Behavior Change Interventions Research Articles

Unintended Consequences of Digital Behavior Change Interventions

Abstract: Background: Digital Behavior Change Interventions (DBCIs) offer substantial potential to widely disseminate prevention and health promotion content. One key issue remains the absence of high-quality evidence of the effects of DBCIs for long-term health outcomes and unintended consequences. Here, we argue that in addition to better-quality evidence for effects on health, a more consideration of unintended consequences of DBCIs on multiple levels is warranted. Objectives: We suggest a multilevel perspective on unintended consequences of DBCIs building on a socio-ecological understanding of health promotion and prevention. Methods: Narrative literature review. Results: Unintended consequences of DBCIs can be located on the level of the individual engaging with DBCIs, on a level of social interactions, and on the level of health services, in multiple domains from health-related, behavior modification, affective aspects to data privacy and financial implications. Implications: Our proposed social–ecological perspective improves the classification of unintended consequences of DBCIs. This could facilitate building a cumulative evidence base to support the development of more effective and inclusive DBCIs.

Behaviour change interventions addressing antibiotic treatment seeking behaviour for respiratory tract infections in primary care settings: A scoping review protocol

Objective This scoping review aims to synthesise the extent and type of evidence on behaviour change interventions which address antibiotic treatment seeking behaviour for respiratory tract infections in the primary care/community setting. Introduction Antimicrobial Resistance is recognised as a global health and economic threat by the World Health Organization and World Bank. Several lines of evidence point to patient and public demand as a key driver of inappropriate antibiotic use. Current policy initiatives acknowledge the need to prepare for the future by managing public expectations regarding antibiotics, especially for influenza-like illness and other respiratory tract infections. These initiatives emphasise the importance of designing and evaluating effective interventions that generate actionable knowledge for policy and practices related to the appropriate use of antibiotics. Behaviour change interventions, in this context, can aim to modify patients' attitudes, beliefs, and behaviours regarding antibiotics. Inclusion criteria Identified studies will describe behaviour change interventions aimed at potential patients/participants within the primary care/community setting that address patient expectations of antibiotic use for respiratory tract infections. Diagnoses for respiratory tract infections will be classified by ICD-10 criterion. Methods This scoping review will search the literature in Medline, Embase, CINAHL, PsycINFO, Web of Science Core Collection, Scopus, and Google Scholar to explore behaviour change interventions used to reduce expectations of antibiotics for respiratory tract infections in primary care. This review will follow the Joanna Briggs Institute guidelines for scoping reviews. It will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

A Cross-sectional Study to Identify Risk Factors for Hepatitis C in Punjab, India.

Hepatitis C virus (HCV) antibody prevalence in Punjab, India (0.56%) is higher than the national average (0.32%), but primary drivers of local transmission are unclear. The objective of this study was to identify behavioral and demographic predictors of screening positive for HCV in Punjab. Interviews assessing exposure to potential HCV risk factors were administered cross-sectionally to persons screening for HCV across 10 treatment facilities. Risk ratios (RRs) were calculated using generalized estimating equation models accounting for clustering by health facility. One thousand seven hundred and sixty-three patients tested anti-HCV positive; 595 were negative. 57.7% of respondents were male; the median age was 40 years. 13.8% reported injecting drugs. Males were more likely to test positive than females (RR: 1.14, 95% confidence interval [CI]: 1.07-1.21). Unmarried men were at higher risk of anti-HCV positivity compared with married men (RR: 1.16, 95% CI: 1.08-1.24), but unmarried women were at lower risk (RR: 0.65, 95% CI: 0.43-0.98). The strongest risk factors were history of injecting drugs (RR: 1.37, 95% CI: 1.24-1.51), incarceration (RR: 1.22, 95% CI: 1.12-1.33), acupuncture use (RR: 1.20, 95% CI: 1.09-1.33), having household member(s) with a history of incarceration (RR: 1.17, 95% CI: 1.08-1.26), and tattoos (RR: 1.16, 95% CI: 1.09-1.24). Additional risk factors among men included receiving injections in a public hospital or from unregistered medical practitioners and among women included a history of childbirth. Injecting drugs was most strongly associated with anti-HCV positivity in this population. Greater attention to HCV prevention is needed, with a focus on people-centered harm reduction programs, behavioral change interventions, and increasing safety in potential transmission settings.

