Framework For Behavior Change Research Articles

Novel behaviour change frameworks for digital health interventions: A critical review.

Digital health interventions - interventions delivered over digital media to support the health of users - are becoming increasingly prevalent. Utilising an intervention development framework can increase the efficacy of digital interventions for health-related behaviours. This critical review aims to outline and review novel behaviour change frameworks that guide digital health intervention development. Our comprehensive search for preprints and publications used PubMed, PsycINFO, Scopus, Web of Science and the Open Science Framework repository. Articles were included if they: (1) were peer-reviewed; (2) proposed a behaviour change framework to guide digital health intervention development; (3) were written in English; (4) were published between 1/1/19 and 1/8/2021; and (5) were applicable to chronic diseases. Intervention development frameworks considered the user, intervention elements and theoretical foundations. However, the timing and policy of interventions are not consistently addressed across frameworks. Researchers should deeply consider the digital applicability of behaviour change frameworks to improve intervention success.

Understanding risk factors for musculoskeletal disorders in Iranian housewives: Development of a comprehensive health promotion behavior model

BackgroundChronic musculoskeletal problems are a major source of disability, reduced productivity and poor quality of life. Prevalence of musculoskeletal disorders among Iranian housewives is particularly high. Understanding how housework causes the injuries, mobility restrictions and pain associated with musculoskeletal disorders is vital to developing health promotion behavior models to support intervention. The aim of this qualitative study was to explore the experiences of housewives with musculoskeletal disorders and, according to the risk factors identified, to develop a comprehensive behavior change framework to facilitate implementing a musculoskeletal health-promoting training intervention for women.MethodsTwenty-four in-depth interviews were conducted with Iranian housewives aged 20–65 years experiencing musculoskeletal pain over a 13-month period from September 2020 to October 2021. The conventional content analysis approach was used to interrogate the data. The transcript of each interview was considered a unit of analysis, and data analysis was performed using MAXQDA2018 software.ResultsThe analysis of the interview data provided 1432 meaning units. From these codes, a conceptual framework was developed. This comprehensive model is comprised of 24 subcategories, eight categories and three themes: Individual and social predictors of MSDs and their control, Risk factors for MSDs, and Prevention and treatment of MSDs. Altogether the developed conceptual framework specified the multiple risk factors for MSDs in housewives. The findings were aligned to various health promotion models, and it was seen that ecological models, especially the Theory of Triadic Influence, can be very helpful as a supportive roadmap to implementing multilateral interventions to improve the quality of life of housewives.ConclusionsThis study developed an evidence based comprehensive model that identifies the individual, psychosocial, and cultural factors that influence the status of MSDs in women’s domestic work to support the development and implementation of effective ergonomic interventions to manage potentials for MSDs.

Health promotion programs for middle-aged adults that promote physical activity or healthy eating and involve local governments and health services: A rapid review.

Noncommunicable diseases can be prevented or delayed through health promotion programs. Little is known about programs delivered by partnership organisations that address lifestyle behaviours. The study's purpose was to review the literature on physical activity or healthy eating health promotion programs, delivered in partnership by the local government and local health services, to describe characteristics of programs and their impact on physical activity, healthy eating or related health outcomes among middle-aged adults. This rapid review was conducted from November 2021 to June 2022, informed by the Cochrane Rapid Reviews Methods guidance for conducting rapid reviews. Articles published in English since 2000 were identified in Medline, Embase, CINAHL, AgeLine and Scopus databases. A narrative synthesis was performed. Ten articles involving 19 802 participants were identified from a total of 4847 articles identified from the search. The primary role of the partnership was providing funds. Other roles were facilitating stakeholder involvement, program development, delivery and recruitment. Positive outcomes were likely if programs were developed by collaborative stakeholder partnerships, informed by previous research or a behaviour change framework. The heterogeneity of study designs and reported outcomes did not permit meta-analysis. This review highlights the lack of evidence of local government-health service partnerships delivering physical activity or healthy eating health promotion programs for middle-aged adults. Programs designed collaboratively with an evidence base or a theory base are recommended and can guide future work investigating strategies for partnership development. SO WHAT?: Physical activity or healthy eating health promotion programs need early stakeholder collaborative input designed with a theory/evidence base. This can guide future work for investigating strategies for partnership development.

Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP)

Dengue represents a major public health concern. With effective vaccines in development, it is important to identify motivational factors to maximize dengue vaccine uptake. A cross-sectional, quantitative, electronic survey was administered to a nationally representative adult population (n = 3800) in Argentina, Brazil, Colombia, Mexico, Indonesia, Malaysia, and Singapore. Willingness to vaccinate against dengue, and Knowledge, Attitudes, and Practices (KAP) toward dengue, vector control, prevention, and vaccination were determined. The Capability, Opportunity, Motivation for Behavior change (COM-B) framework was used to identify factors correlated with dengue vaccine(s) uptake. KAP scores (standardized, 0-100% scale) resulted in a low global score for Knowledge (48%) and Practice (44%), and a moderate score for Attitude (66%); scores were comparable across countries. Of all respondents, 53% had a high willingness (Score: 8-10/10) to vaccinate against dengue, which was higher (59%) in Latin America (Argentina, Brazil, Colombia, Mexico) than in Asia Pacific (40%) (Indonesia, Malaysia, Singapore). Key factors significantly (p < 0.05) associated with increased willingness to vaccinate included accessibility to the public (subsidies and incentives) and trust in the healthcare system and government. A common approach to dengue prevention across endemic countries--with some country-specific customization, including education, vaccination, and vector control (multi-pronged)--may reduce dengue burden and improve outcomes.

Changing Hearts and Minds in the Equestrian World One Behaviour at a Time.

Equestrianism is currently facing a range of pressing challenges. These challenges, which are largely based on evolving attitudes to ethics and equine wellbeing, have consequences for the sport's social licence to operate. The factors that may have contributed to the current situation include overarching societal trends, specific aspects of the equestrian sector, and factors rooted in human nature. If equestrianism is to flourish, it is evident that much needs to change, not the least, human behaviour. To this end, using established behaviour change frameworks that have been scientifically validated and are rooted in practice-most notably, Michie et al.'s COM-B model and Behaviour Change Wheel-could be of practical value for developing and implementing equine welfare strategies. This review summarises the theoretical underpinnings of some behaviour change frameworks and provides a practical, step-by-step approach to designing an effective behaviour change intervention. A real-world example is provided through the retrospective analysis of an intervention strategy that aimed to increase the use of learning theory in (educational) veterinary practice. We contend that the incorporation of effective behaviour change interventions into any equine welfare improvement strategy may help to safeguard the future of equestrianism.

The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care.

<h3>Key Messages</h3> With increased evidence of the importance of promoting respectful maternity care (RMC), and more interventions being developed, implementers and intervention developers could learn from existing frameworks to guide the design of more effective interventions. We argue that a behavior change framework, such as the capability, opportunity, and motivation behavior model, holds value for moving the needle on RMC because respectful care relies primarily on the behavior of the provider. We map existing interventions to this framework to highlight opportunities for learning from existing interventions and to guide future development.

Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

BackgroundHand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitating and stimulating HH behavior.MethodsConcept development was initiated by selecting a theoretical framework after which contextual field studies aimed at discovering causes for poor compliance were conducted. Potential solutions were brainstormed upon during focus group sessions. Low-fidelity prototypes were tested regarding feasibility, usability, and acceptability. A final concept was crafted drawing from findings from each design phase.ResultsComplying with recommended HH guidelines is unrealistic and infeasible due to frequent competing (clinical) priorities requiring HH. The concept “Island-based nursing,” where a patient room is divided into two geographical areas, namely, the island and general zone, was created. HH must be performed upon entering and exiting the island zone, and after exposure to any surface within the general zone. Reminding of HH is prompted by illuminated demarcation of the island zone, serving as the concept’s nudge.ConclusionsIsland zone demarcation facilitates and economizes HH indications in an innovative and intuitive manner.ImpactAlthough hand hygiene (HH) is the single most important element in the prevention of nosocomial infections in neonates, improving and sustaining adequate HH compliance rates remains a significant challenge.Complying with recommended HH guidelines was found to be unrealistic and infeasible due to the significant amount of time required for HH in a setting with a high workload and many competing (clinical) priorities.The concept of “Island-based nursing,” under which the primary HH indication is upon entering and exiting the island zone, facilitates and economizes HH indications in an innovative and user-friendly manner.

