Effective Behavior Change Strategies Research Articles

Behavioral determinants for COVID-19 vaccine acceptance among students, faculty, and staff at a rural public university

ABSTRACT Background Vaccine hesitancy for COVID-19 is a major obstacle to achieving high vaccine coverage. Low vaccine confidence among college students is one factor fueling the COVID-19 pandemic in the U.S. Objective The purpose of this study was to evaluate COVID-19 vaccine hesitancy and barriers to vaccine uptake among students, faculty, and staff at a rural public university. Method We used the Barrier Analysis (BA) mixed-methods approach, which explores determinants of the desired behavior using the Health Belief Model and Theory of Reasoned Action. We developed a BA questionnaire and distributed it through Qualtrics to 4,600 randomly selected students (n = 4,000), faculty (n = 300), and staff (n = 300) from March 11 to April 1, 2021. We defined Acceptors as those who were willing to be vaccinated and Non-acceptors as those who were not. Results Our analysis found that among Non-acceptors, perceived social norms, perceived negative consequences, and trust had the highest association with COVID-19 vaccine hesitancy among students, faculty, and staff. Conclusion These findings illustrate the need to develop effective behavior change strategies for COVID-19 vaccines uptake that identify sources of trusted information among vaccine-hesitant college students, faculty, and staff, while leveraging enablers to increase COVID-19 vaccination coverage on university campuses.

Qualitative evidence for improved caring, feeding and food production practices after nutrition-sensitive agriculture interventions in rural Vietnam

BackgroundResearch on nutrition-sensitive agriculture (NSA) has mostly been aimed at demonstrating its impact on nutrition and explicating underlying pathways, and more rarely at understanding processes and lessons learnt from them. This study aimed to gain insights into the processes that influence behaviour change, contributing to improved caring, feeding and food production practices, using a program theory perspective. It also investigated perceived challenges to the sustainability of interventions and potential solutions, in the context of an NSA program in rural Vietnam. Using a participatory approach, data were gathered on impact pathways and perceived outcomes, on elements of program theory that led to behavioural change, as well as barriers and facilitators. Respondents in semi-structured interviews (n = 30) and seven focus group discussions (total n = 76) were selected purposively among program participants. Data was collected and triangulated across several stakeholder groups.ResultsThe impact pathways (production-consumption, caring and feeding, and home-grown school feeding) envisaged in the NSA program functioned as intended; synergies were revealed. The increased supply of locally produced nutrient-rich foods not only contributed to the emergence of a promising income sub-pathway but also reinforced synergy with the home-grown school feeding pathway. Improved diets, feeding and caring practices, and school attendance were key outcomes of the program. Successful elements were pathway-specific, such as flexibility in implementing context-appropriate agricultural models. Others, such as benefit-driven motivation and improved knowledge, triggered changes in multiple pathways. Role models, increased self-confidence, and change agents were the main process facilitators. The biggest barrier to both implementation and sustainability was the poor socio-economic conditions of the most disadvantaged households.ConclusionsThis study showed the relevance of NSA programs in addressing undernutrition in remote areas by enhancing self-reliance in local communities. The integration of behaviour change activities proved to be a key strategy in the process to enhance the impact of agriculture on nutrition outcomes. Though outcomes and influencing factors are very context-dependent, lessons on what worked and what did not work could inform the design and implementation of effective behaviour change strategies in future NSA programs in Vietnam and elsewhere.

Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment.

Nudging, a strategy that uses subtle stimuli to direct people's behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion. A comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations. This scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience. Three key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of 'what works' and 'how it works'. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC.

Web-Based Behavioral Intervention Utilizing Narrative Persuasion for HIV Prevention Among Chinese Men Who Have Sex With Men (HeHe Talks Project): Intervention Development.