Development and Validation of the Motivation for Healthy Eating Behavior Scale (MHEBS) in the Bengali-Speaking Adults

Purpose: This study aimed to develop and validate a scale to assess the motivation for healthy eating behavior in Bengali-speaking adults. Methodology: The study was cross-sectional in nature and was conducted online via Google Forms. A total of 220 Bengali-speaking adults participated in the study. A literature review was conducted to generate an item pool regarding motivation for healthy eating. The content validity of the items was evaluated by an expert panel from related fields. Based on their responses, the items were modified, and 15 items were assessed for face validity. The scale’s construct validity was assessed by performing an Exploratory Factor Analysis (EFA). The reliability of the scale was examined using the internal consistency reliability coefficient or Cronbach’s alpha. To establish the convergent and divergent validity of the scale, the Satisfaction with Life Scale (SWLS) and Fear of COVID-19 Scale (FCV-19S) scale were used. Major Findings: The MHEBS showed good content and face validity. The internal consistency reliability of the scale was in the acceptable range with Cronbach’s alpha value of 0.820. The EFA suggested a three-factor scale structure, and the factors were “benefits of healthy eating”, “external regulation”, and “affordability”. The scale also showed acceptable convergent and divergent validity with SWLS and FCV-19S respectively. Implications: MHEBS — a 15-item 5-point Likert scale — is the first developed scale to measure the motivation for healthy eating behavior in the Bengali-speaking adult population. The scale would help identify what motivates Bengali adults to for maintaining healthy eating behavior. In addition, it would aid program planners to effectively design health promotion strategies as well as health practitioners and dietitians to counsel patients before applying dietary behavior change interventions. Bioresearch Commu. 10(2): 1557-1564, 2024 (July)

Quality improvement interventions targeting immunization data from urban lower-level private-for-profit health service providers in Kampala Capital City: processes and implementation experiences

BackgroundLower-level private-for-profit urban immunization service providers contribute immensely to service delivery and data generation which informs evidence-based planning for the delivery of equitable immunization services within the urban context. And yet, current efforts tend to over-concentrate on supporting the public health sector. We conducted this implementation research study in a bid to contribute to improvements in the accuracy and timeliness of immunization service data among lower-level private-for-profit immunization service providers within Kampala Capital City of Uganda.MethodsA quasi-experimental design was adopted with a participatory process leading to the identification of two poor-performing city divisions where the intervention was implemented. Forty private health facilities participated in the implementation research with 20 assigned to the intervention while the other 20 were assigned to the control. Performance measurements were assessed at baseline and end-line to compare outcomes between the intervention and control groups.ResultsThrough a theory-driven design with the COM-B as the guiding model, the behavioural change intervention functions targeted to cause the desired change leading to improvements in data quality among private providers were; (1) training, (2) modelling, (3) persuasion, (4) education, (5) environmental restructuring, (6) enablement and (7) coercion. In combination, they were primed to contribute to improvements in skills and approaches to data handling while maintaining of a close oversight function.ConclusionsThe applied intervention components were preferred for their contextual applicability within the urban private immunization service delivery settings with a likelihood of sustaining the gains for some time.

Engaging nursing students with a behaviour change intervention designed to improve their lifestyle.

In common with the general population, nursing students struggle to live a healthy lifestyle. To recruit students in a behaviour change intervention, using the COM-B model of behaviour change to understand engagement. Nursing students were invited to complete an online survey assessing height, weight, BMI, physical activity, lifestyle satisfaction, motivation for leading a healthy life, and quality of life. Those identified as overweight or not physically active were offered a webinar and social media site to support setting personal goals and boosting motivation to achieve a healthy lifestyle. 25% of invited students engaged with the interventions, 19% attending a webinar and 19% joining the social media site. No statistically reliable differences between those who engaged and those who did not were identified. Current models of behaviour change do not predict engagement. Interventions may need to be integrated into the curriculum to elicit change.

