Motivate Behavior Change Research Articles

Asking Numbers to Speak: Verbal Markers and Stages of Change.

Through routine screenings for sexually transmitted infections (STIs) and HIV, medical providers are able to motivate behavior change. Although established models rely on quantitative measures, doing so requires time and ability to score each. Listening for verbal cues, however, could simplify the process of suggesting HIV screenings. Using mixed methods to identify verbal indicators for readiness to change, this article conducted two phases of study. First using quantitative means of identifying participant's knowledge of HIV, perceptions of safer sex, and readiness to change safer sex behaviors ( N = 487). Interviews were then conducted exploring the possibility of verbal markers for one's readiness to change ( n = 25). Results confirmed the use of verbal markers when discussing perceptions of risk. Identification of verbal markers, at three stages of change, provides new possibilities for medical providers' such as providing time saving and effective tools when seeking to motivate HIV and STI testing, and other safer sex behaviors.

Add a Little Friendly Competition to Your Nutrition Promotion Activities

Looking for a fun way to encourage healthy behaviors? Try introducing a little friendly competition with SuperTracker’s new challenge feature. The newest enhancement to SuperTracker (US Department of Agriculture’s free, interactive tracking tool for food, physical activity, and weight) offers an easy way for registered dietitian nutritionists (RDNs) to help Americans make healthier choices. We know that for some people, trying to improve their diet and logging every food they eat is overwhelming, or seen as too time consuming. SuperTracker challenges offer a new, simpler way for Americans to get feedback on their health behaviors and work toward their goals. Participants use “Quick Tracker” to easily record daily foods and physical activities in a matter of seconds, and they get positive reinforcement by earning points for making healthy choices (Figure 1). Challenges use competition and social support to empower participants to eat the MyPlate way. Along with support from an RDN, SuperTracker challenges can help them discover that adopting a healthy eating pattern is doable. Earlier this year, SuperTracker group challenges were announced, allowing members of a group to compete against one another in a healthy eating challenge. Now the competition can really heat up with group-to-group challenges. With this new feature, one group can challenge another group in a team-style competition. Participants in both groups can compare progress on a joint leaderboard and compete to see which team gets the highest average points per member (Figure 2). By leading a SuperTracker group, RDNs can set up versus challenge, choosing a ready-made MyPlate Challenge or designing a custom challenge—eg, a 5-day fruit and vegetable challenge or a 2-week whole-grains challenge. Consider creating a challenge between two offices for a little friendly competition in the workplace, between two classes, or between two groups of clients. The SuperTracker Groups feature, originally launched last fall, allows RDNs to manage a group of SuperTracker users and inspire them to work toward their healthy eating goals together. In addition to private groups, RDNs can now create public groups and invite up to 500 people to join via Facebook, e-mail, or a group-specific access code. Unlike private groups, any SuperTracker user can join a public group—no invitation is needed. To help people find your group, you can label it by using our list of over 240 tags representing various locations, affiliations, and hobbies/interests. Public groups can help RDNs extend their reach to a broader audience and encourage more Americans to meet their health and wellness goals. Group leaders also now have the ability to transfer group ownership. For example, if you are going to be out of the office for a week, you can transfer ownership to a colleague, so they can run your group while you’re away. SuperTracker groups and challenges offer endless possibilities for RDNs to motivate behavior change among groups and individuals. Consider creating a group or challenge for your clients, students in your nutrition education class, colleagues, or friends and family. You can find more information, including video tutorials and a detailed SuperTracker Groups & Challenges User Guide, on the SuperTracker “About Groups” page: www.SuperTracker.usda.gov/aboutgroups.

Evaluation of a Behavioral Mobile Phone App Intervention for the Self-Management of Type 2 Diabetes: Randomized Controlled Trial Protocol.

