Behaviour Change Techniques Research Articles

DE-PASS best evidence statement (BESt): determinants of adolescents’ device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis

BackgroundAlthough physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents’ device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings.MethodsA search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents’ device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID: CRD42021282874.ResultsFourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual–psychological, four individual–behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found.ConclusionsWeak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents’ device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents’ PA/SB, including policy and environmental variables.

Virtual active sports: identifying main barriers and facilitators for casual fitness fans

PurposeThe aim of this study is to utilise the Theoretical Domains Framework (TDF) to identify the main barriers and facilitators of positive attitude towards trying Virtual Active Sports (VAS).Design/methodology/approach200 individuals took part in an online cross-sectional survey based on 11 domains within the TDF. Linear logistic regression analysis was performed on the participant’s self-reported attitudes and believes. Based on the results from the regression analyses, a list of suggested behaviour change techniques was designed using the Behaviour Change Wheel (BCW) framework and the BCT taxonomy (BCTTv1).FindingsThis research suggested that Beliefs about Consequences, Beliefs about Capabilities, Goal Conflict, Coping Planning, and Environmental Context and Resources are the main factors, influencing the positive attitude towards VAS and the self-reported desire to try it in the future. Future interventions were recommended and supported by 22 possible BCTs identified using the BCW approach. The TDF and BCW proved to be useful models for identifying both internal and external factors influencing fitness fans during the adoption of the new sportstech.Originality/valueThe main contribution of the present work was the implementation of a structured and effective approach derived from the healthcare domain to design solutions for behaviour change in the emerging and expanding virtual sports context.

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.

Improving retrospective intervention descriptions: Lessons learned from research on type 2 diabetes programmes in the United Kingdom and the Republic of Ireland.

In recent years, multiple countries worldwide have implemented behavioural interventions within national healthcare systems. Describing the content of these interventions is critical to improve their implementation, replication, and effectiveness, as well as to advance behavioural science. Tools, such as the Behaviour Change Technique Taxonomy, can enhance the quality of intervention description and reporting. As interventions are frequently developed without the use of such tools, retrospective coding of existing interventions to accurately characterise their content is becoming more common. However, the use of these tools for retrospective coding poses various challenges, the discussion of which has been neglected to date. This commentary discusses the challenges encountered when retrospectively describing the content of five nationally implemented programmes for type 2 diabetes in the United Kingdom and the Republic of Ireland and suggests recommendations to tackle these challenges. We present important methodological, practical, and ethical considerations for researchers to reflect on, relevant to the retrospective description of existing interventions. Specifically, we discuss (i) the importance of positive relationships and collaboration with intervention stakeholders, (ii) the practical and ethical considerations when analysing the content of implemented interventions, (iii) the independence of research teams and the potential for misclassification of intervention content, and (iv) the challenges associated with the analysis of intervention content using behavioural science tools. There is a growing demand for more robust approaches to address the methodological, practical, and ethical challenges associated with such studies. The present commentary describes key issues to be considered by research teams, as well as concrete recommendations to improve the retrospective characterisation of intervention content.

Co-designing The Healthy Gut Diet for Preventing Gestational Diabetes: Co-design methods and process outcomes.

Gestational diabetes mellitus (GDM) is a common and costly condition of pregnancy. The Healthy Gut Diet for Preventing Gestational Diabetes study is a novel randomised controlled trial that aims to prevent GDM through a diet that modulates the gut microbiota for pregnant women with GDM risk factors. Despite increasing interest in co-designing interventions with consumers (lived experience experts), co-design methods and outcomes are often poorly reported. The present study aims to report on the co-design process used to develop The Healthy Gut Diet intervention. Co-design occurred across three online workshops with consumer participants (women with a lived experience of GDM, n = 11), researchers (n = 6) and workshop co-facilitators (including a consumer co-facilitator, n = 2). The workshops explored women's preferences for the mode and length of education sessions, as well as the types of information and supportive resources women wanted to receive, and undertook a "behaviour diagnosis" to understand barriers and enablers to the target behaviours (eating for gut health). The final intervention is reported according to the Template for Intervention Description and Replication. A co-designed dietary intervention (The Healthy Gut Diet), delivered via telehealth, with a suite of educational and supportive resources that integrates published behaviour change techniques, was developed. Generally, the co-design process was reported as a positive experience based on participant feedback and evidenced by no participant dropouts over the 3-month study period. Co-design is recognised as a process that creates a partnership between lived experience experts and researchers who can engage and empower research recipients and improve health behaviours.

