Development Of Behaviour Change Interventions Research Articles

Factors influencing unrelated stem cell donation a mixed-methods integrated systematic review.

There is an imbalance between demand for and availability of stem cell donors worldwide. The purpose of this systematic review is to provide the first comprehensive understanding of facilitators and barriers influencing unrelated stem cell donation (USCD) in adults, through a data synthesis of qualitative and quantitative evidence. Identification of the facilitators and barriers associated with stem cell donation intention and behaviour is essential to inform the development of behaviour change interventions to meet the current demand. Four databases were searched (Embase, PsycINFO, MEDLINE and CINAHL) and the last search was in February 2021. The search was limited to studies written in English and published from 1980 to present. Screening, quality assessment, data extraction and data synthesis incorporating the COM-B model were undertaken in line with the Joanna Briggs Institute methodology for an integrated mixed-methods review. Fifty studies were included in the review, analysis and mapping produced four integrated findings. Donation-related knowledge was a facilitator and conversely, lack of knowledge was a barrier to donation related behaviours. Perceived convenience, positive social influences, religious beliefs and the accessibility of positive donation-related social norms promoted positive donation related behaviours. Altruism and sense of duty were the most commonly cited motives for donation related behaviours.Through mapping to the COM-B model, Communication/Marketing, and Service Provision are the primary policy categories that can be used to change donation related behaviours. Future interventions should focus on targeted education regarding unrelated stem cell donation and creating recruitment campaigns that emphasise the life-saving potential of donation.

Operationalizing the Behaviour Change Wheel and APEASE criteria to co-develop recommendations with stakeholders to address barriers to school-based immunization programs

Introduction: School-based immunization programs offer an accessible route to routine vaccines for students. During the COVID-19 pandemic, school closures to comply with public health measures had a drastic effect on school-based immunization program delivery and associated vaccine uptake. We sought to integrate findings from a mixed methods study to co-develop evidence-based and theory-informed recommendations with a diverse group of stakeholders (i.e., decision makers, healthcare providers, school staff, parents and adolescent students) to address barriers to new and existing school-based immunization programs. Methods: Findings from a mixed methods study were integrated using a joint display and narrative summary. These findings were mapped through the Behaviour Change Wheel, a series of tools designed to facilitate the development of behaviour change interventions. Draft recommendations were provided to previous mixed methods study participants who consented to participating in future phases of the research study (n = 26). Feedback was captured using a Likert-scale survey of acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria, with feedback and additional insights captured using open-ended textboxes. Data was used to revise and finalize recommendations. Results: Applying the Behaviour Change Wheel, we drafted 26 evidence-based, theory-informed recommendations to address barriers to school-based immunization programs. Participants (n = 16) provided feedback, with half of the recommendations scoring 80% or higher across all six APEASE criteria. The remaining 13 recommendations received a moderate score across one or more criteria. Stakeholders identified a high level of interest in expanding the use of e-consent forms, expanding programming to offer a meningitis B vaccine, and recommendations to ease student anxiety. Conclusion: We co-developed a range of recommendations to improve school-based immunization programs with stakeholders using data generated from a mixed methods study. Implementation of any single or combination of recommendations will need to be tailored to local clinic procedures, school system and health system resources.

Design-led solutions for reducing airline food waste: A participatory approach to develop behaviour change interventions

Airline food waste is a critical issue which is affected by passenger behaviour. In parallel with the unexpected advent of COVID-19, passengers have exhibited changes in eating behaviour, generating more food waste during flights. In this paper, the authors explore and reflect on the use of participatory design workshops conducted with designers and airline passengers with the aim to develop behaviour change interventions towards reducing airline food waste. This paper identifies seven types of behaviour change intervention, whilst empirically evidencing the effectiveness of participatory design in facilitating the development of behaviour change interventions, towards achieving airline food waste reduction.

Exploring determinants of antimicrobial prescribing behaviour using the Theoretical Domains Framework

BackgroundFew theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). Objective(s): To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians’ antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. MethodsSemi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. ResultsData saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants’ beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. ConclusionsAntimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship.

Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework.

Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty-three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: 'Environmental Context and Resources', 'Knowledge', 'Skills' and 'Memory, Attention and decision processes'. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient-practitioner relationships were enablers to adherence. We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.

Linking a Survey of Clinician Benzodiazepine-Related Beliefs to Risk of Benzodiazepine Prescription Fills Among Patients in Medicare.

