Health Behavior Change Programs Research Articles

Development of Respiratory Infection Prevention and Control Self-Efficacy Scale for Adults.

This study aimed to develop a scale for respiratory infection prevention and control self-efficacy (R-PACS) to measure self-efficacy in the prevention and control of the spread of respiratory infections among adults and to confirm the applicability of the developed scale by testing its validity and reliability. This methodological study was conducted in two phases. During the first phase, the R-PACS scale was developed after conducting a thorough literature review, content validity, and a pilot test. In the second phase, its validity and reliability were verified against 210 university students in Korea. The criterion validity of the developed R-PACS scale was tested using the correlation with resilience scale. Item analysis, explanatory factor analysis, and convergent and discriminant validity analyses were conducted in order to verify construct validity. Furthermore, Cronbach's α was used to verify internal consistency reliability. The final version of the R-PACS scale comprises 4 factors and 16 items rated on a 5-point Likert scale. Higher scores are interpreted as higher levels of self-efficacy in the prevention and control of respiratory infection. The R-PACS scale exhibited good content validity, construct validity, criterion validity, and reliability. The correlation coefficient of the four factors was ≥.4, confirming the validity of item convergence; meanwhile, the Cronbach's α coefficient for the final 16 items of the developed scale was 0.923, verifying reliability. This scale consists of four factors: "environmental management", "contact restrictions", "general infection prevention and control", and "early detection". The applicability of the R-PACS scale exhibited acceptable validity and reliability. This scale can be utilized to assess and evaluate the degree of self-efficacy in the prevention and control of respiratory infections among adults. Data obtained using this scale can be utilized for preparing health behavior change and health promotion programs, and practical policies for preventing respiratory infections.

Primary Care Clinic Approaches to Facilitating Patient Health Behavior Change in Alabama.

Background Non-communicable chronic diseases (NCCDs), such as cardiovascular disease, diabetes, and cancer, are the leading cause of death and disability and the leading driver of healthcare costs in the U.S. It is estimated that 80% of chronic diseases and premature deaths are attributable to modifiable lifestyle factors related to smoking and alcohol intake, poor eating patterns, and physical inactivity. Inadequate sleep also plays a significant role. Among other directives, primary care providers (PCPs) have the opportunity to contribute to preventing and treating NCCD in their patients. Comprehensive, evidence-based behavioral counseling interventions are recommended to PCPs as a first-line approach to improving outcomes. However, presumably due to a lack of PCP time, training or resources, most patients report not receiving such services. Currently, the extent to which PCPs in Alabama offer or refer patients to health behavior change (HBC) services is unknown. Objectives This study aims to assess the following: (1) Alabama PCPs' current approaches in facilitating patient HBC in the domains of eating patterns, physical activity, sleep, and stress and (2) the likelihood of the Alabama PCPsreferring patients to virtual HBC programs, once developed by an osteopathic medical school in the state. Methods Data were collected from clinic personnel who were knowledgeable regarding the clinic's approach to facilitating patient HBC via scripted telephone interviews and online surveys sent via email. The clinic list utilized for the study was derived from a list of VCOM-Auburn clinical preceptors. Primary care and specialty clinics were included. Data were analyzed descriptively to determine the number of clinics that (1) provide, recommend, or refer programs, services, or resources to patients to facilitate HBC related to eating patterns, physical activity, sleep, and stress management and (2) are likely to refer patients to free virtual HBC programs, once developed by an osteopathic medical school in the state. Results Of the 198 clinics that were contacted, 75 were excluded, 46 were "no response," 53 agreed to participate, and 50 completed the survey. Of the 50 clinics that completed the survey, 33 indicated offering resources or referrals for diet, 29 stated they offered resources or referral services for physical activity, 33 indicated offering resources or referrals for sleep, and 28 indicated offering or recommending resources for stress management to patients. Most of the clinics (29/50) felt that their patients would benefit most from a program that facilitates improvement in eating patterns, and 41/50 clinics said that they are either "somewhat" or "extremely" likely to refer patients to a free VCOM-Auburn HBC program, once available. Conclusions Findings indicate that a significant percentage of PCP clinics are not offering HBC resources to patients and that most PCP clinics would consider referring patients to free VCOM-Auburn HBC programs, once available. Phone data were significantly different from email data. The primary limitations were a low response rate and potential response bias.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study.