Feasibility and acceptability of a theory-based online tool for reducing stress-induced eating

Stress-induced eating is associated with various health risks like obesity and cardiovascular disease, exacerbated by the overconsumption of unhealthy foods. This study sought to investigate replacement coping strategies for stress-induced eating that participants can seek to implement using behaviour change techniques like implementation intentions. The study adopted a feasibility and acceptability design, with 258 participants (88.37% female) aged 17–75 years old who self-reported stress-induced eating. Participants were asked to identify cues for their stress-induced eating and evaluate the acceptability of eight potential replacement coping strategies. After selecting their preferred strategy, participants formed implementation intentions, linking the strategy with their previously identified cues. There were six themes of cues for stress-induced eating as identified by participants, including a range of external and internal stressors. Themes regarding the acceptability of the replacement coping strategies were organised based on constructs from integrated social cognition theories. Participant responses reflected cognitive and affective attitudes, and control and normative beliefs behind engagement in coping behaviour; further, automatic and volitional processes were described by participants as playing a role in whether a coping strategy was deemed as useful. Plans formulated by participants commonly detailed specific situations and strategies to utilise, though few described start times or durations of their plan. Action planning was found to significantly increase following formation of implementation intentions, and participants’ descriptions supported the feasibility and acceptability of utilising implementation intentions to adopt alternative coping strategies to stress-induced eating. Future research should conduct a randomised controlled trial to assess the efficacy of the implementation intentions intervention in promoting uptake of replacement coping strategies to reduce stress-induced eating.

Unveiling wearables: exploring the global landscape of biometric applications and vital signs and behavioral impact

The development of neuroscientific techniques enabling the recording of brain and peripheral nervous system activity has fueled research in cognitive science. Recent technological advancements offer new possibilities for inducing behavioral change, particularly through cost-effective Internet-based interventions. However, limitations in laboratory equipment volume have hindered the generalization of results to real-life contexts. The advent of Internet of Things (IoT) devices, such as wearables, equipped with sensors and microchips, has ushered in a new era in behavior change techniques. Wearables, including smartwatches, electronic tattoos, and more, are poised for massive adoption, with an expected annual growth rate of 55% over the next five years. These devices enable personalized instructions, leading to increased productivity and efficiency, particularly in industrial production. Additionally, the healthcare sector has seen a significant demand for wearables, with over 80% of global consumers willing to use them for health monitoring. This research explores the primary biometric applications of wearables and their impact on users’ well-being, focusing on the integration of behavior change techniques facilitated by IoT devices. Wearables have revolutionized health monitoring by providing real-time feedback, personalized interventions, and gamification. They encourage positive behavior changes by delivering immediate feedback, tailored recommendations, and gamified experiences, leading to sustained improvements in health. Furthermore, wearables seamlessly integrate with digital platforms, enhancing their impact through social support and connectivity. However, privacy and data security concerns must be addressed to maintain users’ trust. As technology continues to advance, the refinement of IoT devices’ design and functionality is crucial for promoting behavior change and improving health outcomes. This study aims to investigate the effects of behavior change techniques facilitated by wearables on individuals’ health outcomes and the role of wearables in promoting a healthier lifestyle.

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.

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.

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.

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.