Use of designing for behaviourchange framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8-23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition-sensitive agriculture programme.

Inadequate diet quality is a cause of undernutrition among children 6-23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8-23 months. Data were collected from 45 mothers of children 8-23 months, who provided animal-source foods to their children (doers),and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severityand perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at homeand the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn incomeand support gender-equitable household workloads and decision-making for optimal child feeding.

Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = −2.06, p = .046, d = −0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement’s effects on physical and mental health.

Older adults' and caregivers' perceptions about urinary tract infection and asymptomatic bacteriuria guidelines: a qualitative exploration.

To explore older adults' and caregivers' knowledge and perceptions of guidelines for appropriate antibiotics use for bacteria in the urine. Semi-structured qualitative interviews. Infectious disease clinics, community senior living facilities, memory care clinics, and general public. Patients 65 years or older diagnosed with a urinary tract infection (UTI) in the past two years, or caregivers of such patients. We conducted interviews between March and July 2023. We developed an interview guide based on the COM-B (capability, opportunity, motivation-behavior) behavior change framework. We thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. Thirty participants (21 patients, 9 caregivers) enrolled. Most participants understood UTI symptoms such as pain during urination and frequent urination. However, communication with multiple clinicians, misinformation, and unclear symptoms that overlapped with other health issues clouded their understanding of asymptomatic bacteriuria (ASB) and UTIs. Some participants worried that clinicians would be dismissive of symptoms if they suggested a diagnosis of ASB without prescribing antibiotics. Many participants felt that the benefits of taking antibiotics for ASB outweighed harms, though some mentioned fears of personal antibiotic resistance if taking unnecessary antibiotics. No participants mentioned the public health impact of potential antibiotic resistance. Most participants trusted information from clinicians over brochures or websites but wanted to review information after clinical conversations. Clinician-focused interventions to reduce antibiotic use for ASB should also address patient concerns during clinical visits, and provide standardized high-quality educational materials at the end of the visit.

Framework for behaviour change implemented in real-time and post-trip interventions of the H2020 i-DREAMS naturalistic driving project

The aim of the European funded Horizon 2020 project i-DREAMS11†Information about the i-DREAMS project can be found on the website: https://idreamsproject.eu is to develop, implement and evaluate a cluster of innovative real-time and post-trip interventions to improve road safety among both private and professional drivers operating different modes in road (i.e., car, bus, truck) and rail by means of a field trial with 600 participants in five different countries (i.e., Belgium, UK, Germany, Greece, and Portugal). This paper presents the theoretical paradigms of behavioural change adopted in the i-DREAMS interventions, and elaborates on the methodological framework used to determine intervention objectives, select suitable techniques for behavioural change, and further translate these into a series of gamification features to be integrated into an in-vehicle feedback display, and a smartphone app supported by an online web-platform.

Informing the design of a digital intervention to support sexually transmissible infection care in general practice: a qualitative study exploring the views of clinicians.

Strengthening sexually transmissible infection (STI) management in general practice is prioritised in Australian STI strategy. Digital interventions incorporating clinical decision support offer a mechanism to assist general practitioners (GPs) in STI care. This study explored clinicians' views towards a proposed digital intervention for supporting STI care in Australian general practice as a first step in the tool's design. Semi-structured one-to-one interviews were conducted during 2021 with sexual health physicians (n =2) and GPs (n =7) practicing in the state of Victoria, Australia. Interviews explored views on a proposed STI digital intervention for general practice. We applied the Theoretical Domains Framework (TDF), a behaviour change framework to our analysis. This involved: (1) directed content analysis of transcripts into TDF domains; and (2) thematic analysis to identify sub-themes within relevant TDF domains. Subthemes were subsequently categorised into enablers and barriers to the use and implementation of a STI computerised clinical decision support system (CDSS). All interviewees viewed a digital intervention for STI care favourably, expressing confidence in its potential to improve care and support management. Within the relevant TDF domains (e.g. environmental context and resources), subthemes emerged as barriers (e.g. lack of sensitivity to patient context) or enablers (e.g. clear communication and guidance) to the use and implementation of a STI CDSS in primary care. Multiple subthemes (e.g. time constraints) have the potential to be a barrier or an enabler, and is largely dependent on end-user needs being met and clinical context being appropriately addressed. A digital intervention incorporating clinical decision support was viewed favourably, indicating a possible role for such a tool in Australian general practice. Co-design with end-users and prototype evaluation with health consumers is recommended to ensure relevance and usefulness.

