Behavior Change Research Articles

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Long-Term Physical Activity Behavior Change in Pulmonary Rehabilitation: Promoting Motivation.

Determinants of Citizens’ Intention to Participate in Self-Led Contact Tracing: Cross-Sectional Online Questionnaire Study

Background Contact tracing (CT) is a key intervention to contain outbreaks of communicable diseases. During large-scale outbreaks, public health services may lack the resources required to perform CT effectively. One way of mitigating this issue is to shift some of the tasks in CT normally performed by public health services to cases and their contacts, supported by digital tools. We refer to this as “self-led CT.” However, while the effectiveness of the self-led CT inherently depends on the willingness and skills of citizens to participate, the determinants of citizens’ intention to participate in self-led CT are not yet fully understood. Objective We aimed to identify determinants of Dutch citizens’ intention to participate in self-led CT and assess their potential for behavioral change, so as to identify “behavior change targets,” which may be used in the development and implementation of self-led CT to increase citizens’ intention to participate. Methods In March 2022, we performed an online cross-sectional questionnaire study. The questionnaire was developed based on findings from a previous exploratory semistructured interview study and distributed among a Dutch consumer panel. Using all questionnaire items as potential predictors, we performed a random forest analysis to identify determinants of citizens’ intention to participate in self-led CT. We then performed an Agglomerative Hierarchical Cluster Analysis to identify groups of related determinants that may be considered overarching behavior change targets. Finally, we used Confidence Interval-Based Estimation of Relevance and calculated the Potential for Change Indices to compare the potential for behavioral change of the selected individual determinants and determinant clusters. Results The questionnaire was completed by 3019 respondents. Our sample is representative of the Dutch population in terms of age, gender, educational level, and area of residence. Out of 3019 respondents, 2295 (76%) had a positive intention to participate in self-led CT. We identified 20 determinants of citizens’ intention that we grouped into 9 clusters. In general, increasing citizens’ trust in the digital tools developed for self-led CT has the highest potential to increase citizens’ intention, followed by increasing the belief that using digital tools makes participating in self-led CT easier, reducing privacy-related concerns, and increasing citizens’ willingness—and sense of responsibility—to cooperate in CT in general. Conclusions Overall, Dutch citizens are positive toward participating in self-led CT. Our results provide directions for the development and implementation of self-led CT, which may be particularly useful in preparing for future, large-scale outbreaks.

Perceived protective behavioral changes in Chinese residents post-dynamic zero-COVID policy lifting: a cross-sectional study

ObjectiveTo investigate how Chinese residents perceived changes in their protective behaviors in the early stage after the lifting of the dynamic zero-COVID policy, and to explore the associations between the overall perceived change and factors such as demographic and health-related information, COVID-19 related perceptions, negative emotions, and coping styles.MethodsThis cross-sectional study involved 798 Chinese residents who completed an online questionnaire between 16 and 25 December 2022. The questionnaire covered demographic and health-related information, COVID-19 related perceptions, negative emotions, coping styles, and perceived changes in protective behaviors. Multiple linear stepwise regression analysis was used to determine the factors associated with the overall perceived change in protective behaviors.ResultsThe mean score for perceived protective behavioral change among participants was 61.38 (SD = 10.20), which was significantly higher than the hypothesized no-change value of 49 (p < 0.001). The mean scores for each of the 15 behaviors (excluding the two vaccination-related items) were significantly greater than the hypothesized no-change value of 3 (p < 0.001). The mean scores for the two vaccination-related items were significantly greater than the hypothesized no-change value of 2 (p < 0.001). Among all behaviors, avoiding dining out or gathering with friends had the highest mean score (Mean = 4.16), while engaging in regular physical activity had the lowest (Mean = 3.32). Avoiding dining out or gathering with friends had the highest percentage of individuals reporting an increase (71.3%), whereas maintaining a social distance of more than 1 m had the highest percentage of individuals reporting a decrease (17.5%). Regression analysis indicated that age, worry, positive coping, female sex, negative coping, and perceived severity were associated with the overall perceived change in protective behaviors, with worry being the most predictive variable.ConclusionThis study suggested that Chinese residents perceived an increase in their protective behaviors in the early stage after the policy change, with varying magnitudes across behaviors. We identified some potentially modifiable factors associated with perceived protective behavioral change, with worry emerging as the strongest predictor, followed by positive coping, negative coping, and perceived severity. These insights offer valuable information for developing effective communication strategies, psychological support, and comprehensive models in health behavior research.

