Behavior Change Programs Research Articles

Designing an eHealth Well-Being Program: A Participatory Design Approach.

In recent years, the relevance of eHealth interventions has become increasingly evident. However, a sequential procedural application to cocreating eHealth interventions is currently lacking. This paper demonstrates the implementation of a participatory design (PD) process to inform the design of an eHealth intervention aiming to enhance well-being. PD sessions were conducted with 57 people across four sessions. Within PD sessions participants experienced prototype activities, provided feedback and designed program interventions. A 5-week eHealth well-being intervention focusing on lifestyle, habits, physical activity, and meditation was proposed. The program is suggested to be delivered through online workshops and online community interaction. A five-step PD process emerged; namely, (1) collecting best practices, (2) participatory discovery, (3) initial proof-of-concept, (4) participatory prototyping, and (5) pilot intervention proof-of-concept finalisation. Health professionals, behaviour change practitioners and program planners can adopt this process to ensure end-user cocreation using the five-step process. The five-step PD process may help to create user-friendly programs.

Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors

BackgroundNorthwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval.MethodsData for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants.ResultsKnowledge, approval of family planning, and social influences, particularly from husbands, were all associated with improved family planning outcomes. Approval of family planning was critical – women who personally approve of family planning were nearly three times more likely to be currently using modern contraception and nearly six times more likely to intend to start use in the next 6 m. Husband’s influence was also critical. Women who had ever talked about family planning with their husbands were three times more likely both to be currently using modern contraception and to intend to start in the next 6 m.ConclusionSBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use—even without large-scale changes in socio-economic and health services factors—by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Uncertainty about the time-order of influencers and outcomes however precludes inferences about the existence of causal relationships and the potential for impact from interventions.

A Women’s Group-Based Nutrition Behavior Change Intervention in India Has Limited Impacts Amidst Implementation Barriers and a Concurrent National Behavior Change Campaign

Abstract Objectives Women's self-help groups (SHGs) have become one of the world's largest institutional platforms of the poor, reaching over 70 million Indian women in 2020. Limited evidence exists on effects of nutrition interventions through SHGs on maternal and child nutrition outcomes. Methods The Women Improving Nutrition through Group-based Strategies (WINGS) study was a quasi-experimental impact evaluation, comparing 16 matched blocks where communities were provided support to form SHGs and improve women's livelihoods; 8 blocks (1 in each matched pair) received a 3-year nutrition intervention (NI) with nutrition education, agriculture- and rights-based information, facilitated by a trained female volunteer; the other 8 blocks received standard activities (STD) to support savings & livelihoods. We conducted repeated cross-sectional surveys of mother-child pairs in 2017–18 (n = 1609 pairs) and 2019–20 (n = 1841 pairs). We matched treatment groups over time and applied difference-in-difference (DID) regression models to estimate NI impacts. Outcomes were knowledge domains (nutrition for pregnant women, breastfeeding, complementary feeding, child health), child feeding (e.g., early breastfeeding initiation, dietary diversity, animal source food (ASF) consumption), woman's diets, woman's BMI and child anthropometry. Matching covariates included woman, child, and community characteristics. Results About 40% of women were SHG members. Nutrition intervention exposure was low; only ∼10% of NI women had heard of intervention content at endline. There were large improvements in women's knowledge in both groups. DID estimation revealed a positive NI impact on knowledge of timely introduction of ASFs to children (P < 0.05), but knowledge of nutrition for pregnant women unexpectedly improved more in the STD group (P < 0.05). No impacts were observed for any anthropometry or diet indicators except child ASF consumption (P < 0.01). Conclusions Limited impacts on nutrition outcomes may be due to limited exposure, low motivation or skills of volunteers, and a concurrent national nutrition behavior change program targeting mothers and children in all study areas. Our findings add to a growing literature on SHG-based behavior change interventions and the conditions necessary for their success. Funding Sources Bill & Melinda Gates Foundation.

605-P: Generating Self-Reported Clinical and Lifestyle Data in Patients Living with T2DM in Qatar