Identifying the active content of interventions targeting the psychological well-being of carers of people with motor neuron disease: A systematic review.

The primary aim of this research was to use a taxonomy of behavior change techniques (BCTTv1) to identify, map, and describe the active components of intervention and comparator groups in studies evaluating the psychological well-being (PWB) of motor neuron disease (MND) carers. Secondary aims were to (a) identify absent active ingredients and (b) explore whether variability in the effectiveness of interventions targeting the PWB of MND carers could be better explained through improved characterization of the active content of these interventions. Mixed-methods systematic review based on Joanna Briggs Institute methodology for quantitative, qualitative, and mixed-methods reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Content-coding of interventions targeting the PWB of MND carers using BCTTv1 was conducted. Sixteen manuscripts describing 14 studies were included. Forty-one of the possible 93 behavior change techniques (BCTs, 44%) were identified as active ingredients, while 52 BCTs (56%) were absent. BCTs were identified in all 14 intervention groups and 4 control groups. Four of the 16 overall BCTTv1 categories were absent. Eleven of the 14 studies demonstrated PWB benefits from their interventions. Identified and absent BCTs and BCTTv1 categories were mapped for all study groups, enabling a transparent characterization of active intervention content associated with positive PWB outcomes. Directions to improve interventions in this nascent field of research included the investigation of relevant untested BCTs in this population and the management of reporting and methodological quality issues.

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.

Using the behavior change wheel to design a novel home-based exercise program for adults living with overweight and obesity: Comprehensive reporting of intervention development.

Physical activity and exercise are movement behaviors that support the lifestyle management of overweight and obesity. However, home-based exercise programs are commonly generic, and inconsistently undertake a holistic approach to program design. This work applied the Behavior Change Wheel, supplemented with previously conducted interviews, to the development of a home-based exercise program, specifically for people living with overweight and obesity. This provided an understanding of the target behavior and identified a behavioral diagnosis. These findings were mapped onto the Capability, Opportunity, Motivation-Behavior model and Theoretical Domains Framework, identifying changes needed and corresponding intervention functions. Suitable Behavior Change Techniques were identified, alongside Capability Opportunity Motivation-Behavior components needed to facilitate an increase in exercise behaviors, and five key intervention functions. This housed the delivery of 24 Behavior Change Techniques, including goal setting, feedback, monitoring and repetition. Applying the Behavior Change Wheel has enabled detailed development of a home-based exercise program for adults living with overweight and obesity.

The power of animation: encouraging doctors to access support for psychological wellbeing

The COVID-19 pandemic has exacerbated already high rates of poor psychological wellbeing in doctors. Many doctors perceive a stigma associated with acknowledging psychological wellbeing concerns, resulting in a reluctance to seek support for those concerns. The aim of this study was to develop a theoretically-informed and evidence-based composite narrative animation (CNA) to encourage doctors to access support for psychological wellbeing, and to evaluate the acceptability of the CNA.A composite narrative was developed from an evidence-base of interviews with 27 GP participants across Scotland (May–July 2020). The Behaviour Change Wheel was used to identify behaviour change techniques (BCTs) to be embedded within the CNA. The narrative was turned into a script in collaboration with an animation company. A brief animation ‘Jane the GP’ was developed reflecting specific BCTs.Scottish doctors (n = 83) were asked for their views on acceptability of the CNA concept, and subsequently asked to provide views on the acceptability of the CNA after viewing it. Participants thought the concept of a CNA was novel but may not appeal to all. After viewing the CNA, the widespread view was that it portrayed an authentic experience, could reduce stigma around seeking support for psychological wellbeing, and highlighted formal routes to access such support.CNAs are a novel and acceptable intervention method for encouraging doctors to access support for psychological wellbeing. The use of a theory driven intervention development framework to create the CNA facilitates the link between theory and practice.

Cultural Adaptation and Development of an Educational Intervention 'Meri Sehat, Mere Rules' Relating to Cardiovascular Disease Associated with Rheumatoid Arthritis for South Asian People.

