Behaviour Change Techniques Research Articles

Using the BCW and TDF to identify factors related to increasing fruit and vegetable consumption in children to guide future intervention development.

This study used the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF) to identify parental factors that are associated with increasing their child's fruit and vegetable consumption. The information gathered enabled a behavioural diagnosis and the identification of intervention functions to increase fruit and vegetable consumption in children. A qualitative design using open-ended online survey methodology was utilised. United Kingdom. Twenty-eight parents of primary school-aged children (4-11 years) aged 29-51 years participated. Thematic and summative analysis identified skills in preparation and cooking, awareness of and desire to increase fruit and vegetable intake, knowledge of the recommendations, and better health for their child as the main facilitators. The main barriers were time and financial constraints, their child's food preferences and refusal to eat fruit and vegetables, negative role modelling from parents and grandparents and beliefs that fruit and vegetable intake will increase with age. For behaviour change to occur, "knowledge", "social influences", "environmental context and resources", "beliefs about consequences" and "beliefs about capabilities" need to be altered. Novel findings suggest that future intervention development should focus on parental beliefs and skills around how to increase fruit and vegetable consumption as their child ages and expanding parental knowledge on the benefits of fruit and vegetable consumption such as mental and future health. The use of the TDF and BCW identified appropriate intervention functions that will guide future behaviour change techniques, modes of delivery, and policy categories that best target increasing children's fruit and vegetable consumption.

Initial participant perspectives about participating in an online, semi-supervised, cirrhosis-specific nutrition and exercise intervention.

In chronic diseases, there have been issues with low levels of participant adherence and retention during well-supported lifestyle behaviour change interventional studies. Theoretically informed, the objective was to explore the types of challenges participants are experiencing to inform future designs. We conducted an exploratory descriptive study in an adult cirrhosis population after the first 4-6 weeks of a 12-week semi-supervised nutrition and exercise online program. Participants in the parent feasibility study, assessing the nutrition and exercise intervention (Heal-Me), were eligible for this nested study. Heal-Me is a multimodal program that is tailorable to a participant's abilities through regular interaction with the study's registered dietician and exercise specialist. Interviews (~60 min) with participants were recorded then analysed descriptively, guided by the capability, opportunity and motivational behaviour change model. The 20 participants preferred the expert-led group online nutrition and exercise classes over independent activities such as protein tracking and the exercise videos. Social gamification (e.g., weekly polls on favourite things like movies or sports teams) contributed to the group experience. All except one person required program tailoring to address preferences, abilities and new onset health events. Findings led to the inclusion of 4 behaviour change techniques to the initial 17, whereas 2 others were expanded. While program tailoring, awareness of cirrhosis nutrition and regular interactions with staff influenced participant retention and adherence in the first 4-6 weeks of the online program.

Healthcare professionals’ promotion of physical activity to people living with and beyond head and neck cancer: a cross-sectional survey

PurposePhysical activity (PA) can improve health-related outcomes for head and neck cancer (HaNC) patients, and PA guidance from healthcare professionals’ can increase patients’ PA levels. However, less than 9% of HaNC patients are physically active. This study explored healthcare professionals’ promotion of PA across the National Health Service (NHS) in North West England and North Wales, to HaNC patients.MethodsA cross-sectional online survey exploring healthcare professionals’ promotion of PA in HaNC. The International Physical Activity Questionnaire–Short Form was used to estimate healthcare professionals’ PA levels. Quantitative data were analyzed using descriptive or inferential statistics and qualitative data were analyzed using reflexive thematic analysis. Data were synthesized drawing on the capability-opportunity-motivation-behavior model and theoretical domains framework.ResultsEighty-one professionals participated. Fifty-three percent self-reported high levels of PA. Seventy-five percent considered PA promotion as part of their role; however, only 39% discussed PA with their patients (reflective motivation and social/professional role and identity). Only 38% felt confident initiating PA discussions and 76% reported needing further training. Training on the benefits of PA for HaNC patients and how to encourage health-related behavior change were identified as beneficial (psychological capability and knowledge).ConclusionHealthcare professionals are influential in enabling patients to adopt health-related behavior change; however, PA promotion was not routine practice for professionals involved in the care of HaNC patients. Training should be provided to professionals on PA promotion, with a focus on behavior change techniques. Future research should explore how behavior change techniques can be implemented into clinical practice to improve health-related outcomes in HaNC.