Efficacy of a Multimodal Digital Behavior Change Intervention on Lifestyle Behavior, Cardiometabolic Biomarkers, and Medical Expenditure: Protocol for a Randomized Controlled Trial.

The US Preventive Services Task Force recommends providers offer individualized healthy behavior interventions for all adults, independent of their risk of cardiovascular disease. While strong evidence exists to support disease-specific programs designed to improve multiple lifestyle behaviors, approaches to adapting these interventions for a broader population are not well established. Digital behavior change interventions (DBCIs) hold promise as a more generalizable and scalable approach to overcome the resource and time limitations that traditional behavioral intervention programs face, especially within an occupational setting. We aimed to evaluate the efficacy of a multimodal DBCI on (1) self-reported behaviors of physical activity, nutrition, sleep, and mindfulness; (2) cardiometabolic biomarkers; and (3) chronic disease-related medical expenditure. We conducted a 2-arm randomized controlled trial for 12 months among employees of an academic health care facility in the United States. The intervention arm received a scale, a smartphone app, an activity tracker, a video library for healthy behavior recommendations, and an on-demand health coach. The control arm received standard employer-provided health and wellness benefits. The primary outcomes of the study included changes in self-reported lifestyle behaviors, cardiometabolic biomarkers, and chronic disease-related medical expenditure. We collected health behavior data via baseline and quarterly web-based surveys, biometric measures via clinic visits at baseline and 12 months, and identified relevant costs through claims datasets. A total of 603 participants were enrolled and randomized to the intervention (n=300, 49.8%) and control arms (n=303, 50.2%). The average age was 46.7 (SD 11.2) years, and the majority of participants were female (80.3%, n=484), White (85.4%, n=504), and non-Hispanic (90.7%, n=547), with no systematic differences in baseline characteristics observed between the study arms. We observed retention rates of 86.1% (n=519) for completing the final survey and 77.9% (n=490) for attending the exit visit. This study represents the largest and most comprehensive evaluation of DBCIs among participants who were not selected based on their underlying condition to assess its impact on behavior, cardiometabolic biomarkers, and medical expenditure. ClinicalTrials.gov NCT04712383; https://clinicaltrials.gov/study/NCT04712383. RR1-10.2196/50378.

Forces at play: A qualitative study of risk aversion, policy and decision making for children's physically active play in schools

This study investigated (i) the social and political factors driving risk averse decision making for children's physically active play in schools, and (ii) the policies shaping these decisions in Victoria, Australia. A theory-informed multi-method case study design combined policy document mapping, semi-structured interviews, and photo elicitation with 30 education policy actors. Data were analysed using reflexive thematic analysis. Findings showed the policy landscape was heavily skewed towards managing risk and safety (84%; n = 42), with fewer, mostly optional, policies for promoting physical activity, and a lack of policy to promote or protect play. Thematic findings indicated an intersecting range of factors in this setting (including occupational health and safety, knowledge and skill gaps, parent factors, children's physical capabilities, an undervaluing of play) can deter schools from providing an environment that enables children's freely chosen, physically active play. Multi-faceted, systems-based approaches that go beyond interventions aimed at individual behaviour change are needed.

Fidelity, acceptability, and feasibility of the revised functional autonomy measurement system for hospitalised people: An implementation study.