Background: Lack of localized tools to monitor lifestyle patient data between doctor visits challenges healthcare providers in the Middle East to personalize care to Arabic-speaking patients living with T2DM. This study presents Droobi Health (DH), the first Arabic, digital therapeutic, as an effective tool to increase patient self-reported data and share clinical and lifestyle data between visits efficiently to enable doctors to personalize care without a time burden. Methods: The Droobi Health app is a digital therapeutic that delivers a online behavior change programs that combines real-human coaching, digital tracking and data analytics to deliver timely and personalized interventions for behavior change. The messaging system is based on the Transtheoretical Model of Behavior Change to encourage users to self-report data on blood glucose, weight, food intake and physical activity. This study described data collected from participants with T2DM (N=44) using DH who completed the 16-week program. Results: During the 16-weeks, users reported a total 1270 blood sugar logs, 1527 food logs, 3202 activity logs, and 213 weight logs. Users initiated a total of 2880 chat messages with their coach. On average per user, 28.8 blood sugar logs, 34.7 food logs, 72.8 activity logs, and 4.8 weight logs. Conclusion: This study shows that DH can help healthcare providers generate patient self-reported clinical and lifestyle data between doctor visits, enabling the care team to personalize care based on patients lifestyle. Disclosure N. Jandali: None. R. Zarzour: Employee; Self; Droobi Health Technology. A. M. Fadlelbari: Employee; Self; Droobi Health and Technology.

Applying Social Norms Theory for Improved Nutrition Outcomes: A Case Study of JEEViKA Self Help Groups.

This paper demonstrates that malnutrition among children under the age of 5 years can be addressed by disseminating information and social and behaviour change communication. This paper discusses a social and behavioural change program implemented through a women’s self-help group under JEEViKA run by the Government of Bihar.

Long-Term Food Choice and Weight Loss on a Mobile Program With Food Color System

ObjectivesIt is unclear if individuals sustain healthy food choices long-term on a mobile, self-directed weight loss program, or how those choices influence weight loss. We examined differences in food choice and dietary quality by weight lost at 18 months on a mobile behavior change weight loss program with a traffic light food system designed to encourage healthier eating behaviors. We expected that users with greater amounts of weight loss would show healthier food choices and dietary quality. MethodsOn the program, users are encouraged to consume a ratio of 30% green (low-calorie, high-volume, nutrient-rich foods), 45% yellow, and 25% red (high-calorie, low-volume) foods. They are also provided information on behavior change principles. We evaluated food ratios and self-reported dietary quality in 148 adults 18 months after starting the program with a retrospective cohort design. Food ratios were measured via food intake self-reported on the program. Dietary quality was measured using a validated questionnaire assessing adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (DASH-Q). Respondents were categorized into high (>10%, n = 71), moderate (5–10%, n = 35), and low or no (<5%, n = 42) weight loss groups based on weight lost by 18 months. ANOVAs tested differences in food ratios and dietary quality between groups. ResultsBaseline BMI did not differ between weight loss groups (high: 36.9, moderate: 36.0, low: 36.5; P = 0.68). However, there were significant differences in green food ratios across weight loss groups for breakfast (high: 37%, moderate: 37%, low: 34%; P = .02), lunch (29%, 27%, 25%; P < .001), and dinner (22%, 20%, 16%; P < .001). Red food ratios also differed across groups for breakfast (21%, 27%, 26%; P < .001), lunch (34%, 35%, 37%; P < .002), and dinner (36%, 39%, 43%; P < .001). The weight loss groups also differed in DASH dietary pattern scores (high: 41.79, moderate: 42.52, low: 36.95; P = .02). ConclusionsUsers with greater weight loss ate more green foods, fewer red foods, and adhered more to the DASH diet than users with less weight loss. These differences were apparent even 18 months later. This highlights the role of food choice and dietary quality in weight loss and suggests that a mobile behavior change program with a traffic light system could aid in healthier long-term dietary consumption. Funding SourcesThis study was funded by Noom Inc.

TasminBradleyGlobal Perspectives on Violence against Women and GirlsZed Books, 2020, 208 p., £65.00

TasminBradleyGlobal Perspectives on Violence against Women and GirlsZed Books, 2020, 208 p., £65.00

Longitudinal Associations Between Changes in Cigarette Smoking and Alcohol Use, Eating Behavior, Perceived Stress, and Self-Rated Health in a Cohort of Low-Income Black Adults.

Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions. We examined associations between change in cigarette smoking and alcohol use, body mass index, eating behavior, perceived stress, and self-rated health in a cohort of Black adults who resided in low-income urban neighborhoods and participated in an ongoing longitudinal study. Interviews were conducted in 2011, 2014, and 2018; participants (N = 904) provided at least two waves of data. We fit linear and logistic mixed-effects models to evaluate how changes in smoking status from the previous wave to the subsequent wave were related to each outcome at that subsequent wave. Compared to repeated smoking (smoking at previous and subsequent wave), repeated nonsmoking (nonsmoking at previous and subsequent wave) was associated with greater likelihood of recent dieting (OR = 1.59, 95% CI [1.13, 2.23], p = .007) and future intention (OR = 2.19, 95% CI [1.61, 2.98], p < .001) and self-efficacy (OR = 1.64, 95% CI [1.21, 2.23], p = .002) to eat low calorie foods, and greater odds of excellent or very good self-rated health (OR = 2.47, 95% CI [1.53, 3.99], p < .001). Transitioning from smoking to nonsmoking was associated with greater self-efficacy to eat low calorie foods (OR = 1.89, 95% CI [1.1, 3.26], p = .021), and lower perceived stress (β = -0.69, 95% CI [-1.34, -0.05], p = .036). We found significant longitudinal associations between smoking behavior and eating behavior, perceived stress, and self-rated health. These findings have implications for the development of multiple behavior change programs and community-level interventions and policies.