BackgroundIn the era of potent antiretroviral therapy, a high level of condomless anal intercourse continues to drive increases in HIV incidence in recent years among men who have sex with men. Effective behavior change strategies for promoting HIV-preventive behaviors are warranted. Narrative persuasion is a novel health communication approach that has demonstrated its persuasive advantages in overcoming resistance to counterattitudinal messages. The efficacy of narrative persuasion in promoting health behavior changes has been well documented, but critical research gaps exist for its application to HIV prevention.ObjectiveIn this study, we aimed to (1) capitalize on narrative persuasion to design a web-based multisession intervention for reducing condomless anal intercourse among men who have sex with men in Hong Kong (the HeHe Talks Project) by following a systematic development process; and (2) describe the main components of the narrative intervention that potentially determine its persuasiveness.MethodsPersuasive themes and subtopics related to reducing condomless anal intercourse were initially proposed based on epidemiological evidence. The biographic narrative interview method was used to elicit firsthand experiential stories from a maximum variation sample of local men who have sex with men with diverse backgrounds and experiences related to HIV prevention; different types of role models were established accordingly. Framework analysis was used to aggregate the original quotations from narrators into collective narratives under 6 intervention themes. A dedicated website was finally developed for intervention delivery.ResultsA series of video-based intervention messages in biographic narrative format (firsthand experiential stories shared by men who have sex with men) combined with topic-equivalent argumentative messages were produced and programmed into 6 intervention sessions. The 6-week intervention program can be automatically delivered and monitored online.ConclusionsWe systematically created a web-based HIV prevention intervention derived from peer-generated stories. Strategies used to enhance the efficacy of the narrative intervention have been discussed within basic communication components. This paper describes the methods and experiences of the rigorous development of a narrative communication intervention for HIV prevention, which enables replication of the intervention in the future.

Efficacy, characteristics, behavioural models and behaviour change strategies, of non-workplace interventions specifically targeting sedentary behaviour; a systematic review and meta-analysis of randomised control trials in healthy ambulatory adults.

BackgroundSedentary behaviour (SB) research has grown exponentially but efficacy for interventions to reduce sedentary behaviour is often contaminated by interventions primarily or co-targeting other behaviours and outcomes. The primary aim of this research therefore, was to systematically review the efficacy of interventions specifically targeting sedentary behaviour reduction, as a sole primary outcome, from randomised control trials in healthy ambulatory adults. This research also sought to identify the successful interventions characteristics, behaviour change techniques (BCT’s) and underlying theories, and their relation to intervention effectiveness.MethodsWe followed PRISMA reporting guidelines for this systematic review. Six electronic databases were searched and a grey literature review conducted. Only randomised or cluster randomised controlled trials, from 2000 to 2020, in adult populations with a sole primary outcome of change in sedentary behaviour were included. Data codebooks were developed, data were extracted, and a narrative synthesis and meta-analysis was conducted using mixed methods random effects models.ResultsOf 5589 studies identified, 7 studies met the inclusion criteria. Six studies reported activPAL3 measures of mean daily sitting time, and four reported mean daily standing time, stepping time and number of sedentary breaks. Pooled analysis of weighted mean differences revealed a reduction in mean daily sitting time of -32.4mins CI (-50.3, -14.4), an increase in mean daily standing time of 31.75mins CI (13.7, 49.8), and mean daily stepping time of 9.5mins CI (2.8, 16.3), and an increase in rate of sedentary breaks per day of 3.6 (CI 1.6, 5.6). BCTs used exclusively in two of the three most effective interventions are ‘feedback on behaviour’ and ‘goal setting behaviour’ whilst all three most effective interventions included ‘instruction on how to perform the behaviour’ and ‘adding objects to the environment’, BCTs which were also used in less effective interventions.ConclusionsAlthough limited by small sample sizes and short follow up periods, this review suggests that interventions specifically designed to change sedentary behaviour, reduce overall daily sitting time by half an hour, with an equivalent increase in standing time, in the short to medium term. Effective characteristics and behaviour change strategies are identified for future development of high quality interventions targeting change in sedentary behaviour.Prospero registrationPROSPERO 2020 CRD42020172457 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172457.

Exploring the behavioral determinants of COVID-19 vaccine acceptance among an urban population in Bangladesh: Implications for behavior change interventions.