The revised functional autonomy measurement system (SMAF-R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF-R as a routine outcome measure in acute and subacute inpatients. This was a mixed-methods implementation study. Occupational therapists were asked to complete the SMAF-R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12-month period (n= 13,348). A baseline audit of SMAF-R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF-R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated. Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions. Peak completion of the SMAF-R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF-R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF-R influenced acceptability; (2) using the SMAF-R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF-R scores during their hospital stay (median difference 16.5 [6.5-27.0], p< 0.001, n= 764). Although most occupational therapists reported the SMAF-R was acceptable, there were mixed opinions regarding the relevance of the SMAF-R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF-R relevance to practice) may assist with improving SMAF-R completion. Further research is required to assess the psychometric properties of the SMAF-R in the hospital environment. The revised functional autonomy measurement system (SMAF-R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve. This study aimed to measure (1) how often occupational therapists use the SMAF-R with patients in hospital, (2) how acceptable occupational therapists find the SMAF-R, and (3) whether the SMAF-R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF-R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF-R completion over 12 months. After this, completion of the SMAF-R improved to between 9% and 38% in different hospital settings. Changes in SMAF-R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF-R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF-R was not fit for purpose in this setting or that more support is needed to increase completion.

Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model

Background Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults’ autonomy, competence, and relatedness. Methods Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants’ experiences with the smart displays. Conclusions Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization.

Multifaceted implementation strategy to improve the evaluation of penicillin allergies in perioperative patients: a pre-post feasibility implementation study.

The U.S. Centers for Disease Control and Prevention encourages nurses to evaluate penicillin allergies as part of hospital-based antibiotic stewardship programs. We evaluated the feasibility of an implementation strategy to improve nurses' comprehensive documentation of penicillin allergies. We defined feasibility as the uptake and acceptability of documentation procedures. Six-month pre-post feasibility implementation study. Outpatient surgical areas of an academic medical center located in the U.S. The implementation strategy was guided by the Capability, Opportunity, Motivation Model for Behavior Change and included, building an interdisciplinary coalition to iteratively evaluate the implementation effort, educational meetings with surgical prescribers and perioperative nurses, the development and distribution of educational pocket cards, and structured communication messages in the electronic medical record. A total of 426 patients with 487 penicillin allergy records (216 records pre-implementation period, 271 records post-implementation period) were analyzed. Penicillin allergy documentation contained the following information in the pre- versus post-implementation period: symptoms of the reaction (87% vs 87%), timing/years since reaction (8% vs 26%), onset of reaction in relation to taking penicillin (0% vs 21%), how symptoms resolved (0% vs 21%), and penicillin re-exposure (3% vs 21%). Focus groups revealed nurses perceived documentation procedures as highly acceptable. Major drivers of acceptability included the perceived effectiveness of a detailed allergy history and self-efficacy in conducting a detailed allergy history. Nurses perceived the comprehensive documentation of penicillin allergy history intervention as acceptable, and uptake improved following a theory-informed implementation strategy. We offer implementation strategy components to facilitate nurses' engagement in penicillin allergy evaluation.

Determinants of breast cancer screening behavior amongst Nigerian women using the transtheoretical model

Breast cancer is a leading cause of morbidity and mortality amongst women in developing and developed countries. Breast Self-Examination (BSE), mammography and clinical examination are amongst the most effective methods of early detection, however uptake remains low. The Transtheoretical Model (TTM) has been used in many other countries to characterize behavioral shifts related to enable the adoption of more focused tactics for improving breast cancer screening behaviors among Nigerian women. A cross-sectional research study was conducted to assess the level of knowledge and uptake of breast cancer screening practice based on the various stages of readiness and change predictors using the Transtheoretical Model (TTM). The model was applied to identify and characterise key behavioural determinants such as decision balance, stage of change, and process of change (POC) for breast cancer screening through breast self-examination and mammography. A total of 265 adult female respondents in Kaduna State, Northwest, Nigeria was sampled out of which ninety-one (91%) had no family history of breast cancer. Although 80.3% had knowledge of breast cancer disease, 68% of respondents knew how to conduct BSE and only 55% practiced it. In terms of BSE behaviour staging, 29.4% and 26.7% respondents are in the preparation and maintenance stages respectively. In terms of mammography adoption, most respondents (34%) are in the preparation stage. Review of process of change determinants show that breast cancer screening behaviour are driven more by experiential determinants as compared to behaviour determinants. Addressing the complex factors influencing BSE and mammography practice requires a comprehensive social behaviour change approach that may sustaining positive behaviour-driving factors and minimise inhibitive factors that can promote breast cancer screening.

