Future Behavior Change Interventions Research Articles

From educator to facilitator: Healthcare professionals' experiences of, and views about, delivering a type 1 diabetes structured education programme (DAFNEplus ) informed by behavioural science.

The DAFNEplus programme incorporates behaviour change techniques into a modified educational intervention and was developed to help address the glycaemic drift observed amongst graduates of standard DAFNE programmes. As the programme's success will be contingent on staff buy-in, we explored healthcare professionals' experiences of, and views about, delivering DAFNEplus during a clinical trial to help inform decision making about rollout post-trial. We interviewed n = 18 nurses and dieticians who delivered DAFNEplus during the trial. Data were analysed thematically. While many shared initial reservations, all described how their experiences of DAFNEplus programme delivery had had a positive, transformative impact upon their perceptions and working practices. This transformation was enabled by initial training and supervision sessions, the confidence gained from using scripts to support novel programme content delivery, and experiences of delivering the programme and observing DAFNEplus principles being well received by, and having a positive impact on, attendees. Due to these positive experiences, interviewees described a strongly felt ethical mandate to use some DAFNEplus techniques and curriculum content in routine clinical care. While being supportive of a national rollout, they anticipated a variety of attitudinal and logistical (e.g. workload) challenges. This study provides a vital dimension to the evaluation of the DAFNEplus programme. Interviewees found the intervention to be acceptable and expressed high levels of buy-in. As well as offering potential endorsement for a national rollout, our findings offer insights which could help inform development and rollout of future behaviour change interventions to support diabetes self-management.

Physical Activity in Individuals Newly Diagnosed With Multiple Sclerosis Through the Lens of the COM-B Model.

Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population.

Barriers to and Facilitators of Delabelling of Antimicrobial Allergies: A Qualitative Meta-synthesis.

Patients who report penicillin allergies may receive alternative antibiotics. Such substitution contributes to antimicrobial resistance, lower treatment efficacy, increased frequency of adverse events, and increased costs. Approximately 90% of individuals who report a penicillin allergy can tolerate a penicillin. To identify the barriers to and facilitators of removal by health care workers of inaccurate antimicrobial allergies from patient records, known as delabelling. The MEDLINE database was searched from inception to December 29, 2020. Qualitative studies evaluating health care professionals' perceptions of barriers to and/or facilitators of the act of delabelling a patient's antimicrobial allergies were included in the meta-synthesis. The Theoretical Domains Framework was used to code and group individual utterances from the included studies, which were mapped to the Behaviour Change Wheel and corresponding intervention function and policy categories. Four studies met the inclusion criteria. Eight themes were identified as representing barriers to delabelling: delabelling skills, patient education skills, knowledge, electronic health records (EHRs), communication frameworks, time, fear about allergic reactions, and professional roles. Behaviour change interventions that may overcome these barriers include education, training, algorithms and toolkits, changes to EHRs, use of dedicated personnel, policies, incentivization of correct labelling, and an audit system. Eight themes were identified as barriers to delabelling of antimicrobial allergies. Future behaviour change interventions to address these barriers were proposed. Confidence in the findings of this study was judged to be moderate, according to the GRADE CERQual approach.

Reductions in inhaler greenhouse gas emissions by addressing care gaps in asthma and chronic obstructive pulmonary disease: an analysis

IntroductionClimate change from greenhouse gas (GHG) emissions represents one of the greatest public health threats of our time. Inhalers (and particularly metred-dose inhalers (MDIs)) used for asthma and chronic obstructive...

Social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in newly diagnosed women with breast cancer.