BackgroundPatients with type 2 diabetes mellitus (T2DM) struggle with the management of their condition due to difficulty relating lifestyle behaviors with glycemic control. While self-monitoring of blood glucose (SMBG) has proven to be effective for those treated with insulin, it has been shown to be less beneficial for those only treated with oral medications or lifestyle modification. We hypothesized that the effective self-management of non-insulin treated T2DM requires a behavioral intervention that empowers patients with the ability to self-monitor, understand the impact of lifestyle behaviors on glycemic control, and adjust their self-care based on contextualized SMBG data.ObjectiveThe primary objective of this randomized controlled trial (RCT) is to determine the impact of bant2, an evidence-based, patient-centered, behavioral mobile app intervention, on the self-management of T2DM. Our second postulation is that automated feedback delivered through the mobile app will be as effective, less resource intensive, and more scalable than interventions involving additional health care provider feedback.MethodsThis study is a 12-month, prospective, multicenter RCT in which 150 participants will be randomly assigned to one of two groups: the control group will receive current standard of care, and the intervention group will receive the mobile phone app system in addition to standard of care. The primary outcome measure is change in glycated hemoglobin A1c from baseline to 12 months.ResultsThe first patient was enrolled on July 28, 2015, and we anticipate completing this study by September, 2018.ConclusionsThis RCT is one of the first to evaluate an evidence-based mobile app that focuses on facilitating lifestyle behavior change driven by contextualized and structured SMBG. The results of this trial will provide insights regarding the usage of mobile tools and consumer-grade devices for diabetes self-care, the economic model of using incentives to motivate behavior change, and the consumption of test strips when following a rigorously structured approach for SMBG.Trial RegistrationClinicalTrials.gov NCT02370719; https://clinicaltrials.gov/ct2/show/NCT02370719 (Archived at http://www.webcitation.org/6jpyjfVRs)

The effectiveness of social marketing in global health: a systematic review.

Social marketing is a commonly used strategy in global health. Social marketing programmes may sell subsidized products through commercial sector outlets, distribute appropriately priced products, deliver health services through social franchises and promote behaviours not dependent upon a product or service. We aimed to review evidence of the effectiveness of social marketing in low- and middle-income countries, focusing on major areas of investment in global health: HIV, reproductive health, child survival, malaria and tuberculosis. We searched PubMed, PsycInfo and ProQuest, using search terms linking social marketing and health outcomes for studies published from 1995 to 2013. Eligible studies used experimental or quasi-experimental designs to measure outcomes of behavioural factors, health behaviours and/or health outcomes in each health area. Studies were analysed by effect estimates and for application of social marketing benchmark criteria. After reviewing 18974 records, 125 studies met inclusion criteria. Across health areas, 81 studies reported on changes in behavioural factors, 97 studies reported on changes in behaviour and 42 studies reported on health outcomes. The greatest number of studies focused on HIV outcomes (n = 45) and took place in sub-Saharan Africa (n = 67). Most studies used quasi-experimental designs and reported mixed results. Child survival had proportionately the greatest number of studies using experimental designs, reporting health outcomes, and reporting positive, statistically significant results. Most programmes used a range of methods to promote behaviour change. Programmes with positive, statistically significant findings were more likely to apply audience insights and cost-benefit analyses to motivate behaviour change. Key evidence gaps were found in voluntary medical male circumcision and childhood pneumonia. Social marketing can influence health behaviours and health outcomes in global health; however evaluations assessing health outcomes remain comparatively limited. Global health investments are needed to (i) fill evidence gaps, (ii) strengthen evaluation rigour and (iii) expand effective social marketing approaches.

Physical activity and motivating factors of participants in a financially incentivized worksite wellness program

Worksites are continuing to use wellness programs to encourage employees to adopt and maintain healthy behaviors. Some of these programs offer financial incentives to maximize employee participation and motivate behavior change. Purpose: The purpose of this study was to gather information regarding a financially incentivized worksite wellness program at a Southeastern United States university. Participants: A 15-item electronic survey was distributed to participants enrolled in the Virgin Pulse HealthMiles (VHM) program at Belmont University. Methods: Steps per day were uploaded to the VHM website by program enrollees (N = 458). The survey inquired about physical activity habits, motivating factors, and improvements in cardiovascular disease risk factors since joining the program. Results: VHM enrollees took an average of 7321 steps/day, as measured by objective pedometer data. Among the 146 respondents, the most motivating factor for participation was the financial incentive, which was considered ‘strongly motivating’ by 64%. About 82% reported being more physically active, 71% felt better, 57% had more energy, and 56% had lost weight since joining the program. The average self-reported weight loss was 7 ± 12 lb (mean ± SD). About 87% indicated they would recommend this program to a friend. Conclusions: The enrollees in the VHM program are taking about 2000 steps/day more than the average American. Most of the people who responded to the survey reported that their physical activity had increased since starting the program. The financial incentive was the most motivating factor to participate.

