Healthy Behavior Change Research Articles

Application of health behavior change integration theory in pelvic floor muscle exercise in patients with early cervical cancer surgery

Objective: To explore the effect of nursing intervention based on the integration theory of health behavior change on pelvic floor muscle exercise in patients with pelvic floor dysfunction after early cervical cancer surgery.Methods: Select 40 patients with pelvic floor dysfunction after surgery for early cervical cancer, and divide them into experimental group (20 cases) and control group (20 cases) by random number table method. Based on the pelvic floor muscle exercise based on the integration theory of healthy behavior change, the control group received routine pelvic floor rehabilitation nursing, and Oxford pelvic floor muscle strength was used before the intervention (T0), after 1 month of intervention (T1) and at the end of the intervention (T2). Scoring systems, Short Form of Pelvic Floor Dysfunction (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), General Self-Efficacy Scale (GSES), and Social Support Rating Scale (SSRS) were assessed.Results: (1) In terms of pelvic floor muscle strength, the muscle strength ratings of TO, T1 and T2 in the control group were (1.10±0.70), (1.46+0.64 (1.90+0.70), respectively, and (1.12±0.73) in the experimental group. , (1.96±0.73), (3.04+0.81) levels, the difference between the two groups at each time point after intervention was statistically significant (F group=25.730, F time=329.809, F interaction=56.688, all P<0.001); (2) On the PFDL20 score, the total scores of TO, T1 and T2 in the control group were respectively (80.19+18.75)>(78.67+17.99 (77.47+15.91) points, the test group was (77.77+19.97 ) >(69.11±15.97), (66.54+14.04) points, the difference between the two groups at each time point after the intervention was statistically significant (F group=6.876, F time=62.536, F interaction=29.196, all P<0.05); ( 3) On the PFIQ-7 score, the total scores of T0, T1 and T2 in the control group were (82.80+12.04)> (80.88+11.62)> (78.39+8.51) points, and the experimental group were (82.66±11.24), (82.66±11.24), (80.88+11.62) 76.69±10.12) and (73.20+7.41) points, the difference was statistically significant between the two groups at each time point after the intervention (F group=3.551, P=0.062; postmortem time=69.943, F interaction=13.213, all P<0.001 ); (4) In general self-efficacy, the total scores of TO, T1 and T2 in the control group were (2.44±0.53), (2.49+0.49) respectively (2.51+0.34) points, the experimental group was respectively (2.47+0.53)> (2.67+0.38 (2.86+0.30) points, the difference between the two groups at each time point after the intervention was statistically significant 3 group = 6.788, F time = 50.994, F interaction=25.664, all <0.05); (5) In terms of social support, the total scores of T0, T1 and T2 in the control group were (45.16±3.28), (45.84±3.02),(46.42+2.82) points, and the experimental group were respectively (45.48+3.43(48.25+2.83)> (5037+2.45) points, the difference was statistically significant between the two groups at each time point after the intervention (F group=20.12, F time = 199.34, F interaction = 70.24, both P<0.001).Conclusion: Nursing intervention scheme based on the integration theory of health behavior change can significantly improve the pelvic floor muscle strength, self-efficacy, social support level and quality of life of patients with pelvic floor dysfunction after early cervical cancer surgery, and improve the short-term and long-term pelvic floor rehabilitation.

Assessment of Healthy Lifestyle Behaviors among First-Year Medical, Dentistry and Health Sciences Students in Turkey

