Behavior Change Tools Research Articles

Leveraging emotion-behavior pathways to support environmental behavior change

Many global environmental threats are driven by human behavior and require behavioral solutions. Researchers in the environmental field have recently explored the behavioral sciences as core to changing behavior for conservation, yet leveraging human emotions remains an underused tool for behavior change compared to others like social norms. Humans experience a range of emotions that each cause distinct patterns of behavior depending on unique contexts that evolved over time; this presents an opportunity to leverage emotions to support behavior-change goals. The existing literature and models of behavior change offer minimal guidance about which specific emotions to use in which contexts and how those emotions might lead to certain behaviors. In the environmental field specifically, there have been mixed recommendations on using emotions, resulting from an incomplete understanding of the causal relationship between emotions, contexts, and environmental behaviors. We propose that adopting a functionalist approach, which describes emotions as functional states designed to produce outcomes in specific contexts, will help to unlock emotions as a tool for conservation. To demonstrate this approach, we identified fear, hope, the prospect of shame, pride, anger, and interest as particularly relevant for environmental behavior change. Based on an understanding of each emotion’s function, we developed an emotion-behavior pathway that described the expected outcome of using an emotion in a particular context. Applying these emotional-behavior pathways can allow both researchers and practitioners to advance the science of shifting environmental behavior through emotion.

Improving Resilience, Optimism, Purpose, and Loneliness Among Older Adults

Aging Strong 2020 was developed to promote health and well-being and increase resilience by focusing on the pillars of enhanced purpose in life, social connectedness, and optimism. A series of eight interventions over three years tested the feasibility of enhancing these pillars. Interventions included: 1) An expressive writing program, 2) Animatronic pets, 3) A telephonic reminiscent program, 4) An online self-compassion mindfulness program, 5) A technology-based behavior change tool, 6) An online and workbook tool for purpose, 7) An online happiness program, and 8) A peer-to-peer support program. Each program demonstrated efficacy dependent on the pillar targeted and the population sampled. Overall, some improvement was found among participants in resilience (47%), purpose (49%), optimism (44%), and loneliness (48%). Further, participant satisfaction improved in each program with Net Promoter Scores increasing between 7-19 points. Results demonstrate that Aging Strong 2020 was successful, contributing to a holistic model of healthy aging.

Inspiring Movement — Physical Activity in a Virtual Sea as a Driver for Ecological Awareness

As environmental pollution continues to expand, new ways for raising awareness for the consequences need to be explored. Virtual reality has emerged as an effective tool for behavioral change. This paper investigates if virtual reality applications controlled through physical activity can support an even stronger effect, because they enhance attention and recall performance by stimulating working memory through motor functions. This was tested in an experimental study ([Formula: see text]) using a virtual reality head-mounted display in combination with the ICAROS fitness device enabling participants to explore either a plastic-polluted or a non-polluted sea. Results indicated that using a regular controller elicits more presence and a more intense Flow experience than the ICAROS condition, which people controlled via their physical activity. Moreover, the plastic-polluted stimulus was more effective in inducing people’s stated tendency to change their attitude than a non-polluted sea.

Adding family digital supports to classroom-based physical activity interventions to target in- and out-of-school activity: An evaluation of the Stay Active intervention during the COVID-19 pandemic

