with private health insurance planning to conceive within 12 months, received a standardised intervention, including access to a digital healthy lifestyle platform (educational materials, behaviour change activities, and self-monitoring resources), ongoing text messaging, and remotely delivered health coaching (two appointments) with randomised delivery methods (telephone/videoconference). Engagement and acceptability were assessed through mixed method analyses. The results show that 76.2% attended both coaching sessions, with similar participation rates for telehealth (75.2%) and videoconferencing (77.2%) (p = 0.469). All participants logged into the digital platform, with 90.6% accessing educational materials and 91.3% using behaviour change tools. Digital platform engagement declined over time, suggesting potential benefits from additional health coaching support for ongoing participation. The post-intervention evaluation (n = 217 participants) demonstrated that approximately 90% found the digital module engaging, meeting information needs, would recommend the program, and were satisfied with the support. OptimalMe demonstrated positive acceptability and engagement; however, further research is warranted to explore strategies for sustaining engagement with the digital interventions.

What next for behaviour change professional development in general practice? Insights from an environmental scan and workshops.

A key role of general practice professionals (that is, GPs, and general practice nurses [GPNs]) is to support patients to change behaviours. Traditional approaches to assisting patients with, and learning about, behaviour change have modest outcomes. To explore behaviour change with GPs and GPNs and the availability of related professional development (PD) opportunities. Multi-methods study comprising an environmental scan survey of behaviour change tools and PD opportunities, and online workshops with Australian GPs and GPNs. Survey data were analysed using qualitative content analysis, informing the design of the workshops. Workshop data included observation, note-taking, and collaborative reflection, which were analysed thematically and synthesised with survey data. The survey had 18 complete responses. For the two virtual workshops, workshop 1 had 16 participants and workshop 2 had eight participants. There was diversity in awareness of existing behaviour change tools and resources. Preferences for future tools and PD opportunities related to specific aspects of its design, content, activities, and delivery. The following three themes developed from the workshop data: recognising the importance of relationships; recognising the importance of continuity; and keeping context in mind. In the absence of tools and resources, GPs and GPNs discussed behaviour change as something that occurs best through a patient-centred alliance that is continuing, respectful, grounded in trust and an understanding of their patient, and prioritises patient autonomy. Future general practice behaviour change PD should support clinicians to 'assist' patients and recognise the social and contextual influences on behaviour.

Implementation of the CHIldren with acute COugh (CHICO) intervention to improve antibiotics management: a qualitative study in primary care.

Childhood respiratory tract infections (RTIs) are common and can lead to unnecessary antibiotic use and antimicrobial resistance. The CHIldren with COugh (CHICO) intervention incorporates a clinician-focused algorithm (STARWAVe) to predict future hospitalisation risk, elicitation of carer concerns, and a carer-focused personalised leaflet recording treatment decisions and safety-netting information. To examine the implementation of the CHICO intervention by primary care clinicians. A qualitative study with primary care clinicians in England taking part in the CHICO randomised controlled trial. Interviews explored the CHICO intervention's acceptability and use. Clinicians from a range of practices with high and low antibiotic dispensing rates were recruited. Normalisation process theory underpinned data collection and thematic analysis. Most clinicians liked the intervention because it was quick and easy to use, it helped elicit carer concerns, and reassured clinicians and carers of the appropriateness of treatment decisions. However, clinicians used it as a supportive aid for treatment decisions rather than as a tool for behaviour change. The accompanying advice leaflet helped explain treatment decisions and support self-care. The intervention did not always align with clinicians' usual processes, which could affect use. Increased familiarisation with the algorithm led to reduced intervention use, which was further reduced during the COVID-19 pandemic as a result of changes to practice and remote consultations. Clinicians found the CHICO intervention useful to support decision making around antibiotic prescribing and it helped discussions with carers about concerns and treatment decisions. The intervention may need to be adapted to align more with clinicians' consultation flow and remote consultations.

Using narrative 360° video as a tool to promote breast self-examination

This experiment examined the feasibility of 360° video as a tool for public health messaging by investigating the effect that viewing the 360° documentary The Waiting Room VR had on female viewers’ sense of identification, attitudes to breast cancer screening and mortality salience. A key part of the documentary places participants in a viewpoint ambiguously aligned to that of the film’s director and subject, Victoria Mapplebeck (VM), in a scene that recreates her radiotherapy treatment for breast cancer. Eighty female participants watched the documentary either sitting upright with the chair back set at a 90° angle or reclining with the chair back set at a 140° angle (consistent with VMs posture) under conditions of either high or low cognitive load. The effect of posture type was measured explicitly using questionnaires on presence, identification and breast self-examination (BSE) intention as well as implicitly using a lexical decision task to measure death-thought awareness (DTA). Reclined posture led to a higher sense of spatial presence but no increase in identification with VM. Significantly increased identification with VM led to greater intention to conduct BSE. There were no effects of posture, cognitive load or identification on DTA. The implications of these results for using 360° video as a behaviour change tool, the effects of the COVID-19 pandemic on the terror management manipulation and the relevance of spatial viewpoint in 360° video are discussed.

