Behavior Modification Strategies Research Articles

User-centered design of a mobile app for physical activity advice in cancer care: preliminary study in Morocco at the National Institute of Oncology

ContextUtilizing mobile apps to increase physical activity levels is now standard practice in cancer care. The study’s objective was to provide patients with precise physical activity recommendations and/or initiate self-directed exercise programs.MethodsA multidisciplinary group directed the design procedure. We adhered to the self-determination approach,and accompanying behavior modification strategies, as well as international guidelines in the field of physical activity in cancer care. The design process was user-centered and involved three steps: Understanding the user and the context, conceptualization, and evaluation of the prototype. The testing was carried out by the beneficiaries, healthcare professionals, and two experts. Three criteria were evaluated in the designed solution: usability, quality, and potential for behavior change.ResultsThe evaluation results of the designed solution showed good perception by both beneficiaries and healthcare professionals. The average system usability scale score was 90,6 (SD: 7.33) for beneficiaries, and 92.75 (SD: 3.83) for healthcare professionals. The first expert received a mean overall quality score of 4.51 on the mobile app rating scale, while the second received a score of 4.27. The results of the app behavior change scale gave the first expert a score of 17/21 and the second a score of 15/21.ConclusionBased on the criteria of usability, quality, and potential for behavior change, the designed app demonstrated positive results. This is a preliminary evaluation, which will be followed by additional, in-depth evaluations with larger sample sizes.

Teachers’ Knowledge and Use of Behaviour Modification Strategies in Classroom Management: Does Gender Matter?

Teachers’ Knowledge and Use of Behaviour Modification Strategies in Classroom Management: Does Gender Matter?

U.S. Preparedness and Response to Increasing Clade I Mpox Cases in the Democratic Republic of the Congo - United States, 2024.

Clade I monkeypox virus (MPXV), which can cause severe illness in more people than clade II MPXVs, is endemic in the Democratic Republic of the Congo (DRC), but the country has experienced an increase in suspected cases during 2023-2024. In light of the 2022 global outbreak of clade II mpox, the increase in suspected clade I cases in DRC raises concerns that the virus could spread to other countries and underscores the importance of coordinated, urgent global action to support DRC's efforts to contain the virus. To date, no cases of clade I mpox have been detected outside of countries in Central Africa where the virus is endemic. CDC and other partners are working to support DRC's response. In addition, CDC is enhancing U.S. preparedness by raising awareness, strengthening surveillance, expanding diagnostic testing capacity for clade I MPXV, ensuring appropriate specimen handling and waste management, emphasizing the importance of appropriate medical treatment, and communicating guidance on the recommended contact tracing, containment, behavior modification, and vaccination strategies.

Every sip counts: Understanding hydration behaviors and user-acceptability of digital tools to promote adequate intake during early and late pregnancy.

Maintaining adequate hydration over the course of pregnancy is critical for maternal and fetal health and reducing risks for adverse pregnancy outcomes (e.g., preeclampsia, low placental and amniotic fluid volume). Recent evidence suggests that women may be at risk for under-hydration in the second and third trimesters when water needs begin to increase. Scant research has examined pregnant women's knowledge of hydration recommendations, water intake behaviors, and willingness to use digital tools to promote water intake. This study aimed to: 1) describe hydration recommendation knowledge and behaviors by the overall sample and early vs late pregnancy, and 2) identify habits and barriers of using digital tools. Pregnant women (N = 137; M age = 30.9 years; M gestational age = 20.9) completed a one-time, 45-minute online survey. Descriptive statistics quantified women's knowledge of hydration recommendations, behaviors, and attitudes about utilizing digital tools to promote adequate intake, and Mann-Whitney U and chi-squared tests were used to determine group differences. Most women lacked knowledge of and were not meeting hydration recommendations (63%, 67%, respectively) and were not tracking their fluid consumption (59%). Knowledge of hydration recommendations differed by time of pregnancy, such that women in later pregnancy reported 82 ounces compared to women in early pregnancy (49 ounces). Common barriers included: forgetting to drink (47%), not feeling thirsty (47%), and increased urination (33%). Most were willing to use digital tools (69%) and believed a smart water bottle would help them achieve daily fluid recommendations (67%). These initial findings suggest that pregnant women may benefit from useful strategies to increase knowledge, decrease barriers, and maintain adequate hydration, specifically earlier in pregnancy. These findings will inform the design of a behavioral intervention incorporating smart connected water bottles, wearables for gesture detection, and behavior modification strategies to overcome barriers, promote proper hydration and examine its impact on maternal and infant health outcomes.