Introduction: Interventions targeting multiple levels of influence and settings may have a greater impact on children’s total daily physical activity than those targeting a single setting. This study evaluated the addition of family supports to a classroom-based physical activity intervention.
 Methods: 6 schools were randomized to a remotely delivered classroom-based physical activity only (CBPA) or classroom-based physical activity plus family (CBPA+) arm. The latter added behavior change tools (e.g., self-regulation) delivered via text messages and newsletters to caregiver/child dyads. The intervention lasted for 7 weeks with a 1-week baseline and 1-week post-intervention assessment (9 weeks total). Children who enrolled in the evaluation study received a Garmin activity monitor, which was used to tailor the text messages and evaluate changes in moderate to vigorous physical activity (MVPA). Caregivers completed surveys evaluating intervention acceptability.
 Results: The 53 child participants (CBPA n=35; CBPA+ n=18) were 9.7±0.7 years old, 64% were female, 59% were Black, and 23% were Hispanic/Latinx. Almost 90% of caregivers reported high satisfaction with the added family-based intervention content. Adherence to wearing the Garmin was higher in the CBPA+ arm. MVPA was low at baseline and during the first 3 weeks of the intervention (CBPA 7.5±3.1 minutes/day; CBPA+ 7.9±2.7 minutes/day) and increased by ~45 min/day by weeks 6-8 (CBPA 56.8±34.2 minutes/day; CBPA+ 49.2±18.7minutes/day). Changes in MVPA were similar between arms.
 Conclusion: The high acceptability and intervention engagement in the CBPA+ arm show promise for integrating mHealth tools to provide additional family support in multilevel multiapproach interventions targeting children’s physical activity.

Addressing Marine Wildlife Entanglement in Derelict Fishing Nets Using Community-Based Social Marketing: Case Study and Lessons Learnt

Background Entanglement of marine species, particularly endangered sea turtles and cetaceans, in abandoned, lost or otherwise discarded fishing gear is a major conservation concern. Focus of the Article This case study applies Community-Based Social Marketing (CBSM) to reduce marine wildlife net entanglement in the waters surrounding Masirah Island, a marine biodiversity hotspot in Oman. Importance to the Social Marketing Field The study demonstrates the use of social marketing tools in biodiversity conservation, bringing new knowledge to the cross-application of these two fields. Methods The CBSM methodology was applied to select behaviours, identify barriers and benefits, develop strategies and design a pilot study. The responsible disposal of derelict nets in skip bins was selected as the target behaviour, and a mix of behavioural change tools was applied to achieve change: convenience (installation of three skip bins), education (installation of informative signs, distribution of awareness posters, one-to-one engagement with fishers on the beaches), prompts (installation of signs and posters on vessels) and social norms (one-to-one engagement with key influencers and decision makers). The monitoring of behaviour change took place through structured observations over 23 weeks, focussing on the number of nets disposed of in the allocated skip bins. Results Results showed a low level of behaviour adoption rate by skiff and launch vessel fisheries, respectively, 5.36% and 2.58%. Positive results were observed for a short time but did not reach the estimated target value throughout the study period. Recommendations for Research Our pilot study did not lead to broad-scale implementation and we recommend further awareness and engagement with the target audience, trials of various behaviour change tools and increase field monitoring time. We further recommend the application and funding of behaviour change methods applied to fishers with the incorporation of conventional financial, conservation and regulatory tools to support resource management. Limitations Our results show that focussing on specific behaviours with appropriate measurement is both resource and time demanding to solve pressing conservation problems, particularly ones generated by complex industries such as fishing. Various lessons, useful for other social marketers, have been drawn from our evaluation of the overall study.

Long-term physical activity outcomes in the Seamos Activas II trial

Latinas report disproportionately low physical activity (PA) levels and related health conditions. Reducing chronic disease in Latinas requires interventions to increase and maintain health-enhancing PA levels; yet limited intervention studies have examined PA maintenance among Latinas. The present study evaluated the efficacy during the maintenance phase (months 6–12) of the Enhanced PA intervention for Latina adults in Seamos Activas II compared to the Original PA Intervention. Seamos Activas II was conducted in San Diego, California from 2015 to 2020. Underactive adult Latina women (N = 199), mainly of Mexican descent (89%) were randomized to the original intervention or a theory- and technology-enhanced intervention. Their PA was measured objectively (via accelerometers) and via self-report at baseline, 6, and 12 months. Quantile regression models assessed treatment effects on min/week of moderate to vigorous PA (MVPA) at 12 months. Generalized linear models examined treatment effects on indicators of meeting 2008 National PA Guidelines. Both groups maintained the significant gains in MVPA they had made during the first 6 months of the intervention, neither increasing nor decreasing their MVPA over the maintenance period, with no significant between-group differences. At 12 months, 46.3% of Enhanced Intervention participants were meeting self-reported PA guidelines (vs 35.6 % of the Original PA Intervention arm, p = .02). Even with minimal contact throughout the maintenance phase, participants maintained their MVPA, which underscores the importance of continued use of evidence-based behavior change tools and techniques to reinforce newly established habits. Theoretical and technological enhancements may help Latinas to continue meeting PA guidelines during maintenance periods.

