Effective Behavior Change Research Articles

Trends in Exercise-Related Internet Search Keywords by Sex, Age, and Lifestyle: Infodemiological Study

Background Exercise prescription by physicians is beneficial for initiating or intensifying physical activity. However, providing specific exercise prescriptions is challenging; therefore, few physicians prescribe exercise. Objective This infodemiological study aimed to understand trends in exercise-related internet search keywords based on sex, age, and environmental factors to help doctors prescribe exercise more easily. Methods Search keyword volume was collected from Yahoo! JAPAN for 2022. Ten exercise-related terms were analyzed to assess exercise interest. Total search activities were analyzed by sex and age. Characteristic scores were based on the Japanese prefecture. By performing hierarchical cluster analysis, regional features were examined, and Kruskal-Wallis tests were used to assess relationships with population and industry data. Results The top-searched term was “Pilates” (266,000 queries). Male individuals showed higher interest in activities such as “running” (25,400/40,700, 62.4%), “muscle training” (65,800/111,000, 59.3%), and “hiking” (23,400/40,400, 57.9%) than female individuals. Female individuals exhibited higher interest in “Pilates” (199,000/266,000, 74.8%), “yoga” (86,200/117,000, 73.7%), and “tai chi” (45,300/65,900, 68.7%) than male individuals. Based on age, search activity was highest in the 40-49 years age group for both male and female individuals across most terms. For male individuals, 7 of the 10 searched terms’ volume peaked for those in their 40s; “stretch” was most popular among those in their 50s; and “tai chi” and “radio calisthenics” had the highest search volume for those in their 70s. Female individuals in their 40s led the search volume for 9 of the 10 terms, with the exception of “tai chi,” which peaked for those in their 70s. Hierarchical cluster analysis using a characteristic score as a variable classified prefectures into 4 clusters. The characteristics of these clusters were as follows: cluster 1 had the largest population and a thriving tertiary industry, and individuals tended to search for Pilates and yoga. Following cluster 1, cluster 2, with its substantial population, had a thriving secondary industry, with searches for radio calisthenics and exercise bike. Cluster 4 had a small population, a thriving primary industry, and the lowest search volume for any term. Cluster 3 had a similar population to that of cluster 4 but had a larger secondary industry. Conclusions Male individuals show more interest in individual activities, such as running, whereas female individuals are interested in group activities, such as Pilates. Despite the high search volume among individuals in their 40s, actual exercise habits are low among those in their 30s to 50s. Search volumes for instructor-led exercises are higher in cluster 1 than in other cluster areas, and the total number of searches decreases as the community size decreases. These results suggest that trends in search behavior depending on sex, age, and environment factors are essential when prescribing exercise for effective behavioral change.

Active rest with exercise for pharmacy workers: an ergonomic approach to prevent musculoskeletal injury risk

This study aims to carefully review published articles examining the effect of active rest with exercise to prevent the risk of musculoskeletal injuries among pharmacy workers. Using the systematic literature review method, data were obtained from a thorough search on Google Scholar. The keywords were "Active Rest AND Exercise AND Injury Risk AND Musculoskeletal AND Pharmacy Worker AND Ergonomics". Additionally, inclusion and exclusion criteria were applied to select articles that align with the study objective. For example, it focused on articles indexed in the Scopus database and published between 2019 and 2024. For standard operationalization, this study followed the PRISMA method. Based on the search results, 6,850 articles were found from various sources. Furthermore, the articles went through several stages of the screening process, in which 8 articles that fit the theme and met the inclusion requirements were selected. The results of this study found that active rest programs had a positive impact on the work productivity, physical activity, and physical fitness of pharmacy workers. In addition, an occupational safety and health (OSH) program, a supportive work environment, and the promotion of an active lifestyle with exercise were also important in improving productivity. Adjustment of active rest programs for specific types of workers, effective behavior change interventions, ergonomic education, and multimodal physical therapy have been shown to reduce the risk of musculoskeletal disorders. The findings of this study support the assumption that a comprehensive intervention program can prevent musculoskeletal injuries, improve employee well-being and comfort, and provide guidance for healthcare practitioners and pharmaceutical company managers in designing effective active rest programs.

Identifying behavior change techniques (BCTs) in responsive feeding interventions to prevent childhood obesity-A systematic review.