The cardiovascular disease (CVD) risk is elevated by 1.5 times among South Asians with rheumatological conditions like rheumatoid arthritis (RA) in the UK. However, there is a dearth of culturally sensitive educational interventions tailored to this population. We have culturally adapted an existing cognitive behavioural patient education intervention, originally designed for predominantly White populations, to address this gap. The adaptation process followed the Ecological Validity Model, comprising four phases: stage-setting and expert consultations, preliminary content adaptation, iterative content adaptation with patient partners, and finalisation with patient partners and feedback. The Theoretical Domains Framework (TDF) was employed to evaluate the relevance, acceptability, and cultural adaptation of the existing intervention. Seven South Asian Patient Experts with RA were interviewed, and their input aided in developing new content for the culturally sensitive intervention. The intervention was successfully adapted to suit South Asians. Cultural adaptation involved reviewing elements of the existing intervention, including language tone, content, and metaphors. Moreover, by incorporating behaviour change techniques, the content was designed to enhance understanding of RA, CVD risk associated with RA, and promote a healthy lifestyle. The newly developed educational intervention addressed topics such as community resistance, perspectives on health and culture, societal pressure, and opportunities for change. Key messages were visually illustrated through pictorial diagrams in a twenty-five-minute online resource. The first culturally adapted CVD intervention targeting South Asian individuals with RA, particularly those who are non-English-speaking, is now accessible free of charge at www.nras.org.uk/apnijung nationally and internationally.

Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial.

Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels.

Electronic health record-based behaviour change interventions aimed at general practitioners in the UK: a mixed methods systematic review using behaviour change theory

ObjectivesElectronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians’ behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice...

A Gender-Informed Smoking Cessation App for Women: A Protocol for an Acceptability and Feasibility Study.

Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex and/or gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral, and fail to address women's specific needs. To test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking. We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes quit goal setting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one's social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed-methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semi-structured interview regarding their experience with the app and suggestions for improvement. Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024. Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey towards smoking cessation.

Behavioural change for Parkinson’s Disease: A randomised controlled feasibility study to promote physical activity and exercise adherence among people with Parkinson’s: study protocol

Background Parkinson’s is a common progressive neurological condition characterized by motor and non-motor deficits. Physical activity and exercise can improve health, but many people with Parkinson’s (PwP) have trouble reaching the recommended dosage. Our recent literature review found improvements in exercise adherence with behavioural change interventions, but it remains unclear which are most effective. Further qualitative research and patient and public involvement has informed a novel behavioural change intervention to be tested alongside an existing exercise program. Objective To examine the feasibility of behavioural change techniques delivered alongside an exercise programme to improve physical activity, function, and self-efficacy in PwP (and study procedures) to inform a future pilot RCT trial. Methods A parallel-arm single blinded randomised feasibility study. Twenty participants with Parkinson’s (Hoehn and Yahr stage 1-3) will be recruited from a physiotherapy primary-care waiting list. Following written consent, and baseline assessment, the participants will be randomly allocated to the intervention (n=10) or the control group (n=10). Both groups will receive usual care, which includes a weekly program of a multidisciplinary education, a supervised exercise class and a prescribed home exercise program. The intervention group will receive additional behavioural change techniques, targeting behaviour regulation, belief about capabilities and social influences. Class and home exercise adherence, behavioural component uptake and adherence, and negative events will be recorded. Outcomes will include enrolment and maintenance rates, physical function, falls, physical activity, and exercise self-efficacy measured pre- and post- the 12-week program (in-person). Surveys will be used to compare experiences and satisfaction between groups. Exit interviews will be completed with the intervention group only, exploring their experience of the behavioural change techniques. Discussion The results will help inform a future pilot RCT, based on the intervention acceptability, consent rate, maintenance, and protocol integrity. Trial Registration ClincialTrials.gov NCT06192628