Long-term Health Behavior Change Research Articles

Digital Technology in Community Engagement: Impacts and Implications.

Health professionals are increasingly using digital technology as a strategy to maximize community engagement and effectively implement health interventions, a phenomenon evidenced by the COVID-19 pandemic. While technology has improved health information dissemination, communication, and data management, it cannot replace the human-based interactions offered by traditional grassroots outreach that can influence long-term health behavior change, particularly for underserved communities. Digital community engagement can be part of the digital divide, often widening disparities by excluding those without access or limited access to technology. It may hinder the accurate collection of contextual and comprehensive data needed to analyze social determinants of health, thereby widening the equity gap. This commentary explores the challenges of using digital technology and justifies leveraging it to complement traditional community engagement rather than as a replacement.

Seeing is believing? The pivotal role of personal experience in contemporary health behaviour: A narrative review

AbstractIn the age of people aspiring after sense experiences, encouraging long-term health behaviour changes to prevent future disorders that are, without previous personal experiences, unimaginable threats for the public, maybe one of the greatest challenges preventive medicine has to face. In order to become trusted sources, and influence public health behaviour in an experience-oriented manner, we need to formulate strategies offering emotionally evocative sense inputs that elicit self-relatedness. The current narrative review discusses the relevance of personal experiences in contemporary health behaviour by focusing on three major areas: 1) the importance of personal sources of health-related information, 2) cognitive and neurobiological background of personal experiences, 3) potential strategies to induce health behaviour changes through personal experiences. Based on the reviewed body of knowledge, three potential “rules” are proposed to increase the effectiveness of health promotion programs through sense or personal experiences: 1) Rule of Senses (stressing the importance of multisensory learning); 2) Rule of Affect (emphasizing the motivational significance of evoking positive emotions); and 3) Rule of Self-relatedness (highlighting the role of the self-referential composition of human experiences).

A Narrative Review of Ethnic Minority Studies for Faith-Based Health Promotion Interventions with Special Reference to the Contemporary Christian Nurse.

Heart disease, diabetes mellitus (DM) type 2, and obesity are three of the most prevalent diseases in the USA. Some obesity-related comorbidities are disproportionately higher within African-American and Hispanic communities. While governmental and local health programs offer educational opportunities encouraging long-term health behavior changes, the most accessible programs have been through faith-based communities. This narrative review investigates the outcomes of faith-based wellness programs on Latino and African-American populations with respect to general health and wellness, obesity management, DM type 2, and hypertension. Perceived authority of faith community nurses, faith leaders, and accountability and encouragement provided by faith communities are critical. Long-term behavior change is positively affected by elements faith-based organizations can provide: cultural appropriateness, community support, and self-efficacy.

Changes in alcohol consumption, body weight and physical activity among breast cancer survivors and population-based unaffected women in a prospective study

BackgroundIt is unclear whether a breast cancer diagnosis affects health behaviour changes that occur with ageing. We aimed to compare long-term changes of alcohol consumption, body weight, and physical activity in women with breast cancer and in age-matched unaffected women. MethodsWe used data from 1,925 women with breast cancer and 3,473 unaffected women aged 50–74 years enrolled in the population-based case-control study MARIE (Mamma Carcinoma Risk Factor Investigation) in 2002–2005, who also completed the follow-up in 2014-2016. Multinomial logistic regression was applied to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the associations between breast cancer status and categories of change in alcohol consumption, weight and physical activity. ResultsAfter 11.6 years of follow-up, breast cancer survivors had significantly lower odds than unaffected women of increasing alcohol consumption from ≤10 to >10 g/day (adjusted OR 0.48, 95 % CI 0.35-0.65), but were more likely to experience a major weight change of ≥10 % compared to having stable weight (±<5 %) (OR for increase and decrease 1.32, 95 % CI 1.03–1.70 and 1.36, 95 % CI 1.05–1.77, resp.) and to decrease transport physical activity to below 2.5 h/week compared to maintaining the activity level (OR 1.61, 95 % CI 1.26–2.04). No significant group difference was found for changes in recreational physical activity. ConclusionOur data indicate that some long-term health behaviour changes can be attributed to a breast cancer diagnosis rather than ageing, suggesting that long-term medical care of breast cancer survivors could pay greater attention to weight control and sufficient physical activity.