Optimizing implementation: elucidating the role of behavior change techniques and corresponding strategies on determinants and implementation performance: a cross-sectional study

IntroductionBehavior change techniques (BCTs) are considered as active components of implementation strategies, influencing determinants and, ultimately, implementation performance. In our previous Delphi study, experts formulated ‘implementation hypotheses’, detailing how specific combinations of BCTs and strategies (referred to as BCT-strategy combinations) might influence determinants and guideline implementation within youth care. For example, educational meetings providing instructions on guideline use were hypothesized to enhance practitioners' knowledge and, consequently, guideline implementation. However, these hypotheses have not been verified in practice yet.MethodWe conducted a cross-sectional study involving practitioners and management professionals from youth (health)care organizations. Using questionnaires, we obtained data on the presence of BCT-strategy combinations and their perceived influence on determinants and implementation performance. Chi-squared tests and regression analyses were employed to determine the influence of specific BCT-strategy combinations on determinants and implementation performance.ResultsOur analyses included data from 104 practitioners and 34 management professionals. Most of the management professionals indicated that the BCT-strategy combinations positively influenced or had the potential to influence their implementation performance. At the practitioner level, half of the combinations were perceived to have a positive influence on determinants and implementation performance. Furthermore, practitioners who reported the absence of BCT-strategy combinations were more skeptical about their potential influence on determinants and implementation performance.ConclusionSeveral BCT-strategy combinations were perceived to improve or potentially improve implementation performance of both practitioners and management professionals. In the development and evaluation of implementation efforts, we advocate for clearly describing the implementation effort’s objective and using frameworks that detail the BCTs inducing behavior change, the strategy employed, and the processes driving the observed changes. Understanding these interconnected processes is important in designing targeted, evidence-based behavior change interventions. This understanding optimizes resource allocation and contributes to the overall success of implementation efforts in youth care.

Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials.

Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis.

Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial

BackgroundEvidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians’ attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians’ knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use.MethodsDesign: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians’ alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI.Participants: ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months.Outcomes: We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff’s alcohol use and clinic-level alcohol expectations in the EBAI arm.DiscussionThis trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases.Trial RegistrationNCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885.

Identifying and characterising digital behaviour change interventions to improve fruit and vegetable intake in low-socioeconomic status primary school children: a systematic review

BackgroundDigital behaviour change interventions aiming to improve dietary intakes; specifically fruit and vegetable intake, in low-socioeconomic children are being developed and tested. However there is currently no synthesis of the characteristics or reported effectiveness of these interventions. This systematic review aims to: (1) identify existing digital interventions targeting fruit and vegetable intake in low-socioeconomic status children, (2) identify and synthesise characteristics and reported effectiveness of these interventions using the Behaviour Change Intervention Ontology.MethodCINAHL, ERIC, PubMed, Cochrane Library, ACM Digital Library and Scopus were searched in December 2021 – February 2022 and in February–March 2024. Inclusion criteria for studies were: 1) children of low-SES families, aged between 5–11 years old; 2) Digital intervention to improve fruit and vegetable intake; 3) Comparison groups could be digital or non-digital; 4) Outcome measures were fruit and vegetable intake and antecedents to diet behaviours; 5) Randomised controlled trials (cluster and parallel designs). Characteristics of identified studies were coded using the Behaviour Change Techniques Taxonomy and Modes of Delivery, Setting and Source ontologies of the Behaviour Change Intervention Ontology.ResultsFive studies met all inclusion criteria, with majority reporting significant effects of interventions on improving fruit and vegetable intake. Most common Behaviour Change Techniques found were Goal Setting (k = 4), Problem Solving (k = 3), Instruction on how to perform a Behaviour (k = 3), and Prompts and Cues (k = 3). Characteristics relating to intervention source were unclear.ConclusionsDigital interventions had positive outcomes in fruit and vegetable intake in children; particularly more for fruit than vegetable intake. Characteristics in digital interventions which have direct effects on child fruit and vegetable intake in low-socioeconomic families should be further investigated. Furthermore, clearer reporting on intervention characteristics is needed.