Food Grabbing Behavior Modification Program Using Shaping Techniques with Tablet Media for Autistic Children

Children with autism often have difficulty interacting socially and understanding applicable social norms. Therefore, appropriate behavior modification strategies are needed to help autistic children overcome food-grabbing behavior and learn how to interact better socially. This research aims to use shaping techniques to change the behavior of autistic students who often grab other people's food. This research involves the use of tablet media as a tool to provide intervention. The research subjects in this study were autistic students who tended to snatch other people's food. This research uses the Single Subject Research method with an A-B design. Data in this research was collected through audio documentation, photos, videos, and written documentation. The data was then analyzed using within-condition analysis and between-condition analysis. The research results show that the shaping Technique using tablet media effectively changes the behavior of autistic students who often grab other people's food. By using shaping techniques, autistic students can understand that snatching other people's food is not right and can control themselves not to do it. It shows that the use of behavior modification techniques using tablet media can help autistic students overcome unwanted behavior.

Effects of a physical activity promotion programme on body composition in emerging adults with physical inactivity: a study protocol of a randomised controlled trial

IntroductionA dramatic decline in physical activity may occur in emerging adulthood because of a major transition over the course of a life. The potential for implementing structured behaviour modification strategies...

Screening tools interventions and strategies for early identification and management of autism spectrum disorders

Autism spectrum disorder is a neurodevelopmental disorder marked by social communication difficulties, restricted interests, and repetitive activities. Both genetic and environmental variables impacting the growing brain influence it. Around the world, 1 in 100 children is identified with autism spectrum disorder. Estimates of prevalence have increased over time and varied significantly inside and across sociodemographic groups. Autism spectrum disorder is a prevalent neurodevelopmental condition that significantly shortens life expectancy. Early diagnosis on a community level is a critical public health concern since mounting evidence shows that early diagnosis makes functional gains and has better outcomes. In healthcare settings, autism spectrum disorder screening tools can be utilized to precisely confirm the diagnosis of autism. The American Academy of Pediatrics recommends screening for ASDs between ages 18 and 24 months, although recent research indicates that abnormal behaviours may be visible in certain children even earlier. the checklist for autism in toddlers, the modified checklist for autism in toddlers, the psychological development questionnaire-1, and the autism behaviour checklist are some of the commonly used screening tools in practice for the diagnosis of autism spectrum disorder. The majority of interventions are non-pharmacological and depend on behavioural modification strategies. Pharmacological therapy should only be used to treat target symptoms that are resistant to behavioural treatment. Although there is no cure, prompt and suitable intervention can dramatically raise the quality of life for children. The purpose of this research is to review the screening tools, interventions, and strategies for early identification and management of autism spectrum disorder.

Evaluating the Efficacy of Behavior Modification Strategies on Physical Activity Levels Among Incarcerated Youth.

This study examined the impact of prompting only and prompting combined with independent group-oriented contingency on incarcerated adolescent males' physical activity level during a sport-leadership program. An alternating treatment design was employed to allow for the evaluation among multiple treatment conditions. The study occurred during 35 consecutive sport programming lessons at a juvenile correctional facility. Participants were 16 adolescent males (Mage = 18.79). Two behavior modification strategies, prompting only and prompting combined with independent group-oriented contingency, were employed. Data were plotted graphically so visual analysis could be determined in order to explore any functional associations between the treatment conditions (e.g., interventions) and target behavior (e.g., step count). Prompting only slightly increased physical activity, whereas prompting in conjunction with independent group-oriented contingency elevated activity levels by 36%, with a smaller standard deviation indicating that all participants were equivalently physically active. The results of this study underpin the expansive benefits of sport-leadership programming, not just in similar programs' ability to develop life skill integration, positively impact life during incarceration, improve attitudes, and promote physical activity, but also to provide elevated opportunities for youth to be physically active.