While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p<0.001) predictors of vaccine acceptance in this population are beliefs around both injunctive and descriptive social norms. Specifically, Acceptors were 3.2 times more likely to say they would be very likely to get a COVID-19 vaccine if a doctor or nurse recommended it, twice as likely to say that most people they know will get a vaccine, and 1.3 times more likely to say that most close family and friends will get a vaccine. The perceived safety of vaccines was found to be important since Non-acceptors were 1.8 times more likely to say that COVID-19 vaccines are "not safe at all". Beliefs about one's risk of getting COVID-19 disease and the severity of it were predictive of being a vaccine acceptor: Acceptors were 1.4 times more likely to say that it was very likely that someone in their household would get COVID-19, 1.3 times more likely to say that they were very concerned about getting COVID-19, and 1.3 times more likely to say that it would be very serious if someone in their household contracted COVID-19. Other responses of Acceptors on what makes immunization easier may be helpful in programming to boost acceptance, such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols. An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.

Medical Research Council Hot Topic workshop report: Planning a UK Nutrition and Healthy Life Expectancy Trial

AbstractThere is a drive in the UK to harness findings from novel fundamental and efficacy nutritional research and, through inter‐disciplinary and multi‐agency collaborations, to improve eating behaviour for the benefit of population health. This report summarises the progress made during the Medical Research Council‐funded Hot Topic workshop on the planning for a potential UK‐wide nutrition primary prevention randomised controlled trial with incident disease as the study endpoint: the UK Nutrition and Healthy Life Expectancy (NuLifE) Trial. Through two workshops, along with online discussions and a systematic evidence synthesis, over 40 experts from a range of disciplines came together over 6 months. The workshop reached a consensus and delivered a three‐stage plan with the ultimate ambitious aim of providing effective eating behaviour change strategies to address the growing inequalities in the UK and contribute to both a reduced risk of prevalent diet‐related chronic disease and an increase in healthy life expectancy.

Using Social Marketing to Promote Preventive Behaviors Related to COVID-19.

Coronavirus disease 2019 (COVID-19), is an infectious disease caused by SARS-CoV-2 virus, a newly discovered coronavirus, the best strategy to deal with the infection is prevention aimed at reducing transmission in the community. This article aimed to using effective behavior change strategies are needed to control COVID-19. Social marketing facilitates the acceptance, rejection, modification, abandonment, or maintenance of particular behaviors by groups of individuals, often referred to as the target audience. The six-benchmark criteria for social marketing interventions include Behavior change, Customer research, Audience segmentation Marketing mix, Exchange, Competition. Social marketing can promote healthy behaviors. Perceived benefits of the preventive behaviors can be considered. Besides, media, advertising, and other methods to reach out to the consumers to inform and encourage them should be considered. For this purpose, a slogan and a logo should be designed and installed in all educational interventions and media such as posters, pamphlets, face-to-face training sessions, group discussion sessions, telephone counseling, and videos. Advertising using celebrities covering their faces with masks can persuade people to wear face mask. To promote health behaviors, professionals should pay attention to the segmentation of the target audience before providing any service. All plans should be piloted before implementation. Besides, information sources should be organized, and media that should be used to inform the target audience should be identified.

Clustering of Six Key Risk Behaviors for Chronic Disease among Adolescent Females.

Chronic diseases are the leading cause of disability and mortality globally. In Australia, females are at heightened risk. This research explored the prevalence, patterns, and correlates of six key risk behaviors (physical inactivity, poor diet, recreational screen time, inadequate sleep, alcohol use, and smoking) among adolescent females and whether knowledge of health guidelines was associated with adherence. Adolescent females completed an anonymous online questionnaire (N = 687; Mage = 13.82). Logistic regression assessed the association between knowledge and adherence. A Latent Class Analysis (LCA) and three-step procedure identified risk behavior clusters and their correlates. Despite positive health self-ratings (77% good/very good), most participants reported insufficient moderate-to-vigorous physical activity (MVPA; 89%), vegetable intake (89%), and excessive screen time (63%). Knowledge of guidelines was associated with adherence for MVPA, vegetable intake, sleep, and alcohol abstinence. Three classes emerged: “moderate risk” (76%), “relatively active, healthy eaters” (19%), and “excessive screen users” (5%). These risk-behavior clusters were associated with perceived value of academic achievement and physical wellbeing. Adolescent females commonly perceive they are in good health, despite engaging in unhealthy behaviors. Public health interventions should utilize effective behavior change strategies, adopt a multiple health behavior change approach (MHBC), and be tailored to specific risk profiles and values among females.

Wearable Devices to Monitor and Reduce the Risk of Cardiovascular Disease: Evidence and Opportunities.