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

MAINTENANCE OF HEALTH BEHAVIOR CHANGE: CHALLENGES, IMPLICATIONS, AND FUTURE DIRECTIONS

Abstract Health behavior change is critical for healthy aging. Evidence-based programs are available to support a variety of health behavior changes in older adults, including programs for activity, diet, sleep, and medication adherence. Health behavior change programs are typically guided by one or more theoretical models or frameworks describing common constructs related to behavior change. Examples of such constructs include intention, motivation, self-efficacy, and self-regulation. To date, much focus has been on how such constructs relate to initiating and/or achieving behavior change. Although some models specify anticipated outcomes of behavior change over time, maintenance remains largely overlooked. This symposium presents a series of presentations exploring concepts and challenges related to maintenance of health behaviors in older adults. Together, these presentations will explore the definitions and characteristics of maintenance as described in the scientific literature, review maintenance-related trends within physical activity interventions, and discuss findings from stakeholder-engaged sessions designed to identify gaps within the theoretical and scientific literature describing maintenance. The session will conclude with recommendations for future research. This is a Health Behavior Change Interest Group Sponsored Symposium.

Experiences of social support by participants with morbid obesity who participate in a rehabilitation program for health-behavior change: a qualitative study

BackgroundObesity is a global public health concern with significant implications for individuals’ physical health and overall well-being. Health-behavior change programs are crucial for addressing obesity and its associated health risks. Social support plays a central role in facilitating successful outcomes in these programs, yet limited qualitative research exists on the experiences of individuals with morbid obesity participating in such interventions. Thus, this study explores how participants with morbid obesity experienced social support in a group-based rehabilitation program for health-behavior change.MethodsFourteen participants in a group-based rehabilitation health-behavior change program in Norway were interviewed using semi-structured interviews. Data were analyzed with thematic analysis.ResultsThe thematic analysis revealed three primary sources of social support: support from other participants in the group, social support from family and friends, and support from the interdisciplinary team. The participants emphasized the significance of ongoing social support throughout their health-behavior change program. Participants appreciated fostering a sense of community and regular interaction with other members of the program to ensure ongoing social support.ConclusionsParticipants outlined the importance of maintaining a sense of community in the group and appreciated platforms for facilitating ongoing interactions and support among group participants. Future studies should focus on long-term interventions, tailored approaches for individuals with diverse needs involving family and friends, and the impact of enhanced peer support. By understanding the role of social support in health-behavior change programs, interventions can be optimized to better support individuals with morbid obesity.

Time to move beyond monological perspectives in health behavior change communication research and practice.

Chronic disease self-management and health behavior change programs are becoming increasingly important to health service delivery to prevent the development of chronic disease and optimize health outcomes for those who suffer from it. To train people to deliver these programs effectively, we need to understand both the what and how of program delivery. While there is an abundant literature on what, and a merging evidence about what techniques to use, such as goals setting and self-monitoring, the literature on how programs should be delivered is less well developed. This paper reviews emerging research in this area and identifies an underlying monological approach. We argue that this currently dominant model cannot address the key issues in this area. By considering the theoretical framework of Dialogism, we introduce the method of Conversation Analysis to the field of behavior change interventions. Extensive research into health communication has endeavored to show the importance of language and the organization of interactions. We demonstrate and discuss how a monological approach to interventions prevents exploration of what professionals do to deliver intervention content. In doing so, we show that techniques do not account for how successfully an intervention is delivered.