Identifying correlates of physical activity and sedentary behaviour allows for the identification of factors that may be targeted in future behaviour change interventions. This study sought to determine the social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in individuals recently diagnosed with breast cancer. Data were collected from 1381 participants within 90 days of diagnosis in the Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study. Physical activity and sedentary behaviour were measured with ActiGraph GT3X+® and activPALTM devices, respectively, for seven consecutive days. Correlates were collected via a self-reported questionnaire, medical record extraction, or measured by staff. Multivariable models were fitted for sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity. Greater sedentary behaviour was associated with higher body fat percentage (BF%) (ß=0.044; p<0.001) and being single (ß=0.542; p<0.002). Lower light physical activity was associated with higher BF% (ß=-0.044; p<0.001), higher body mass index (ß=-0.039; p<0.001), greater disease barrier influence (ß=-0.006; p<0.001), a HER2-positive diagnosis (ß=-0.278; p=0.001), and being single (ß=-0.385; p= 0.001). Lower moderate-to-vigorous physical activity was associated with higher BF% (ß =-0.011; p=0.001), greater disease barrier influence (ß=-0.002; p<0.001), and being of Asian (ß=-0.189; p=0.002) or Indian/South American (ß=-0.189; p=0.002) descent. Greater moderate-to-vigorous physical activity was associated with having greater intentions (ß=0.049; p=0.033) and planning (ß=0.026; p=0.015) towards physical activity. Tailoring interventions to increase physical activity for individuals recently diagnosed with breast cancer may improve long-term outcomes across the breast cancer continuum.

Barriers and facilitators to physical activity and further digital exercise intervention among inactive British adolescents in secondary schools: a qualitative study with physical education teachers.

Previous studies indicated that physical education programs in schools were unsuccessful to ameliorate physical activity (PA) behaviors among adolescents. This study investigated PE teachers' perceptions of barriers and facilitators to PA and further digital exercise interventions among inactive British adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model, the Behavior Change Wheel (BCW), and Theoretical Domains Framework (TDF). A qualitative study was conducted among 156 PE teachers in England. deductive thematic analysis approach was applied to analyze data. A comprehensive perception of PE teachers revealed 21 barriers to PA among inactive adolescents in secondary schools. The study findings show that barriers exist across all categories of the COM-B model in physical opportunity (7), reflective motivation (5), social opportunity (4), psychological capability (4) and physical capability (1). The majority of these barriers were reported in previous studies as being barriers to PA from the perspective of children and adolescents. This shows that the findings are consistent with the views of children and adolescents that participated in these studies. Particular salient barriers for inactive adolescents were reported and greater insight into their experiences was highlighted. The study reported the main sources of behavior, intervention functions, policy functions, and behavior change tools that can be used for future behavior change interventions to support inactive adolescents. The study recommends using its findings to design interventions for inactive adolescents to achieve recommended levels of physical activity (PA). The study's comprehensive approach and evidence-based solutions provide extensive reference points for future intervention design, informing policy and contributing to enhancing support for inactive adolescents. Further development of digital exercise interventions, including conversational artificial intelligence (AI), is suggested to engage adolescents at scale and provide personalized support to overcome multiple barriers to PA.

Barriers and facilitators to adopting healthier lifestyle among low-income women in Saudi Arabia: A qualitative study.