This cross-sectional study, in which the first-year findings of a prospective followup study were presented, was conducted with 356 students enrolled in the firstyear of three faculties at a state university in Istanbul between November 1st and December 31st, 2019. With this study, it was aimed to evaluate the changes in certain healthy lifestyle behaviors, risky behaviors and depression levels of students enrolled at the different faculties of a public university in Istanbul during their university life. The data were obtained through a questionnaire of 65 questions, and the Beck Depression Inventory, which consisted of 21 questions. They were administered under supervision by providing preliminary information to the students. The mean body mass index, mean systolic blood pressure and mean diastolic blood pressure values of the students were 23.23 + 4.1, 108.97 + 15.21 and 66.98 + 10.08, respectively. The mean daily sleep time was 6.77 + 1.21 hours, the mean TV viewing time was 0.77 + 1.13 hours, and the mean time they spent with a smartphone, tablet or computer was 3.67 + 2.50 hours. Among the students, 37.07% were smokers, 26.12% consumed alcohol, and 4.77% used addictive substances. Of the students, 31.46% considered themselves at risk for depression. At the universities, there is a need for the implementation of health promotion programs focusing on promoting physical activity and healthy nutrition and reducing risky behaviors. In addition, these programs should be strengthened with the trainings on changing behaviors.

Sensory evaluation of new recipes for Supplemental Nutrition Assistance Program Education (SNAP‐Ed) informs consumer acceptance and recipe development needs

AbstractFederal nutrition education programs use food demonstrations and tastings of healthy recipes to elicit behavior change among their target audiences, but acceptance and liking of such recipes has not been systematically evaluated. This study aimed to assess acceptability and key sensory attributes (appearance, flavor, texture, saltiness, and sweetness) of culturally tailored recipes using sensory evaluation methods in a nontraditional setting. Affective ballots were used to assess overall liking (OL), key attributes, and preparation intent of seven new recipes on a 9‐point hedonic scale. Open‐ended feedback was also collected. A convenience sample of 338 low‐income adults rated two out of seven recipes as meeting a standard acceptability rating ≥7. These ratings were significantly related to their preparation intent. Flavor and texture were revealed as attributes that significantly influenced OL. Findings support the practicality of sensory evaluation methodology in nontraditional settings for the development of recipes in Federal nutrition education programs.Practical applicationsThis novel application of sensory evaluation in nontraditional settings can provide curriculum developers' of federal nutrition education programs a holistic understanding of their target audience's recipe needs. Developers have the ability to analyze specific attributes, ask about preparation intent behaviors, and more accurately determine areas for improvement of each recipe through these targeted consumer sensory tests. Developers can thus ensure that recipes in their curricula (present and future) are well equipped to promote healthy behavior change. Additionally, this information can be built upon over the course of many sensory evaluations of more recipes to create a living record of the target audience's likes and dislikes for future recipe development. The inclusion of sensory evaluation in Federal nutrition programs provides opportunity for collaboration between sensory scientists and these programs nationwide.

Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study.

BackgroundThe rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public.ObjectiveThe aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore.MethodsWe performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants’ knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants’ satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress.ResultsWe recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior.ConclusionsThe delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial.

Behavior Change Interventions for Health Promotion in Physical Therapist Research and Practice: An Integrative Approach.

There is an increasing focus on health promotion in physical therapist research and practice. A clinical model (Health-Focused Physical Therapy Model) was developed for identifying major steps in the delivery of health promotion focusing on adoption of healthy lifestyle behaviors. One of the primary steps within this model is the design and delivery of behavior change interventions. Such interventions involve coordinated sets of activities that target change in a specific pattern of unhealthy behavior (eg, physical inactivity, smoking). This Perspective contends that the science and practice of behavior change interventions can be significantly advanced in the field of physical therapy (implementation science) through the integration of behavior change frameworks and techniques within the context of an experimental medicine approach for health behavior change. This perspective presents the integration of the Theoretical Domains Framework, the Behavior Change Wheel, including the Capability Opportunity Motivation-Behavior core system, and the Behavior Change Technique Taxonomy as a comprehensive approach for designing and delivering behavior change interventions in physical therapy. An experimental medicine approach is described, outlining a 4-step process in the design, delivery, and evaluation of behavior change interventions that can be applied to health promotion in physical therapist research and practice. The proposed integrative approach can advance public health and health promotion through healthy lifestyle behavior change in the field of physical therapy.