Physical activity in 9–15 year-old pediatric cancer survivors compared to a nationwide sample

IntroductionSufficient physical activity (PA) has the potential to mitigate late effects of cancer, but objective data of PA levels in adolescents are scarce. The aim of this study was to investigate differences in PA behavior between childhood cancer survivors (CCS) and healthy peers.MethodsPA levels of n = 74 CCS and n = 1304 healthy peers from the MoMo study aged 9–15 years were assessed with validated objective accelerometry and group means were compared. A binary multiple logistic regression was performed to investigate the potential predictors of PA.ResultsCCS spent significantly more time sedentary (p < 0.001) and less time in moderate-to-vigorous physical activity (p = 0.002) compared to the healthy cohort. Subgroup analysis revealed the largest deviations of PA levels for CCS aged 9–11 years who fulfilled international PA recommendations on significantly fewer days than MoMo (p < 0.01). Health conditions seem to be a predictor concerning the fulfillment of international PA recommendations by the WHO (p = 0.015).ConclusionsOur study identified vulnerable groups which seem to require targeted exercise and health behavior change programs to increase physical activity and reduce sedentary time. The presence of treatment sequelae as a significant predictor of insufficient physical activity underlines the need of multidisciplinary supportive care approaches.

PENERAPAN THEORY OF PLANNED BEHAVIOR DALAM PEMBERIAN ASI EKSKLUSIF DI KECAMATAN TAROKAN

Introduction: The achievement of exclusive breastfeeding in Kediri Regency 2020 is only 13%, in the Tarokan District area there are several villages which are still below the national target of 40%. The mother's role is very dominant in achieving the target of exclusive breastfeeding. This study aims to determine the behavior of mothers in exclusive breastfeeding using the theory of planned behavior. Method: Quantitative research, observational analytic methods, cross-sectional approach. The research location is in the Tarokan District, carried out from 1 to 20 December 2021 using a simple random sampling technique. Independent Variables: Attitude, Subjective Norm, Behavioral Control. Intervening Variable: Intention, Dependent Variable: Behavior using path analysis. Result: Goodness of Fit CMIN = 0.020, probability = 0.888, GFI=1,000, CFI=1,000, NFI=1,000, TLI=1.009, IFI=1.001, RFI=1,000, AGFI=0.999, RMSEA=0.000, PGFI=0.067. Path coefficient of attitude with intention (β=0.754) (p-value=0.000), (CR=14.871). Subjective norm with intention (β=0.130), (p-value=0.000), (CR=3.374). Behavioral control with intention (β=0.126), (p-value=0.000), (CR=3.429). Intention with behavior (β=0,269), (p-value=0.000), (CR=3.176) Attitude with behavior (β=0.637), (p-value=0.000), (CR=9,198). Behavioral control with behavior (β=0.098), (p-value=0.000), (CR=3.292), attitude through intention towards behavior (0.8325) and behavior control over behavior through intention (0.1505). Discussion: The development of research on health behavior needs to be carried out by further researchers so that they can explore in more depth changes in behavior change in order to plan health behavior change programs in order to improve government programs in the health sector

Key Focus Group Themes to Inform Weight Management Interventions in Deep South African Americans

ObjectiveTo understand African Americans’ perceptions, barriers, and facilitators to recruitment, enrollment, adoption, maintenance, and retention in a nutrition and physical activity promotion program. DesignFour focus groups were conducted. SettingTwo community settings located in Jackson and Hattiesburg, Mississippi. ParticipantsParticipants (n = 28) were aged 18–50 years. Main Outcome Measure(s)Barriers and facilitators associated with healthy eating, physical activity, achieving a healthy weight, and participation in a health behavior change program. AnalysisA conventional thematic content analysis approach includes data familiarization, initial code generation, initial theme generation, themes review, and team review for finalization of themes. ResultsMajor themes related to health behaviors and participation in a behavior change program were identified by participants, including time constraints, costs, social support, consistency and self-efficacy, motivation for longevity and disease prevention, physical appearance, fear of injury/pain, social norms/stigma associated with outdoor physical activity, body criticism from family members, and having empathic and validating program staff support. Conclusions and ImplicationsSeveral social determinants of health were identified as essential considerations for promoting healthy nutrition and physical activity behaviors among African American adult Mississippians. Cultural and spiritual implications were also identified. Study insights inform policy approaches for designing culturally appropriate health behavior change programs in the Deep South.