In this pilot study, we used a Medicare sample to identify primary care clinicians who prescribed a benzodiazepine (BZD) in 2017 and surveyed a random sample (n = 100) about BZD prescribing. Among 61 respondents, 11.5% (SD 5.9) of their patient panels filled a BZD prescription. Patients of primary care clinicians who agreed that potential harms to long-term BZD users were low had a greater BZD fill risk relative to patients of disagreeing primary care clinicians (adjusted risk ratio 1.31; 95% CI, 1.01-1.7). We highlight the potential of using Medicare claims to sample clinicians. Using claims-based objective measures presents a new method to inform the development of behavior-change interventions.

Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare

BackgroundAn implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap.MethodsThe BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus.ResultsThe behavioural diagnosis identified healthcare professionals’ initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies.ConclusionsThis study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals’ frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice.

Explaining adults’ mental health help-seeking through the lens of the theory of planned behavior: a scoping review

BackgroundDespite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged >18 years.MethodsThis scoping review was conducted based on the methodology presented by Arksey and O’Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel.ResultsInitially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results.ConclusionsThe present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice.

Translation of findings from laboratory studies of food and alcohol intake into behavior change interventions: The experimental medicine approach.

Objectives: Laboratory studies have contributed important information about the determinants of food and alcohol intake, and they have prompted the development of behavior change interventions that have been evaluated in randomized controlled trials conducted in the field. In this article we apply a recent experimental medicine (EM) framework to this body of research. Method: A conceptual review and focused discussion of the relevant literature is presented. Results: We illustrate how it is possible to translate findings from studies of food and alcohol intake in the laboratory into interventions that are effective for changing behavior in the real world. We go on to demonstrate how systematic failures can occur at different stages within the EM framework, and how these failures ultimately result in interventions that are ineffective for changing behavior. We also consider methodological issues that may constrain the external validity of findings from laboratory studies including demand effects, participant characteristics, and the timing and dose of behavioral interventions. Throughout, we make recommendations to improve the translation of findings from laboratory studies into behavior change interventions that are effective in the field. Conclusions: Consideration of the EM framework will help to ensure that promising candidate interventions for eating and drinking that are identified in laboratory studies can fulfill their translational promise. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development of a pre- and postoperative physical activity promotion program integrated in the electronic health system of patients with bladder cancer (The POPEYE study): An intervention mapping approach.

Uptake of sufficient physical activity before and after radical cystectomy is important to improve physical and psychosocial outcomes in bladder cancer (BC) patients. In this paper, we describe the development of an evidence-based and theory-informed intervention, guided by the steps of the Intervention Mapping approach, to promote physical activity before and after radical cystectomy in patients with BC. The intervention is a home-based physical activity program. The preoperative timeframe of the intervention is 4 or 12weeks, depending on administration of neoadjuvant chemotherapy. Postoperatively, the intervention will last for 12weeks. The intervention consists of a digital oncological platform (DOP), several consultations with healthcare professionals, personal booklet and follow-up phone calls. DOP includes information, diaries, visual representation of progress, mailbox, videos of peers and treating physician explaining the benefits of physical activity, photo material of exercises and a walking program with an activity tracker. Individual goals will be set and will be self-monitored by the patient through DOP. Patients will receive alerts and regular feedback. Intervention Mapping ensures transparency of all intervention components and offers a useful approach for the development of behaviour change interventions for cancer patients and for translation of theories into practice.

Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study

ObjectivesPrevious qualitative research investigating the experiences of women diagnosed with gestational diabetes (GD) has provided important insights into the development of behaviour change interventions. However, these studies often lack a...

Using Internet of Things to Reduce Office Workers' Sedentary Behavior: Intervention Development Applying the Behavior Change Wheel and Human-Centered Design Approach.