The effects of nursing of Roy adaptation model on the elderly hypertensive: a randomised control study.

Hypertension is a chronic disease affecting middle-aged and elderly patients worldwide. Self-management behavior plays a critical role in maintaining blood pressure. Roy adaptation model (RAM), which was proposed by Roy in 1970, has been used to guide hypertension nursing to improve self-management behavior of elderly patients. In the study, to explore the effect of nursing based on the RAM on the self-management behavior of elderly hypertensive patients. A total of 120 elderly hypertensive patients admitted from June 2020 to March 2021 were selected and randomly divided into a control group and observation group based on odd and even numbers of the admission order, with 60 cases in each group. The control group received routine nursing measures while the observation group was given nursing based on the RAM. The self-management behavior, medication compliance, quality of life, and blood pressure control effect were compared between the two groups. The scores of the self-efficacy and self-management behaviors of the observation group and the total score of the scale were higher than those of the control group (P<0.05); the observation group patients' medication compliance score was 6.57±1.47, which was higher than that of the control group (4.90±2.16) (P<0.01); physiological function, physical pain, energy, social function, emotional function, mental health scores, and total scores of the SF-36 scale in the observation group were all higher than those of the control group (P<0.05), while comparison of the general health status dimension scores showed no statistically significant difference; the systolic blood pressure and diastolic blood pressure of the observation group were respectively lower than those of the control group (P<0.05); The blood pressure control compliance rate of the observation group was 85.4%, which was higher than that of the control group 64.6% (P<0.05). Nursing intervention based on Roy's adaptation model can better enhance the self-efficacy and self-management ability of elderly hypertensive patients, have a positive effect on promoting healthy behavior changes and improving the quality of life, improve medication compliance, and achieve better blood pressure control effects. Chinese Clinical Trial Registry ChiCTR2100052466.

AB005. Post-disaster solo dining and healthy food behavioral change through cooking class participation

AB005. Post-disaster solo dining and healthy food behavioral change through cooking class participation

Emerging digital technologies in cancer treatment, prevention, and control.

The very first issue of the journal of Translational Behavioral Medicine (TBM) was dedicated, in part, to the theme of Health Information Technology as a platform for evidence implementation. The topic was timely: legislation in the USA was passed with the intent of stimulating the adoption of electronic health records; mobile smartphones, tablets, and other devices were gaining traction in the consumer market, while members within the Society of Behavioral Medicine were gaining scientific understanding on how to use these tools to effect healthy behavior change. For the anniversary issue of TBM, we evaluated the progress and problems associated with deploying digital health technologies to support cancer treatment, prevention, and control over the last decade. We conducted a narrative review of published literature to identify the role that emerging digital technologies may take in achieving national and international objectives in the decade to come. We tracked our evaluation of the literature across three phases in the cancer control continuum: (a) prevention, (b) early detection/screening, and (c) treatment/survivorship. From our targeted review and analyses, we noted that significant progress had been made in the adoption of digital health technologies in the cancer space over the past decade but that significant work remains to be done to integrate these technologies effectively into the cancer control systems needed to improve outcomes equitably across populations. The challenge for the next 10 years is inherently translational.

Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study

BackgroundApproximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension.MethodsIn this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data.ResultsBlack and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure.ConclusionThis study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.

The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data.

BackgroundThe American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions.ObjectiveThe objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2).MethodsData were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time.ResultsBoth hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well.ConclusionsThis analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD.

Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment.

BackgroundThe incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public.ObjectiveWe explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes.MethodsThis qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis.ResultsThe collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle.ConclusionsParticipants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior.

Leveraging physical activity to engage men in mental health promotion: Informing future directions for lifestyle interventions

Background: Men’s mental health promotion presents unique challenges and opportunities that demand novel approaches to prevention, treatment, and management. Community-based lifestyle interventions targeted at healthy behaviour change (e.g., physical activity) have been identified as a promising avenue to engage men in mental health promotion as these settings may reduce barriers to help-seeking. However, research is needed to identify strategies for designing and delivering relevant intervention content that supports men’s mental health.