Bridging Community, History, and Culture in Personal Informatics Tools

A healthy diet and increased physical activity are essential for reducing the prevalence of cardiovascular disease and related deaths, a worldwide public health concern that disproportionately affects Black American communities. Still, Black Americans can face unique challenges meeting dietary and physical activity requirements due to inequities in access and quality of care, environmental and local factors, and difficulties in changing individual health behaviors. Personal informatics and self-tracking tools are one way of increasing awareness of health behaviors to motivate behavior change. However, there are still gaps in knowledge about what encourages different users to engage with personal informatics tools over time, particularly when used in collaborative, community-health settings. This paper contributes a nuanced understanding of fifteen participants' reasons for engaging in an existing community-based health education and behavior change program that combines collaborative self-tracking with culturally relevant content and social engagement to motivate heart-healthy behaviors. We illustrate participants' positive and negative experiences engaging in self-tracking and collaborative tasks during the program. We also discuss how participants envision that integrating technology might support or hinder participant engagement and the work of deploying community-based public health interventions. Finally, we discuss design implications for culturally informed, community-based personal informatics tools that engage Black American's in heart-healthy activities.

Application of Mindsets to Health Education and Behavior Change Programs

Successful health promotion programs are characterized in part, by the willingness of audiences to engage, participate, and adopt healthier behaviors. But presentation of messages that reach and resonate with the intended audience remains challenging. This is due in part to the variety of mindsets—viewpoints, attitudes, and beliefs—within a population. These mindsets play an essential role in understanding and predicting behaviors and lifestyle factors associated with health or chronic diseases. The purpose of this study is to demonstrate how a specific survey-based method of mindset segmentation can distinguish predominant mindsets and then be used to create, adapt, and/or market health programs to appeal to these mindsets. Steps in survey construction, distribution, and analysis are described. Interpretation of the results, yielding three primary mindsets, is the critical outcome of this segmentation method. The applications of this interpretation to community health education programs are suggested. This approach has potential to inform, enhance, or customize programs, tailoring activities, methods, and messages to the preferences of the community.

Health Behavior Change Programs in Primary Care and Community Practices for Cardiovascular Disease Prevention and Risk Factor Management Among Midlife and Older Adults: A Scientific Statement From the American Heart Association.

Cardiovascular disease predominates as the leading health burden among middle-aged and older American adults, but progress in improving cardiovascular health remains slow. Comprehensive, evidenced-based behavioral counseling interventions in primary care are a recommended first-line approach for promoting healthy behaviors and preventing poor cardiovascular disease outcomes in adults with cardiovascular risk factors. Assisting patients to adopt and achieve their health promotion goals and arranging follow-up support are critical tenets of the 5A Model for behavior counseling in primary care. These 2 steps in behavior counseling are considered essential to effectively promote meaningful and lasting behavior change for primary cardiovascular disease prevention. However, adoption and implementation of behavioral counseling interventions in clinical settings can be challenging. The purpose of this scientific statement from the American Heart Association is to guide primary health care professional efforts to offer or refer patients for behavioral counseling, beyond what can be done during brief and infrequent office visits. This scientific statement presents evidence of effective behavioral intervention programs that are feasible for adoption in primary care settings for cardiovascular disease prevention and risk management in middle-aged and older adults. Furthermore, examples are provided of resources available to facilitate the widespread adoption and implementation of behavioral intervention programs in primary care or community-based settings and practical approaches to appropriately engage and refer patients to these programs. In addition, current national models that influence translation of evidence-based behavioral counseling in primary care and community settings are described. Finally, this scientific statement highlights opportunities to enhance the delivery of equitable and preventive care that prioritizes effective behavioral counseling of patients with varying levels of cardiovascular disease risk.