There is a growing interest in using wearable devices to improve cardiovascular risk factors and care. This review evaluates how wearable devices are used for cardiovascular disease monitoring and risk reduction. Wearables have been evaluated for detecting arrhythmias (e.g., atrial fibrillation) as well as monitoring physical activity, sleep, and blood pressure. Thus far, most interventions for risk reduction have focused on increasing physical activity. Interventions have been more successful if the use of wearable devices is combined with an engagement strategy such as incorporating principles from behavioral economics to integrate social or financial incentives. As the technology continues to evolve, wearable devices could be an important part of remote-monitoring interventions but are more likely to be effective at improving cardiovascular care if integrated into programs that use an effective behavior change strategy.

Exercise And Nutrition Patterns Of Pregnant Women Self-Selecting For Participation In A Lifestyle Intervention

Exercise and healthy eating are integral parts of a comprehensive healthy lifestyle intervention during pregnancy. Women who volunteer to participate in such an intervention in early to mid-pregnancy may already be practicing healthy lifestyle habits such as walking 10,000 steps/day (active), and consuming 1800-2252 kilocalories/day (kcal), whereas most pregnant woman walk on average 3000-7000 steps/day (sedentary to low active) and consume 1882-2789 kcal/day. As such, intervention participants may not be representative of the general population of pregnant women, especially relating to exercise. PURPOSE: To assess the baseline exercise and nutrition patterns of pregnant women who enrol in a healthy lifestyle intervention in London, Canada. METHODS: Pregnant women who had self-selected to participate in a nutrition and exercise intervention completed a baseline (12-18 weeks gestation) 3-day step count log and 3-day food intake record (3dFR). Step counts were recorded over 3 consecutive days using a hip-worn pedometer or a wrist-worn activity tracker, and an average was calculated. The 3dFR was completed over the same 3 consecutive days and was analyzed for average energy intake (kcal) using Nutritionist Pro (NP; Axxya Systems). Measured height and self-reported pre-pregnancy weight were used to calculate pre-pregnancy body mass index (BMI). Gestational age at study entry and maternal age were also collected. RESULTS: Ninety-seven pregnant women chose to participate in a healthy lifestyle intervention study and completed both the 3-day step count log and 3dFR at baseline. At study entry, mean daily steps were 7399±2741 (low to above normal range) and energy intake was 2305±634 kcal/day (within to above normal range). Pre-pregnancy BMI was 26.2±5 kg/m2 (overweight), gestational age was 15±3 weeks, and maternal age was 32±4 years. CONCLUSION: Many pregnant women who self-select to participate in a lifestyle intervention in early to mid-pregnancy may already have healthy patterns of exercise and to a lesser extent nutrition. To achieve a more representative sample of pregnant women, interventions could be performed in a clinical setting, which may allow for better identification of effective behaviour change strategies to promote and maintain healthy exercise and nutrition patterns during pregnancy.

Applying Behavioral Economics to Enhance Safe Firearm Storage.

Behavioral economics applies key principles from psychology and economics to address obstacles to behavior change. The important topic of pediatric firearm injuries has not yet been explored through a behavioral economic lens. Pediatric firearm-related injuries are a significant public health problem in the United States. Despite American Academy of Pediatrics guidelines advising that firearms be stored unloaded, in a locked box or with a locking device, and separate from ammunition, estimates suggest that ∼4.6 million children live in homes with at least 1 loaded and unlocked firearm. In this article, we use behavioral economic theory to identify specific cognitive biases (ie, present bias; in-group, out-group bias; and the availability heuristic) that may influence parental decision-making around firearm storage. We illustrate situations in which these biases may occur and highlight implementation prompts, in-group messengers, and increased salience as behaviorally informed strategies that may counter these biases and subsequently enhance safe firearm storage. We also describe other opportunities to leverage the behavioral economic tool kit. By better understanding the individual behavioral levers that may impact decision-making around firearm storage, behavioral scientists, pediatric providers, and public health practitioners can partner to design and test tailored interventions aimed at decreasing pediatric firearm injuries. Further empirical study is warranted to identify the presence of specific biases and heuristics and determine the most effective behavior change strategies for different subpopulations.