Translating the behaviour change technique taxonomy version 1 into Spanish: Methodology and validation

Background Precise and unequivocal specification of intervention content is key to facilitating the accumulation and implementation of knowledge. The Behaviour Change Technique Taxonomy v1 (BCTTv1) is the most widely used classification of behaviour change techniques (BCTs), providing a shared, standardized vocabulary to identify the active ingredients of behavioural interventions. However, the BCTTv1 is only available in English and this hampers its broad use and adoption. The aim of the present article is to report the process of translation of the BCTTv1 into Spanish. Methods A bilingual team led the translation of the BCTTv1, involving seven iterative steps: (i) establish a Committee, (ii) forward translation from English to Spanish, (iii) back translation from Spanish to English, (iv) comparison of original BCTTv1 and back translation, (v) opportunistic comparison against an independent BCTTv1 translation, (vi) empirical testing, and (vii) final Committee review. Results Changes as a result of the translation process included relabelling BCTs, amending definitions, and fixing conceptual and grammatical inconsistencies, yielding the final version. Very satisfactory inter-coder reliability in BCT identification was observed as part of the empirical testing (i.e., prevalence and bias-adjusted kappa scores > 0.8). Conclusions This work provides the Spanish-speaking population with a rigorous and validated BCTTv1 translation which can be used in both research and practice to provide a greater level of intervention detail for evidence synthesis, comparison, and replication of behaviour change interventions. The translation process described here may prove helpful to guide future translation efforts in behavioural science and beyond.

Effect of social and behavioral change interventions on minimum dietary diversity among pregnant women and associated socio-economic inequality in Rajasthan, India

BackgroundMaternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups.ObjectiveTo measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy.MethodsData from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives.ResultsStudy finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1–1.4), community motivators (aOR = 1.9, CI: 1.7–2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women.ConclusionDespite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions.

Co-design of a walking activity intervention for stroke survivors.

Stroke survivors may not maintain gains made in gait performance after task-oriented circuit training. Behavior change interventions may enhance the long-term adoption of physical activity. This study uses a co-design methodology to develop an intervention and tools to facilitate physical and exercise therapists in supporting an active lifestyle in stroke survivors, which is defined as a lifestyle that integrates daily walking performance with day-to-day activity. (1) To describe the insights generated during the co-design process; and (2) To describe the tools that were developed during the co-design process. A multidisciplinary team consisting of staff members of the Royal Dutch Society for Physical Therapy, exercise and physical therapists specializing in neurorehabilitation and conducting task-oriented circuit class training in primary care settings or day therapy centers within residential care facilities, stroke survivors and their carers, experts in measuring movement behavior in stroke survivors, a company specializing in manufacturing sensors and related software, behavior change specialists, and co-designers all collaborated in a three-stage (define, develop, and deliver) co-design process. In the design process, the team iteratively developed a prototype accelerometer system for measuring walking performance with a feedback function for stroke survivors and their therapists and a prototype toolbox for therapists to support the facilitation of behavior change in their stroke survivors. This study shows how co-design can be applied to develop interventions for stroke survivors. Both the prototype system for measuring walking performance and the toolbox incorporate behavior change techniques to support a more physically active lifestyle in stroke survivors. Further research will investigate the feasibility of the intervention.

DOES A HIGH PREOPERATIVE PAIN CATASTROPHIZATION SCORE INFLUENCE THE OUTCOMES FOLLOWING HALLUX SURGERY?

BackgroundSurgical intervention for hallux valgus and hallux rigidus is an option for patients presenting with severe pain and deformity. Literature suggest that patients with high Pain Catastrophisation Scores (PCS) have poorer outcomes in spinal and to a lesser extent in arthroplasty surgery. There is however very little evidence pertaining to foot and ankle surgery.AimWe aimed to study whether catastrophisation as measured by PCS influenced the outcomes following surgery for Hallux valgus and rigidus.MethodologyEthical approval for this prospective portfolio study was obtained from NRES Committee South Central and Oxford. Approval was granted from the local R&D department prior to data collection. All patients listed for surgery for hallux pathology to the four senior authors were invited to participate. Recruitment into the study started in September 2017 and is ongoing. Pain catastrophising score (PCS), Manchester Oxford Foot Questionnaire (Mox-FQ), Visual analog scale (VAS) for pain and EQ-5D-3L questionnaires were completed Pre-op (baseline), and at 3, 6 and 12- months post-surgery.Results93 patients with minimum follow-up of 6 months were analysed using SPSS software. A P-value of less than 0.05 was considered significant. The mean age of the patients was 58.5 years and 83% were women. 70% of the patients had surgery for hallux valgus and rest for rigidus. Both PROMS and PCS improved significantly following surgical intervention. Patients with higher pre-operative PCS had a worse 6-month PROM score and more pain.ConclusionThis study confirms that pre-operative catastrophisation as demonstrated by a high PCS score has an adverse effect on outcomes following hallux surgery. Risk stratifying patients based on their Pre-op PCS scores may be a useful strategy to identify those at risk of poorer outcomes. We recommend that behavioural change interventions should be considered to try to improve outcomes in patients with pre-op PCS.