Low socioeconomic status (SES) is significantly associated with increased levels of obesity, unhealthy diet, and physical inactivity leading to a higher risk of chronic diseases. This study aimed to explore low SES women's barriers and facilitators to engaging in a healthy lifestyle and their accounts in developing future behaviour change interventions. Qualitative study using focus group interviews informed by the Capability Opportunity Motivation-Behavior (COM-B) framework. Interviews were conducted with a convenience sample, and data were analysed using thematic analysis. This study is conducted in partnership with Alnahda Society, a prominent nongovernmental organization in Riyadh, Saudi Arabia. We conducted five focus groups with a total of 29 participants. We identified five overarching themes from the data related to participants' definition of a 'healthy life', the difficulties they face that hinder their engagement with a healthy lifestyle, the methods and reasons for changing health behaviour and participants' views of an ideal future behaviour change intervention. Women's definition of a healthy lifestyle did not only include a healthy diet and physical activity but also emphasized the importance of improving mental wellness. Following a healthy lifestyle, although desired, is not always a priority for women with low SES due to the high cost, lack of availability of healthy options and time constraints. Many women in our sample discussed the need to have a routine and discipline to follow and maintain a healthy lifestyle. Family members' support for behaviour change was discussed as a facilitator to maintaining a healthy lifestyle. Women highlighted several reasons that would motivate them to change their health behaviour, including having or preventing health conditions, improving mental health, and managing weight. Participants also discussed the characteristics of an ideal behaviour change intervention. This study suggests that women with low SES are faced with several barriers to adopting a healthy lifestyle. Behaviour change intervention targeting this population needs to be tailored to address these barriers and facilitate behaviour change for people with limited resources. National policies to improve the availability and affordability of healthy options are also needed to reduce health disparities. Women of low SES who took part in the study were given a chance at the end of each focus group discussion to reflect on the questions and add any areas important to them that were not covered during the interview. Experts working with disadvantaged populations in a nonprofit organization (Alnahda society) contributed to the design of the topic guide.

‘Because people here are ignorant’: The failure of a community intervention to prevent mycetoma in Sudan

Background: This study is based on fieldwork conducted amongst a community in Sudan where the neglected tropical disease (NTD), mycetoma, is endemic. In 2018 government officials attempted an unsuccessful intervention and we examine what caused this to fail. This intervention was a collaborative project building animal enclosures, designed specifically to counteract some principal causes of mycetoma, i.e., scratches and cuts common in disease transmission. It was a carefully researched, privately funded, and government-endorsed project, which was almost unequivocally rejected by the community. Methods: Data collection took place in July 2018. Eight interviews and two focus group discussions (FGDs) were conducted with village residents. One FGD was conducted with government officials in charge of the implementation and enforcement of the project; three key-informant interviews with officials from the State Ministry of Health and three interviews with community leaders in the village were conducted, including those responsible for allocation of the new enclosures. The data was analysed using framework analysis. Results: The village residents explained that they didn’t use the enclosures for three reasons: (1) it interferes with the relationship they have with their livestock, (2) the function and design are not practical, and (3) they continually feel let down by government officials. The government officials and representatives from the State Ministry of Health identified two reasons the project failed: (1) ignorance of the people in the village, and (2) poor enforcement. Conclusions: This study shows that government enforcement isn’t a viable intervention to reduce disease burden without considering community ways of life, values, and priorities. We revealed that government officials and villagers have contrasting views on the failure and original necessity of the project. Future behaviour-change interventions need to show respect for different ways of life and the values, beginning with the open facilitation of communication between divergent perspectives.

How Does Self-Control Promote Health Behaviors? A Multi-Behavior Test of Five Potential Pathways.

Self-control is generally defined as the capacity to override impulses and is a robust predictor of health behaviors. This paper integrates trait, reasoned action, and habit approaches to develop and test a mechanistic account of how self-control influences health actions. We tested five potential pathways from self-control to behavior, termed the valuation, prioritization, habituation, translation, and inhibition routes. At baseline, participants (N = 663 adults) completed survey measures of reasoned action approach variables and habits in relation to eight health behaviors and the Brief Self-Control Scale. Three months later, participants reported their behavior. Multi-level modeling was used to test pathways across behaviors. Supporting the valuation route, affective attitude, cognitive attitude, descriptive norms, and perceived behavioral control mediated the self-control-intention relation, and intentions and perceived behavioral control mediated the relationship between self-control and health behaviors. Self-control also predicted the priority accorded to different considerations during intention formation. Higher self-control was associated with stronger prediction by cognitive attitudes and perceived behavioral control and weaker prediction by habits and injunctive norms. Self-control predicted habit formation, and habits mediated the self-control-behavior relation. Finally, self-control was associated with the improved translation of intentions into health behaviors and with greater inhibition of affective and habitual influences. Findings for the different pathways were not moderated by whether approach (health-protective behaviors) or avoidance responses (health-risk behaviors) were at issue. The present research offers new insights into why self-control promotes health behavior performance, and how deficits in self-control might be offset in future behavior-change interventions.