Self-efficacy and social support enable women to protect their pelvic floor health: A nonrandomized controlled trial in rural Nepal.

Carrying heavy loads increases the risk of pelvic organ disorders, particularly in low-income countries. Low self-efficacy hampers adoption of pelvic-floor-protective behaviors. The enabling hypothesis suggests that social support may strengthen women's behavioral self-efficacy. A three-arm parallel non-randomized controlled trial with 300 women and their social partners experimentally examined whether self-efficacy and social support can enable women's pelvic-floor-protective behaviors in rural Nepal. Three villages received (1) self-efficacy (2) self-efficacy and social support promotion, or (3) information only control. The co-primary outcomes were reduced weight carried and using protective lifting techniques at 2-month follow-up. Self-efficacy promotion increased the use of protective lifting techniques 9% more than information only (d = 0.28). Weight was reduced by 3 kg more when additionally promoting social support compared to self-efficacy alone (d = 0.39). Self-efficacy and social support promotion enable women to better protect their pelvic floor health and may complement educational approaches to health behavior change in low-resource populations.

Network determinants of relationship influence on HIV prevention decision-making among people in the social networks of women who have experienced incarceration in the US.

Many cisgender women in the US who have experienced incarceration are at substantial risk for HIV acquisition after they return to the community. Various network interventions have been leveraged for HIV prevention in this population. The objective of this study was to identify network and relationship determinants of influence on HIV prevention decisions, including PrEP. We conducted interviews with a network mapping exercise with participants recruited from the social and sexual networks of women who had experienced incarceration. Participants enumerated important individuals in their lives from the past six months and provided demographic and relationship data as well as whether each relationship influenced their HIV prevention decisions. We abstracted network data from the interview transcripts and described the data set using descriptive statistics and network density graphs. To measure associations between characteristics at each level and whether a relationship was considered influential regarding PrEP decision-making, we use multiple logistic regression with random intercepts for each respondent. We interviewed 32 participants, average age 33.5 years (SD = 8.98), majority female (n = 28, 87.5%), white (n = 23, 71.8%), heterosexual/straight (n = 25, 78.1%), and with a personal history of incarceration (n = 29, 90%). They reported 253 relationships (119 family, 116 friend, 18 sexual relationships). Most adult network members had used drugs or alcohol (n = 182, 80.9%), and of those, 30.8% had used them with the participant (n = 53). The mean network size was 7 (SD = 4) and network density was 52.2%. In the full model, significant positive predictors of an influential relationship included participant non-heterosexual identity (OR 27.8), older average age in the network (OR 3.9 per standard deviation), and being a current or prior sexual partner (OR 10.1). Significant negative predictors included relationships with individuals who use or had used drugs (OR 0.28), longer average relationship duration in the network (OR 0.09) and being in a network with at least one sexual partner (OR 0.2). There are significant positive and negative determinants of relationship influence related to PrEP at individual-, dyad-, relationship-, and network-levels. These support using nuanced network approaches to behavior change that respect and leverage the diversity of relationships that comprise the social networks of women who have experienced incarceration.

Developing a mobile-based brief intervention to reduce cannabis-impaired driving among youth: An intervention mapping approach

Behaviour change interventions delivered via smartphones have the potential to reduce youth cannabis use and driving under the influence of cannabis (DUIC). Countless smartphone applications (either downloadable or web-based) are available to help reduce substance use and impaired driving. However, most are developed without evidence-based content and theory, and many have poor user engagement. This study aims to: (1) describe the systematic development and theoretical foundations of a youth DUIC smartphone intervention, and (2) describe the pre-testing among a sample of youth and adult cannabis educators (prior to efficacy testing). A 6-step Intervention Mapping approach was utilized to combine theory, evidence, and user feedback to develop and implement the ‘High Alert’ intervention. This evidence-based and iterative process entailed: (1) conducting a needs assessment, (2) identifying intervention objectives, which map on the following DUIC determinants: knowledge, attitudes, risk perception, perceived norms, and self-efficacy, (3) selecting intervention theory and design, (4) developing of the intervention, (5) implementation, and (6) evaluation. Application of Intervention Mapping resulted in a smartphone web-based application that could support reductions in cannabis use and DUIC. The ‘High Alert’ intervention was created to include four modules with contents focusing on educating youth on the dangers and legal risks of DUIC, limiting risky situations, avoiding riding with an impaired driver, planning a safe ride home, and promoting safer cannabis use. Future research will test the efficacy of the intervention in reducing risky cannabis use and DUIC among youth.