Complex interventions that include responsive infant feeding components can potentially prevent childhood obesity. To develop a replicable responsive feeding intervention, an understanding of the most effective behavior change techniques (BCTs) and theory is needed. To identify the BCTs and theories used in interventions with responsive feeding components for caregivers of children ≤2 years. PsycINFO, CINAHL, Cochrane Library, EMBASE, and MIDIRS were searched from inception to May 2023. Studies of obesity prevention interventions with a responsive feeding component were included. BCT Taxonomy Version 1 and Michie and Prestwich theory coding method were applied. Eighteen interventions were identified; the number of BCTs ranged from 3 to 11 (mean = 5.5). The most used BCTs were "Instruction on how to perform a behaviour" (17/18) and "Adding objects to the environment" (13/18), which were commonly used in the nine trials demonstrating higher responsive feeding behaviours and the four trials reporting reduced likelihood of overweight or obesity, or rapid weight gain. Fifteen trials reported use of theory. BCT use was low in interventions with responsive feeding components. BCTs are replicable; their use in interventions, alongside theory, will ensure that key determinants of responsive feeding behavior are included in future obesity prevention interventions.

8.K. Scientific session: Promoting Healthier and Sustainable Diets – Evidence from the Interdisciplinary MedDietMenus4Campus

Abstract Food service comprises the production of meals consumed outside the home, including consumers from all age groups and in different sectors. This service sector has evolved through the years, providing an increasing number of meals, which have been drifting away from the Mediterranean Food Pattern. Food service is an important setting for public health interventions, educating consumers and modulating behaviours through the meals provided. Prior research on eating habits has mainly focused on a single stakeholder - typically consumers - and on a narrow set of outcome variables. Although these studies provide important clues about the determinants of adherence to food offer, research has yet to address this issue using an integrative approach of multiple stakeholders (e.g., the consumers, food providers, and decisors) across a set of different variables. Also, intervention initiatives, usually act only on the environment without strategies that efficiently engage all the stakeholders involved. In contrast, to promote behavioral change this research will focus on Social Marketing as it has been acknowledged as an effective strategy to enhance the health and well-being of consumers. Establishing and managing long-term partnerships that include different groups of stakeholders - consumers, government, retailers, and other players - are key elements in the application of mid and upstream social marketing to complex issues. The project’s main ambition is to change the food service paradigm, by creating and implementing a new healthy and sustainable food service concept complying with the Mediterranean diet, as well as solutions that comply with consumers’ new needs, and also developing and implementing strategies that engage all the stakeholders with this concept. We expect to create the reference in terms of food offer that will be demanded by consumers of the next generations and the standpoint to inspire the other food service sectors/ settings to achieve an effective and sustainable food offer change and positively influence food service consumers’ food patterns towards Mediterranean recommendations. In this workshop, the findings of the project will be presented focusing on examining the barriers and facilitators of adherence to the Mediterranean Diet in the menus offered in public high education institutes canteens in Portugal, Turkey, and Croatia. To promote the identification of effective intervention pathways, we take on an interdisciplinary approach, integrating the theoretical and methodological frameworks of Nutrition, Psychology, and Marketing. Key messages • Provide an overview of an interdisciplinary approach to promote healthier and more sustainable food offered in university canteens. • Present the pathway to develop social marketing strategies to engage different stakeholders in effective food behaviour change.

Modifying Non-communicable Disease Behaviours through Effective Health Communication and Behaviour Change: A Systematic Review

Abstract Non-communicable diseases (NCD) account for 74% of global mortality. Approximately 86% of all premature deaths occur in low- and middle-income countries majorly attributed to lifestyle changes or behavioural risk factors. The theory-based behaviour change interventions (BCIs) appear promising, but their applicability is not explored within the national programmes. The current paper aims to review the effectiveness of theory-based BCI in modifying the NCD risk factors and provide insights into the national NCD programmes. Interventions conducted to evaluate theory-based BCIs between 2002 and 2022 in modifying behavioural risk factors for NCDs were identified from multiple databases (PubMed, Scopus, Google Scholar and Cochrane Library) for systematic review. The final analysis included 35 studies that used theories and models that broadly come under one of the four approaches, i.e. intrapersonal (targets inherent individual factors for behaviour change), interpersonal (targets the family or groups), community (target socio-cultural ecosystems) and integrated (combination of other three approaches). Twenty-seven studies showed significant results. The highest number of studies were of interpersonal approach using socio-cognitive theory and integrated (11 each), and strength of evidence was moderate for both. Twenty-six studies focused on physical inactivity and unhealthy diet. The review supports the effectiveness of behaviour change interventions for mitigating NCD risk factors. Further efforts, including implementation research study methods, should be directed to evaluate effects of these interventions on population health outcomes within specific cultural and social contexts.