0682 Evaluation Of An Incentive-based Intervention To Improve 90-day Adherence In Pap-naive Patients

Abstract Introduction Although PAP therapy is the gold standard treatment for obstructive sleep apnea, adherence to treatment is suboptimal. Without sustained therapy adherence, patients are at risk of serious negative health outcomes. The objective of this study was to test whether a digitally delivered monetary and social reward program helped patients new to PAP therapy. Financial incentive schemes are effective in helping patients adhere to difficult medication or therapy plans. Additionally, there is an abundance of evidence that social support is a critical component to long-term health behavior change. Methods This prospective, randomized, single site pilot is evaluating the effectiveness of an app-based intervention in helping patients adhere to PAP therapy. The financial incentive design leverages loss aversion, and the social incentive design leverages the strength of close ties and variable reinforcement. The primary endpoint is mean PAP usage at 3 months. Secondary endpoints include Medicare compliance, change in functional status, and baseline scores of perceived disease severity, claustrophobia, coping skills, and health literacy as moderators of the intervention’s effectiveness. Study recruitment is ongoing, with an expected sample size of 150 subjects. Results Of the 132 subjects enrolled, 56% are male, 61% are Caucasian, and 65% are married. The mean age is 49.6 ± 12.0 years and mean BMI is 32.4 ± 8.4 kg/m2. Additional demographics such as income level, education level, and number of children along with the primary and secondary endpoints will be presented. A subgroup analysis of the primary endpoint will be generated for subjects identified as strugglers within the first 3 days of usage. Conclusion The results of this study will provide insight into methods such as financial and social incentives delivered via a smartphone on initial compliance with PAP therapy, as well as provide more information on the behavioral change associated with beginning PAP therapy. Support ResMed

Self-guided Change: The most common form of long-term, maintained health behavior change.

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review—similar in nature to a scoping review—was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80–90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.

Does a future-oriented temporal perspective relate to body mass index, eating, and exercise? A meta-analysis

ObjectiveThe present study aimed to quantify the magnitude of the association between future temporal perspective and Body Mass Index (BMI), diet, and exercise, respectively, and to clarify whether subjective future-focus scales or delay-discounting tasks are a more robust predictor of health behaviors. MethodsA systematic search was conducted for studies that included a dispositional measure of future temporal perspective and a measure of BMI, eating, and/or exercise behavior. Effect sizes for BMI, eating, and exercise were calculated using a random-effects model. ResultsThe aggregate effect sizes for BMI (r = 0.14, k = 36, 95% CI = 0.10 - 0.18, p < 0.001), eating (r = 0.16, k = 18, 95% CI = 0.12–0.21, p < 0.001), and exercise (r = 0.12, k = 18, 95% CI = 0.09–0.14, p < 0.001) were significant and small in magnitude. Neither the type of future temporal perspective task (delay-discounting vs. subjective future-focus scale) nor the percentage of obese participants moderated the effect of temporal perspective on BMI, eating, or exercise. ConclusionsAlthough small in magnitude, the association between temporal perspective and health outcomes is comparable to other individual differences, such as personality and temperament. Future research is needed to examine how increasing the value placed on future outcomes can be integrated into long-term health behavior change interventions.

How Fitness Trackers Facilitate Health Behavior Change

Fitness trackers have broadened the healthcare ecosystem and made self-tracking everyday physical activities possible. Features like heart rate monitoring can help detect health ailments, yet there is little evidence that suggests tracking health indicators and physical activities leads to long-term health behavior change. This proceeding analyzes areas of Human Factors that could be used to increase long-term user engagement. Feedback, information display, and specific design principles and case studies are discussed.