BackgroundSedentary behavior (SB) is associated with various adverse health outcomes. The prevalence of prolonged sitting at work among office workers makes a case for SB interventions to target this setting and population. Everyday mundane objects with embedded microelectronics and ubiquitous computing represent a novel mode of delivering health behavior change interventions enabled by internet of things (IoTs). However, little is known about how to develop interventions involving IoT technologies.ObjectiveThis paper reports the design and development of an IoT-enabled SB intervention targeting office workers.MethodsThe process was guided by the behavior change wheel (BCW), a systematic framework for theory-informed and evidence-based development of behavior change interventions, complemented by the human-centered design (HCD) approach. Intervention design was shaped by findings from a diary-probed interview study (n=20), a stakeholder design workshop (n=8), and a series of theoretical mapping and collaborative technical design activities.ResultsThe resulting intervention named WorkMyWay targets a reduction in office workers’ prolonged stationary behaviors at work and an increase in regular breaks by modifying behavioral determinants in 11 theoretical domains with 17 behavior change techniques. The delivery technology consists of a wearable activity tracker, a light-emitting diode reminder device attached to a vessel (ie, water bottle or cup), and a companion Android app connected to both devices over Bluetooth. The delivery plan consists of a 2-week baseline assessment, a 30-min face-to-face action planning session, and 6-week self-directed use of the delivery technology.ConclusionsThis is the first study to demonstrate that it is possible to develop a complex IoT-enabled intervention by applying a combination of the BCW and HCD approaches. The next step is to assess the feasibility of WorkMyWay prior to testing intervention efficacy in a full-scale trial. The intervention mapping table that links individual intervention components with hypothesized mechanisms of action can serve as the basis for testing and clarifying theory-based mechanisms of action in future studies on WorkMyWay.

Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): A behavioural diagnosis using the COM-B model in a low-income setting.

BackgroundLifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- income countries. The aim of the study was to explore women’s lived experiences of GDM and the feasibility of sustained lifestyle modification after GDM in a low-income setting.MethodsThis was a descriptive qualitative study on the lived experiences of women with prior GDM, who received antenatal care at a public sector tertiary hospital in Cape Town, South Africa. Nine focus groups and five in-depth interviews were conducted with a total of thirty-five women. Data were analysed using content analysis and the COM-B (Capabilities, Opportunities, Motivations and Behaviour) model to identify factors influencing lifestyle change during and beyond the GDM pregnancy.ResultsThe results suggest that the COM-B model’s concepts of capability (knowledge and skills for behaviour change), opportunity (resources for dietary change and physical activity) and motivation (perception of future diabetes risk) are relevant to lifestyle change among GDM women in South Africa. The results will contribute to the design of a postpartum health system intervention for women with recent GDM.ConclusionOur findings highlight the need for health services to improve counselling and education for women with GDM in South Africa. Support from family and health professionals is essential for women to achieve lifestyle change. The experience of GDM imposed a significant psychological burden on women, which affected motivation for lifestyle change. To achieve long-term lifestyle change, behaviour interventions for women with prior GDM need to address their capability, opportunity and motivation for lifestyle change during and beyond pregnancy.

Feeling Under Pressure: Perspectives of the Meaning of Love and Sexual Relationships Amongst Young Men in KwaZulu-Natal Province, South Africa.

This study aimed to explore perspectives on the meaning of love and sexual relations amongst young men in KwaZulu-Natal province of South Africa. Gaining insights into these perspectives will help to understand the sexual behaviors of these young men better and to eventually develop more effective HIV prevention interventions. Focus group discussions were conducted in two study areas using a predetermined semistructured discussion guide. The findings indicate that the phenomenon of romantic relationship try-outs together with the idea of “feeling under pressure” to propose love to more than one woman seem to be accepted practices that often lead to multiple concurrent sexual partners and therefore potentially risky sexual behaviors. The fear of impregnating a woman is seen to be of a more significant concern than acquiring a sexually transmitted infection due to the stigma and embarrassment associated with pregnancy outside marriage. Given these findings, it is recommended that future studies investigate perspectives on sexuality and reproductive health in male populations in great detail prior to the development of behavioral change interventions because failure to do so may hamper well-intended but poorly targeted health interventions.

Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia

The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.

A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer.

Physical activity can improve health, functional capacity, and quality of life among children and adults diagnosed with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to: determine the extent, range, and nature of published studies on physical activity among AYAs; identify knowledge gaps; and provide directions for future research. We searched 4 electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full-texts against inclusion criteria: original research with humans, published in an English-language peer-reviewed journal, ≥50% of participants were diagnosed with cancer between the ages of 15 and 39years, and included at least 1 measure of physical activity behavior. Data were extracted from studies meeting these criteria and subsequently summarized narratively. Our search yielded 4729 articles; 32 met inclusion criteria. These included 18 cross-sectional and 4 longitudinal studies that explored descriptive (ie, sociodemographic or medical), physical, personal/psychological, social, other health behaviors, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behavior or on testing the effects of physical activity. We can conclude that physical activity is not well researched among AYAs. More high-quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behavior change interventions as well as to establish the benefits of physical activity for AYAs.