Digital Human Representations for Health Behavior Change: A Structured Literature Review

Organizations have increasingly begun using digital human representations (DHRs), such as avatars and embodied agents, to deliver health behavior change interventions (BCIs) that target modifiable risk factors in the smoking, nutrition, alcohol overconsumption, and physical inactivity (SNAP) domain. We conducted a structured literature review of 60 papers from the computing, health, and psychology literatures to investigate how DHRs’ social design affects whether BCIs succeed. Specifically, we analyzed how differences in social cues that DHRs use affect user psychology and how this can support or hinder different intervention functions. Building on established frameworks from the human-computer interaction and BCI literatures, we structure extant knowledge that can guide efforts to design future DHR-delivered BCIs. We conclude that we need more field studies to better understand the temporal dynamics and the mid-term and long-term effects of DHR social design on user perception and intervention outcomes.

The role of partner support for health behaviours in people living with and beyond cancer: A qualitative study.

This study aimed to qualitatively explore how partner support for health behaviours is perceived, received, and utilised in people living with and beyond cancer (LWBC). Semi-structured audio interviews were conducted with 24 participants, 15 men and nine women, living with and beyond breast, prostate, and colorectal cancer. Inductive and deductive Thematic Analysis was used to analyse the data. Three key themes with six subthemes were identified relating to partner support for health behaviours: (1) Interdependence (Reciprocity, Overt Control, Influence &amp; Motivation) (2) Concordance (Shared Attitudes &amp; Health Beliefs, Shared Health Behaviour) and (3) Communal Coping (Communal Orientation towards Health and Decision Making, Co-operative Action in Health Behaviour). Partner support plays a unique and significant role in the health behaviours of people LWBC. Partners play a collaborative role in managing health and facilitating health behaviours, while the high level of concordance in couples may represent a potential barrier to change via the reinforcement of maladaptive health beliefs and behaviours. Overall, findings demonstrate that partners should be considered and included where possible when designing future behaviour change interventions for people LWBC.

Which drinkers have changed their alcohol consumption due to energy content concerns? An Australian survey

BackgroundAlcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns.MethodsAn online survey was undertaken with 801 Australian adult drinkers (18–59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns.ResultsWhen prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least ‘sometimes’. Women, those aged 30–44 years, metropolitan residents, those with household income $80,001–120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds.ConclusionsResults indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.

Knowledge and behaviour of community residents’ face mask-wearing during the COVID-19 pandemic: a cross-sectional study in Shanghai, China

ObjectivesCOVID-19 is an infectious disease spreading through respiratory droplets. Using a face mask correctly is one of the essential preventive measures. We launched a survey to discover the current face...

A Systematic Review of Nudge Interventions to Optimize Medication Prescribing.

Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].

Correlates of Sexual Risky Behaviours, HIV Testing, and HIV Testing Intention among Sexually Active Youths in Northern Tanzania.