Assessing the Impacts of Creating Active Schools on Organisational Culture for Physical Activity.

National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.

Barriers and Facilitators to Successful Intensive Adherence Counseling in Rural Northern Uganda: An Exploratory Interview with HIV-Positive Clients Using the COM-B Framework.

Intensive adherence counseling (IAC) was introduced as a strategy to enhance adherence to antiretroviral therapy (ART) among HIV clients with non-suppressed viral loads. There has been sub-optimal viral load suppression among HIV clients in Uganda enrolled in IAC. However, there is a scarcity of literature on the barriers and facilitators of successful IAC. We aim to explore the barriers and facilitators to successful IAC among HIV-positive clients seeking care in public health facilities in rural northern Uganda. This was an exploratory qualitative study conducted among 15 purposively sampled HIV-positive clients enrolled in IAC in public health facilities offering ART services in northern Uganda. We conducted in-depth interviews using semi-structured interview guides based on the capability, opportunity, motivation, and behavior (COM-B) framework for behaviour change. Data were analyzed using the deductive thematic approach of Braun and Clarke following the COM-B framework. The majority of the participants were females (60%), married (53%), and attained primary education (47%). Barriers to successful IAC were Capability - alcoholism and promiscuity, Opportunity - stigma and discrimination, delayed viral load result, shortage of food, and heavy workload; and Motivation - deteriorating health and lack of incentives. Facilitators to successful IAC were Capability - good knowledge of ART, good memory, and reminder alerts; Opportunity - availability of ART, social support, availability of ART, prolonged ART refill, and good counseling; and Motivation - desire to live longer and healthy and the desire to fulfill dreams and goals. Successful implementation of IAC needs to consider the context of the person in care thus the need to strengthen individualized IAC sessions. HIV care providers can adopt the COM-B framework to perform individualized IACs and use the information to strengthen the counseling sessions.

Barriers and enablers to diabetic retinopathy screening: a cross-sectional survey of young adults with type 1 and type 2 diabetes in the UK

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults (YAs) is consistently below recommended levels. The aim of this study was to identify barriers and enablers of DRS attendance among YAs...

Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK

Abstract Background Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite. Methods Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152; focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework. Results Uptake was high (n = 464 students opted-in; 98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority. Conclusions This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings. Key messages • Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing. • This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.

Spatial heterogeneity and socioeconomic transformation challenge the prevention of illegal wildlife consumption in China

Wildlife can be viewed as a renewable resource at ecologically viable levels, but illicit consumption is a major threat to global biodiversity. Using data from crime cases is an emerging new tool for assessing the motives and drivers of wildlife offenders. This approach can be used with behavior change frameworks to devise more effective conservation strategies. We used data from 20,145 online judgments published between 2014 and 2019 to determine the spatial distribution of different wildlife crime and illegal consumption patterns across China, and used multiscale modeling to test the effects of socioeconomic, geographic, and demographic correlates. The results indicated that geographic indicators and agricultural practices had a broad and positive impact on wildlife consumption, implying wildlife availability was a powerful incentive for wildlife crimes. In addition, urbanization and industrial structure were regionally sensitive in predicting convictions for wild meat, traditional medicine, and human-nature conflicts. Given the socioeconomic transformation in modern China, we predict that functional approaches of wildlife utilization will decrease in the coming years, but the illegal consumption characterized by financial and spiritual demand is unlikely to diminish. As a response, the prevention strategy should strengthen law enforcement on non-functional consumption and enhance nature education campaigns among youths across the country.