Assessing fidelity of design and training of Making Every Contact Count (MECC) in a mental health inpatient setting

BackgroundMaking Every Contact Count (MECC) is a public health strategy which strives to enable brief interventions to be implemented through opportunistic healthy lifestyle conversations. In a mental health inpatient setting a bespoke MECC training package has been developed to encourage cascade training through a train the trainer model and to incorporate an additional regional health strategy A Weight Off Your Mind into Core MECC training to provide a focus on healthy weight management. This study evaluated the fidelity of design of MECC in the mental health inpatient setting and fidelity of the training package currently being cascaded across the region.MethodsInitially a documentary analysis of six documents shared through the mental health inpatient setting including MECC implementation guide, logic model, checklist and evaluation framework. Documents were analysed using the Template for Intervention Description and Replication (TIDieR) checklist and coded using the Behaviour Change Technique (BCT) Taxonomy version one (BCTTv1) and the Expert Recommendations for Implementing Change (ERIC) Taxonomy. Coding was compared against MECC guidance documents to complete the fidelity assessment. A training delivery guide, training slides and two recordings of both train the trainer and Core MECC + A Weight Off Your Mind training were analysed for behaviour change techniques (BCTs) and compared to conduct a fidelity training assessment.ResultsOverall the implementation of MECC in the mental health inpatient setting had moderate fidelity to the MECC guidance, with a total of 31 BCTs identified across guidance and provider documents and a 77% adherence of provider documents to guidance. The highest level of fidelity applied to the MECC implementation guide where 86% of identified BCTs were also present. The training package showed high fidelity that both training programmes were being delivered as intended with 100% of BCT matched from training materials to training transcripts. Potential loss of fidelity through additional BCTs was present across provider documents and training transcripts.ConclusionThe implementation of MECC across the mental health inpatient setting and the training package appear to be delivered as intended therefore demonstrating good fidelity and potential benefits to public health. Future research would benefit from assessing cascade training sessions from those who have completed train the trainer to evaluate ongoing fidelity of training across the trust.

Sex moderates diet quality differences in integrated collaborative care for comorbid obesity and depression: Post-hoc analysis of the RAINBOW RCT

ObjectivesTo investigate (1) whether an evidence-based behavioral weight loss intervention was associated with improved diet quality in adults with obesity and depression compared with usual care; and (2) whether the associations were modified by sex. DesignIn the RAINBOW RCT, 409 participants were randomized in 1:1 ratio to receive a 12-month intervention integrating a Diabetes Prevention Program-based behavioral weight loss treatment with problem-solving therapy for depression (n = 204) or usual care (n = 205). Participants completed 24-h dietary recalls at baseline, 6, 12, 18, and 24 months. Dietary outcomes included the DASH score as the composite measure of diet quality and its components. Between-group differences in dietary outcomes were examined among all participants and by sex, using repeated-measures mixed-effects linear models. ResultsIntervention group had mean age 50.9 (SD 12.2) years and 71% women, while control had 51.0 (11.9) years and 70% women. Changes in DASH scores did not differ between the intervention and usual care control groups through 24 months in both females and males. Compared with controls, males in the intervention group had decreased nut, seed, and legume intake at 6 (mean difference, −1.1; 95% CI, −1.9, −0.3 servings/day; P = 0.01; Pajd = 0.73) and 12 months (−1.0; −2.0, −0.0 servings/day; P = 0.048; Pajd = 0.73). Compared with controls, females in the intervention group had decreased fruit and vegetable intake at 18 (−1.8; −2.9, −0.6 servings/day; P = 0.002; Pajd = 0.08) and 24 months (−1.1; −2.2, −0.1 servings/day; P = 0.03; Pajd = 0.25), and whole grain intake at 24 months (−0.5; −0.9, −0.1 servings/day; P = 0.03; Pajd = 0.25), but increased percent calories from fat at 24 months (3.6; 0.6, 6.5; P = 0.02; Pajd = 0.25). ConclusionDiet quality not only did not improve in an effective behavioral weight loss intervention but deteriorated in females, in particular. These post-hoc findings warrant confirmation and may suggest sex-tailored behavior change techniques specifically targeting diet quality are needed in behavioral weight loss interventions aside from caloric reductions. Trial registrationClinicalTrials.gov#NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).