Effect of an activity wristband-based intermittent teaching unit in Physical Education on students' physical activity and its psychological mediators: a cluster-randomized controlled trial. School-fit study.

The main objective of the present study was to examine the effects of an intermittent teaching unit based on the use of activity wristbands and behavior modification strategies on high school students' perceptions of autonomy support, satisfaction of basic psychological needs, motivation toward Physical Education and physical activity, intention to be physically active, and habitual physical activity levels. An initial sample of 353 high school students (final sample = 175; 45.7% females; mean age = 13.3 ± 1.2 years) from two public high schools were cluster-randomly assigned into the intermittent (IG, n = 100) and control (CG, n = 75) groups. The IG performed an intermittent teaching unit twice a week for eight weeks. Specifically, the last 15 min of each lesson were used. As the main strategy to promote the practice of regular physical activity, students wore an activity wristband the whole day during the intervention period. Additionally, other behavior modification strategies were also applied (e.g., educational counseling, physical activity goals or reminders). Regarding the CG, during the intervention period (i.e,, the eight weeks that took place the intermittent teaching unit) they also performed two Physical Education sessions, but without using activity wristbands or other behavior modification strategies. Before and after the intervention, as well as at the end of the follow-up period (six weeks), students' physical activity practice mediators and physical activity levels were measured by validated questionnaires. The Multilevel Linear Model results showed that the IG students statistically significantly improved cognitive and procedural autonomy support from pre- to post-intervention (p < 0.05). They also statistically significantly improved autonomy and relatedness basic psychological needs, and autonomous motivation toward physical activity scores from post-intervention to follow-up (p < 0.05). Moreover, the results showed that the IG students statistically significantly improved habitual physical activity scores from pre- to post-intervention, and from post-intervention to follow-up (p < 0.05). The intermittent teaching unit based on the use of activity wristbands and other behavior modification strategies was effective for improving students' autonomy support and habitual physical activity levels, but not the rest of physical activity practice mediators. https://register.clinicaltrials.gov/, ID: NCT05949463.

A data-driven analytic approach for investigation of electricity demand variability for energy conservation programs

Targeting and designing effective demand response and energy efficiency strategies is a challenging task owing to the variations in electricity usage patterns. To address this problem, we attempt to propose a clustering and Kullback-Leibler (KL) Divergence-based solution to understand the variability across the different consumption patterns. The proposed unsupervised approach utilized hierarchical clustering technique for segmenting the customers based on the similarity in their consumption behaviour, followed by the incorporation of the KL divergence to quantify the variability for different features of customer's load profiles. These features aid in understanding the diversity in load shapes. Depending on the different features, the results reveal that a few of the consumers having certain distinctive consumption can be easily considered as potential for demand flexibility, while others require careful consideration for program offerings. The result also shows significantly higher day-to-day variations in the clustered groups and can be managed by designing suitable behavioural modification strategies. The variability assessment of individual customer profiles helps better comprehend the diversity in usage behaviour. It leads to informed decision-making in planning demand response and energy efficiency initiatives, which was not taken into consideration in the previous studies.

The Effectiveness of Behavior Modification Strategies in Reducing Negative Classroom Behavior in a Blind Child with Autism Spectrum Disorder

The Effectiveness of Behavior Modification Strategies in Reducing Negative Classroom Behavior in a Blind Child with Autism Spectrum Disorder

The Needle Anxiety Program: A Patient-Centered Initiative for Individuals With Developmental Disabilities.

