Health Behavior Change Interventions Research Articles

Factors associated with older adults' perception of health risks of hot and cold weather event exposure: A scoping review.

Hot and cold weather events are increasingly becoming a global burden resulting in premature and preventable morbidity and mortality, particularly in vulnerable groups such as older people and people with chronic health conditions. However, risk perception regarding weather is generally poor among vulnerable groups which often acts as a barrier to the uptake of critical health-protective behaviours. A more cohesive understanding of determinants of risk perception is needed to inform public health risk communication and behaviour change interventions that promote protective health behaviours. This scoping literature review aimed to understand factors influencing perception of personal health risks in vulnerable groups as a result of exposure to hot and cold weather events. A five-stage scoping review framework was followed. Searches were run across Medline, PsychInfo, Web of Science and EMBASE. Papers were included if they provided rationale for risk perceptions in vulnerable groups in indoor/domestic environments and focussed on samples from OECD countries. In total, 13 out of 15,554 papers met the full inclusion criteria. The majority of papers focused on hot weather events: one study exclusively examined cold weather events and one study addressed both cold and hot weather events. Included papers focused on older adults aged 65+ years. The papers identified eight factors that were associated with older adults' personal health risk perception of hot and cold weather events: (1) Knowledge of the relationship between hot/cold weather and health risks, (2) presence of comorbidities, (3) age and self-identity, (4) perceived weather severity, (5) Beliefs associated with regional climate, (6) past experience with weather, (7) misconceptions of effectiveness of protective behaviours, and (8) external locus of control. Future research should explore risk communication methods by implementing the identified risk perception determinants from this review into health protection interventions targeting older adults. Further understanding is needed regarding risk perceptions in non-elderly vulnerable groups, for examples individuals with chronic diseases or disabilities.

Developing theory-driven narrative messages with personal stories: A step-by-step guide.

Narratives are commonly utilized in health promotion and behavior change interventions due to their efficacy over didactic or expository interventions. While grounding narratives in behavioral theory may render them more effective, balancing the integration of theoretical and creative aspects of the narrative development process while maintaining authenticity is challenging. Thus, this manuscript describes a rigorous process through which researchers can intentionally integrate theory and personal stories for health interventions. The process for creating theory-driven narratives involves the following steps: (1) defining the purpose of the narratives, (2) selecting a guiding theory, (3) collecting personal testimonials, (4) immersing self into testimonials, (5) identifying central narratives and important variations, (6) considering additional theories, (7) piecing quotes into cohesive stories, (8) filling in the gaps, and (9) checking for resonance. To exemplify this step-by-step process, we provide a case study from our research involving the development of a psychoeducational intervention to model information seeking strategies for managing cancer-related uncertainty among women who have recently tested positive for pathogenic genetic variants that increase risk for hereditary breast and ovarian cancer. We discuss special considerations for developing theory-driven narrative interventions and reflect on how this rigorous step-by-step process can be adapted by other researchers.

Exploring behavior change motivation in an outpatient sample with more than one health risk behavior

Abstract Background Evidence from western countries shows that the majority of adults have two or more health risk behaviors. The motivation to engage in a health behavior change (HBC) is the most proximal determinant of behavior change in the future. The aim of this study was to investigate the intention to increase physical activity and to quit smoking in an outpatient sample that show both health risk behaviors. Methods We used baseline data (n = 109) of an intervention study (Germany, 2016-2019) on physical activity and smoking cessation. Eligibility criteria were: aged 40 to 65 years, systolic blood pressure ≥130 mmHg, no history of cardiovascular event or vascular intervention. We collected information on HBC motivation, sex, age, and self-rated health (SRH) and identified 32 physically inactive smokers. Descriptive analyses and Fisher’s exact test were used to explore the proportion of those motivated for HBC and differences according to sex, age (45-55 vs. 56-65 years), and SRH (excellent-good vs. poor-very poor). Results Participants (50% female) were on average 52.6 years old and 78% had school education ≤10 years. Overall, 44% intended to change physical inactivity only, 34% intended to change both behaviors, 13% wanted to change neither, and 9% intended to change smoking only. There was no difference in HBC motivation according to sex and age. But, there was a significant difference according to SRH (Fisher’s exact = 0.048); e.g., there were more individuals motivated to change both behaviors among those with lower SRH (64%) compared to those with higher SRH (19%). Conclusions In this baseline sample of an intervention study, the majority of participants intended to change physical inactivity but not smoking. Among those with lower SRH, almost two-thirds intended to change both behaviors. Thus, individuals with more than one health risk behavior differ in their HBC motivation. Lower SRH may offer a window of opportunity to promote HBC interventions. Key messages • Physically inactive smokers with a systolic blood pressure ≥130 mmHg differ in their motivation to change these behaviors. • Lower self-rated health may offer a window of opportunity to promote interventions to change health behavior.