From educator to facilitator: Healthcare professionals' experiences of, and views about, delivering a type 1 diabetes structured education programme (DAFNEplus ) informed by behavioural science.

The DAFNEplus programme incorporates behaviour change techniques into a modified educational intervention and was developed to help address the glycaemic drift observed amongst graduates of standard DAFNE programmes. As the programme's success will be contingent on staff buy-in, we explored healthcare professionals' experiences of, and views about, delivering DAFNEplus during a clinical trial to help inform decision making about rollout post-trial. We interviewed n = 18 nurses and dieticians who delivered DAFNEplus during the trial. Data were analysed thematically. While many shared initial reservations, all described how their experiences of DAFNEplus programme delivery had had a positive, transformative impact upon their perceptions and working practices. This transformation was enabled by initial training and supervision sessions, the confidence gained from using scripts to support novel programme content delivery, and experiences of delivering the programme and observing DAFNEplus principles being well received by, and having a positive impact on, attendees. Due to these positive experiences, interviewees described a strongly felt ethical mandate to use some DAFNEplus techniques and curriculum content in routine clinical care. While being supportive of a national rollout, they anticipated a variety of attitudinal and logistical (e.g. workload) challenges. This study provides a vital dimension to the evaluation of the DAFNEplus programme. Interviewees found the intervention to be acceptable and expressed high levels of buy-in. As well as offering potential endorsement for a national rollout, our findings offer insights which could help inform development and rollout of future behaviour change interventions to support diabetes self-management.

Measuring and shaping the nutritional environment via food sales logs: case studies of campus-wide food choice and a call to action.

Although diets influence health and the environment, measuring and changing nutrition is challenging. Traditional measurement methods face challenges, and designing and conducting behavior-changing interventions is conceptually and logistically complicated. Situated local communities such as university campuses offer unique opportunities to shape the nutritional environment and promote health and sustainability. The present study investigates how passively sensed food purchase logs typically collected as part of regular business operations can be used to monitor and measure on-campus food consumption and understand food choice determinants. First, based on 38 million sales logs collected on a large university campus over eight years, we perform statistical analyses to quantify spatio-temporal determinants of food choice and characterize harmful patterns in dietary behaviors, in a case study of food purchasing at EPFL campus. We identify spatial proximity, food item pairing, and academic schedules (yearly and daily) as important determinants driving the on-campus food choice. The case studies demonstrate the potential of food sales logs for measuring nutrition and highlight the breadth and depth of future possibilities to study individual food-choice determinants. We describe how these insights provide an opportunity for stakeholders, such as campus offices responsible for managing food services, to shape the nutritional environment and improve health and sustainability by designing policies and behavioral interventions. Finally, based on the insights derived through the case study of food purchases at EPFL campus, we identify five future opportunities and offer a call to action for the nutrition research community to contribute to ensuring the health and sustainability of on-campus populations-the very communities to which many researchers belong.

Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes

ObjectiveWe aimed to develop a context-specific intervention toward benzodiazepine deprescribing in nursing homes (NHs), with insights from behavior-change theories and involvement of stakeholders. DesignSelection of behavior change techniques (BCTs), through online survey and group discussion, followed by operationalization of these BCTs into intervention components. Setting and ParticipantsThe intervention was developed for Belgian NHs, involving various stakeholders: health care professionals (HCPs), NH administrators, and policy makers. MethodsUsing the Theory and Techniques Tool, we preselected the BCTs linked to one of the 9 Theoretical Domain Framework domains identified as being the main barriers for benzodiazepine deprescribing in Belgian NHs. These were then presented to stakeholders. Based on the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Ethics) criteria, participants ranked BCTs through an online survey, and then performed final selection during a group discussion. Selected BCTs were operationalized into intervention components, with specific contents and methods of delivery validated by stakeholders. ResultsThirty-seven potential BCTs were identified. Eighteen stakeholders participated in the survey, and 7 in the group discussion. This led to the final inclusion of 9 BCTs: instruction on how to perform the behavior, information about health consequences, pros and cons, problem solving, goal setting (behavior), social comparison, restructuring physical environment, restructuring social environment, and graded tasks. These BCTs were operationalized into a 6-component intervention: process and goal setting, HCP education, physical environment adaptations, audit and feedback, NH residents’ and relatives’ increased awareness, and multidisciplinary work. Conclusion and ImplicationsUse of a theory-based approach toward intervention development has the potential to improve the probability of its feasibility and effectiveness in tackling barriers to benzodiazepine deprescribing. By doing so, we have developed a multifaceted approach with actions taken at the patient, HCP, and NH levels. Our novel 6-component intervention will be evaluated in a pilot cluster-randomized controlled trial to assess its feasibility.