Determinants of food preparation and hygiene practices among caregivers of children under two in Western Kenya: a formative research study

IntroductionDiarrhea is a leading cause of child morbidity and mortality worldwide and is linked to early childhood stunting. Food contamination from improper preparation and hygiene practices is an important transmission pathway for exposure to enteric pathogens. Understanding the barriers and facilitators to hygienic food preparation can inform interventions to improve food hygiene. We explored food preparation and hygiene determinants including food-related handwashing habits, meal preparation, cooking practices, and food storage among caregivers of children under age two in Western Kenya.MethodsWe used the Capabilities, Opportunities, and Motivations model for Behavior Change (COM-B) framework in tool development and analysis. We conducted 24 focus group discussions with mothers (N = 12), fathers (N = 6), and grandmothers (N = 6); 29 key informant interviews with community stakeholders including implementing partners and religious and community leaders; and 24 household observations. We mapped the qualitative and observational data onto the COM-B framework to understand caregivers’ facilitators and barriers to food preparation and hygiene practices.ResultsFacilitators and barriers to food hygiene and preparation practices were found across the COM-B domains. Caregivers had the capability to wash their hands at critical times; wash, cook, and cover food; and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, caregivers’ lack of knowledge of critical times for handwashing, lack of perceived importance of washing some foods before eating, and not knowing the risks of storing food for more than four hours without refrigerating and reheating. Other barriers were opportunity-related, including lack of resources (soap, water, firewood) and an enabling environment (monetary decision-making power, social support). Competing priorities, socio-cultural norms, religion, and time constraints due to work hindered the practice of optimal food hygiene and preparation behaviors.ConclusionFood hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. Our study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene.

Responsive Feeding Environments in Childcare Settings: A Scoping Review of the Factors Influencing Implementation and Sustainability.

Children benefit from responsive feeding environments, where their internal signals of hunger and satiety are recognized and met with prompt, emotionally supportive and developmentally appropriate responses. Although there is existing research on responsive feeding environments in childcare, there is little synthesized literature on the implementation practices using a behavior change framework. This scoping review sought to explore the factors influencing the implementation and sustainability of responsive feeding interventions in the childcare environment, using the behavior change wheel (BCW). A total of 3197 articles were independently reviewed and 39 met the inclusion criteria. A thematic analysis identified the factors influencing the implementation and sustainability of responsive feeding, including the following: (1) pre-existing nutrition policies, (2) education and training, (3) provider beliefs and confidence, (4) partnership development and stakeholder engagement and (5) resource availability. The most common BCW intervention functions were education (n = 39), training (n = 38), environmental restructuring (n = 38) and enablement (n = 36). The most common policy categories included guidelines (n = 39), service provision (n = 38) and environmental/social planning (n = 38). The current literature suggests that broader policies are important for responsive feeding, along with local partnerships, training and resources, to increase confidence and efficacy among educators. Future research should consider how the use of a BCW framework may help to address the barriers to implementation and sustainability.

Assessing the effectiveness of the transformational coaching workshop using behavior change theory

The current study assessed how participation in the Transformational Coaching Workshop (TCW) influenced youth sport coaches’ perceived capability, opportunity, and motivation to incorporate transformational coaching behaviors into their coaching practices. Sixty-three volunteer youth sport coaches participated in the study as part of an intervention ( n = 31; Mage = 45.65 years; SDage = 8.82 years) or comparison group ( n = 32; Mage = 44.59 years; SDage = 11.86 years). The study employed a two-arm, pre- and post-intervention, non-randomized intervention design. Dependent- and independent-sample t-tests were conducted to assess within and between-group differences. Results indicated that participants in the intervention group reported slight improvements in their perceived capability and opportunity to use transformational coaching behaviors post-intervention. There were no significant differences between groups post-intervention. This study provides support for the effectiveness of the TCW, and the application of behavior change frameworks to evaluate coach development programs.