Study protocol: Evaluation of the ‘real-world’ Farmers Have Hearts – Cardiovascular Health Program

Premature cardiovascular disease (CVD) mortality among men represents a public health concern worldwide. In Ireland, male farmers are a ‘high-risk’ group for CVD mortality compared to normative values for Irish males. Despite this, they are perceived to be a ‘hard-to-reach’ (HTR) group to engage with health interventions. Primary prevention measures, including health screening and health behavior change interventions, are key strategies in addressing CVD yet often do not reach HTR groups such as male farmers.The Farmers Have Hearts – Cardiovascular Health Program (FHH-CHP) is a unique large-scale (n = 868) workplace health intervention specifically targeted at Irish male livestock farmers. It included a baseline and Week 52 health check and a health behavior change intervention with three delivery methods: ‘health coach by phone’ and/or mobile (M)-health by text message. The program adopted gender-specific and strengths-based methods to maximize participant engagement. It integrated a multi-actor approach and was trialed in a ‘real world’ practice outside of confined health care settings. Data collection comprised health check results (baseline, Week 52) and self-report measures (baseline, Week 26, Week 52).The FHH-CHP is the first targeted health intervention adopting gender-specific methods to reach and engage male livestock farmers in their cardiovascular health. Documenting the FHH-CHP study protocol is important therefore and will benefit practitioners attempting to apply gender-specific approaches to engage at-risk and HTR groups of men with targeted health interventions. Meeting men outside of clinical health settings and adopting gender competency standards are needed to address inequities in health outcomes experienced by men.

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.

Psychosocial Mediators of Web-Based Interventions for Promoting a Healthy Lifestyle Among Chinese College Students: Secondary Analysis of a Randomized Controlled Trial.

BackgroundWeb-based multiple health behavior change (MHBC) interventions have demonstrated effectiveness in promoting physical activity (PA) and fruit and vegetable consumption (FVC) among Chinese college students. However, there is limited research examining their effects on promoting a healthy lifestyle (ie, adhering to both PA and FVC behavioral recommendations) among Chinese college students. In addition, the salient psychosocial mediators of successful MHBC interventions need to be researched.ObjectiveThis study aims to examine the effectiveness of a previous 8-week web-based MHBC program for promoting a healthy lifestyle and enhancing the psychosocial determinants (intention, self-efficacy, planning, and social support) of behavior change among Chinese college students. Furthermore, the study aims to identify whether changes in these psychosocial determinants mediate intervention effectiveness on the immediate and sustained lifestyle changes.MethodsThis was a secondary analysis for a 3-arm randomized controlled trial. Chinese college students (N=552) were randomly assigned to 1 of 3 groups: a PA-first group (4-week PA intervention followed by 4-week FVC intervention), an FVC-first group (4-week FVC intervention followed by 4-week PA intervention), and a placebo control group. The intervention content was designed based on the health action process approach model. Data for analyses were collected at baseline (T0), postintervention assessment (T1), and 12-week follow-up assessment (T2).ResultsAt baseline, 13.9% (77/552) of the participants maintained a healthy lifestyle. After 8 weeks, more (200/552, 36.2%) participants achieved a healthy lifestyle. PA-first and FVC-first groups were, respectively, 3.24 times and 5 times more likely to adopt a healthy lifestyle than the control group at T1. After 12 weeks, 35.5% (196/552) of the participants adopted a healthy lifestyle. Intervention groups were approximately 2.99 times (PA first) and 4.07 times (FVC first) more likely to adopt a healthy lifestyle than the control group at T2. Intervention effects favored both intervention groups in self-efficacy and planning for PA and in intention and planning for FVC compared with the control condition. In addition, changes in PA self-efficacy and FVC intention mediated intervention effectiveness on the immediate lifestyle change after 8 weeks. Changes in FVC intention were identified as a salient mediator for facilitating sustained lifestyle change after 12 weeks.ConclusionsThis study provides empirical evidence for the effectiveness of an 8-week theory- and web-based MHBC intervention program on promoting a healthy lifestyle, self-efficacy and planning for PA, and intention and planning for FVC among Chinese college students. These research findings add new knowledge to the underlying psychosocial mechanisms of successful MHBC interventions. Overall, this study has considerable implications for future web-based MHBC research and practice in terms of addressing PA self-efficacy and FVC intention and helping students to adopt and maintain a healthy lifestyle independently of whether PA or FVC is addressed first.Trial RegistrationClinicalTrials.gov NCT03627949; https://clinicaltrials.gov/ct2/show/NCT03627949

Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability

The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.

Context matters: Sociocultural considerations in the design and implementation of community-based positive psychology interventions in sub-Saharan Africa

Scholars conducting cross-cultural research in mental health often import intervention programs found to be efficacious in one social context (e.g., Western) and directly implement them in other contexts (e.g., African and Asian) without recourse to the sociocultural disparities between the target populations and the theoretical foundations of the constructs and principles underpinning the intervention programs. Such efforts mistakenly assume that positive psychology interventions (PPIs), most of which were developed from Western perspectives and assumed individualistic cultural orientation and value systems, operate equally across all contexts. Drawing on the extant literature and on insights from designing, implementing, and evaluating group-based (mental) health behavior change intervention programs across several communities in Ghana, we discuss some sociocultural, theoretical, and methodological issues that can significantly constrain the design, uptake, and effectiveness of PPIs in the rural, low literate, socioeconomically disadvantaged, highly collectivistic context of Ghana, and sub-Saharan Africa more generally. In all illustrations, we offer suggestions to guide the design and implementation processes to ensure culturally appropriate, highly acceptable, and potentially effective intervention programs. We argue that PPIs can be potentially fructuous in the sub-region when adapted to, or embedded in, the cultural values of the target population and tailored to the needs, capacities, and circumstances of participants.

Healthy Davis Together: Creating a Model for Community Control of COVID-19.

While many higher-education institutions dramatically altered their operations and helped mitigate COVID-19 transmission on campuses, these efforts were rarely fully extended to surrounding communities. A community pandemic-response program was launched in a college town that deployed epidemiological infection-control measures and health behavior change interventions. An increase in self-reported preventive health behaviors and a lower relative case positivity proportion were observed. The program identified scalable approaches that may generalize to other college towns and community types. Building public health infrastructure with such programs may be pivotal in promoting health in the postpandemic era. (Am J Public Health. 2022;112(8):1142-1146. https://doi.org/10.2105/AJPH.2022.306880).

The unappreciated relevance of auxiliary assumptions for evaluating theory-based interventions in health psychology

The use of theory in health behavior change interventions has been recently questioned with mixed results found for theory-based intervention effectiveness. But theory testing in intervention depends on not only theoretical assumptions, but on auxiliary assumptions too. Specifically, auxiliary assumptions are required to traverse the distance from nonobservational terms in theories and observational terms at the level of the empirical hypotheses in interventions. We believe intervention failures are often due to flaws in auxiliary assumptions rather than assumptions at the theoretical level. We use the theory of planned behavior to illustrate how the consideration of these auxiliary assumptions is important to appraise the effectiveness of interventions informed by theory. We hope that bringing attention to the importance of auxiliary assumptions provides a more nuanced and accurate appraisal of theory utility.