Prevalence and patterns of tobacco use among young adults in India - does perceived stress play a role?

Background: Tobacco use among young people is a public health concern. Perceived stress among young adults as a determinant for tobacco use has not been extensively explored previously in India. Methods: A cross-sectional study was conducted among young adults aged 18-30 years across India. Data was collected using a self-administered, web-based, online questionnaire, on sociodemographic characteristics, tobacco use and its pattern, and the levels of perceived stress using the Perceived Stress Scale (PSS-10). Results: The prevalence of tobacco use in our study sample was 25.7% and the mean age at initiation of tobacco use was 20.71 years. Though tobacco use was significantly associated with male gender [aOR=2.26 (1.16-4.38), p=0.01], current alcohol consumption [aOR=13.73 (6.72-28.04), p=0.00] and having known smokers among family and friends [aOR=3.13 (1.39-7.04), p=0.01], there was no association between levels of perceived stress and tobacco use. Cigarettes/beedis were the most commonly used tobacco product, 27.58% of respondents reported using tobacco products daily or for more than half the days of the week and 48.27% of respondents started using tobacco out of curiosity. Seventy percent of users used tobacco during specific events like social gatherings and vacations while 57.47% used tobacco while meeting specific colleagues/ friends. Conclusions: We found no association between perceived stress and tobacco use. However, current use of alcohol and having knowledge about smokers among family and friends significantly determined tobacco use among our study population. This necessitates more holistic approaches towards behaviour change efforts for tobacco control.

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

A review on efficacy of polygenic risk score information on behavioral change and clinical outcomes

Abstract Background Polygenic Risk Score (PRS) represents a promising advancement in personalized medicine, enabling the inherited risk assessment for disease outcomes based on the effect of various common genetic variants. The utilization of PRS information to promote the adoption of healthier behaviors has witnessed an increase interest in recent years, but its full potential still needs to be fully addressed. Methods This systematic review aims to assess the efficacy of disclosing PRS information on individuals’ engagement in risk-reducing interventions. CENTRAL database has been searched up to December 2023 to identify randomized controlled trials (RCTs) comparing the disclosure of PRS results, with scenarios where other or no information is provided. We performed a preliminary meta-analysis on the mean difference of clinical and psychological outcomes between the two arms. Results Out of 4419 results, we included 12 studies. Trials focused on primary (83%), secondary (8%) and tertiary (8%) preventive interventions. As for the possible diseases predicted by the PRS, cardiovascular diseases (33%) were the most common (n = 4), along with cancers (33%), diabetes (25%) and metabolic disease (8%). PRS result disclosure was compared to standard care (n = 7), no information provided (n = 4), and family risk (n = 1). By pooling data from four comparable studies, we report a reduction in the mean difference for LDL cholesterol in the intervention group of -6.39mg/dL (95%CI -10.09, -2.70, I²=0%, p &amp;lt; 0.001). No significant changes were observed for systolic and diastolic blood pressure, and weight, in 3 studies and 4 analyzed studies, respectively. An increase in anxiety levels was observed towards the PRS group in 4 studies (SMD 0.24, 95%CI 0.02, 0.46, I² = 66%, p = 0.03). Conclusions Preliminary analysis show small or no effects of PRS disclosure on intermediate health or psychological outcomes. Larger trials assessing the potentiality of PRS disclosure are still needed. Key messages • From the analysis of twelve preventive trials on the efficacy of PRS on behavior change, we report a positive effect on LDL cholesterol reduction. • Larger well conducted trials are needed to integrate PRS-based information into future preventive strategies.