Background:HIV testing services are important entry-point into the HIV cascade to care and treatment in order to slow down the spread of HIV infection. Over half of all new HIV infections in Sub-Saharan Africa occur among young people under the age of 25, particularly women. The study aimed to determine factors influencing young people's decision to undergo HIV testing services in Northern Tanzania.Methods:A total of 536 sexually active participants aged 15 to 24 years old completed a semi-structured questionnaire based on the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB).Results:Males compared to femaleparticipants were significantly younger at first age of sexual intercourse (15.4 vs. 16.7 years; p = .001). Out of 536 participants, 418(78%) reported inconsistent condom use, and 203/303(67%) were those practicing casual sex. Only, 189/536(35.3%) of the participants reported to have had an HIV-test. Age, socioeconomic status, perceived HIV severity, attitudes and social approval regarding testing and beliefs about testing procedures and perceived barriers to testing were significant predictors of HIV testing (R2 =.22). Age, unsafe casual sex, perceived severity, HIV-testing attitudes, self-efficacy, social approval, cues for actions and perceived quality of testing procedures were significant and positively related to HIV-testing intentions, while perceived barriers to testing were negatively related (R2 = .36).Conclusion:The integrated constructs of HBM and TPB provides a framework for identifying correlates of HIV testing behaviours and HIV testing intentions among sexually active youths. Future behaviour change interventions should focus on reduction of sexually risky behaviours, increasing perceived HIV severity, enhance positive attitudes and social approvals on testing, reduce misconceptions about testing procedures, alleviation of perceived barriers to testing and improve testing self-efficacy among sexually active youths in this setting.

Why don't they do it? Handwashing barriers and influencer study in Faridabad district, India.

Handwashing has been widely accepted as the simplest protection against communicable diseases. However, despite proven effectiveness and cost-efficiency, adoption of regular handwashing is still poor in developing countries. As children in school-going age are vulnerable and continue to suffer from preventable illnesses, this study aims to spot barriers to handwashing among children while simultaneously recognizing the influencing factors to aid the solutions narrative for effective water, sanitation and hygiene (WASH) strategies. A school-based cross-sectional, mixed-method study was conducted in Ballabhgarh block, Faridabad district, India. A predesigned, pretested, structured questionnaire was administered to 106 class V students in five randomly selected rural government primary schools. Due permissions, consent and ethical clearances were taken. The majority (>91%) of children were found to have low illness threat perception. The inability to visually see germs came out as one of the biggest barriers (46%) that were preventing children from practicing regular handwashing. Family, teachers and peers were found to be the most important sources of information for children and not any particular media channel. In fact, role of peers was found to be critical as 72% children said that they would wash hands if their friends were also washing hands. This study suggests children's need for visible proof of germs and associated casual attitude toward illness threat as a hitherto unexplored potential barrier to practicing regular handwashing. In addition, the human channel of communication seems to be the most relevant regarding public health messaging in rural heartlands. Despite 100% penetration of mobile phones and commonplace presence of television, it is the community ecosystem that is still the most trusted sources of information and influence. The unique role of peers found in this study could have strategic implications for future behaviour change interventions making a case for peer-to-peer behaviour modeling.

Physical Activity Behavior Comparisons Between Adults With and Without Type 1 Diabetes

Physical activity (PA) is a widely accepted strategy to manage chronic diseases like type 1 diabetes; however, unique PA barriers likely result in lower PA levels among person(s) with type 1 diabetes (PWT1D), compared to person(s) without type 1 diabetes (PWOT1D). The integrated theory of health behavior change (ITHBC) (i.e., knowledge/beliefs, self-regulation, and self-management) provides a helpful framework for understanding PA and other health behaviors. This research aimed to determine differences in PA between adult PWT1D and PWOT1D, and characterize their PA-related behaviors using the ITHBC. Participants (N = 90; 86.7% female, 90% white) were recruited via social media and university listserv to complete an online questionnaire. Questions addressed demographics, anthropometrics, diabetes status, and PA-related behaviors. Participants were matched for race, gender, age, and body mass index. PA and related behaviors were compared between PWT1D and PWOT1D using independent samples t-tests and chi-square-tests. No significant differences were found between PWT1D and PWOT1D for weekly minutes of moderate- or vigorous-aerobic PA, or weekly days of muscle-strengthening PA (p > 0.05). Fifty-one percent of PWT1D and 53.3% of PWOT1D reported enough activity to meet PA guidelines. Almost twice as many PWT1D meeting PA guidelines reported using goal setting, a self-regulation behavior, compared to those who did not meet guidelines (82.6% versus 45.5%, p = 0.009). Targeting PA-related behaviors within ITHBC constructs may help reinforce or influence PA behaviors. These findings can inform future behavior change interventions with PWT1D that focus on educational practices for type 1 diabetes educators or healthcare providers for PWT1D so they can better aid patients.