Prevalence, patterns, clinico-social, and behavioral factors associated with the consumption of sugar-sweetened beverages among undergraduate medical students of central India

Introduction: Excessive consumption of sugar-sweetened beverages (SSBs) in adolescents has become a global issue. As its link to obesity and noncommunicable diseases is clear, it is imperative to understand SSB consumption behaviors in the future health-care professionals. The objective of this study is to document the prevalence, patterns, and clinico-social and behavioral factors predicting high intake of SSBs among medical students. Material and Methods: This cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital between October and November 2019 were included in this study. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioral patterns, and money spent in connection with SSB consumption. Data were analyzed using IBM SPSS version 24. Results: The mean age of participants was 19.3 ± 1.6 years, 71.7% being males. The current prevalence of SSB consumption was 90.5%. Furthermore, 49.9% and 29.1% of participants preferred soft drinks and sweetened fruit juice, respectively. Multivariate analysis showed that male gender (adjusted odds ratio [aOR]: 1.83, (1.03–3.25), current alcohol consumption (aOR: 4.09, 1.25–13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs [aOR: 7.36, (3.41–15.87)] whereas, preference of energy/sports category of drinks predicted low intake of SSBs [aOR 0.10, (0.02–0.47)]. Conclusion: The consumption of SSBs among medical students was high. Targeted health education and behavior change interventions should be provided to males, alcohol users, and frequent consumers.

Digital multiple health behaviour change intervention targeting online help seekers: protocol for the COACH randomised factorial trial

IntroductionUnhealthy lifestyle behaviours continue to be highly prevalent, including alcohol consumption, unhealthy diets, insufficient physical activity and smoking. There is a lack of effective interventions which have a large enough...

EPH167 Recursive Partitioning Analysis of COVID-19 Risk and Behavioral Measures in an Urban Setting

Perceptions of health risks can guide individuals’ judgments, inform decisions about protective behaviors, and are often targeted in health behavior change intervention. We applied recursive partitioning analysis to determine the relationship between behavioral measures and self-perceived and Latent Class Analysis (LCA)-derived COVID-19 risks among residents of Onitsha city, Nigeria.

Assessing layered HIV prevention programming: optimizing outcomes for adolescent girls and young women.

To assess how exposure to multiple, layered interventions predicts HIV-related outcomes among adolescent girls (15-19 years) and young women (20-24 years) in Kenya. Survey data from adolescent girls and young women (n = 736) with 14-16 months of engagement with DREAMS, a comprehensive HIV prevention program that provides a range of health education, life skills, social protection, and social and behaviour change interventions. Nonparametric recursive partitioning technique - classification and regression tree (CART) - to identify the best predictors (DREAMS interventions) for achieving the desired HIV-related outcomes (consistent condom use and no transactional sex or sexual violence). Among adolescent girls, schooling support reduced the likelihood of engaging in transactional sex, whereas schooling support and exposure to parenting program reduced the likelihood experiencing sexual violence. Likelihood of consistent condom use increased among adolescent girls with exposure to preexposure prophylaxis (PrEP), schooling support, and the violence prevention programming. Among young women, multiple pathways reduced the likelihood of engaging in transactional sex: exposure to the male sexual partner program; exposure to the youth fund program; exposure to the violence prevention program; or exposure/engagement with schooling support, parenting programming, and the youth fund program. For young women, consistent condom use increased with schooling support and male partner engagement. Additionally, engagement in violence prevention program and male partner engagement increased the likelihood of not experiencing sexual violence among young women. Exposure to a combination of DREAMS interventions predicted outcomes that can reduce HIV risk among AGYW, though the pathways differed by outcome and age group.

Antifragile Behavior Change Through Digital Health Behavior Change Interventions.