Feasibility of a multiple health behavior change program for premenstrual symptoms in university students: A study protocol

IntroductionPremenstrual symptoms affect a significant number of women throughout their reproductive years. There is evidence that adapting and maintaining healthy lifestyle behaviors can improve these symptoms; however, the effectiveness of multiple behavior change interventions remain largely untested. This study aims to test feasibility of a 12-week multiple health behavior change (MHBC) intervention for university students suffering from premenstrual symptoms. MethodA sequential mixed-methods approach will explore the feasibility of a MHBC intervention to reduce premenstrual symptoms in female university students aged 18–35 years. In phase 1, a parallel three-group randomized pilot trial will be conducted among Australian students. Group 1 will receive the full intervention, while Groups 2 and 3 will receive either the period tracking application, or health behavior change intervention, respectively. The second phase of the study will include semi-structured interviews and thematic analysis to gain an in-depth understanding of participants’ perceptions of the acceptability, appropriateness, usefulness, and sustainability of the intervention and its components (Group 1 participants only). DiscussionThe results will inform whether a subsequent fully powered trial is feasible and provide a deeper understanding of the impact of premenstrual symptoms on university student's health and wellbeing. Moreover, the semi-structured interviews will provide insight into the acceptability, appropriateness, usefulness, and sustainability of the intervention in this population group. ConclusionsThis study based on Bandura's social cognitive theory will examine the feasibility of a 12-week MHBC intervention for young women suffering from premenstrual symptoms.

Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs.

Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.

Health Behavior Change in the Classroom: A Means to a Healthy End?

Obesity is a serious public health problem within the United States. One promising approach to obesity prevention is health behavior change among college students, focusing on diet, sleep, and exercise. However, it remains unclear whether a health behavior change promotion program implemented in the classroom will effectively improve these health behaviors and negative outcomes related to obesity, particularly within classes of different topics. We examined the impact of a 6-week health behavior change program based on the Theory of Planned Behavior. Across several years, with two seemingly distinct samples of students from either a health psychology (n = 433) or a home gardening (n = 155) course, we conducted two studies and employed a single group, pre/post design in which self-reported and objectively measured health outcomes were assessed for change relative to the health promotion program. Participants selected one of three health behaviors and sought to meet current Centers for Disease Control and Prevention recommendations by setting goals, tracking behavior, and meeting with social support groups. Within both studies, dramatic changes emerged in the targeted health behaviors of fruit and vegetable consumption, sleep quantity and quality, and exercise. Moreover, several other health indicators improved among our subjective and objective health variables, and a few outcomes (i.e., subjective health, sleep quality, flexibility, loneliness) improved across all health behavior groups. Collectively, these results suggest this health behavior change program may be an effective way to elicit behavior change and highlight avenues for future remediation and prevention of obesity and related disease.

Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study.

BackgroundEffective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement.ObjectiveThe aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status.MethodsThis was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan.ResultsA total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001).ConclusionsAmong overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.

Acceptability of an interactive film-based intervention targeting adolescent boys to prevent sexual risk-taking: findings from the JACK cluster randomised controlled trial process evaluation

BackgroundGlobal health policy recognises the need for evidence-based interventions to promote positive sexual health among teenage boys. Creative solutions involving digital technologies have potential for engaging boys, but there remains insufficient evidence regarding the acceptability and effectiveness of these methods. We aimed to address this gap by examining the acceptability and feasibility of a coproduced, teacher-delivered intervention that uses interactive film to encourage adolescents to engage in episodic future thinking to help prepare for relationships and sexual health decision making. MethodsAcceptability and feasibility of the intervention was determined with a systematic iterative process of intervention development involving a parallel-group feasibility cluster randomised controlled trial with embedded process and cost evaluation, which piloted trial processes and methods in Northern Ireland and a qualitative evaluation of acceptability in England, Scotland, and Wales. The sampling strategy was a maximum variation quota sample and the control group continued with normal practice. Process evaluation data were also collected. Triangulated data were analysed with thematic analysis. FindingsBetween November, 2014, and December, 2017, eight post-primary schools (831 adolescents, mean age 14·4 years [SE=0·019]) were enrolled into the pilot trial and 13 schools were involved in the qualitative evaluation of acceptability. Process evaluation data were collected from 17 focus groups with adolescents, 30 small focus groups and individual semi-structured interviews with school management staff and teachers, four classroom observations, and a satisfaction survey with 159 pupils. Results showed that the intervention was acceptable to schools, engaging to adolescents and teachers, and could be feasibly and cost-effectively implemented with minor amendments including development of an English version of the film for use in England and Wales, amendment of materials for faith-based schools, and refinement of parental components to include online materials. The satisfaction survey revealed that 100% (n=6) of teachers and 91% (n=145) of adolescents were satisfied with the intervention materials. Recruitment and retention targets were achieved. Of 21 schools approached, 38% (n=8) agreed to take part with no withdrawal. Of 1027 eligible students, and 81% (n=831) were recruited with 93% (n=774) retention. InterpretationCo-produced interactive film that encourages episodic future thinking is an acceptable method of engaging teenage boys in sexual health behaviour change programmes. Further applications of this technique in adolescent public health are possible and, thus far, have included smoking cessation, marijuana use, and future fatherhood in male prisoners. FundingIntervention design and development were funded by The UK Economic and Social Research Council (RES-189-25-0300). The feasibility trial (ISRCTN99459996) was funded by the National Institute for Health Research (NIHR) Public Health Research programme (15/181/01). The views expressed are those of the authors and not those of the National Health Service, the NIHR, or the Department of Health. The Scottish transferability study was funded by the UK Medical Research Council (MC_UU_12017/11) and the Scottish Government Chief Scientist Office (SPHSU11). The transferability study in Wales and England was funded by the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University and University College London.