Behavior Change Techniques in Physical Activity Interventions Targeting Overweight and Obese Children and Adolescents: A Systematic Review

Behavior Change Techniques in Physical Activity Interventions Targeting Overweight and Obese Children and Adolescents: A Systematic Review

Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment

BackgroundThe Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.Objectives(1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.MethodsWe conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors’ knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.ResultsThe key moments where participants felt they needed the most support were “treatment”, “report of findings”, “informed consent”, “physical examination”, and “before the appointment”. All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.ConclusionUnderstanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.

The use of intervention mapping to guide the development of a school-based intervention to improve emergency medical services activation for stroke

BackgroundIf carried out correctly and without delay, activation of emergency services by stroke bystanders could improve mortality and disability from stroke. This paper describes the development of a school-based intervention using the Intervention Mapping approach. It aims to improve the appropriate activation of emergency medical services for suspected stroke by 12-15-year-old children.MethodsThe development of the intervention was guided by Intervention Mapping approach. The logic model of the problem was created through analysis of the existing literature and semi-structured interviews with stakeholders. Based on these findings, performance objectives and their determinants were determined and matched to create a model for changing emergency medical services activation behavior. Behavior change methods and their practical applications were then determined. Based on them, intervention messages and materials were designed, the intervention was drafted, pretested, and finalized.ResultsIt was found that the main performance objectives for the activation of emergency medical services were (1) recognizing symptoms, (2) communicating with the victim, and (3) calling an ambulance immediately. Their main determinants were knowledge, social influence, risk perception, self-efficacy, outcome expectations, and skills. Determinants were then matched with performance objectives to create the matrices of requested behavior changes. The following change methods were chosen: modeling, elaboration, belief selection, providing cues, scenario-based risk information, and cultural similarity. Methods were translated into practical applications in the form of a short educational film. The production company created, pretested, and finalized the film. As a result, a 5-minute entertainment-education video was created modeling an acute stroke with a child as the main bystander.ConclusionThe Intervention Mapping approach guided the development of a school-based program to improve Emergency medical services activation in stroke by 12–15 year old children. Our process and approach can serve as a model for researchers and health promotion professionals aiming to improve help-seeking behavior for stroke to improve stroke help-seeking behavior as well as other acute diseases.

From kitchen to climate: multimedia interventions on social media as science tools for sustainability communication among food business actors

Purpose The purpose of this study is to hypothesize that tailored multimedia interventions using the Elaboration Likelihood Model and Behavior Change Techniques via social media platforms have the potential to effectively disseminate scientific information regarding food sustainability to food professionals. The objective is to evaluate the extent of the influence of these interventions on social media in enhancing the knowledge, attitudes and behaviors of food professionals about food sustainability, with a specific focus on next-generation professional chefs. Design/methodology/approach A total of 121 students majoring in gastronomy and culinary arts volunteered to participate in the study. A 5-min multimedia intervention was explicitly tailored for their backgrounds and designed for social media platforms. It covered food sustainability topics and related factors using a diverse range of multimedia elements, such as video, still images, text and audio narration. Furthermore, researchers developed a validated questionnaire that covered the same topics as the multimedia intervention. In a quasi-experimental design, participants were administered the questionnaire both before and after watching the tailored multimedia intervention. Findings The results of this study revealed significant improvements in participants’ knowledge and attitudes of key concepts, including greenhouse gases and their relation to climate change, climate change and meat-based menu items relation, inequality in the distribution of natural resources, primary sources of food loss, the significance of implementing new technology in agricultural activities and the role of the next generation. The multimedia shifted participants’ attitudes, prioritizing climate change as the most critical and strengthening the perception of local food production as the least critical factors. Moreover, it strengthened participants’ attitudes toward the Ministry of Agriculture and Forestry as the primary actor in sustainability. Research limitations/implications Although culinary students may be seen as a subset of a targeted food professional group, they are the future leaders of the global food system. Chefs have substantial influences in a broad range of settings and sectors, including institutional food service, chain restaurants, the food and beverage industry and home cooking via books and television programs, among others. Chefs increasingly adopt sustainable menus and business practices to promote sustainable food systems and reduce climate change associated with the food sector. In addition, they use their community power to advocate for legislation that promotes the long-term sustainability of food systems. Practical implications Chefs and restaurant owners can use the results to tailor multimedia about food sustainability topics for their staff training programs and daily sharing on their social media platforms. Government organizations and policymakers can use the results to develop effective communication plans with food professionals. Non-governmental organizations dedicated to the environment and food sustainability can tailor multimedia campaigns on social media that address the food professionals directly to encourage them to adopt sustainable practices. Professional teams producing content on social media platforms can use the results to create engaging and informative scientific multimedia interventions targeting food professionals. Social implications In a broader societal context, enhancing the scientific knowledge, attitudes and behavior of the professional chefs toward food sustainability will, in turn, lead to widespread adaptation of sustainable practices, not only within their professional domains but also in wider community settings. This will significantly contribute to the major goal of advancing food sustainability and addressing global challenges like food inequality and food insecurity. Originality/value The impact of various variables and the roles of different food sectors and their actors in food sustainability have been extensively studied. Furthermore, a wide range of research has examined diverse consumer groups’ food sustainability knowledge, attitudes and behaviors. However, developing an effective method for communicating and advocating scientific facts about food sustainability-related topics has been a challenge. Traditional environmental education is insufficient for fostering sustainable change. As social media are the fastest-growing science communication tool, this pioneering research suggests multimedia interventions on social media to improve food professionals’ food sustainability knowledge, attitudes and behaviors to fill the literature gap.

Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package.

Care of critically ill patients is complex, requiring effective collaboration co-ordination and communication across care teams and professions. Medicines are a fundamental component of the acute interventions intensive care unit (ICU) patients receive, requiring frequent review and optimisation according to patient needs. ICU patients recovering to transfer to a hospital ward are at risk of medication transition errors, contributing to poorer patient and health-system outcomes. We aimed to develop of a theory-informed intervention package to improve medication safety for ICU patients transferring to a hospital ward. We conducted a qualitative study comprising two UK face-to-face focus group meetings in April and May 2022. There were ten participants in each meeting (7-8 healthcare professionals and 2-3 patient and public representatives). Each meeting had four foci: (i) What needs to change (intervention targets)? (ii) What are the core intervention components? (iii) What will the intervention components change and how (mechanisms of action), and what key outcomes will the changes impact on? (iv) What are the barriers and facilitators to intervention delivery? A background to the problem and previous intervention development work was provided. Meetings were digitally recorded and transcribed verbatim. Iterative analyses, informed by the Behaviour Change Wheel framework, were conducted to provide a behavioural diagnosis, identify key behaviour change techniques and outline the mechanisms of action through which the intervention might impact on key outcome. We identified what needs to change to improve medication safety for UK ICU patients on this care transition. A theory-informed intervention package was developed, based on seven core intervention components (e.g., medication review (targeted), task organisation and prioritisation). For each intervention component the mechanism of action, targeted change, and key outcomes were identified (e.g., medication review (targeted); action planning; decreases problematic polypharmacy; decreased preventable adverse drug events). Barriers and facilitators to intervention component delivery were described. We developed a theory-informed core intervention package to address the limitations in medication safety for ICU patients transferring to a hospital ward. Understanding what needs to change, and the accompanying facilitators provides a basis for intervention feasibility testing and refinement prior to future evaluation of effectiveness.

Adding planning strategies to an experiential and conceptual knowledge-based intervention: Does it help to reduce sedentary time?

ObjectiveThe study compared the effects of an “active” control condition addressing conceptual and experiential knowledge about sedentary behavior, with an intervention condition combining conceptual and experiential knowledge together with action planning, coping planning, and behavioral substitution. We targeted a decrease in sedentary time as the primary outcome. MethodsA preregistered trial (#NCT04131270) was carried out with 603 participants aged 11–86 years (M = 33.57; 65.2% women), randomly assigned to the “planning + knowledge” condition or the “knowledge” condition. Sedentary time was assessed with ActiGraph wGT3X-BT accelerometers at baseline, 1-week, and 36-week follow-ups. Conceptual knowledge strategies involved information about health consequences and instructions on how to perform behaviors while experiential knowledge was enhanced by participants taking/discussing photographs of their home environment that has been triggering sedentary behavior. Action/coping plans referred to ways to substitute sedentary behavior with bouts of physical activity behaviors. Mixed models were fit. ResultsNo significant Time × Condition interaction was found. In the total sample, sedentary time estimated to be around 502.34 min/day at baseline, showed a significant linear decline over time (p = .002), by approximately −1.22 min per each month elapsing since baseline (−9.76 min/day across 8 months). ConclusionsThe findings suggest that applying behavior change techniques targeting both conceptual and experiential knowledge about antecedents, circumstances, and consequences of sedentary behavior may result in a small reduction of sedentary time. Adding action plans, coping planning, and behavioral substitution did not improve the effectiveness of the intervention.

Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study)

Background Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs. Objective This study aims to develop and test an intervention to improve the use of POCTs in managing RTIs involving GPs and CPs in Irish primary care, following the UK’s Medical Research Council’s (MRC) framework for complex intervention development, involving five work-packages (WPs). Methods WP1 involves creating best practice guidance for using POCT in managing RTIs, informed by a scoping review and validated with an expert Delphi panel. This guidance will be used to define target behaviour(s) for GPs and CPs related to POCT use. WP2 explores GP and CP perceived barriers and facilitators to these behaviours using the Theoretical Domains Framework, mapping influential domains to Behaviour Change Techniques to develop draft interventions. WP3 gathers patients’ perspectives on using POCTs for RTIs. In WP4, a task group will review and finalise the intervention(s). They will consider patients’ perspectives from WP3 and assess feasibility of the intervention(s). WP5 involves a proof-of-concept study to test the feasibility of the newly developed intervention(s). Conclusion A theoretically informed intervention(s) for using POCT(s) in the management of RTIs in primary care in Ireland will be developed and tested in a proof-of-concept study, following MRC guidance. Further refinement and larger studies will be needed to determine its effectiveness before widespread implementation.

Development of a habit-based intervention to support healthy eating and physical activity behaviours for pregnant women with overweight or obesity: Healthy Habits in Pregnancy and Beyond (HHIPBe)

BackgroundThe number of women entering pregnancy with overweight or obesity is increasing. This can increase the risk for excessive gestational weight gain (GWG) which is associated with health complications for mother and baby. There are limited evidence-based interventions within antenatal care settings to encourage healthy eating and physical activity behaviours and support women with managing GWG.MethodsA previous habit-based intervention ‘Ten Top Tips for a Healthy Weight’ (10TT) was adapted and made suitable for pregnancy in line with the Medical Research Council’s (MRC) complex intervention development guidelines. It involved three key activities: (1) identifying the evidence base; (2) identifying appropriate theory; and, (3) modelling processes. A core element was integrating lived experience via personal and public involvement (PPI).ResultsThe original 10TTs were adapted with PPI in line with current advice on nutrition and physical activity in pregnancy. New intervention materials were devised, including a leaflet and a logbook and app for self-monitoring to be delivered alongside a brief 1:1 conversation. Behaviour change techniques (BCTs) included in the new materials were coded using a number of behavioural taxonomies. An E-learning resource was created to help standardise the approach to delivery of the intervention and avoid stigmatising conversations.ConclusionFollowing MRC guidance for the development of complex interventions alongside significant PPI allowed for the adaption of 10TT habit-based weight management intervention into the ‘Healthy Habits in Pregnancy and Beyond’ (HHIPBe) intervention. The feasibility and acceptability of implementing this intervention in the antenatal setting will be explored in a feasibility randomised controlled trial.Trial RegistrationThis study was registered on Clinical Trials as ‘Healthy Habits in Pregnancy and Beyond (HHIPBe)’ ClinicalTrials.gov Identifier: NCT04336878. The study was registered on 07/04/2020.

Co-Design of a Facilitated Self-Management Toolkit for People With Parkinson's Disease.