Information and communication technology-based patient education for autoimmune inflammatory rheumatic diseases: A scoping review

ObjectiveThis review aimed to map the existing the information and communication technology (ICT)-based patient education for autoimmune inflammatory rheumatic diseases and identify key effectiveness factors and guidelines for professionals. MethodsA scoping review systematically reviewed PubMed, Cochrane library, EMBASE and Web of Science. We designed search strategies to identify ICT-based patient education for autoimmune inflammatory rheumatic diseases focused on rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, published between January 2011 and October 2023. Data extraction was independently screened by two reviewers according to the eligibility criteria. ResultsOf 13,861 records, 18 met the eligibility criteria. Most studies were randomized controlled trials, primarily conducted in the USA, focusing on rheumatoid arthritis. ICT-based interventions included web-based platforms, aiming to improve self-management, medication adherence, with most interventions showing significant improvements. Digital tools such as websites, chatbots were common. Five groups representing the ICT functions were identified: digital self-management tools, multimedia learning materials, personalized educational sessions, behavior change and empathy games, and interactive online communities and peer support. Most studies lacked theoretical frameworks, or guidelines for developing patient education. ConclusionICT-based patient education has significant potential for enhancing self-management and behavior changes in patients with autoimmune inflammatory rheumatic diseases.

Health coaching: the node of health literacy &amp; health promotion

Abstract Introduction To achieve sustainable health behaviors and outcomes to move from a precarious health situation to good health, people need to be supported in health literacy in behavior change that ensure interventions’ success. As a non-clinical approach, health coaching aims to increase a person’s levels of self-efficacy, confidence and resilience, by promoting the sense of coherence. This communication aims to identify the benefits that health coaching as a salutogenic approach can trigger. Methods The work is structured in a narrative review of literature and the lived experience of the authors in health coaching. Results The published research on health coaching and the systematic professional experience of the authors highlight: (1) the anchoring of health coaching in the salutogenic model and in the person-centered approach focused on individual characteristics and needs in driving healthy behaviors; (2) health coaching as a collaborative relationship with chronically ill people and people at risk of developing illness; (3) the role of health coaching as a sense of coherence (SOC) promoter; (4) health coaching as a new profession in the healthcare ecosystem (e.g. NHS, UK), cooperating with multidisciplinary teams. Discussion From A.Antonovsky’s model approach to health, the SOC stands out and constitutes one of the basic theories in health coaching interventions, by strengthening the person’s capabilities of comprehensibility, manageability, and meaningfulness. As an emerging profession, with ethical and a growing research foundation, it is facilitated by trained professionals in managing and monitoring health behavior change. Conclusions Health coaching aims to bring relevance, meaning and strategy to a person’s behavioral change. Health coaching demonstrates positive effects on several health parameters by supporting the implementation of health literacy development and empowering people to trigger sustainable changes that lead to healthier lifestyles.

Preventing type 2 diabetes in Portugal: a novel person-centered digital intervention

Abstract Introduction Diabetes, particularly type 2 diabetes (T2D), stands as one of the leading noncommunicable diseases worldwide. In Portugal, the prevalence of diabetes has surged, with T2D affecting 14% of adults in 2021. Its repercussions extend beyond individual health, deeply impacting familial, social, and community dynamics, presenting a significant public health challenge globally. Objectives The VA|PREVENTION project (https://doi.org/10.54499/2022.02969.PTDC) aims to assess the (cost-) effectiveness and implementation of an innovative person-centered digital intervention to prevent T2D among high-risk adults. Methodology A comprehensive approach encompasses the Behavior Change Wheel for intervention design, scalability principles, the WHO guidelines for digital health interventions, co-design, and the ISO framework for usability assessment. Evaluation will be pursued through a type 1 hybrid effectiveness-implementation study (randomized controlled trial), supplemented by qualitative and economic studies. Results The web application prototype features Ema, an automated virtual human coach (VHC), educational menus and a dashboard (version 1.0). Co-design included 2 workshops with 11 representatives of end-users and health professionals. Ema uses standardized techniques from an ontology to support behavior change, based on an initial assessment of low-level target behaviors (e.g. walking, fruit consumption, and reducing red meat intake), and barriers to performing these behaviors. Ema communicates in a helpful-cooperative style using a synthetic voice in European Portuguese, with its speech also appearing as subtitles on the interface. Users interact with Ema by pressing buttons or entering data, such as the daily number of steps. Ethics approval was granted for usability assessment with end-users. Conclusions The project is expected to yield health, scientific, technological, and policy impacts, powered by an exploitation and sustainability roadmap. Key messages • Innovative type 2 diabetes prevention through a scalable web app with a virtual human coach. • Comprehensive and robust approach for developing and evaluating the digital behavior change intervention.