The Impact of Various Promotional Activities on Ebola Prevention Behaviors and Psychosocial Factors Predicting Ebola Prevention Behaviors in the Gambia Evaluation of Ebola Prevention Promotions.

The outbreak of the Ebola virus disease (EVD) from 2014 to 2016 is over. However, several outbreaks of contagious diseases have already arisen and will recur. This paper aims to evaluate the effectiveness of EVD prevention promotions in the Gambia and to assess the psychosocial factors that steer three behaviors: handwashing with soap, calling the Ebola Hotline, and not touching a person who might be suffering from EVD. In 2015, data were gathered from 498 primary care providers. The questionnaire was based on psychosocial factors from the risks, attitudes, norms, abilities, and self-regulation (RANAS) model. Three promotional activities were significantly associated with psychosocial factors of handwashing and, thus, with increased handwashing behavior: the home visit, posters, and info sheets. Norm factors, especially the perception of what other people do, had a great impact on handwashing with soap and on calling the Ebola Hotline. The perceived certainty that a behavior will prevent a disease was a predictor for all three protection behaviors. Commitment to the behavior emerged as especially relevant for the intention to call the Ebola Hotline and for not touching a person who might be suffering from EVD. Health behavior change programs should rely on evidence to target the right psychosocial factors and to maximize their effects on prevention behaviors, especially in emergency contexts.

Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

IntroductionHealth interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar.MethodsCost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs.ResultsThe cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved.ConclusionSHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

From didactic to personalized health and nutrition counselling: A mixed-methods review of the GALIDRAA approach in Nepal.

GALIDRAA (greet, ask, listen, identify, discuss, recommend, agree, and appoint), an interpersonal communication method, is used in health and nutrition behaviour change programmes to structure communication between front-line workers (FLWs) and beneficiaries. However, programmatic experiential evidence and monitoring and evaluation of the method are scarce. Suaahara aims to address maternal and child undernutrition, in part by influencing household-level behaviours. Suaahara trained both government and programme FLWs in GALIDRAA for use during counselling. This study investigates their adherence to the GALIDRAA method 2years later, using quantitative and qualitative data from a 2014 process evaluation study. Descriptive and thematic analyses were conducted to assess adherence to GALIDRAA. We found variation in adherence to each of the eight GALIDRAA steps among both Suaahara field supervisors (FSs) and Nepal's female community health volunteers (FCHVs). The prevalence of FLWs identifying a beneficiary's problem, discussing, questioning, and probing for constraints with the beneficiary, and, only then, recommending a doable solution, that is, the process of personalized nutrition counselling, was substantially higher among Suaahara FSs than FCHVs. However, both FCHVs and FSs counselling skills, particularly regarding adherence to each step of the GALIDRAA approach, have room for improvement. This highlights the need for additional training and post-training follow-up including supportive supervision related to appropriate counselling methods such as GALIDRAA and may indicate that there are additional FLWs constraints, beyond knowledge, that programmes need to address.