Digital health behavior change interventions (DHBCIs) offer users accessible support, yet their promise to improve health behaviors at scale has not been met. One reason for this unmet potential may be a failure to offer users support that is tailored to their personal characteristics and goals. We apply the concept of antifragility to propose how DHBCIs could be better designed to support diverse users’ behavior change journeys. We first define antifragility as a feature of an individual’s relationship to a particular challenge such that if one is antifragile to a challenge, one is well positioned to benefit from facing that challenge. Second, we introduce antifragile behavior change to describe behavior change processes that leverage person-specific antifragilities to maximize benefits and minimize risk in the behavior change process. While most existing behavior change models focus on improving one’s motivation and ability to face challenges, antifragile behavior change complements these models by helping to select challenges that are most likely to produce desired outcomes. Next, we propose three principles by which DHBCIs can help users to develop antifragile behavior change strategies: providing personalized guidance, embracing variance and exploration in choosing behaviors, and prioritizing user agency. Finally, we offer an example of how a DHBCI could be designed to support antifragile behavior change.

A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention.

Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme’s tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.

Program Impact Pathway of the Positive Deviance/Hearth Interactive Voice Calling Program in a Peri-Urban Context of Cambodia

ABSTRACTBackgroundPositive Deviance/Hearth (PDH) is an internationally recognized nutrition rehabilitation program. However, nutritional improvements are inconsistent across contexts. It is unclear if variations are due to differences in program design, implementation, utilization, or other contextual factors. Furthermore, few PDH programs have addressed the high time and work burdens of caregivers and volunteers. To address this, the study integrated interactive voice calling (IVC) with PDH.ObjectivesA program impact pathway (PIP) analysis was used to evaluate the secondary outcomes of facilitators, barriers, and contextual factors that influenced the design, implementation, and utilization of a Positive Deviance/Hearth-Interactive Voice Calling program to improve the nutritional status of children in Cambodia.MethodsA PIP analysis was done on data collected through in-depth interviews with caregivers (n = 32), key informant interviews with volunteers (n = 16) and project staff (n = 3), and surveys of project staff (n = 5).ResultsIn the design phase, facilitators included quality training, technical support and design tools, community mobilization, and linkage to existing health services. Barriers included poor community mobilization. For the implementation phase, facilitators were good volunteer knowledge, follow-up tools and guidance, supervision, and spot checks of volunteers. Barriers were lack of time and overworked older caregivers. For the utilization phase, facilitators included family and volunteer support and access to phones, whereas barriers were lack of support, time, and financial resources; low levels of education and old age of caregivers; and inconsistent phone use. Contextual factors included food insecurity and increased childcare responsibilities of grandmothers due to migration of mothers.ConclusionsThe PIP analysis identified facilitators, barriers, and contextual factors that may affect the design, intervention, and utilization of IVC interventions for health and nutrition behavior change and elements to consider when designing and implementing them. When implementing child nutrition programs in Cambodia, supporting interventions addressing mental health and time and resource constraints of elderly caregivers should also be included.This trial was registered at clinicaltrials.gov as NCT03399058.

Evaluation of an online intervention for improving stroke survivors' health-related quality of life: A randomised controlled trial.