Experiences of Undergraduate Students Enrolled in a University Instructional Physical Activity Course: Exploring Factors Contributing to Behavior Modification

Background: There is a trend of decreased daily physical activity among college students. Demands of coursework, hectic schedules, and stress often prevent students from engaging in regular exercise, leading to negative impacts on mental and physical well-being. University Instructional Physical Activity Programs have the potential to address this issue by offering courses that can encourage healthier habits and promote wellness. Aim: The purpose of this study was to analyze the experiences of undergraduate students enrolled in a two-credit elective physical activity course. Methods: Participants were 587 undergraduate students enrolled in an online instructional physical activity course. Data collection included a survey consisting of three questions on a five-point Likert scale and one open-ended response regarding their experience in the course. Results: Descriptive survey data indicated positive trends regarding participants’ experience. Based on thematic analysis, qualitative data produced four themes including (1) awareness, (2) accountability, (3) ease and convenience, and (4) behavior change. Conclusions: Participants had an overall positive response to wearing an activity tracker in an online physical activity course and believed the awareness the activity tracker provided changed their daily behaviors, enabled health outcomes, and changed future intentions for physical activity. This study provides insight into the inclusion of technology to facilitate physical activity in college-age students. Aim: The purpose of this study was to analyze the experiences of undergraduate students enrolled in a two-credit elective physical activity course. Methods: Participants were 587 undergraduate students enrolled in an online instructional physical activity course. Data collection included a survey consisting of three questions on a five-point Likert scale and one open-ended response regarding their experience in the course. Results: Descriptive survey data indicated positive trends regarding participants’ experience. Based on thematic analysis, qualitative data produced four themes including (1) awareness, (2) accountability, (3) ease and convenience, and (4) behavior change. Conclusions: Participants had an overall positive response to wearing an activity tracker in an online physical activity course and believed the awareness the activity tracker provided changed their daily behaviors, enabled health outcomes, and changed future intentions for physical activity. This study provides insight into the inclusion of technology to facilitate physical activity in college-age students.

Discussing health behavior change during pregnancy: co-creation of a training and conversation tool

Abstract Background Health risk behaviors during pregnancy are major risk factors for adverse health outcomes for mother and child, and they are more prevalent among vulnerable pregnant women. However, interventions often do not sufficiently meet the needs of disadvantaged groups. Changing behavior is more likely when people feel autonomous and when a behavior aligns with our identity (how we see ourselves). Despite the clear importance of identity in health behavior change, very few identity- based interventions exist for pregnant women, let alone for vulnerable pregnant women. Through co-creation, this study aims to develop an identity- and autonomy- based training program and conversation tool tailored to the needs and preferences of healthcare professionals and vulnerable pregnant women. Methods Four co-creation sessions were conducted with five professionals from medical and social domains, and five (expectant) parents in vulnerable situations. The Participatory Learning and Action research methodology was applied to ensure an equal and democratic process in designing the training and conversation tool. Results The training for professionals will focus on enhancing knowledge about the importance of identity and autonomy in behavior change, and on improving their self-efficacy through practicing the conversation tool. Example of the conversation tool, which can be integrated into daily practice, is a comic strip illustrating the conflict of being a smoker and a mother. Conclusions During intervention development, it is important to consider the needs and preferences of end-users, particularly for whom few appropriate interventions exist. Involving end-users yields valuable insights for feasible (e.g. one-consultation time frame) and accessible (e.g. easy-to-understand language) interventions. This study aligns with public health efforts toward early intervention and health promotion among vulnerable groups. Key messages • During intervention development, it is important to consider the needs and preferences of end-users. • This study aligns with public health efforts toward early intervention and health promotion among vulnerable groups.