Parkinson's disease is a complex progressive neurodegenerative disease increasing globally. Self-management interventions have shown promise in improving the quality of life for people with chronic conditions. This paper aims to describe the development processes and the core components of a facilitated self-management toolkit to support people with Parkinson's disease to self-manage their condition. An iterative co-design approach was adopted and included the use of systematic reviews, qualitative methods and theory to develop the Live Well with Parkinson's toolkit. A co-design group was established consisting of people with Parkinson's, family carers and health and social care experts to produce and refine an online self-management toolkit to be tested in practice. Five co-design groups were conducted alongside several phases of toolkit development. An online self-management toolkit, called Live Well with Parkinson's, was developed with core aspects such as tailored information to the individual, a well-being section using an asset-based approach and problem-solving skills to create and maintain goals, symptom review and management sections and a tracker of medication, symptoms and activities/actions. A paper-based alternative version was also created for those who cannot use an online resource. The toolkit is fully manualised and facilitated by six sessions from a 'supporter' who is trained in behaviour change techniques. It can be shared with carers and healthcare professionals. The toolkit is a robust and comprehensive approach to self-management of Parkinson's disease. It is evidenced based, incorporates theory and was developed with people with Parkinson's and experts in the area. The Live Well with Parkinson's toolkit has the potential to be embedded within routine healthcare, aligning with self-management policies. Author B.M. is our patient and public involvement (PPI) representative and author on this paper. B.M. supports a team of 15 PPI members who have contributed to the development of the toolkit. This involvement has included attending research team and steering group meetings, attending and facilitating co-designed workshops, reviewing all the toolkit information before approval and supporting with the user testing.

A behaviour change intervention to increase volunteer participation in charity

The factors that influence volunteerism are still insufficiently investigated today. What motivates people to engage as volunteers, and how can their willingness to do so be increased through the application of behavioural psychology in marketing campaigns? This study analyses the possibility to influence volunteer participation by applying behavioural psychology, in particular, ten behaviour change techniques (BCTs) from the BCT Taxonomy. Eighty-three study participants were recruited via the mailing list of an inclusive local charity (KEEN Oxford). Individuals were assigned to one of two groups (control/intervention) in a survey, each consisting of an email addressing potential recruits. The results show a significant difference between the two groups (p<.05), for the increase in both willingness to volunteer (1.56 vs 0.35 points on a ten-point scale) as well as time commitment (4 vs 0.54 hours). This reinforces the hypothesis that behavioural psychology can increase volunteer participation.

Nutrition as therapy - the role of dietitian counseling: a best practice implementation project.

The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies. Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes. This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice. The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline. Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As the next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods. http://links.lww.com/IJEBH/A289.

A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study.

Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial.

Effectiveness of behaviour change techniques in lifestyle interventions for non-communicable diseases: an umbrella review

ObjectiveTo identify the most commonly reviewed behaviour change techniques (BCTs) and their effectiveness based on consistency across reviews for lifestyle interventions of non-communicable diseases.DesignUmbrella review of systematic reviews.Data sourcesPubMed, Embase, PsycINFO, Cochrane CENTRAL, Global Health.Data extraction and synthesisA narrative synthesis of extracted findings was conducted. The Behaviour Change Technique v1 Taxonomy was used to identify and code behaviour change techniques (e.g., goal setting) in a standardised manner, which were independently assessed by two reviewers. Study quality was independently assessed by two reviewers using the assessment of multiple systematic review tools.Results26 reviews were included with a total of 72 BCT labels evaluated across the different lifestyle interventions and non-communicable diseases. A total of 13 BCT clusters were identified to be reported as effective. The most commonly reviewed BCTs and their effectiveness/ineffectiveness were as follows: ‘Goals and Planning’ (12 effective/1 ineffective), ‘Feedback and monitoring’ (9 effective/3 ineffective), ‘Social support’ (9 effective/1 ineffective), ‘Shaping knowledge’ (11 effective/1 ineffective), and ‘Natural consequences’ (6 effectiveness/ 2 ineffective). The vast majority of the studies were conducted in high-income and a few in upper middle-income countries, with hardly any studies from lower middle-income and lower income studies.ConclusionThe most common BCTs were ‘Goals and Planning’, ‘Feedback and Monitoring’, ‘Shaping Knowledge’, ‘Social Support’, and ‘Natural Consequence’. Based on consistency across reviews, several BCTs such as ‘Goals and Planning’, Feedback and Monitoring’, ‘Shaping Knowledge’, and ‘Social Support’ have demonstrated effectiveness (Recommendation Grade A) in improving health behaviours across a limited range of NCDs. The evidence is less clear for other BCT techniques. It is also likely that not all BCTs will be transferable across different settings. There is a need for more research in this area, especially in low-middle-income countries.Protocol registrationRegistered on the International Prospective Register of Systematic Reviews; PROSPERO (CRD42020222832).