Nonpharmacological Treatment for Supporting Social Participation of Adults with Depression.

Background Social withdrawal is predominantly seen among adults with depression. However, a dearth of reviews exists that explore nonpharmacological treatments, especially occupational therapy (OT) interventions and their effect in promoting social participation. The aim of this research was to review what intervention programs are conducted to support the social participation of adults with depression and their effectiveness. Method A systematic review was performed wherein relevant articles were searched in PubMed, CINAHL, Wiley Online Library, PsycINFO, and OTseeker databases and AJOT, BJOT, SJOT, and OTMH journals. Only English articles published from January 2010 to December 2018, which tackled intervention for adults aged 20–60 years with depression, were considered. Ten out of 918 studies met the screening criteria. Result Among the ten studies, the effective intervention programs were categorized as either occupation-based intervention (OBI) or cognitive behavioral therapy-based intervention (CBT-BI). These programs sought the following outcomes: behavioral change in social participation (n = 4), reduction of depression or depressive symptoms (n = 13), life satisfaction (n = 4), and quality of life (QoL) (n = 1). Studies showed moderate (n = 3) to strong (n = 7) level of certainty, whereas they also revealed high to unclear (n = 3) and low (n = 7) risk of bias. Conclusion Both OBI such as animal-assisted therapy and CBT-BI such as behavioral change program and health education have a strong level of certainty and low risk of bias in promoting social participation by supporting positive behavioral change and reducing depressive symptoms. Furthermore, the sport and exercise program of OBI was popular in encouraging participation and engagement with other people. Other programs were suggested for combined interventions to support social participation, life satisfaction, and QoL.

A Cluster Analysis of University Commuters: Attitudes, Personal Norms and Constraints, and Travel Satisfaction.

Higher education institutions are recognised as settings where the community’s awareness of sustainable mobility can be strengthened or reshaped. The first objective of the present study was to identify groups of commuters based on their modal choice in a large higher education institution in Italy. The second objective was to compare the groups on socio-demographic and psychosocial variables, specifically attitudes, personal norms, personal constraints, and travel satisfaction. The cluster analysis revealed five different types of commuters: car-oriented, two-wheeled urban users, pedestrians, long-distance commuters, and regular bus users. Attitudes, personal constraints and norms, and satisfaction differed in the five groups of commuters. The present study provides insights for behavioural change programmes and organizational policies on sustainable mobility.

Influence Networks Relating to Health Knowledge Among Nairobi’s Micro-Retailers and Their Clients

TRANSFORM, founded in 2015 by Unilever and the UK’s Department for International Development, supports several social enterprises by combining public sector resources with private sector technical capabilities and networks to support innovative social enterprises. Digital programs have enabled social enterprise partnerships to expand the reach of their initiatives to broader audiences including specifically defined groups that hitherto were untapped or difficult to reach. Unilever partnered with TRANSFORM and Every1Mobile to develop UJoin and UAfya in informal settlements of Nairobi, Kenya. UJoin is a social enterprise initiative for promoting business growth among underserved neighborhood shops called dukas. UAfya focuses on young expectant and new mothers, and women interested in family and maternal health topics. Each initiative uses an online community network to discuss and improve knowledge and behaviors regarding livelihoods and health. Online communities provide opportunities to reach specific groups with targeted behavior change messages and campaigns. However, little systematic knowledge is currently available on how to develop, and scale-up effective behavior change programs for digital communities in low-income markets. There is also little information about key guiding principles and best practices that underlie successful digital and online, social networking models. A systematic and participatory tool known as Net-Map was used to explore and understand potential frameworks for establishing digital-based community-driven partnerships with the private sector for health promotion through behavior change. The Net-Map approach was used to help individuals and groups clarify their view of a situation (including networks and power structures), foster discussion, and develop a strategic approach to their networking activities. Eight Net-Maps were constructed, stratified by groups based on location and digital platform. Each map was constructed by an average of 9-10 people for a total of 76 participants. Seventy-six participants identified actors – stakeholders and groups of people involved - and influential links – ways actors are connected - through the Net-Map activity. Among UAfya participants, local government, family, and friends, and the media were identified as the most important actor types. A comparison of the discussions associated with the creation of the maps by UAfya members shows that the two most important link types are conflict, and collaboration/partnership. Among UJoin participants, the three most important actor types were local government, business and financial institutions, and customers. UJoin members identified regulation, and conflict and competition, collaboration and, information sharing as key links between actors. Recommendations based on findings support a vision for scale-up of the UJoin and UAfya programs through accreditation and branding of a novel type of duka. Shop keepers would be trained and knowledgeable to provide high-quality services to improve customer health while also selling health products that benefit the bottom line.