Behavior Change Techniques to Reduce Sugars Intake by Adolescents: A Systematic Review.

The adolescent diet is high in sugars compared with other age groups. Effective approaches to support sugar reduction by adolescents are needed as part of caries prevention. To systematically review peer-reviewed evidence (1990 to 2023) to identify effective behavior change techniques (BCTs) for sugars reduction in adolescents aged 10 to 16 y. Nine databases (CINAHL, Cochrane, Dental and Oral Sciences Source, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus, and Web of Science) were searched. Identified articles were screened independently in duplicate for eligibility. Interventions were eligible if they aimed to change adolescent dietary behavior(s) and reported pre- and postsugar-relevant outcome measures. Interventions from included studies were coded using a 93-item BCT Taxonomy (Michie Taxonomy v1). Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Evidence synthesis by vote counting (number of studies showing positive versus null or negative effects) was applied to BCTs that were present in more than 5 interventions. Of 16,271 articles identified, 764 were screened in full, yielding 35 studies (in 43 papers), of which 3 were uncodeable. BCTs coded in interventions covered 11 of 16 BCT clusters and 25 of 93 individual BCTs in the BCT taxonomy. The median number of BCTs applied per study was 3 (interquartile range 2-6). Evidence synthesis indicated that the BCTs most positively associated with a positive reduction in sugars were (with the percentage of strong-/moderate-quality studies applying these techniques that successfully reduced sugars intake in brackets) feedback on behavior (100%), information on social and environmental consequences (100%), problem solving (75%), and social comparison (75%). Notwithstanding limitations in available data, the current evidence most strongly supports the use of BCTs relating to feedback on behavior, providing information on the social and environmental consequences, include problem solving and making social comparisons, to lower sugars intake in adolescents. The results of this study will enable clinicians to provide more effective dietary advice when supporting dietary behavior change to reduce sugars intake in adolescents. The results may also be used by researchers to guide future directions for research into effective sugars reduction in adolescents.

The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities.

We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival. This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions. Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries. To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.

Designing a carbon-trading incentive scheme for mode shifts in multi-modal transport systems

The pressing need to reduce greenhouse gas emissions triggers the imperative for efficient travel demand management. Previous studies have explored budget-based and aggregated incentive programs, which place a significant financial burden on governments and tend to be limited in contributing to effective behavior change in practice due to budget issues. This study proposes a personal carbon trading travel incentive (PCTTI) mechanism, to encourage private car commuters shifting to using public transit. The incentive budget for PCTTI is sourced from the revenue generated through selling carbon emission reductions resulting from commuters’ travel mode shifts. To determine the optimal incentives, we developed an incentive scheme optimization model based on the Stackelberg game model. Numerical analysis reveals the significant potential of the PCTTI to reduce carbon emissions and travel costs across various scenarios within a multi-modal transportation system. This potential is evident amidst changes in the fixed costs of car travel, carbon trading prices, the use of different travel modes, the value of time, and the prevalence of electric vehicles. The advantages are most pronounced when the carbon trading price exceeds 40 CNY/ton, and when the usage of public transit, the value of time, and the proportion of electric vehicles each fall below 0.4, 50 CNY/hour, and 0.4, respectively.