Sport and fitness app uses: a review of humanities and social science perspectives

Sport and fitness mobile applications (SFMAs) have led to significant changes in how people engage in sport and physical activity. This development is part of a broader trend of self-tracking (the ‘quantified self’) and gamification, whose effects are discussed in an increasing number of publications in the humanities and social sciences. The aim of this interdisciplinary literature review is to provide an overview of the main research results on these apps. It summarises their emergence and the discourse of those who promote them, the factors leading to their adoption, their uses in practice, the reasons for their abandonment or rejection, and the risks and perverse effects linked to their use. The main sociological, psychological and philosophical interpretations of the phenomenon are also outlined: mobile applications as a tool for behaviour change, the agentive capacities of these sociotechnical systems, and the contemporary imperative of self-management. Some users find real support in SFMAs to set goals, plan their sessions, and/or to make physical activity a regular routine. However, for others, their use becomes excessive, leading to frustration or changes in social behaviour. Many studies point out the difficulty of engaging athletes in the use of SFMAs in a lasting way. While instances of long-term and balanced use are not uncommon, they coexist with use that borders on obsession, or even forms of dependence. We conclude with current research priorities and highlight avenues of research that merit further study.

Climate Services Transformed: Decision-Making Practice for the Coast in a Changing Climate

Climate services play an important role in informing decision makers about how to reduce the impact of climate-related hazards, by building capacity through access to relevant data and information globally and regionally. Different types of climate services include long-term warning systems, projections, monitoring/triggers and signals, risk evaluation tools, and behavior change tools. However, climate services are often promoted as “improving uptake” and “translating and communicating science” This framing, which assumes that climate services are developed by scientists and “provided” to users, has limitations for decision makers designing actions to address changing coastal hazard risk driven by sea-level rise. Acting upon the IPCC 1.5 Degree Special Report imperative for urgent actions to reduce exposure and vulnerability at the coast will require a transformation in the way climate services are developed and delivered, in tandem with an understanding of the decision-making and policy context. Tools and policies must explicitly address deepening uncertainty and changing risk over long timeframes. Their use also must be compatible with the jurisdiction’s institutional frameworks and decision-making practice and relevant to user needs as changing risks unfold. Attention to both short- and long-term decisions are paramount to avoid lock-in and path dependency of decisions taken today, and to ensure relevance for the timeframes of investments in infrastructure and settlements. This requires actionable science and usable tools developed through multi-disciplinary efforts by scientists, co-producing them with decision agencies and communities. We give examples of different types of climate services developed with users and draw out some universal lessons learned in developing and applying them in New Zealand.

Eliciting Community Participation using Social and Behaviour Change Tools

The fight against COVID-19 is expected to mobilise the human behavioural aspects like voluntary screening, testing, quarantining as well as wearing a mask, frequent washing of hands, and avoiding/minimising physical and social contact through distancing. However, due to the initial high fatality rate, followed by stigmatisation, discrimination and non-sensitive handling of cases by the government, there is still resistance towards these measures. Getting people to adhere to scientifically validated knowledge on disease prevention and treatment has proved to be challenging. This article focuses on the need to employ the social and behaviour change approach in eliciting community participation, particularly in untested situations. A micro empirical study is presented as an illustration.

Eliciting Community Participation using Social and Behaviour Change Tools

The fight against COVID-19 is expected to mobilise the human behavioural aspects like voluntary screening, testing, quarantining as well as wearing a mask, frequent washing of hands, and avoiding/minimising physical and social contact through distancing. However, due to the initial high fatality rate, followed by stigmatisation, discrimination and non-sensitive handling of cases by the government, there is still resistance towards these measures. Getting people to adhere to scientifically validated knowledge on disease prevention and treatment has proved to be challenging. This article focuses on the need to employ the social and behaviour change approach in eliciting community participation, particularly in untested situations. A micro empirical study is presented as an illustration.