Preventing Delirium and Promoting Long-Term Brain Health: A Clinical Trial Design for the Perioperative Cognitive Enhancement (PROTECT) Trial.

Perioperative neurocognitive disorders (PND), including postoperative delirium (POD), are common in older adults and, for many, precipitate functional decline and/or dementia. In this protocol, we describe a novel multidisciplinary, multicomponent perioperative intervention that seeks to prevent or reduce POD and associated cognitive decline. We will conduct a prospective, single-blind, pragmatic, randomized-controlled trial to compare our tailored multi-disciplinary perioperative pathway against current standard of care practices. We will recruit a total of 692 elective surgical patients aged 65 years or more and randomize them in a 1:1 design. Our perioperative intervention targets delirium risk reduction strategies by emphasizing the importance of early mobilization, nutrition, hydration, cognitive orientation, sensory aids, and avoiding polypharmacy. To promote healthy behavior change, we will provide a tailored psychoeducation program both pre- and postoperatively, focusing on cardiovascular and psychosocial risks for cognitive and functional decline. Our primary outcome is the incidence of any PND (encapsulating POD and mild or major postoperative neurocognitive disorder) at three months postoperative. Secondary outcomes include any incidence of POD or neurocognitive disorder at 12 months. A specialized delirium screening instrument, the Confusion Assessment Method (3D-CAM), and a neuropsychological test battery, will inform our primary and secondary outcomes. Delirium is a common and debilitating postoperative complication that contributes to the cognitive and functional decline of older adults. By adopting a multicomponent, multidisciplinary approach to perioperative delirium prevention, we seek to reduce the burden of delirium and subsequent dementia in older adults.

Enhancing Type 2 diabetes risk communication with message framing and tailored risk feedback: an online randomised controlled trial

ABSTRACT Objective Type 2 diabetes (T2D) risk communication may help individuals better understand their risk and motivate behavioural changes. There is a wealth of research in health risk communication which suggest the effectiveness of message framing and tailored risk feedback; however, little is known about their potential utility when used concurrently and in high-risk population approaches to T2D prevention. Methods This study evaluated the effects of message framing and tailored risk feedback on T2D risk perception and behavioural intentions, and if these effects were varied by level of alcohol consumption. Three hundred and forty-seven online participants were stratified by levels of alcohol consumption and subsequently randomised to receive T2D information, risk estimates, and lifestyle recommendations that were subjected to four different message framing and tailoring manipulations. Results No significant differences were observed in T2D risk perceptions or behavioural intentions by study arm. However, T2D risk perception scores and accuracies, and behavioural intentions significantly increased post-intervention across all conditions. Conclusions Despite the lack of impact of message framing or message tailoring, this study suggests that a brief online T2D risk communication can help to correct risk perceptions and increase behavioural intentions. These preliminary findings are encouraging and support the continued development of online risk assessment and communication to help combat the current T2D epidemic. KEY POINTS What is already known about this topic: (1) Most individuals at risk of Type 2 diabetes do not engage in risk-reducing behaviours. (2) Risk communication may help to correct Type 2 diabetes risk perception and lead to healthy behavioural changes. (3) Message framing and tailored risk feedback have been shown to be effective ways of communication, though no studies have examined them in combination. What this topic adds: (1) Preliminary support for the brief online Type 2 diabetes risk communication intervention in correcting risk perceptions and increasing behavioural intentions. (2) Effectiveness of manipulation did not differ based on message manipulation. (3) Preliminary support for the use of the risk communication intervention in high-risk populations.

Intrinsic motivation in exercise: A concept analysis.