Perceptions of Behaviour Change Interventions for Physical Activity in People with Chronic Obstructive Pulmonary Disease: A Survey

Abstract Background Physical inactivity in chronic obstructive pulmonary disease (COPD) is common and behaviour change interventions could help improve physical activity (PA). This survey aimed to explore perceptions of behaviour change interventions for physical activity in people with COPD. Methods An anonymous cross-sectional electronic and paper survey was distributed among people with COPD in the Republic of Ireland (n=150) via relevant gatekeepers. Descriptive statistics, means, medians, percentages and frequencies, were used to summarise and describe the findings. Chi- squared t-tests (where P was set at 0.05) were used to investigate relationships between variables. Results Responses were received from n=113 people with COPD (75.33% response rate, 113/150) and most respondents (83.03%, n= 93/112) were aged over 61 years. 90.53% (n=86/95) of respondents agreed/strongly agreed that PA helps them to manage their COPD. There was a strong statistically significant relationship between those who wear PA monitoring devices and those who believe that being physically active can help them to manage their lung disease (p<0.001), however, in this survey, the use of PA monitors in those over 61 years was proportionally lower (21.11%, n=19/90) than those under 60 years (61.53%, n= 8/13). Respondents perceived social support as the most effective behaviour change intervention to influence PA behaviour (67.62%, n= 71/105), with counselling for PA perceived to be the least effective (13.33%, n=14/105). Conclusion People with COPD perceived that social support can influence their PA behaviour. The spontaneous use of PA monitoring devices was lower in older respondents than in younger respondents, however a strong relationship between using monitoring devices and perceived benefits of PA on COPD may exist overall.

Dyadic concordance and other considerations for matching pairs for peer support diabetes prevention interventions: A mixed methods assessment

ObjectivesDyadic peer support helps patients make health behavior changes for improved outcomes, yet the impact of matching dyads on demographic characteristics such as race or gender is unknown. Therefore, we investigated associations of concordant characteristics with peer outcomes in a diabetes prevention intervention and qualitatively examined participant perspectives on matching. MethodsBinary variables for peer-supporter concordance on 6 demographic characteristics were created for 177 peers and 69 supporters. Regression models compared changes in weight, HbA1c, perceived social support, patient activation, and formal diabetes prevention/education program participation for concordant and non-concordant dyads. Semi-structured qualitative interviews were conducted with 39 peers and 34 supporters. ResultsConcordance on demographic characteristics was not significantly associated with outcomes. Qualitatively, peers and supporters emphasized that more important than shared demographic characteristics was a supporter's empathic, non-judgmental communication style. ConclusionsDemographic characteristics for matching supporters with adults with prediabetes are less important than ensuring high-quality coach training in goal setting and communication style, supporting prior research on the necessity of autonomy supportive communication for effective behavioral change interventions. Practice implicationsExisting peer support programs should incorporate fidelity assessments into practice to ensure peer supporter skill in motivational interviewing-based, autonomy supportive communication and brief goal setting.

“As a patient I do not belong to the clinic, I belong to the community”: co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa

BackgroundAnticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.MethodsUsing a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.ResultsIntervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.ConclusionsDecreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

If you want to learn about real behaviour, measure real behaviour

We argue that research aiming to understand or change human behavior must measure real behavior, not just behavioral intentions, to draw valid conclusions. The work highlights the well-established gap between people’s intentions and behavior across various tourism and hospitality contexts. Methodologically, we encourage authors not to rely on behavioral intentions and instead measure real behavior. We provide an overview of methods available to capture real behavior either automatically or manually in tourism contexts. The article also introduces a special issue in the Journal of Sustainable Tourism that showcases the measurement of real environmentally significant tourist behavior using diverse methods, such as biometric techniques, big data analytics, field observations, and experiments. We conclude by discussing five issues that prevent studies form drawing causal conclusions about behavior, namely, (i) reliance on behavioral intentions; (ii) a sample that does not reflect the population of interest; (iii) errors in measuring latent psychological constructs; (iv) consumer hypocrisy and social desirability bias; and (v) situational factors and habits. By advocating for a transition towards measuring real behavior, the article and the special issue aim to increase the validity and impact of research seeking to understand human behavior and drive effective behavior change for addressing global challenges.