Context matters: Self-regulation of healthy eating at different eating occasions.

Self‐regulation plays an important role in healthy eating behaviors. The current research explores temporary fluctuations in self‐regulation next to variations between individuals. In an online observational study, 892 participants (Mage = 44.3, SD age = 12.7) monitored their self‐regulation three times a week before a meal moment for 3 weeks. To analyze the data, a random intercept and slopes model was used, including variables on within‐individual level (i.e. meal moment, tiredness, distractedness, social, and physical environment) and variables on between‐individual level (i.e. self‐efficacy, intrinsic motivation, and perception of social and physical opportunity). Self‐regulation was found to be higher at breakfast compared with dinner (estimate = −0.08, p < .001), higher at home than out‐of‐home (estimate = −0.08, p < .001) and lower when individuals are more tired (estimate = 0.04, p < .001) and distracted (estimate = 0.07, p < .001). Moreover, self‐regulation was higher for individuals with higher levels of intrinsic motivation (estimate = 0.19, p < .001) and self‐efficacy (estimate = 0.41, p < .001). Insights from this research advance our knowledge regarding temporal influences on self‐regulation and can provide input for behavior change tools such as personalized dietary advice.

Experiences with and Perception of a Web-Based Mindfulness, Nutrition, and Fitness Platform Reported by First-Year University Students: A Qualitative Study

BackgroundMy Viva Plan (MVP) (https://www.myvivainc.com/) is a web-based application developed by a dietitian that aims to support healthy living by providing resources and self-monitoring tools to help promote a healthy diet, healthy mind, and physical fitness. First-year university students have the potential to benefit because poor dietary choices, limited physical activity, and high stress are prevalent in this population. In addition, they are also active technology users. ObjectiveThis study aims to understand experiences and perception of MVP by first-year university students using this tool as part of a 12-week randomized controlled trial. DesignOne-on-one semistructured interviews were conducted following a 12-week intervention involving use of MVP. Participants/settingFirst-year university students from the University of Alberta, Edmonton, Canada (n = 32). InterventionParticipants were instructed to use MVP as much as possible for 12 weeks in either the fall/2018 or winter/2019 semesters. Qualitative data analysisInterviews were audio-recorded, transcribed verbatim, and analyzed abductively using content analysis. ResultsParticipants reported varied use of MVP across the 12-week period. Data were categorized using the HealthChange Methodology (Behaviors, Emotions, 37 Situations, Thinking) framework. Participants provided various examples of emotions (eg, motivation, stress), situations (eg, time, living arrangements, finances), and thinking (eg, self-awareness, level of satisfaction with MVP, and how MVP was or could be better tailored for students) that acted as either facilitators or barriers to MVP use and explained their behaviors associated with this tool. ConclusionsOverall, participant behaviors regarding MVP varied and were influenced by several factors, including their emotions, situations, and thinking. The Behaviors, Emotions, Situations, Thinking framework may be helpful for dietitians to identify barriers and facilitators affecting their client’s use of ehealth tools for lifestyle behavior change. This information can be used to optimize client support when using these tools.