Interpersonal Communication and Smoking Cessation in the Context of an Incentive-Based Program: Survey Evidence From a Telehealth Intervention in a Low-Income Population

The tobacco epidemic disproportionately affects low-income populations, and telehealth is an evidence-based strategy for extending tobacco cessation services to underserved populations. A public health priority is to establish incentive-based interventions at the population level in order to promote long-term smoking cessation in low-income populations. Yet randomized clinical trials show that financial incentives tend to encourage only short-term steps of cessation, not continuous smoking abstinence. One potential mechanism for increasing long-term cessation is interpersonal communication (IPC) in response to population-level interventions. However, more research is needed on IPC and its influence on health behavior change, particularly in the context of incentive-based, population-level programs. This study used survey data gathered after a population-level telehealth intervention that offered $20 incentives to low-income smokers for being connected to Minnesota's free quitline in order to examine how perceived incentive importance and IPC about the incentive-based program relate to both short-term and long-term health behavior change. Results showed that IPC was strongly associated with initial quitline utilization and continuous smoking abstinence as measured by 30-day point prevalence rates at 7-month follow-up. Perceived incentive importance had weak associations with both measures of cessation, and all associations were nonsignificant in models adjusting for IPC. These results were found in descriptive analyses, logistic regression models, and Heckman probit models that adjusted for participant recruitment. In sum, a behavioral telehealth intervention targeting low-income smokers that offered a financial incentive inspired IPC, and this social response was strongly related to utilization of intervention services as well as continuous smoking abstinence.

Health Behavior Change and Life Course: A Qualitative Study Using Focus-Groups

This study aimed to explore the mechanisms of long-term behavior changes to a healthier lifestyle. We conducted focus group interviews with a sample of 18 adults without further selection criteria and applied a top-down thematic analysis approach to extract the determinants of long-term health behavior change. The results showed that long-term health behavior changes only occurred as a response to life events that force individuals to abandon established habits. These triggers accrued from the interplay of three life course elements: the life phase, a change in external living conditions (e.g. the social environment) over time, and internal motifs (past experience, future goals, and perceived immediate payoff). Our results are discussed in the context of sociological lifestyle theories, suggesting that long-term lifestyle change follows from a disturbed equilibrium between external determinants and identity cues.

Patient-centered financial incentives for health: Can employers get change for their dollars?

While employer-sponsored financial incentives for healthy behaviors have demonstrated the potential to promote short-term employee behavior change, the effectiveness of such incentives in promoting long-term health behavior change has often been disappointing. This paucity of sustained change could be explained by the many factors that shape employees' health behaviors, only some of which may be influenced by incentives. We discuss how employer-sponsored incentives for healthy behaviors could become more patient-centered, and thus perhaps more effective, by integrating insights from self-determination theory and health behavior theories, targeting employees' capacity for change, and using tailoring.

Two-year follow-up of sequential and simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake

Limited evidence exists on long-term efficacy of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake, and even more so when they are implemented simultaneously or sequentially. This study aims to examine long-term efficacy of interactive computer-tailored physical activity and fat intake interventions, and evaluate their efficacy in a simultaneous or sequential implementation over 2 years. Participants (392) were randomly assigned to a simultaneous group receiving both interventions at baseline; a sequential group first receiving the physical activity intervention and 3 months later the fat intake intervention; and a sequential group first receiving the fat intake intervention and 3 months later the physical activity intervention. Strong time effects were seen for total physical activity (F = 38.7, p < .001) and fat intake (F = 103.9, p < .001), indicating that intervention effects remained over 2 years for those participants that were still available for the 2-year follow-up. At 2-year follow-up the interventions resulted in a 10% and a 27% increase of participants that met public health recommendations for physical activity and fat intake, respectively. Overall the interventions were more effective for participants not meeting the public health recommendations at baseline. The sequential intervention mode was overall slightly more effective than the simultaneous mode in maintaining intervention effects. Both interventions showed efficacy in maintaining long-term health behavior changes. More research is needed on sequential and simultaneous intervening modes.

Trends of abdominal adiposity in white, black, and Mexican-American adults, 1988 to 2000.

To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican-American adults from 1988 through 2000. Nationally representative cross-sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC > or =102 cm in men and > or 88 cm in women. There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican-American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks. Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence-based programs that show promise for long-term health behavior changes to facilitate the prevention of AO and related comorbidities.