BMI and explicit-implicit cues on food choice: The fake food buffet in the United Kingdom and Indonesia

We examined whether people with high BMI sampled from two different countries were more susceptible to behavioural change via an implicit, rather than explicit, intervention. We measured BMI and used three types of cue interventions (implicit vs explicit healthy lifestyle cue vs neutral cue) to examine their impact on our participants’ food choice using the Fake Food Buffet. Healthiness of the meal chosen was measured by the percentage of healthy food items in the meal. Portion size of their chosen meal was operationalised by the total number of food items chosen and its total calorie content was also estimated. Participants were recruited from the United Kingdom (N = 264) and Indonesia (N = 264). Our results indicated that while explicit food cues were overall more effective, implicit cues were a more effective strategy to change food choice behaviours among individuals with high BMI. Participants with high BMI were more likely to regulate the healthiness of their meal and less likely to regulate its portion size or calorie content. The efficacy of our healthy eating interventions was cross-culturally generalizable. Our study supports previous research that implicit cues of a healthy lifestyle might be a more effective behavioural change strategy for individuals with high BMI.

2' Life-changing minutes: impact evaluation of a novel health promotion format on cancer prevention.

Cancer is one of the most important societal challenges in the world, with over 23 million new cases/year and 10 million deaths/year, that will only be properly tackled with a stronger focus on prevention. This calls for an informed population, aware of risk factors and willing to adopt preventive behaviors and early cancer screenings. For that purpose, 2' Life-changing minutes was created, the first ever televised Entertainment-Education series on cancer prevention. This study aims to evaluate the impact of 2' Life-changing minutes, a novel E-E format for cancer prevention, on knowledge gains and behavior changes. Two complementary studies were performed involving a total of 1314 participants: a test-screening (TS) study targeting potential viewers of the series, and a natural-screening (NS) study targeting those that spontaneously watched the series on television. We found (i) very high levels of appreciation and narrative engagement, and also willingness to see more episodes; (ii) statistically significant knowledge gains, ranging from 17% to 44%, on all four topics tested; (iii) evidence of effective behavior change. Regression analysis showed that narrative engagement was the best predictor of behavior change [NS: odds ratio (OR) = 3.38, 95% confidence interval (CI) = 1.70-6.74, p = 0.001; TS: OR = 2.05, 95% CI = 1.13-0.371, p = 0.018]. This study demonstrates the series' real impact and serves as a proof-of-concept for a novel strategy of cancer prevention that is based around compelling health narratives, rather than information or data, to engage viewers, increase knowledge and induce behavior change.

Systematic Development of an AI Chatbot for Physical Activity Habit Formation in Prehypertension Individual Integrating Needs, Theories, and Evidence.

Prehypertension, an early stage in the development of hypertension, impacts a substantial segment of the adult population worldwide. Addressing this issue, our study introduces HabitBot, an AI-driven chatbot tailored to encourage physical activity (PA) habits among individuals with prehypertension. HabitBot combines natural language processing with multidisciplinary approaches, drawing from both theoretical frameworks and empirical studies. The chatbot development followed a systematic, five-phase process: comprehensive needs assessment, literature review on behavior change theories, analysis for selecting effective behavior change techniques (BCTs), prototype design through intervention mapping, and refining the intervention based on user feedback. The outcome includes a prototype that integrates the Health Action Process Approach and Habit Formation Theory, utilizing twelve identified BCTs effective in fostering PA habits. User feedback further refined the chatbot across multiple dimensions such as user interface, content accessibility, and privacy. HabitBot exemplifies an innovative integration of behavior change strategies with advanced language model technology, paving the way for digital health interventions in chronic disease prevention. Future studies should assess its long-term efficacy in habit formation and explore its applicability to various demographic groups.

Perception is reality: qualitative insights into how consumers perceive alcohol warning labels.

This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change. New Zealand participants ≥18years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n = 53) by ethnicity (general population, Māori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis. Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like "WARNING" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Māori and Pacific participants. Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand's varied drinkers.

The Plastic-Reduction Behavior of Chinese Residents: Survey, Model, and Impact Factors