A Context-Aware, Interactive M-Health System for Diabetics

The authors' context-aware interactive mobile-health (m-health) system (ImHS) provides real-time, two-way communication between diabetes patients and caregivers by utilizing Internet of Things (IoT) technology. When a diabetic patient records abnormal blood sugar values during measurement, the ImHS sends a reminder to the patient and caregivers, motivating behavior change and improving the quality of chronic care. The ImHS features user-friendly interfaces for patients, family, and professional caregivers that lets them rapidly understand the patient's health status. In this study, the authors look at ImHS use in diabetes care. However, the ImHS can be easily adapted for integration into other healthcare systems.

Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome.

The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes. A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters. Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.

Commercial office plug load energy consumption trends and the role of occupant behavior

This study evaluates the energy patterns of 137 individual plug loads (desktops, laptops, monitors, and task lights) collected in a California office building over two years, and the effects of a behavior-based intervention on a subset of these devices to reduce plug load energy consumption. An analysis of the data reveals that desktops consume the most power per person and demonstrate the widest range of power consumption, and that occupants are more likely to turn equipment off before a longer break from the office than overnight during the week. Much of the literature on reducing commercial plug loads is focused on technology-based solutions, while the literature on changing occupant behavior is focused on residential occupants. Multiple studies show that non-financial incentives, such as games, can motivate behavior change. An online sustainability game, Cool Choices, was initiated on-site with 30 occupants, where players competed on teams to earn points for completing resource-saving actions. The analysis revealed that because occupants were already engaging in relevant energy saving behaviors (e.g. turning equipment off at the end of the day), there was limited opportunity for further behavior-based reductions. This study highlights the need for additional research in commercial buildings examining how to motivate occupant behavior change through non-financial incentives.

Can collective action strategies motivate behaviour change to reduce open defecation in rural India?

The world’s remaining open defecation is increasingly concentrated in rural India. The Indian Government’s efforts to reduce open defecation by providing subsidies for latrine construction have bee...

The Dynamic Effect of Incentives on Post-Reward Task Engagement

Although incentives can be a powerful motivator of behavior when they are available, an influential body of research has suggested that rewards can persistently reduce engagement after they end. This research has resulted in widespread skepticism among practitioners and academics alike about using incentives to motivate behavior change. However, recent field studies looking at the longer-term effects of temporary incentives have not found such detrimental behavior. We design an experimental framework to study dynamic behavior under temporary rewards, and find that although there is a robust decrease in engagement immediately after the incentive ends, engagement returns to a post-reward baseline that is equal to or exceeds the initial baseline. As a result, the net effect of temporary incentives on behavior is strongly positive. The decrease in post-reward engagement is not on account of a reduction in intrinsic motivation, but is instead driven by a desire to take a ‘break’, consistent with maintaining a balance between goals with primarily immediate and primarily delayed benefits. Further supporting this interpretation, the initial decrease in post-reward engagement is reduced by contextual factors (such as less task difficulty and higher magnitude incentives) that reduce the imbalance between effort and leisure. These findings are contrary to the predictions of major established accounts and have important implications for designing effective incentive policies to motivate behavior change.

Motivational interviewing: relevance in the treatment of rheumatoid arthritis?

Advances in pharmacological treatment options in RA have led to a dramatic potential for improvement in patients' physical and psychological status. Despite advances, poor outcomes, including fatigue, pain, reduced physical activity and quality of life, are still observed. Reasons include non-adherence to medication, insufficient knowledge about the disease and lack of support in coping and effectively self-managing their condition. Motivational interviewing (MI) is a person-centred approach that relies on collaboration and empathy aiming to elicit a person's own motivation for behaviour change. It has been implemented in a variety of long-term conditions, addressing issues such as lifestyle changes with beneficial effects, but it is yet to be widely recognized and adopted in the field of rheumatology. This review will explain the techniques underpinning MI and the rationale for adopting this approach in rheumatology with the aim to increase medication adherence and physical activity and improve patients' coping strategies for pain and fatigue.