The aim of this trial was to evaluate the effectiveness of an online health behaviour change intervention-Prevent 2nd Stroke (P2S)-at improving health-related quality of life (HRQoL) amongst stroke survivors at 6 months of follow-up. A prospective, blinded-endpoint randomised controlled trial, with stroke survivors as the unit of randomisation, was conducted between March 2018 and November 2019. Adult stroke survivors between 6 and 36 months post-stroke with capacity to use the intervention (determined by a score of ≥4 on the Modified Rankin Scale) and who had access and willingness to use the internet were recruited via mail-out invitations from 1 national and 1 regional stroke registry. Participants completed baseline (n = 399) and 6-month follow-up (n = 356; 89%) outcome assessments via computer-assisted telephone interviewing (CATI). At baseline the sample had an average age of 66 years (SD 12), and 65% were male. Randomisation occurred at the end of the baseline survey; CATI assessors and independent statisticians were blind to group allocation. The intervention group received remote access for a 12-week period to the online-only P2S program (n = 199; n = 28 lost at follow-up). The control group were emailed and posted a list of internet addresses of generic health websites (n = 200; n = 15 lost at follow-up). The primary outcome was HRQoL as measured by the EuroQol Visual Analogue Scale (EQ-VAS; self-rated global health); the outcome was assessed for differences between treatment groups at follow-up, adjusting for baseline measures. Secondary outcomes were HRQoL as measured by the EQ-5D (descriptive health state), diet quality, physical activity, alcohol consumption, smoking status, mood, physical functioning, and independent living. All outcomes included the variable 'stroke event (stroke/transient ischaemic attack/other)' as a covariate, and analysis was intention-to-treat. At 6 months, median EQ-VAS HRQoL score was significantly higher in the intervention group than the control group (85 vs 80, difference 5, 95% CI 0.79-9.21, p = 0.020). The results were robust to the assumption the data were missing at random; however, the results were not robust to the assumption that the difference in HRQoL between those with complete versus missing data was at least 3 points. Significantly higher proportions of people in the intervention group reported no problems with personal care (OR 2.17, 95% CI 1.05-4.48, p = 0.0359) and usual activities (OR 1.66, 95% CI 1.06-2.60, p = 0.0256) than in the control group. There were no significant differences between groups on all other secondary outcomes. The main limitation of the study is that the sample comprises mostly 'well' stroke survivors with limited to no disability. The P2S online healthy lifestyle program improved stroke survivors' self-reported global ratings of HRQoL (as measured by EQ-VAS) at 6-month follow-up. Online platforms represent a promising tool to engage and support some stroke survivors. Australian New Zealand Clinical Trials Registry ACTRN12617001205325.

Social Media-Based Interventions for Health Behavior Change in Low- and Middle-Income Countries: Systematic Review.

BackgroundDespite the wealth of evidence regarding effective health behavior change techniques using digital interventions to focus on residents of high-income countries, there is limited information of a similar nature for low- and middle-income countries.ObjectiveThe aim of this review is to identify and describe the available literature on effective social media–based behavior change interventions within low- and middle-income countries.MethodsThis systematic review was conducted in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, Embase, Elsevier, CINAHL, PsycInfo, and Global Index Medicus, and the final search was conducted on April 6, 2021. We excluded studies published before 2000 because of the subject matter. We included studies that evaluated interventions conducted at least partly on a social media platform.ResultsWe identified 1832 studies, of which 108 (5.89%) passed title-abstract review and were evaluated by full-text review. In all, 30.6% (33/108) were included in the final analysis. Although 22 studies concluded that the social media intervention was effective, only 13 quantified the level of social media engagement, of which, few used theory (n=8) or a conceptual model (n=5) of behavior change.ConclusionsWe identified gaps in the settings of interventions, types and sectors of interventions, length of follow-up, evaluation techniques, use of theoretical and conceptual models, and discussions of the privacy implications of social media use.Trial RegistrationPROSPERO CRD42020223572; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223572

A Health Behavior and Lifestyle Intervention Pilot Trial for Childbearing Adolescents

We pilot tested a multiple health behavior change (MHBC) intervention to improve breastfeeding rates, healthy eating/active living, and depression prevention among pregnant and parenting adolescent mothers. We also assessed utility of the MHBC mHealth approach by examining health behavior coaction and intervention acceptability. We used a longitudinal randomized controlled trial to compare the tablet-delivered momHealth to a control condition (usual care). Delivered between 32 weeks of pregnancy and one month postpartum, momHealth included nine multi-media education modules, simultaneous daily educational text messaging, and weekly videoconferences for individual and group support. Main outcomes included “any” and “exclusive” breastfeeding initiation and continuation for 5 weeks and 3 months postpartum; number of fruit and vegetable servings; minutes of moderate/vigorous physical activity per day; and depressive symptoms. Sixty-two adolescents aged 16–19 having their first baby were randomized. Compared to Control, more momHealth participants were still breastfeeding at 5 weeks (chi-square = 3.91, df = 1, P = .048). Mothers who breastfed for 3 months were more likely to eat adequate daily fruits/vegetables. Participants positively rated the intervention. momHealth positively affected early breastfeeding continuation and trended toward positive outcomes in healthy living and depressive symptoms. A fully powered trial is planned to test the intervention more effectively.