Effectiveness of complex behaviour change interventions tested in randomised controlled trials for people with multiple long-term conditions (M-LTCs): systematic review with meta-analysis

IntroductionThe prevalence of multiple long-term conditions (M-LTCs) increases as adults age and impacts quality of life and health outcomes. To help people manage these conditions, complex behaviour change interventions are...

Evaluation of a web-based, interactive guide to enhance patient-clinician electronic communication.

e13659 Background: Secure messaging (SM) enables patients to ask clinicians questions asynchronously. Benefits include enhancing patient engagement, contributing to oral chemotherapy adherence, and lowering symptom distress. However, patients are unsure how to address concerns effectively, and clinicians find it challenging to decipher patients’ needs within messages. Coupled with clinicians not having adequate time to respond to messages, breakdowns in communication are common. We developed an interactive guide to help patients with cancer craft effective secure messages. It featured an oncologist providing strategies to write messages with specificity, expressing concerns, stating needs, being direct, and included a downloadable tip sheet. Methods: Patients 18+ with a current cancer diagnosis who were enrolled in the portal at a large health center were recruited. Between October 2023 and January 2024, participants were sent a link to interact with the guide, followed by a survey. The survey included several measures: 1) Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer); 2) Digital Behavior Change Intervention (DBCI) Engagement Scale; 3) Website User Satisfaction questionnaire (WUS); 4) Acceptability of Intervention Measure (AIM); 5) Intervention Appropriateness Measure (IAM). We used R version 4.3.2 for the descriptive analysis. The Wilcoxon rank-sum test compared groups by demographic categories. The local IRB approved this study. Results: One hundred patients participated. Median age was 64 years (range=21-86), 54% male, 83% white, 35% diagnosed with prostate cancer, 35% lung cancer, and 23% hematologic cancer. Respondents reported high levels of self-efficacy based on CASE-cancer (mean 43.3 of 48). Respondents averaged 15 minutes using the guide. 96% thought the guide’s content was presented clearly, 95% found it easy to understand, 90% enjoyed using it, 89% thought the guide was suitable, and 88% could rely on its information. Results by demographic categories found that non-white respondents (M = 43.0) were significantly more engaged than white respondents (M = 28.4), P = 0.038 , and those with a bachelor’s degree+ (M = 96.5) had higher satisfaction than those without (M = 91.6), P = 0.025. Conclusions: Patients with cancer embraced an interactive guide that provided strategies to craft secure messages. They found it engaging, satisfying, acceptable, and appropriate, with racially minoritized patients being most engaged. As SM is a widely used tool for patient-clinician communication, it is crucial to concentrate on the way messages are constructed. We found potential to improve patients’ message-writing techniques, which could result in clinicians writing more complete answers to questions. Additionally, there is the possibility to enhance underserved patients’ communication skills and make them more engaged in their care.

On the Importance of Field Studies for Testing Theory-Driven Behavioral Change Interventions in (Sustainable) Tourism

Practical measures to entice tourists to behave in environmentally sustainable ways are urgently needed. The effectiveness of such measures is typically tested in survey experiments. This study demonstrates that this approach can be misleading. We test two messages aimed at reducing buffet food waste. One builds on established theories of human behavior (theory of planned behavior, value-belief-norm theory); it assumes that changing beliefs by providing information triggers behavior change. The second message builds on hedonic psychology; it attempts to change behavior through humor, presenting the pro-environmental behavior as enjoyable. In the survey experiment, the belief-based message significantly increases intentions to reduce plate waste; but both messages fail to change behavior in a real hotel. These insights have methodological and practical implications: the effectiveness of new practical measures developed to trigger specific tourist behaviors must be tested in the field before reliable managerial recommendations can be derived.