A Content Analysis of Free, Popular Low FODMAPs Diet mHealth Apps

ObjectivesCanada has one of the highest Irritable Bowel Syndrome rates (IBS) globally (18% vs. 11%). There is growing interest in the low FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides, And Polyols) diet as nutrition therapy for IBS. However, recognizing IBS symptoms and identifying low FODMAPs foods has been challenging for users. Mobile technology may be a convenient and cost-effective tool in helping users adhere to the low FODMAPs diet. The objective was to assess free, popular mobile Health (mHealth) Apps supporting a low FODMAPs diet. MethodsApple iTunes and GooglePlay App stores were searched on December 22, 2020, using pre-selected search terms. The top 100 returns were screened for eligibility. Free and popular (≥3 out of 5 ratings; ≥100 total reviews) mHealth Apps available in English and primarily marketed to help follow FODMAPs diets were included. Apps were downloaded and assessed by 3 nutrition professionals using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) tool. ResultsOf the 1304 screened Apps, n = 9 (mean ratings ± SEM = 4.4 ± 0.1) met the eligibility criteria for assessment, comprising 5 FODMAPs identifiers and 4 tracking/monitoring symptoms Apps. Apps targeted the general population, and 70% focused on nutrition education and food shopping. The Apps used education (9), skills training (5), and/or goal setting (5) as a behavior change tool. 3 Apps provided a cognitive behavioral therapy component. The MARS (rated out of 5) revealed a high overall App quality score (3.6 ± 0.2), credibility (3.1 ± 0.5) and subjective quality scores (2.9 ± 0.3). The AQEL (rated out of 10) revealed high scores in App function (6.2 ± 0.7) and purpose (7.4 ± 0.8), but low scores in behavioral change potential (5.2 ± 0.7), knowledge acquisition (5.4 ± 0.7) and skills development (2.4 ± 1.2). ConclusionsA small number of free FODMAPs diet Apps are available, with limited information on the nutritional adequacy and users’ compliance in following a low FODMAPs diet. Considering the need for careful assessment and management of IBS symptoms with the highly restrictive low FODMAPs diet, Apps should be evidence-based and designed with Behavioral Change Techniques and easy access to healthcare professionals that support Canadians in acquiring knowledge about the diet and in self-monitoring IBS. Funding SourcesNone.

Community-Led Health Promotion Groups in a Bhutanese-Nepali Refugee Community.

This practice note reports on the work of the Namaste Community Health Partnership, an academic-community partnership established to address health disparities in a metro-area Bhutanese-Nepali refugee community in the western United States. Partners worked together to develop, implement, and evaluate a culturally-tailored health promotion program where Bhutanese-Nepali individuals led weekly walking groups and shared health promotion information and behavior change tools with community participants. The program was implemented with approximately 70 community members across two metro-area neighborhoods and two adult day care centers serving elders. Evaluation strategies included documenting walk attendance, tracking engagement with health promotion goals, and focus group discussions with program participants. Once enrolled, most participants consistently attended walks and achieved weekly goals-some even increased walking frequency beyond program requirements. Participants provided positive feedback about having a community leader and reported learning new information and enjoying participating with other community members. Challenges and lessons learned included difficulties engaging younger adults from the community, concerns about signing research consent forms, cultural norms discouraging the distribution of individual research participation incentives, variability across groups in preferences for program activities, and barriers to administering survey-based evaluation instruments. This academic-community partnership built capacity in the local Bhutanese-Nepali community, produced culturally relevant health programming, and trained and employed community members as health educators and physical activity leaders. The program resulting from this work has the potential to improve health knowledge and chronic disease prevention practices and ultimately reduce health disparities in an underserved refugee community.

Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model.

Health information technology (HIT) has not been broadly adopted for use in outpatient healthcare settings to effectively address obesity in youth, especially among disadvantaged populations that face greater barriers to good health. A well-designed HIT tool can deliver behavior change recommendations and provide community resources to address this gap, and the Obesity-Related Behavioral Intervention Trials (ORBIT) model can guide its development and refinement. This article reports the application of the ORBIT model to (1) describe the characteristics and design of a novel HIT tool (the PREVENT tool) using behavioral theory, (2) illustrate the use of stakeholder-centered “designing for dissemination and sustainability” principles, and (3) discuss the practical implications and directions for future research. Two types of stakeholder engagement (customer discovery and user testing) were conducted with end users (outpatient healthcare teams). Customer discovery interviews (n = 20) informed PREVENT tool components and intervention targets by identifying (1) what healthcare teams (e.g., physicians, dietitians) identified as their most important “jobs to be done” in helping adolescents who are overweight/obese adopt healthy behaviors, (2) their most critical “pains” and “gains” related to overweight/obesity treatment, and (3) how they define success compared to competing alternatives. Interviews revealed the need for a tool to help healthcare teams efficiently deliver tailored, evidence-based behavior change recommendations, motivate patients, and follow-up with patients within the constraints of clinic schedules and workflows. The PREVENT tool was developed to meet these needs. It facilitates prevention discussions, delivers tailored, evidence-based recommendations for physical activity and food intake, includes an interactive map of community resources to support behavior change, and automates patient follow-up. Based on Self-Determination Theory, the PREVENT tool engages the patient to encourage competence and autonomy to motivate behavior change. The use of this intentional, user-centered design process should increase the likelihood of the intended outcomes (e.g., behavior change, weight stabilization/loss) and ultimately increase uptake, implementation success, and long-term results. After initial tool development, user-testing interviews (n = 13) were conducted using a think-aloud protocol that provided insight into users' (i.e., healthcare teams) cognitive processes, attitudes, and challenges when using the tool. Overall, the PREVENT tool was perceived to be useful, well-organized, and visually appealing.