Development of a food literacy intervention for couples trying to conceive

AbstractIntroductionAs a preconception healthy diet is not only beneficial for couples’ general health but also for their reproductive health, effective interventions are necessary and lacking. In the field of nutrition, the concept of food literacy is emerging. Food literacy is the interrelated combination of knowledge, skills and self-efficacy on food planning, selecting foods, food preparation, eating and evaluating information about food with the ultimate goal of developing a lifelong healthy, sustainable and gastronomic relationship with food. The present study describes the systematic development of a food literacy intervention for couples trying to conceive.Materials and methodsThe development of the food literacy intervention was guided by Intervention Mapping, a protocol for developing theory- and evidence-based health promotion interventions in combination with consulting stakeholders. Decisions during intervention development were based on literature, an observational study evaluating the diet of couples trying to conceive using a food frequency questionnaire (FFQ) and semi-structured interviews and user tests with experts in the field and couples trying to conceive.ResultsAn innovative intervention to influence preconception diet and food literacy based on stakeholders opinion, effective behavior change strategies and attractive intervention channels was developed. Regarding needs assessment, the observational study showed that the diet of couples trying to conceive (n = 57) was inadequate (i.e. lack of vegetable intake) and highly correlated between partners. Objectives regarding food literacy were determined by participating experts (n = 12) rating ‘making healthy food choices’ as most important objective. A blended format (i.e. a mobile application in combination with telephone interaction with a health care professional) was selected as intervention channel based on semi-structured interviews with people trying to conceive (n = 17) as they highlighted the importance of support by experts and a time efficient intervention. Knowledge and self-efficacy regarding food literacy were selected as determinants to address. The main behavioral change strategies included in the intervention were tailoring, goal setting and motivational interviewing resulting in tailored goals, tips about food literacy and recipes. Experts (n = 15) and couples trying to conceive (n = 8) evaluated the intervention as easy to use.DiscussionThis intervention will be evaluated on reproductive and dietary outcomes via a randomized controlled trial in Belgian Fertility clinics among 460 couples trying to conceive. If this theory- and evidence based food literacy intervention proves to be effective on reproductive and dietary outcomes in couples trying to conceive, it will offer vision and practical tools for implementing food literacy interventions in preconception care.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE.

Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). Secondary analysis of a randomized controlled trial. Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150min of moderate physical activity weekly. A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04). We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS. NCT01828567.

Obesity intervention programs among adolescents using social cognitive theory: a systematic literature review.

Social cognitive theory (SCT) is a well-known theory for designing nutrition education and physical activity programs for adolescents. This systematic review aimed to evaluate the efficacy of intervention studies based on SCT in reducing or preventing overweight and obesity in adolescents. An electronic literature search in PubMed-Medline, Web of Science and Scopus was performed to identify intervention studies based on SCT aiming at preventing or reducing obesity in adolescents. All the articles published up to July 2016 were included. Only studies reporting body mass index (BMI) or its variant as one of the outcome measures were included. From 240 initially identified studies, 12 met the eligibility criteria. Seven had moderate or strong study quality. Two of the eight randomized controlled trials (RCT) and two of the four quasi-experimental studies showed significant reduction in BMI among intervened participants compared to control. Impacts on diet and physical activity were mixed, but were mostly not significant. The current systematic review found only weak evidence for the efficacy of SCT-based interventions in treating and preventing obesity in adolescents. Further studies systematically using effective behavior change strategies or techniques, larger population sizes, better measurement tools and more robust designs are warranted for a conclusive judgment.

Theory based interventions for caries related sugar intake in adults: systematic review

BackgroundTheories of behavior change are essential in the design of effective behaviour change strategies. No studies have assessed the effectiveness of interventions based on psychological theories to reduce sugar intake related to dental caries. The study assessed the effect of interventions based on Social Congition Models (SCMs) on sugar intake in adults, when compared with educational interventions or no intervention.MethodsA range of papers were considered: Systematic review Systematic Reviews with or without Meta Analyses; Randomised Controlled Trials; Controlled Clinical Trials and Before and after studies, of interventions based on Social Cognition Models aimed at dietary intake of sugar in adults. The Cochrane database including: Oral Health Group’s Trials Register (2015), MEDLINE (from 1966 to September 2015), EMBASE (from 1980 to September 2015), PsycINFO (from 1966 to September 2015) were searched.ResultsNo article met the full eligibility criteria for the current systematic review so no articles were included.ConclusionThere is a need for more clinical trials to assess the effectiveness of interventions based on psychological theory in reducing dietary sugar intake among adults.Systematic Review Protocol RegistrationPROSPERO: CRD42015026357.