Utilizing behavioral theories to explain hospital visitors’ observed hand hygiene behavior

Hand hygiene is essential for infection prevention. This study aimed to find a suitable theoretical model and identify critical facilitators and barriers to explain hospital visitors' hand hygiene practice. Visitors in 4 hospitals were observed and asked to give explanations for using or not using the hand rub dispenser. The written explanations of N = 838 participants were coded according to three theoretical models: Theory of Planned Behavior, Health Action Process Approach (HAPA), and Theoretical Domains Framework (TDF). Self-reported hand hygiene behavior differed from observed behavior, with 15.75% wrongly claiming to have cleaned their hands. Critical facilitators for hand hygiene were attitude toward the behavior,subjective norm, outcome expectancies, risk perception, planning, action control, knowledge and skills, motivation and goals, and social influences. Key barriers included perceived behavioral control; barriers and resources; memory, attention, and decision processes; and environmental context and resources. Visitors' self-reported hand hygiene behavior is over-reported. Both HAPA and TDF were identified as suitable theoretical models for explaining visitor's hand hygiene practice. Future behavior change interventions should focus on (1) visibility and accessibility of cleaning products; (2) informing laypeople about their role regarding infection prevention; and (3) leveraging social influence processes.

Choice of methods can determine which behavioral determinates are identified for targeting in future behavior change interventions: Increasing antibiotic adherence in Pakistan.

When developing a behavioral intervention, formative research should be conducted to determine which behavioral barriers and facilitators to target. This is often done using qualitative interviews, but quantitative surveys may also be used. The current study examines the consequences of applying descriptive (rank order and t-tests) versus predictive (regression) quantitative analyses on intervention development, specifically for increasing antibiotic course completion. For demonstrative purposes, 1892 adults in Pakistan completed a cross-sectional survey that measures a comprehensive set of barriers/facilitators to their course completion. The descriptive and predictive analyses disagreed regarding which barriers/facilitators to prioritize. Reasons to prefer predictive analyses are discussed.

What influences the selection of contextual cues when starting a new routine behaviour? An exploratory study

BackgroundContextual cues play an important role in facilitating behaviour change. They not only support memory but may also help to make the new behaviour automatic through the formation of new routines. However, previous research shows that when people start a new behaviour, they tend to select cues that lack effectiveness for prompting behaviour. Therefore, it is important to understand what influences cue selection, as this can help to identify acceptable cues, which in turn could inform future behaviour change interventions to help people select cues that best fit their context and so ensure continued repetition.MethodsWe conducted a qualitative study to investigate what cues people select, how, and what influences their decisions. We recruited 39 participants and asked them to take vitamin C tablets daily for 3 weeks and later interviewed them about their experience. Quantitative habit strength and memory measures were taken for descriptive purposes.ResultsCue selection was primarily influenced by a desire to minimise effort, e.g. keeping related objects at hand or in a visible place; prior experience with similar behaviours (regardless of whether the cues used in the past were reliable or not); and beliefs about effective approaches. In addition, we found that suboptimal remembering strategies involved reliance on a single cue and loosely defined plans that do not specify cues. Moreover, for many participants, identifying optimal cues required trial and error, as people were rarely able to anticipate in advance what approach would work best for them.ConclusionsFuture behaviour change interventions that rely on routine behaviours might fruitfully include the provision of educational information regarding what approaches are suboptimal (single factors, vaguely defined plans) and what is most likely to work (combining multiple clearly defined cues). They should also assess people’s existing beliefs about how to best remember specific behaviours as such beliefs can either enhance or inhibit the cues they select. Finally, interventions should account for the fact that early failures to remember are part of the process of developing a reliable remembering strategy and to be expected.