To explore the concept of intrinsic motivation in exercise as it pertains to nursing. Exercise is an integral part of treating and preventing chronic diseases, and yet the vast majority of adults do not adequately meet endorsed exercise recommendations. Evaluating motivation for exercise assists in the effort to promote sustained exercise participation. Intrinsic motivation speaks to the innate drive for an action or behavior. Intrinsic motivation has previously been evaluated in various disciplines including nursing, education, exercise science, medicine, and psychology. The combination of intrinsic motivation and exercise can be applied in the nursing discipline to evaluate, predict, and impact behavior change. Concept analysis using Walker and Avant (2019) methodology. PubMed, CINAHL, and PsychINFO. Articles from the years 2011 to 2020 were included. Literature from multiple disciplines was synthesized to explore the concept of intrinsic motivation in the context of exercise. Characteristics of intrinsic motivation, their attributes, antecedents, and consequences were identified. The concept analysis represents a consensus of the identified literature providing a concise description of intrinsic motivation with exercise. Four vital attributes were identified in the literature and became the basis of the concept analysis; self-efficacy, competence, self-determination, and satisfaction. This concept analysis provides a foundation from which to create nursing interventions aimed at fostering intrinsic motivation for exercise. Expansion of our knowledge of intrinsic motivation, in the context of exercise, has the potential to enhance approaches used by nurses and nurse providers to affect healthy behavior changes.

The social and physical consequences of weight stigma in obese adolescents – primary care view

Negative attitudes regarding obese adolescents are learned early in life. Weight stigmatizing experiences occur frequently in the context of personal relationships with peers, teachers, family members, and health professionals. Adolescents’ weight stigma is insufficiently considered in the obesity’s management, and this contributes to negative health outcomes and behaviors that act as obesogenic factors into adulthood. Primary care professionals provide opportunity for translating expert recommendations for healthy behavior changes of obese adolescents, having facilities and staff to implement them in the community. However, comprehensive programs for controlling body weight and stigmatizing obese adolescents are not sufficiently addressed in primary care because they require psycho-educational skills development and dedicated time. In the framework of the curricular reform of the family medicine residency program a study design in the community served by the family physician trainer and carried out with the family medicine residents involvement was included. We describe an integrative community-based educational program dedicated to the social and physical health consequences of obese adolescents’ weight stigma that should be implemented in primary care. Conclusions. Psycho-educational skills development in the future family doctors training will lead to greater efficacy in addressing emotional needs of obese adolescents. Their increased involvement in counseling parents will help better cope with their children's eating disorders and weight-based victimization.

Perceptions of recurrence risk and behavioural changes among first-ever and recurrent stroke survivors: A qualitative analysis.

BackgroundAmong stroke survivors, the risk of stroke recurrence is high, and stroke survivors' perception of the risk of recurrence is crucial to promote healthy behaviours.ObjectivesThis study aimed to explore the perceptions of stroke survivors about their risk of recurrence and healthy behavioural modifications.DesignA qualitative interview study was carried out.ResultsWe interviewed 19 stroke survivors from 3 hospitals. Thematic analysis showed that the perceptions of recurrence risk and healthy behavioural changes differed between first‐ever and recurrent stroke survivors. Three themes were generated from the data of first‐ever stroke survivors: indifference to and unawareness of the risk of stroke recurrence, the need for professional information support and different awareness of the importance of different healthy behaviours. For first‐relapse stroke patients: worry but feel powerlessness towards recurrent event, accurate information is still warranted, regret of unhealthy behaviour patterns. For the survivors suffered two or more times recurrences: perceived severity of recurrences, increased psychological care need, incorrect perceptions of healthy behaviour.Discussion and ConclusionStroke survivors with or without recurrence hold different perceptions towards the risk of recurrence and behavioural changes. The need for information related to warning signs, recurrence risk and risk factors remained consistently unmet. The benefits of healthy behaviours could be a double‐edged sword for the prevention of stroke recurrence if the survivors fail to understand these accurately. It is strongly recommended that a specific recurrence risk communication tool and related health education plan be explored on the basis of the number of times patients have experienced stroke recurrence to inform secondary prevention of stroke in the future.Patient/Public ContributionThe patients were involved in the formulation of interview questions and conduct of this study. No public was involved in this study.