Objective To describe the development process of a patient-centered initiative focused on improving primary care health outcomes of patients with intellectual and developmental disabilities (IDD) and needle-related anxiety usingevidence-based practices andnovel approaches that canbe implemented in outpatient settings. The overall outcome of the program isto increase vaccine uptake andaccessibilityin the IDD population as well as improve needle-related procedures in primary care settings to be more humane and effective. Methods The development process occurred in the context of a large healthcare system serving a diverse patient population in the U.S. and was led by an expert committee made of an multidisciplinary team of physicians, psychologists, ambulatory and clinic nurses,pharmacists, and anesthesiologistscommitted to promoting quality healthcare for the IDD population. Committee members were recruited within the healthcare system based on their relevant expertise. The methodology included an iterative and collaborative process that took place over three development phases: ideation and design, literature review and synthesis, and expert engagement.The ideation and design phase included a series of planning meetings among the expert committee, in which committee members identified preliminary concerns based on their expertise in the field and background knowledge on the current procedures related to improving routine care for individuals with IDD and/or needle-related anxiety.The literature review and synthesis phase led to the development of an annotated bibliography of research and clinical guidelines that synthesized findingson needle anxiety in clinical care.The expert engagement phase included all Committee members meeting for a final discussion to establish a tiered approach to utilizing evidence-based strategies that could be implemented across clinics within the healthcare system. Results The multidisciplinary team of experts developed a three-tier system, deployed sequentially as needed. The first tier focuses on training nurses in evidence-based behavioral modification strategies to implement as standard of care. The second tier uses the addition of a distraction device and topical analgesic to reduce anxiety in patients with slightly elevated procedural anxiety. The third tier involves a novel minimal sedation protocol using intranasal midazolam for patients with needle phobia that can be administered in an outpatient setting. Conclusion The Needle Anxiety Program eases the administration of needle-related medical procedures in the primary care setting for patients with IDD and needle-related anxiety. The use of evidence-based practices and a novel minimal sedation protocol for individuals with needle phobia assists in the completion of routine healthcare procedures, such as vaccinations and phlebotomy, in a patient-preferred setting. The purpose of delineating needle-related processes and procedures through the Needle Anxiety Program is to reduce health disparities for patients with IDD and promote uptake of the Needle Anxiety Program in similar healthcare settings.

Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD.

Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. 32 patients with COPD (mean±sd forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. The magnitude of improvement across physical activity outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by -2 units, 95% CI -4-1 units) and 6MWD (by 33±20 m). Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.

Guidelines for Orthodontic Management of Individuals With Mental Illness Using Psychiatric Medication: A Systematic Review.

The majority of mentally challenged individuals anticipate treatment with inflated levels of concern more than conventional orthodontic patients. However, there are no systematic reviews on behavioral modification techniques and orthodontic therapy for people with mental illness. Therefore, the goal of the review was to highlight the orthodontic concerns for people with mental disabilities with the intent to address the problems that emerge when providing orthodontic care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and population, exposure, and outcome (PEO) criteria were followed in conducting the review. An electronic search was performed in the PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases searched through EBSCO and Google Scholar for potentially relevant publications in the English language from January 2002 to December 2022. Studies reporting behavioral modification strategies and/or physical constraints used during orthodontic treatment of mentally challenged patients were included in the review. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and research reviews and synthesis. The initial electronic and manual search yielded 233 articles. After eliminating duplicates and reviewing the title/abstracts, 75 articles were selected for independent full-text review. Based on the eligibility criteria, 12 studies were finally chosen for qualitative synthesis. Four of these studies were case reports, while eight were comprehensive reviews. TheJBI critical assessment criteria for case reports revealed that two studies had moderate-quality evidence, one case report with high-quality evidence and the other with low-quality evidence. The quality of the selected comprehensive literature reviews assessed usingJBI critical assessment for reviews and research syntheses was judged to have poor-quality evidence. A thorough literature search on the topic did not reveal a single systematic review, and all of the reviews that were chosen were exhaustive. Parental cooperation and patient motivation are crucial components of a successful treatment regimen. A better prognosis is determined by the choice of appropriate orthodontic mechanotherapy along with the utilization of an array of behavior modification modalities and the availability of a team with expertise.

Pregnant women's intentions to use maternity waiting homes and its associated factors in rural districts of Hadiya Zone, Southern Ethiopia.