Does the presence of cardiovascular disease risk factors or established disease influence the dietary intake of affected adults and their children residing in the same household? A secondary analysis of the Australian Health Survey (2011\u20132013)

BackgroundDiet is an important contributor to risk of cardiovascular disease (CVD) and integral in management and delaying progression. Little is known however about whether increased CVD risk or established CVD has any influence on dietary intakes of Australian adults or children residing in the same household. This study aimed to determine whether the presence of CVD or CVD risk factors influences dietary intake of Australian adults and if the presence of an adult with increased CVD risk influences the dietary intake of a child living in the same household.MethodsData were sourced from the 2011–2013 Australian Health Survey for: (1) adults ≥18 years with risk factors or established CVD and (2) children 2–17 years residing in the same household as adults with CVD risk factors or established CVD. Selected nutrient intakes (total fat, saturated fat plus trans fat, alpha-linolenic acid, total long chain omega 3 fatty acids, fibre and sodium) collected by repeated 24 h recalls were compared to national dietary recommendations and to the intakes of all other adults and children surveyed. Standard errors of the estimates were calculated using the replicate weights method, and an alpha value of <0.05 considered statistically significant.ResultsSix thousand two hundred sixty five of 9435 adults surveyed were identified as having CVD risk factors or established disease and of these 1609 had a child in the same household that also contributed data in this survey. No differences were observed in adjusted mean dietary intakes between those without risk factors or established CVD and those with, except for total energy and sodium which were significantly lower in the adults with CVD risk factors and/or established disease. However sodium intakes across both groups were higher than recommended targets. There were no differences for selected nutrients between children residing with affected adults and other children surveyed.ConclusionsWhile intakes of Australian adults with CVD risk factors or established disease were favourable for sodium, compared to unaffected adults, there is still scope for improvement as many Australian adults, despite CVD risk, are unable to achieve targets for selected nutrients. Effective dietary behaviour change strategies and resources are urgently needed.

Gaming Your Way to Health: A Systematic Review of Exergaming Programs to Increase Health and Exercise Behaviors in Adults.

Adults who are not engaged by traditional exercise methods require a strategy to achieve and maintain sufficient physical activity for health benefits. Exergames, or active videogames, may motivate some adults to engage in physical activity. This review explored the use of exergaming to promote physical activity behaviors and health in adults. A systematic literature review of the use of exergaming was conducted. The review included experimental studies with a nonclinical adult population, which measured changes in physical activity behaviors and changes in anthropometric healthy weight indicators. From an initial search that yielded 1644 results, nine articles were found to satisfy the predetermined inclusion criteria and were included in this review. Exergaming provided a novel method for increasing or substituting physical activity in the short term. Although low participation was not associated with anthropometric changes, significant healthy anthropometric changes were associated with moderate to high exergaming participation. Exergaming may be employed as an effective exercise behavior change strategy in the short term and may have positive health benefits if recommendations are made regarding intensity and duration of play for optimal health outcomes. However, additional research is required to evaluate the effectiveness of exergaming as a long-term health promotion strategy.

Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations

Substantial reductions in U.S. cigarette smoking and associated chronic diseases over the past 50 years have benefited health. Unfortunately, those reductions have distributed unevenly throughout the population. Smoking remains prevalent and even increasing among certain vulnerable populations: economically disadvantaged groups, those with other substance-use disorders or mental illness, certain ethnic and racial minorities, and gender and sexual minorities. Moreover, other unhealthy behavior patterns (physical inactivity, unhealthy food choices, risky sexual behavior, poor adherence to medical preventive regimens) and associated chronic diseases are also overrepresented in many of these same populations. Disparities in unhealthy behavior patterns contribute to health disparities and escalating health care costs, underscoring the need for more effective behavior-change strategies. This report reviews research on the efficacy of financial incentives for reducing smoking in vulnerable populations, while also touching on applications of that behavior-change strategy for promoting other health-related behavior changes in vulnerable populations.