Cooking for Health: a comprehensive narrative review of Culinary Medicine as an educational tool in medical training in Brazil and Globally.

The poor diet quality in line with the rising prevalence of noncommunicable chronic diseases, coupled with the substantial deficit in nutritional education within medical training programs, has precipitated the emergence of Culinary Medicine as an evolving discipline. Culinary Medicine fuses the art of home cooking with the sciences of human nutrition, psychology, gastronomy, and medicine to promote health and well-being. This comprehensive narrative review explores the diverse facets of Culinary Medicine, elucidating its historical evolution, theoretical foundations, educational initiatives in Brazil and worldwide, and its practical implementation in clinical contexts. By integrating evidence-based nutrition knowledge with culinary skills, behavior change tools, and well-established principles of healthy dietary practices, Culinary Medicine arrives to empower individuals - physicians and patients - to make informed dietary choices and enhance their overall health outcomes. Moreover, this review contemplates the roles of physicians in providing dietary guidance within the Culinary Medicine paradigm and the challenges associated with incorporating Culinary Medicine as a complementary facet of conventional medical care and medical education.

Unveiling the Impact of Mobile Fitness Applications on Motivational Orientation in Sustaining Exercise Behaviors: A Qualitative Investigation

Abstract Notably, a lack of motivation appears as a significant contributing factor to physical inactivity, which raises one’s susceptibility to noncommunicable diseases. While research indicates a strong link between smartphone fitness applications (apps) and people’s motivational orientation towards physical activity and exercise, the theoretical basis of fitness app features for sustaining exercise routines remains unclear. Therefore, the purpose of this study was to investigate the utility of fitness apps as a behaviour modification tool on people’s motivation to maintain physical activity and exercise behaviour. Using individual semi-structured interviews, we collected detailed accounts from nine active male and female fitness app users (M age = 23.4 years, SD = 2.8). The findings of both inductive and deductive reflective thematic analysis revealed core themes emphasising that the use of fitness apps satisfies the participants’ psychological needs through fostering emotions of competence, autonomy, and relatedness. Furthermore, fitness apps make it easier to track progress, challenge oneself, and compete against other exercisers, which further motivates participants to sustain their exercise behaviours. Confirming the use of fitness apps as an effective behaviour change tool for sustaining healthy exercise routines, the findings offer valuable feedback on specific app features for fitness software and wearable device developers that could potentially enhance the functionality and impact of their apps. Further discussions include limitations and areas for future research, such as discerning the role of fitness apps in sustaining motivation among diverse age groups with specific health, sport, or lifestyle goals in varying sensory, social, and affective contexts.

The Healthy Hearts Project: Development and evaluation of a website for cardiovascular risk assessment and visualisation and self-management through healthy lifestyle goal-setting.

Materially deprived communities in the UK have excess morbidity and mortality from cardiovascular disease (CVD) but are less likely to engage with formal care pathways. Community engagement and e-health may be more effective ways to promote risk-reducing lifestyle change. The "Healthy Hearts Project" website was designed for use by community health workers (CHWs) for cardiovascular risk assessment and lifestyle goal setting, or for independent use by community members. This paper describes the website's development and evaluation. The website was developed using interactive wire frame prototypes in a user-led approach. Qualitative evaluation of the completed website's usability and acceptability was conducted using the "Thinking Aloud" method in a purposive sample of 10 participants (one voluntary sector employee, three CHWs, two community members and four healthcare professionals). Thinking Aloud interview transcripts were thematically analysed using an inductive approach. A separate quantitative evaluation of usability and the effect of using the website on CVD knowledge and beliefs was conducted. A random sample of 134 participants, recruited using the online platform Prolific, completed the "Attitudes and Beliefs About Cardiovascular Disease" (ABCD) questionnaire before and after using the website, along with the System Usability Scale (SUS). Qualitative evaluation-Four key themes were identified: 1) Website functionality and design-participants generally found the website easy to use and understood the risk communication graphics and the feedback and goal-setting features,; 2) Inclusivity and representation-most participants considered the website inclusive of a range of users/cultures; 3) Language and comprehension-participants found the language used easy to understand but suggested reducing the amount of text; 4) Motivation and barriers to change-participants liked the personalized feedback and empowerment offered by goal-setting but commented on the need for self-motivation. Quantitative evaluation-The mean score across all domains of the ABCD questionnaire (from 2.99 to 3.11, p<0.001) and in the sub-domains relating to attitudes and beliefs around healthy eating and exercise increased after using the website. The mean(sd) score on the SUS was 77.5 (13.5). The website's usability was generally rated well by both quantitative and qualitative measures, and measures of CVD knowledge improved after use. A number of general recommendations for the design of eHealth behaviour change tools are made based on participants' suggestions to improve the website.