As part of a strategy to reduce maternal and perinatal mortality, Ethiopia's government has made a significant effort to expand the number of Maternity Waiting Homes (MWHs). However, worldwide there is a substantial regional variation in pregnant women's intention to use MWHs. Therefore, the aim of this study is to assess pregnant women's intention to use maternity waiting home and its associated factors in the rural district of Hadiya Zone, Southern Ethiopia. This was a cross-sectional study carried out on 385 pregnant women from March 1-28, 2020. A systematic random sampling technique was used to recruit the study participants. SPSS software (version 24.0) was used to enter and analyze the data. Bivariate and multivariate logistic regression analyses were used to determine an association between each independent and dependent variables. Odds ratio with their 95% confidence intervals was computed to ascertain the existence and strength of an association, and statistical significance was affirmed at a p-value of < 0.05. The prevalence of pregnant women's intension to use MWHs was observed to be 55.6%. A poor wealth status (AOR = 2.52; 95% CI:1.05-6.05), having a previous history of institutional delivery (AOR = 4.78; 95% CI:1.16-9.64), attending four or more antenatal care visits (AOR = 3.34; 95%CI:1.35-8.29), having obstetric complications during previous pregnancy (AOR = 3.76; 95% CI:1.45-9.77), and having favourable attitude towards MWHs (AOR = 13.51; 95% CI: 5.85-9.54) had a significant association with an intention to use MWHs. According to the findings of this study, more than half of pregnant women have been intended to use MWHs. Therefore, boosting the uptake of the antenatal care visit, raising awareness about the risk and consequences of obstetric complications, and strengthening behavioral modification strategies is very crucial to increase pregnant women's intention to use MWHs.

MEAL REPLACEMENT AS A PART OF OBESITY TREATMENT: A NARRATIVE REVIEW

Obesity is thought to be a complicated, multifaceted chronic disease that results from the combination of environmental and genotypic variables. Implementing a wide strategy for obesity prevention and management is required given the variety and complexity of factors impacting obesity. Most healthcare practitioners use dietary therapies such calorie-restricted diets, Mediterranean diets, DASH diets, and intermittent fasting to encourage weight loss. Meal replacement products (MRPs) are used as part of a calorie restricted diet which helps to control our food choices and leads to calorie reduction. This article reviews the usage of MRP as a weight loss therapy and summarizes the literature about their effectiveness to reduce weight in patients with obesity. From the literature search, it can be concluded that MRPs contain a precise amount of macronutrients, micronutrients, and fiber to provide a nutritionally balanced meal. MRPs have been extensively studied as a weight loss therapy, and several scientific studies have confirmed their efficacy. The main ways that MRPs aid in weight loss are by reducing appetite and improving diet adherence, which makes it easier for individuals to stick to their diet plan and achieve their weight loss goals. Overall, MRPs should be considered as a viable treatment option for patients who are motivated to lose weight, as they offer a simple, convenient, and effective way to reduce calorie intake, improve diet adherence, and achieve sustainable weight loss. However, it is important to note that MRPs should be used as part of a comprehensive weight loss plan that includes regular physical activity and behavior modification strategies for long-term success.

Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study

BackgroundChallenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting.MethodsThis was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated.ResultsThe mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4–99.7) and loneliness of 30.1% (95%CI = 25.6–34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems.ConclusionThe results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.

Physical Activity and Sleep in Adults and Older Adults in Southern Brazil.

Good sleep quality is a well-known indicator of physical and mental health, well-being, and overall vitality. This study aimed to verify the association between the practice of physical activity and sleep duration and quality in adults and older adults in southern Brazil. A cross-sectional population-based study was carried out with 820 individuals of both sexes aged 18 years or more, where sociodemographic variables were collected and also health-related variables. This study included 523 (63.8%) women and 297 (36.2%) men, and the prevalence of adequate sleep hours was 41.5% (95%CI: 39.1; 44.9). People who performed leisure walking were 34% more likely to present adequate sleep duration (PR: 1.34; 95%CI: 1.10; 1.64) compared to those who did not perform leisure walking. Individuals who met the recommendations for moderate or vigorous physical activity were more likely to have good sleep quality (PR: 1.16; 95%CI: 1.01; 1.34). Future health behavior modification strategies to improve sleep quality at the population level should consider encouraging lifestyle improvements, thus increasing the practice of physical activities.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

Shaming: A Concept Analysis.

Nurses in a variety of settings frequently use behavior modification strategies to promote health behavior change. Shaming is one such behavior modification tool, but its use in nursing is poorly understood. A concept analysis using Walker and Avant's method was performed. After an extensive literature review, a conceptual definition of shaming is proposed and defining attributes, antecedents, and consequences are presented. Shaming is also differentiated from related concepts often used synonymously such as stigmatization and incivility. Shaming as a behavior modification strategy is incongruous with nursing values and its utilization in nursing warrants further investigation.