Using Behavioral Economics to Promote Positive Youth Development through Sport

Many sport-based youth development (SBYD) programs assume that short-term changes in participant attitudes, knowledge, and intentions will lead to long-term behavior change. However, this does not automatically occur, leading to questions about the efficacy and longevity of outcomes from SBYD programs. This paper discusses innovative solutions from the field of behavioral economics, which SBYD programs could use to support and promote individual behavior change. Nine tools for behavior change are outlined within a MINDSPACE (Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitment, and Ego) model, with a specific focus on how SBYD programs can use these tools to promote positive youth development.

Effectiveness of an Integrated Engagement Support System to Facilitate Patient Use of Digital Diabetes Prevention Programs: Protocol for a Randomized Controlled Trial.

BackgroundDigital diabetes prevention programs (dDPPs) are effective behavior change tools to prevent disease progression in patients at risk for diabetes. At present, these programs are poorly integrated into existing health information technology infrastructure and clinical workflows, resulting in barriers to provider-level knowledge of, interaction with, and support of patients who use dDPPs. Tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient engagement and adherence to these programs and improved health outcomes.ObjectiveThis study aims to use a rigorous, user-centered design (UCD) methodology to develop a theory-driven system that supports patient engagement with dDPPs and their primary care providers with their care.MethodsThis study will be conducted in 3 phases. In phase 1, we will use systematic UCD, Agile software development, and qualitative research methods to identify key user (patients, providers, clinical staff, digital health technologists, and content experts) requirements, constraints, and prioritization of high-impact features to design, develop, and refine a viable intervention prototype for the engagement system. In phase 2, we will conduct a single-arm feasibility pilot of the engagement system among patients with prediabetes and their primary care providers. In phase 3, we will conduct a 2-arm randomized controlled trial using the engagement system. Primary outcomes will be weight, BMI, and A1c at 6 and 12 months. Secondary outcomes will be patient engagement (use and activity) in the dDPP. The mediator variables (self-efficacy, digital health literacy, and patient-provider relationship) will be measured.ResultsThe project was initiated in 2018 and funded in September 2019. Enrollment and data collection for phase 1 began in September 2019 under an Institutional Review Board quality improvement waiver granted in July 2019. As of December 2020, 27 patients have been enrolled and first results are expected to be submitted for publication in early 2021. The study received Institutional Review Board approval for phases 2 and 3 in December 2020, and phase 2 enrollment is expected to begin in early 2021.ConclusionsOur findings will provide guidance for the design and development of technology to integrate dDPP platforms into existing clinical workflows. This will facilitate patient engagement in digital behavior change interventions and provider engagement in patients’ use of dDPPs. Integrated clinical tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient adherence to these programs and improved health outcomes by addressing barriers faced by both patients and providers. Further evaluation with pilot testing and a clinical trial will assess the effectiveness and implementation of these tools.Trial RegistrationClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500International Registered Report Identifier (IRRID)DERR1-10.2196/26750

Reminders as a Tool for Behavior Change

In a world where everyone wants our attention, reminders and notifications are omnipresent. It is evident that reminders work. They steer our attention towards a particular decision, and in many cases, they can be a powerful tool for motivation and behavior change. However, reminders also have a dark side – they distract us and turn our into time confetti by pulling our attention away from what we are currently focusing on. I will draw on my research on reminders as well as the many great experiments done by colleagues. First, I will give insights into why reminders work to change behavior. Then, I will discuss whether pure reminders can be improved upon with framing or other types of nudges. I will briefly discuss the difference between physical and digital reminders. Next, I will discuss the optimal timing of reminders and what happens when they are used repeatedly. That leads me to the challenge of annoyance costs that reminders create and present evidence on how reminders can backfire. Lastly, I summarize what we have learned about designing reminders so far and what we need to investigate further.