The persistent generation of plastic waste represents a critical environmental challenge. Despite the implementation of various management policies spanning from usage to disposal that are aimed at incentivizing plastic reduction, the accumulation of plastic debris continues to pose a significant threat to both terrestrial and marine ecosystems. Moreover, this environmental issue adversely impacts economic development and human health. This study seeks to analyze the influencing factors of plastic-reduction behavior at the individual level. Through a diverse sample of 869 participants across 29 provincial-level administrative regions, this research utilizes structural equation modeling to elucidate the intricate factors influencing plastic-reduction behaviors. This study examines the factors influencing plastic-reduction behavior through the frameworks of economic savings and spiritual satisfaction, focusing on two specific behavioral intentions: economically driven behavior and spiritually driven persuasive behavior. Results show that the primary motivator for plastic reduction is the decrease in individual expenses. Environmental values and policy regulations have become important influencing factors, which also promote behaviors regarding plastic reduction through economic savings. The study distinguishes between the impacts of environmental knowledge and skills, highlighting the necessity of practical skills for effective behavior change. Moreover, the study reveals the pivotal role of local attachment in encouraging plastic-reduction actions. The urban natural environment, particularly when characterized by accessible and well-maintained features, such as lakes and rivers, can foster residents’ appreciation for the environment, thereby motivating them to engage in plastic-reduction actions to attain personal spiritual satisfaction.

The Effectiveness of Nutritional Interventions Implemented through Lady Health Workers on the Reduction of Stunting in Children under 5 in Pakistan: The Difference-in-Difference Analysis.

In Pakistan, the 2018 National Nutrition Survey reported that 40% of children under five years old were stunted. This study assessed the effectiveness of nutritional supplementation in reducing stunting among children under five years old in two rural districts in Sindh, Pakistan. This was a mixed-method quasi-experimental study comprising intervention and control populations, with 3397 and 3277 children under five years old participating in the baseline and end-line surveys, respectively. The study areas were similar in terms of demographic and economic circumstances. In the intervention group, pregnant and lactating women (first six months post-partum) received wheat soy blend, children 6-23 months old received Wawamum (lipid-based supplement), and children 24-59 months old received micronutrient powders, all through lady health workers. This was underpinned by nutrition behaviour change communication for appropriate complementary feeding practices and hygiene promotion targeted at primary caregivers. The control group received no intervention. The impact was assessed using the difference-in-difference analysis with kernel propensity score matching to adjust the differences among the control and intervention populations. The overall DID analysis indicated that the intervention did not significantly reduce the prevalence of stunting (under 5 years) [DID = -5.1, p = 0.079]. The adjusted DID indicated a significant decrease of 13% [DID = -13.0, p = 0.001] in the number of stunted children 24-59 months of age at the endline survey. A significant reduction in underweight among children 24-59 months old was also observed (DID = -9.4%, p = 0.014). In conclusion, this evidence further establishes that nutrient uptake through an intervention for a short duration cannot effectively reduce stunting. It requires continuous nutritional supplementation for mothers during the pregnancy and an initial six months of lactation and then nutritional supplementation for children 6-59 months of age underpinned by effective behaviour change communication targeting mothers and other caregivers for improving complementary feeding practices and hygiene promotion.

Development and Implementation of a Novel Approach to Dietary Education for People With Inadequate Health Literacy and Advanced Kidney Disease

To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat. The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying Cook for Life cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Māori elder and his whānau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the Storybook, a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals. Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style. This practical skill-based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change.

The Effect of Using Anchored Wake Time to Derive 24-h Device Measured Circadian Physical Behavior Patterns.

Tailoring physical activity interventions to individual chronotypes and preferences by time of day could promote more effective and sustainable behavior change; however, our understanding of circadian physical behavior patterns is very limited. To characterize and compare 24-h physical behavior patterns expressed relative to clock time (the standard measurement of time-based on a 24-h day) versus wake-up time in a large British cohort age 46. Data were analyzed from 4979 participants in the age 46 sweep of the 1970 British Cohort Study who had valid activPAL accelerometer data across ≥4 days. Average steps and upright time (time standing plus time stepping) per 30-min interval were determined for weekdays and weekends, both in clock time and synchronized to individual wake-up times. The mean weekday steps were 9588, and the mean weekend steps were 9354. The mean weekday upright time was 6.6 h, and the mean weekend upright time was 6.4 h. When synchronized to wake-up time, steps peaked 1 h after waking on weekdays and 2.5 h after waking on weekends. Upright time peaked immediately, in the first 30-min window, after waking on both weekdays and weekends. Aligning accelerometer data to wake-up times revealed distinct peaks in stepping and upright times shortly after waking. Activity built up more gradually across clock time in the mornings, especially on weekends. Synchronizing against wake-up times highlighted the importance of circadian rhythms and personal schedules in understanding population 24-h physical behavior patterns, and this may have important implications for promoting more effective and sustainable behavior change.