The Impact of Mindset on Self-Tracking Experience.

Self-tracking technologies aim to offer a better understanding of ourselves through data, create self-awareness, and facilitate healthy behavior change. Despite such promising objectives, very little is known about whether the implicit beliefs users may have about the changeability of their own behavior influence the way they experience self-tracking. These implicit beliefs about the permanence of the abilities are called mindsets; someone with a fixed mindset typically perceives human qualities (e.g., intelligence) as fixed, while someone with a growth mindset perceives them as amenable to change and improvement through learning. This paper investigates the concept of mindset in the context of self-tracking and uses online survey data from individuals wearing a self-tracking device (n = 290) to explore the ways in which users with different mindsets experience self-tracking. A combination of qualitative and quantitative approaches indicates that implicit beliefs about the changeability of behavior influence the extent to which users are self-determined toward self-tracking use. Moreover, differences were found in how users perceive and respond to failure, and how self-judgmental vs. self-compassionate they are toward their own mistakes. Overall, considering that how users respond to the self-tracking data is one of the core dimensions of self-tracking, our results suggest that mindset is one of the important determinants in shaping the self-tracking experience. This paper concludes by presenting design considerations and directions for future research.

Acceptability of Intervention Design Factors in mHealth Intervention Research: Experimental Factorial Study.

BackgroundWith the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies’ scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist. ObjectiveThis study aims to evaluate the impact of two common design factors in mHealth intervention research—requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content—on reported participant acceptability. MethodsA diverse US adult convenience sample (female: 104/255, 40.8%; White: 208/255, 81.6%; aged 18-74 years) was recruited to complete a web-based experiment. A 2×2 factorial design (number of devices×nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented. ResultsReported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested. ConclusionsThe results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time.

O48 Urban, Low-Income Teens’ Opinions on Game-Based Classroom Nutrition and Physical Activity Lessons

<h3>Background</h3> A novel concept for educating teens is "game-based learning (GBL)" or "gamification." GBL is an educational approach evoking motivation and engagement while learning through playing games. International studies have reported successful gamification outcomes, including favorable changes in fruit and vegetable intake, physical activity levels, overall well-being, nutrition knowledge, and peer influence. <h3>Objective</h3> The purpose of this study was to obtain opinions from urban, low-income, high school-aged teens' regarding their acceptance of gamified nutrition lessons, as well as to identify what knowledge they retained when this methodology was employed. <h3>Study Design, Setting, Participants</h3> This was a descriptive study using a purposive, convenience sample of high school-aged participants who were recruited from a cohort that had attended 6 sample lessons at the John F Kennedy High School in Passaic City, and the YMCA in Newark, New Jersey. Data were collected through semi-structured, face-to-face group interviews. <h3>Measurable Outcome/Analysis</h3> Two independent coders performed a thematic analysis of interview transcripts. Findings were discussed until both researchers came to a consensus on the final themes. <h3>Results</h3> A total of 25 teens (12 females) participated in 4 focus groups. Participants reported improved knowledge and perceptions of healthy eating and behavior changes they had made regarding their choices at fast-food restaurants, their intake of energy-dense snacks, their reduced intake of sugar-sweetened beverage intake, and overall healthier choices. Teens reported positive attitudes towards gamified classroom activities. They said the lessons were, "fun," "interactive," and "creative." They were particularly fond of the activities that involved music or sound effects, prizes, and the use of technology. <h3>Conclusion</h3> These preliminary results suggest that GBL nutrition lessons can lead to an increase in knowledge and improvements in the dietary behaviors of low-income, urban teens over the short-term. Additional research is needed with additional teens and to assess this approach's long-term impacts.