Comparing the application of two theoretical frameworks to describe determinants of adverse medical device event reporting: secondary analysis of qualitative interview data

BackgroundPost-market surveillance of medical devices is reliant on physician reporting of adverse medical device events (AMDEs). Few studies have examined factors that influence whether and how physicians report AMDEs, an essential step in the development of behaviour change interventions. This study was a secondary analysis comparing application of the Theoretical Domains Framework (TDF) and the Tailored Implementation for Chronic Diseases (TICD) framework to identify potential behaviour change interventions that correspond to determinants of AMDE reporting.MethodsA previous study involving qualitative interviews with Canadian physicians that implant medical devices identified themes reflecting AMDE reporting determinants. In this secondary analysis, themes that emerged from the primary analysis were independently mapped to the TDF and TICD. Determinants and corresponding intervention options arising from both frameworks (and both mappers) were compared.ResultsBoth theoretical frameworks were useful for identifying interventions corresponding to behavioural determinants of AMDE reporting. Information or education strategies that provide evidence about AMDEs, and audit and feedback of AMDE data were identified as interventions to target the theme of physician beliefs; improving information systems, and reminder cues, prompts and awards were identified as interventions to address determinants arising from the organization or systems themes; and modifying financial/non-financial incentives and sharing data on outcomes associated with AMDEs were identified as interventions to target device market themes. Numerous operational challenges were encountered in the application of both frameworks including a lack of clarity about how directly relevant to themes the domains/determinants should be, how many domains/determinants to select, if and how to resolve discrepancies across multiple mappers, and how to choose interventions from among the large number associated with selected domains/determinants.ConclusionsGiven discrepancies in mapping themes to determinants/domains and the resulting interventions offered by the two frameworks, uncertainty remains about how to choose interventions that best match behavioural determinants in a given context. Further research is needed to provide more nuanced guidance on the application of TDF and TICD for a broader audience, which is likely to increase the utility and uptake of these frameworks in practice.

A new framework for the design and evaluation of a learning institution's student engagement activities

ABSTRACTIn this article we explore the potential for attempts to encourage student engagement to be conceptualised as behaviour change activity, and specifically whether a new framework to guide such activity has potential value for the Higher Education (HE) sector. The Behaviour Change Wheel (BCW) (Michie, Susan, Maartje M van Stralen, and Robert West. 2011. “The Behaviour Change Wheel: A New Method for Characterising and Designing Behaviour Change Interventions.” Implementation Science : IS 6 (1): 42. doi:10.1186/1748-5908-6-42) is a framework for the systematic design and development of behaviour change interventions. It has yet to be applied to the domain of student engagement. This article explores its potential, by assessing whether the BCW comprehensively aligns with the state of student engagement as currently presented in the HE literature. This work achieves two things. It firstly allows a prima facie assessment of whether student engagement activity can be readily aligned with the BCW framework. It also highlights omissions and prevalence of activity types in the HE sector, compared with other sectors where behaviour change practice is being successfully applied.

When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults.

Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.

Exploring the Role of Messenger Effects and Feedback Frames in Promoting Uptake of Energy-Efficient Technologies

The persuasive potential for varying messenger types and feedback frames to increase pro-environmental choice was explored in a 2 (feedback frame: financial vs. environmental) × 5 (messenger type: neighbour, government, industry, utilities vs. control) factorial design experiment. Using the context of home heating choice, 493 non-student participants were given information on either the financial or environmental benefits of selecting an energy-efficient heat pump versus a standard boiler, as described by one of four messenger types (versus a no-messenger control). Likelihood of selecting the ‘green’ technology was assessed, as well as any carry-over effects on real-life behavioural intentions. Additionally, we assessed the messenger attributes that appeared to be most important in this context, in terms of whether sources that were perceived to be trustworthy, knowledgeable, or a combination of both dimensions, would hold greater sway over preference formation. Overall, no evidence was found for any impact of messenger type on either preference formation or behavioural intentions. However, message content (i.e. how information on the benefits of pro-environmental choice was framed), was found to have substantial impact on behaviour; with the financial versus environmental decision frame being significantly more likely to encourage uptake of the energy-efficient versus standard technology. We suggest that the level of processing required for the kinds of large-scale purchase decisions we consider here may explain the lack of any messenger effect on choice behaviour. Implications for the development of behaviour change interventions designed to promote consideration of energy-efficient technologies in this context are discussed.