Design and development of a mobile health intervention for rehabilitation support after knee arthroplasty: TeleRehabilitation after knee ArThroplasty (TReAT) project

BackgroundThe steep increase in knee arthroplasties in lower- and middle-income countries has increased demand for personalised rehabilitation care. Technology-based rehabilitation programs offer potential to replace or augment conventional face-to-face rehabilitation for providing continuum of care. We aimed to systematically develop a theory, evidence-driven, contextualised, and user-centred mobile health platform for people undergoing knee arthroplasty to facilitate monitoring progress during rehabilitation.MethodsWe followed the UK Medical Research Council’s framework and adopted a behaviour design thinking approach, consisting of five steps; (1) conduct multiple literature reviews and cross-sectional surveys to determine the needs and problems experienced during the rehabilitation phase by healthcare professionals and individuals with replaced knees, (2) identify target behaviours along with barriers and facilitators, integrated within the Capability, Opportunity, Motivation-Behaviour (COM-B) framework, (3) identify intervention functions and components, behaviour change techniques, and features for the mobile application, selected after discussions with orthopaedic surgeons, physiotherapists and behavioural experts, (4) develop a prototype application for end-users, and a web-based platform for healthcare professionals, and (5) pilot test the intervention for end-users’ feedback on usability of the application and to identify possible strategies for implementing the intervention package.ResultsUsing the COM-B model, education, training, persuasion, enablement, and modelling were chosen as intervention functions for improving adherence to exercise protocol during early-phase of rehabilitation. The application featured five interlinked components; education, training, goal setting and self-management, communication, and a personalized therapy plan utilising 13 behaviour change techniques. An education booklet, exercise videos, text messaging, video consultation, and a digital tool for measuring range of motion were incorporated into the application. Feedback on the interactive prototype and education material was sought from ten patient volunteers and a physiotherapist. Pilot testing in a convenient sample with broad eligibility criteria (n = 30) indicated importance of digital literacy and dedicated time for remote consultation by healthcare provider within the existing clinical work. Overall, the intervention was well received and valued by the end users.ConclusionThis paper demonstrates the development of a contextualised digital behavioural intervention grounded in behavioural theory and evidence from literature to improve end-user’s engagement with rehabilitation protocols after knee arthroplasty in lower- and middle-income country context.Trial registrationStudy registered prospectively (on 16 February 2023) at Clinical Trials Registry of India (CTRI/2023/02/049792).

Short-term outcome of personalized theory-based pharmaceutical care service on the medication administration problems of family caregivers: a pre-post intervention study.

Family caregivers face many problems during administration of medications. Pharmacists are reliable and accessible healthcare providers in addressing family caregivers' medication related inquiries in primary care. This study aimed to evaluate theshort-term outcome of apersonalized theory-based pharmaceutical care service on the medication administration problems of family caregivers. This pre-post intervention study was carried out among family caregivers at a community pharmacy in Istanbul, Türkiye from May through December 2022. The service was developed by mapping problems using theTheoretical Domains Framework and selecting related behavioural change techniques. The primary outcome was the change in the scores on the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR) from baseline to the one-month follow-up assessment. Secondary outcomes were their ability to read health related materials, care burden, and satisfaction. Among family caregivers (n = 100), total score of FCMAHS-TR was significantly reduced after receiving theory based pharmaceutical care service (median [IQR]23.0 [17.0-27.0] vs 17.0 [10.3-20.0]; p < 0.001). The proportion of family caregivers with high ability to read health related materials was significantly increased (34.0% vs 48.0%; p < 0.05) with non-significant change in the proportion of family caregiver with high burden (97.0% vs 94.0%; p > 0.05). Younger family caregivers had significantly higher scores on the Turkish version of Patient-Oriented Pharmacy Services Questionnaire (PSPSQ) 2.0 when compared with the older ones (≥ 65 y) (p < 0.05). Family caregivers' medication administration problems werereduced after receiving thetheory based pharmaceutical care service. Long term impact and national implementation of this service should be assessed in the further studies.