“Activity Matters was great - I now realize: if I move, I’m fitter.”: development and process evaluation of a web-based program for persons with multiple sclerosis

Purpose Research shows that persons with mild to moderate multiple sclerosis are less physically active than healthy controls even though they would benefit from it. This study focusses on the feasibility testing and process evaluation of the pilot study of Activity Matters, a twelve-week web-based program, from Ireland, to increase physical activity in this population. Materials and Methods The intervention was adapted to local circumstances in Hamburg, Germany and consists of eleven modules incorporating behavior change techniques. After feasibility had been confirmed, 43 persons with multiple sclerosis participated in a pilot study with a pre-post, single-group intervention design. Qualitative data was collected with questionnaires and semi structured interviews. Physical activity level and stage of change was measured quantitatively. Results Participants had a mean age of 49.5 years (SD 9.29) and an average Patient Determined Disease Step Score of 2.2 (SD 1.47). Thirty-six participants answered the follow-up questionnaire. On average 9.8 modules were processed within 13 weeks. Each tool for behavior change was perceived as helpful except the chat group. Physical activity levels increased significantly from pre- to post intervention (p-value 0.042, Cohen’s d = 0.35). Conclusions The results indicate that Activity Matters is feasible and satisfactory and may change activity levels.

Optimistic narrative future visions: a communication tool for promoting sustainable (plastic) behavior.

Plastic pollution is a pressing global issue, necessitating a focus on consumer behavior to curb this problem at its source. To effectively promote sustainable practices, communication strategies that employ future visions have gained attention. This study examines the effects of a narrative video intervention depicting an optimistic future vision concerning single-use plastic bag consumption in South Africa, compared to a representation of the prevailing status quo. Using a preregistered within-subject design, we assess the psychological and emotional responses to two scenarios of which one is illustrating adaptive behaviors toward reduced plastic bag usage, and the other showcasing current consumption patterns. Parametric analyses revealed a shift in emotional states, characterized by a greater experience of positive emotions and a reduced experience of negative emotions following the exposure to the optimistic future scenario video, as compared to the status quo video. Moreover, engagement with the optimistic future scenario was associated with higher levels of perceived behavioral control and behavioral intentions. No significant changes were found regarding sense of responsibility. These findings point to the potential of optimistic future visions to influence individuals at psychological and emotional levels. This renders optimistic future vision communication as an effective tool for sustainable behavior change, particularly in relation to the sustainable use of plastic shopping bags.

Carbon foot printing school meals: data linkage and engagement activity

Introduction &amp; BackgroundFood production is a substantial contributor to greenhouse gas emissions and climate change. A more sustainable diet is often a healthier one, so making lower carbon food choices serves to benefit the planet and person. In order to understand the carbon footprint of food choices, linkage of recipe information to carbon footprint data and transaction records is required. To inform positive change insights from data linkage must be communicated to the target audience, in this case schoolchildren.&#x0D; Objectives &amp; ApproachSchool dinner recipe information and transaction records for school meals at five schools for a six week period were acquired. Carbon footprint estimates were calculated for each recipe, using published data. An automated dashboard was created in order that these calculations could be replicated by catering teams. Carbon footprints were appended to the school transaction records for meal choices. An interactive web game was created in ‘top trump’s' style using a selection of the recipes, with carbon footprint and popularity ranking, generated from the transaction records.&#x0D; Relevance to Digital FootprintsTransactional meal sales data from schools are digital footprint data. In this work we link these digital footprint data to detailed recipe information with estimated carbon footprints from an open data source.&#x0D; ResultsThe Consumer Data Research Centre Carbon Calculator and The Planet Plates game were created. The Carbon Calculator is being used in a number of settings to support food procurement and recipe development. The Planet Plates game has been used in Leeds Schools to empower schoolchildren to make positive changes to lower the carbon footprint of their meal choices. The children were engaged with all the activities and not only learned about sustainability of their food choices, but about how data they generate can be used anonymously for public good.&#x0D; Conclusions &amp; ImplicationsData linkage of digital footprint data is a powerful tool for behaviour change to tackle some of the world’s most pressing challenges. Methods and insights should be shared widely and made accessible to a range of stakeholders wherever possible.

Facilitators and barriers to physical activity among English adolescents in secondary schools: a mixed method study.

It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity. A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B. The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys. This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."

Dementia prevention and the GP's role: a qualitative interview study.

GPs play an increasingly important role in proactively preventing dementia. Dementia in 40% of patients could be prevented or delayed by targeting 12 modifiable risk factors throughout life. However, little is known about how GPs perceive their role in dementia prevention and the associated barriers. To explore the role of GPs in dementia prevention. Qualitative study among UK GPs. Semi-structured online interviews were conducted with 11 UK GPs exploring their views regarding their role in dementia prevention. Data were analysed using thematic analysis. GPs reported that they never explicitly discuss dementia risk with patients, even when patients are presenting with risk factors, but acknowledge that dementia prevention should be part of their role. They advocate for adopting a whole team approach to primary care preventive practice, using long-term condition/medication reviews or NHS health checks as a platform to enable dementia risk communication targeting already at-risk individuals. Barriers included a lack of time and an absence of knowledge and education about the modifiable dementia risk factors, as well as a reluctance to use 'dementia' as a term within the appointment for fear of causing health anxiety. 'Brain health' was perceived as offering a more encouraging discursive tool for primary care practitioners, supporting communication and behaviour change. There needs to be a whole-systems shift towards prioritising brain health and supporting primary care professionals in their preventive role. Education is key to underpinning this role in dementia prevention.