P217 Delivering quality improvement coaching in a virtual world: the use of digital technology to empower and engage CFDigiCare clinicians to undertake quality improvement activities nationally

Background: CFDigiCare is a community of practice using digital adherence data, FEV1 and BMI to inform clinical decision-making and comprehensive digital behaviour change tools to support patient self-care. The 16 UK adult CF centres that form CFDigiCare work together using improvement science to embed digital data into routine care. The collaborative uses the Dartmouth Microsystems approach to build quality improvement (QI) capability Most CFDigiCare teams attended a one-day class-based QI training pre-COVID-19, with subsequent coaching delivered online. We discuss digital QI refresher training and coaching to the nationally dispersed improvement collaborative during the COVID crisis. Methods: 1-hour QI refresher training was delivered via MS Teams. Dartmouth improvement ramp activities were undertaken during subsequent 3 sessions. Results: Average attendance was 9. We explored two areas for improvement, teams participated in group ‘Fishbone’ exercises, silent brainstorming, discussed change ideas and planned PDSA cycles. Staff rated the meetings 9.4/10, commenting: • Useful QI demonstration and collaboration of ideas • Jamboard is a useful tool for gathering ideas • Can deliver it to the team • Good feedback for PDSAs Attendance was high with staff valuing practical interactive sessions using facilitated MS Teams calls and tools such as Google Jamboard. Virtual sessions connected clinicians from 16 centres providing a national “hive brain” perspective on system optimisation. The Dartmouth microsystems paradigm focused attention on specific aims, providing a structure to deliver iterative change. Virtual connectivity allowed QI to continue despite COVID-19. Familiarity with MS Teams increased over time with shared mastery of the technology a clear improvement outcome. Conclusion: Digital technology not only supports the delivery of QI training and coaching but can enhance it;clinical teams quickly mastered platforms such as MS Teams and Google Jamboard.

Mental health training to improve communication with children and adolescents: A process evaluation.

To characterise the intervention components, mechanisms of change and barriers to implementation of an intervention to improve communication behaviour of hospital staff surrounding mental health with children and adolescents. Healthcare professionals consistently report a lack of confidence and knowledge to care for young people experiencing mental health difficulties. We Can Talk is a one-day training, delivered to hospital staff, which provides tools to improve their communication with children and adolescents about mental health. Initial evaluation suggests the training improved confidence and skills regarding communication; however, the effective intervention components and mechanisms of change are not yet understood. A process evaluation was conducted using a qualitative research design. Document analysis of the training manual, using the Behaviour Change Technique Taxonomy, characterised intervention components. Ten interviews with paediatric staff from an east London hospital were conducted post-intervention. Using the Theoretical Domains Framework, the mechanisms of change and remaining barriers to communication were coded thematically. COREQ checklist was used in the reporting of the study. Twenty behaviour change techniques were identified. Communication about mental health was mainly facilitated through improving the knowledge, cognitive and interpersonal skills, and beliefs about capabilities of healthcare professionals. A small number of staff continued to experience barriers to communication including a lack of opportunity for communication, beliefs that their professional role is not suited to supporting mental health and nervousness. Behaviour change techniques are highlighted to address remaining barriers reported post-intervention. Using validated and systematic behaviour change tools, this process evaluation contributes to the translation of evidence to clinical practice for more effective, sustainable and transparent mental health care, reducing the research-practice gap in this area. These findings can facilitate implementation of evidence-based practice and inform interventions, improving clinical practice and outcomes for children and adolescents.