Delivering behavioural change at scale: What conservation can learn from other fields

Developing interventions to change human behaviour at scale is critical to achieving the new Global Biodiversity Framework goals. One strategy that conservation practitioners can adopt in pursuing this ambition is to look for lessons from other fields engaged in sustainable development, such as development economics and behavioural science. Over the past twenty years, these fields have generated a large and growing evidence-base of strategies for improving key sustainability indicators in areas such as health, livelihoods and education. This empirical revolution has been accelerated by rapid advances in understanding the social and psychological foundations of human behaviour. In this paper, we identify three areas that can help conservation to bring behaviour change programmes to scale. First, conservation practitioners should develop expertise in human behaviour developed in the social and cognitive sciences. Second, conservation researchers should adopt empirical methods widely practiced in development economics to rigorously identify whether, how and why interventions work. Third, conservation should integrate with the policy institutions and systems to facilitate learning and scaling.

Sustainable Innovations to Combat COVID-19 Rising Cases in India: Public Health Perspective

Globally, there was an outbreak of a disease in Wuhan, China in 2019. Diagnosis indicated that the infectious disease was a novel virus called SARS-CoV2 and previously there was no information about the new virus. In January 2020, the new coronavirus disease was confirmed by World Health Organization (WHO), as COVID-19. In 2015, United Nations developed 17 sustainable development goals that no one is left behind for sustainable future. Globally, with COVID-19 we were faced with various challenges not limited to health and safety, increased morbidity, supply chain, crunched cash flow, and daily mortality from the virus. This issue has forced the world to come to a halt and rethink on sustainable future for our planet and its existence. Hence have raised the deliberation by everyone to redefine, implement and actionize the concept of sustainability to combat COVID-19 in the long run. India is approaching the festive winter seasons where COVID-19 cases have been predicted to increase, except the preventive measures are followed. Through strategic IEC, diagnostics, therapeutics, behavioral change programs, health system monitoring, and collaborative effort of all like social distancing, face mask, frequent hand hygiene practices and practicing the public health preventive measures. We can flatten the curve totally!

Assessing Knowledge and Self-Efficacy among Nursing Students to Operate a Diabetes Behavior-Change Program in Kolkata, India

Assessing Knowledge and Self-Efficacy among Nursing Students to Operate a Diabetes Behavior-Change Program in Kolkata, India

Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by\xa0a food-based digital education-assisted lifestyle intervention program: a feasibility study

PurposeRecent trials demonstrated remission of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) following formula diet-induced weight loss. To improve the outreach for populations in need, many mobile health apps targeting weight loss have been developed with limited scientific evaluation of these apps. The present feasibility study investigated the effects of a novel approach incorporating a regular ‘whole food-based’ low-calorie diet combined with app-based digital education and behavioral change program on glucose metabolism and disease management.MethodsTwenty-four individuals with type 2 diabetes followed this approach supported by weekly coaching calls for 12 weeks. Phenotyping included bioimpedance analysis, mixed-meal tolerance test, magnetic resonance spectroscopy and transient elastography for assessing liver fat content and liver stiffness.ResultsOver 12 weeks, participants reduced their body weight by 9% (97 ± 13 to 88 ± 12 kg), body mass index (BMI; 33 ± 5 to 29 ± 4 kg/m2), total fat mass (31 ± 10 to 27 ± 10%) (all p < 0.01) and liver fat by 50% alongside with decreased liver stiffness. Target HbA1c (< 6.5%) was achieved by 38% and resolution of NAFLD (liver fat content < 5.6%) was observed in 30% of the participants.ConclusionThis novel approach combining digital education with a low-calorie diet results in effective improvements of body weight, glycemic control and NAFLD and could complement existing care for patients with type 2 diabetes.Trial registrationNCT04509245

Future directions of the National Institutes of Health Science of Behavior Change Program.

The National Institutes of Health Science of Behavior Change Common Fund Program has accelerated the investigation of mechanisms of behavior change applicable to multiple health behaviors and outcomes and facilitated the use of the experimental medicine approach to behavior change research. This commentary provides a brief background of the program, plans for its next phase, and thoughts about how the experimental medicine approach to behavior change research can inform future directions in two areas of science-reproductive health and COVID-19 vaccine uptake. The incorporation of a mechanisms-based approach into behavior intervention research offers new opportunities for improving health.

Sanitation, financial incentives and health spillovers: A cluster randomised trial

Poor sanitation and its consequent negative health outcomes continue to plague the developing world. Drawing on the finding that financial subsidies have changed behaviour in other health contexts, we conducted a clustered randomised trial in 160 villages in Lao PDR to evaluate the effectiveness of combining financial incentives with Community-Led Total Sanitation (CLTS), a widely-conducted behaviour change program. Villages were randomly allocated to four groups, all of which received CLTS but differed in the type of subsidy offered (none, household, village or both). Using data from a random sample of households with young children and village administrative data, we show that household incentives increased sanitation take-up among the poor, whereas a village incentive increased take-up primarily among the non-poor. Improved sanitation produced positive health spillovers - a 10 percentage point increase in village sanitation coverage decreased the probability of childhood stunting by 3 percentage points.

Using Co-Design to Create Community Advocacy for Biosecurity Behavior Change

Background: New Zealand’s Ministry for Primary Industries (MPI) manages the “declare or dispose” biosecurity border compliance social marketing program. Its aim is to protect the country’s important horticulture and agriculture industries from imported pests and diseases, and its environment. The program encourages visitors to New Zealand to leave potential biosecurity risk items at home or dispose in specially marked bins on arrival. An important part of this is having New Zealand ethnic communities advocate on MPI’s behalf to friends and family overseas to follow the biosecurity rules. To fully engage the community to be advocates, it was felt that the community should be involved in the creation of this aspect of the program. Focus of the article: The article is a case study explaining how MPI used co-design methodology to create an advocacy program with a local community to assist behavior change in overseas visitors. The article focusses on the process and planning (including following a six-step co-design model) from a practitioners’ perspective to develop a program co-created with the target audience, rather than the final interventions developed. Program design/approach: The “declare or dispose” program had been solely “expert led” and designed by social marketers and researchers. The program is heavily influenced by a mix of quantitative and ethnographic research. These feed into customer journey mapping where interventions are inserted to influence audiences’ behavior. To assist in advocacy from the New Zealand Indian community to friends and family overseas, a customer led co-design process was developed to create community engagement and advocacy. Methods: MPI ran three co-design sessions involving members of local Indian community groups. The sessions used a mixture of card sorting and open discussion within small groups. The card sorting was used to review, and rate current interventions used in the behavior change program (including interventions both overseas direct to visitors and locally to community members). The open discussion asked participants to generate new ideas for potential new interventions to reach visitors. Results: Through the ranking of existing tools and participant suggestions of new ideas—MPI has developed an advocacy program that spans expert-led and user-led interventions. As hoped, the user-led suggestions were at a community-based level, resulting in a stronger buy-in from the community to deliver advocacy messages to overseas friends and family. Recommendations for practice: The article is useful for practitioners by detailing how to not only use co-design for creating new ideas, but also to evaluate existing ones to create a program blending both expert- and user-led interventions. MPI followed a six-step co-design process to organize its co-design program. This ensured that the right preparation was followed, sessions were effective, and the desired results of the program were achieved.

Improving childhood nutrition in Indonesia through an innovative behavioural change programme

Improving childhood nutrition in Indonesia through an innovative behavioural change programme

Understanding Gender-Based Violence Prevention among Young Women : Youth Workers Perspective?

This study focused on the expertise of youth workers in preventing violent acts with special focus on young women. A qualitative research approach was employed in this study. Ten youth workers were purposefully sampled to participate in this study. An unstructured interview schedule was also used to gather data. An exploratory research design was used to explore the experience of the participants. Data were analysed using thematic coding. Violence against young women in South Africa is a widespread problem that affect young women’s capabilities. South Africa is also facing a high prevalence of gang rape and young women are the most affected group. The findings reflect that youth workers prevent violence against young women by offering young people, both male and female, the following interventions: building youth self-esteem, health education and empowerment, soft skills programmes and building youth resilience. The study recommends that the Department of Women, Youth and Persons with Disabilities establish a funding directorate that will focus on funding youth workers led non-profit organisations (NPOs) that have holistic youth programmes that mainly address violence against young women and social behaviour change programmes among young men.