The Application of Gaming Theory in Health Care

As the US health care system moves rapidly toward a population health management focus in communities and care settings, the chief nursing officer has an opportunity to lead innovation efforts for patient care. One innovative strategy for use to influence patient behavior change, ongoing clinical education, and prelicensure education is the application of gaming theory into learning strategies. With the ever-increasing emphasis the general public is placing on social media and online gaming, there has been a significant push by the health sector in recent years to harness this medium for use in health management, education, and behavior change. A number of organizations and insurers have dedicated significant resources to researching and developing games and apps to help patients manage diseases, track self-management activities, and motivate behavior change for healthy lifestyles. This article shares information about gaming theory and its application to health care including a review of the science behind the theory, the use of technology, and gaming education strategies for both patients and clinicians.

Public preferences for communicating personal genomic risk information: a focus group study.

BackgroundPersonalized genomic risk information has the potential to motivate behaviour change and promote population health, but the success of this will depend upon effective risk communication strategies.ObjectiveTo determine preferences for different graphical and written risk communication formats, and the delivery of genomic risk information including the mode of communication and the role of health professionals.DesignFocus groups, transcribed and analysed thematically.ParticipantsThirty‐four participants from the public.MethodsParticipants were provided with, and invited to discuss, a hypothetical scenario giving an individual's personalized genomic risk of melanoma displayed in several graphical formats.ResultsParticipants preferred risk formats that were familiar and easy to understand, such as a ‘double pie chart’ and ‘100 person diagram’ (pictograph). The 100 person diagram was considered persuasive because it humanized and personalized the risk information. People described the pie chart format as resembling bank data and food (such as cake and pizza). Participants thought that email, web‐based platforms and postal mail were viable options for communicating genomic risk information. However, they felt that it was important that a health professional (either a genetic counsellor or ‘informed’ general practitioner) be available for discussion at the time of receiving the risk information, to minimize potential negative emotional responses and misunderstanding. Face‐to‐face or telephone delivery was preferred for delivery of high‐risk results.ConclusionsThese public preferences for communication strategies for genomic risk information will help to guide translation of genome‐based knowledge into improved population health.

Can metabotyping help deliver the promise of personalised nutrition?

Over a decade since the completion of the human genome sequence, the promise of personalised nutrition available to all has yet to become a reality. While the definition was originally very gene-focused, in recent years, a model of personalised nutrition has emerged with the incorporation of dietary, phenotypic and genotypic information at various levels. Developing on from the idea of personalised nutrition, the concept of targeted nutrition has evolved which refers to the delivery of tailored dietary advice at a group level rather than at an individual level. Central to this concept is metabotyping or metabolic phenotyping, which is the ability to group similar individuals together based on their metabolic or phenotypic profiles. Applications of the metabotyping concept extend from the nutrition to the medical literature. While there are many examples of the metabotype approach, there is a dearth in the literature with regard to the development of tailored interventions for groups of individuals. This review will first explore the effectiveness of personalised nutrition in motivating behaviour change and secondly, examine potential novel ways for the delivery of personalised advice at a population level through a metabotyping approach. Based on recent findings from our work, we will demonstrate a novel strategy for the delivery of tailored dietary advice at a group level using this concept. In general, there is a strong emerging evidence to support the effectiveness of personalised nutrition; future work should ascertain if targeted nutrition can motivate behaviour change in a similar manner.

Parental receptivity to child biomarker testing for tobacco smoke exposure: A qualitative study

ObjectiveWidespread tobacco smoke exposure (TSE) of children suggests that parents may be unaware of their children's exposure. Biomarkers demonstrate exposure and may motivate behavior change, but their acceptability is not well understood. MethodsSixty-five in-depth interviews were conducted with parents of young children, in smoking families in central Israel. Data were analyzed using thematic analysis. ResultsConsent to testing was associated with desire for information, for reassurance or to motivate change, and with concerns for long-term health, taking responsibility for one's child, and trust in research. Opposition to testing was associated with preference to avoid knowledge, reluctance to cause short-term discomfort, perceived powerlessness, and mistrust of research.Most parents expressed willingness to allow measurement by urine (83%), hair (88%), or saliva (93%), but not blood samples (43%); and believed that test results could motivate behavior change. ConclusionsParents were receptive to non-invasive child biomarker testing. Biomarker information could help persuade parents who smoke that their children need protection. Practice implicationsBiomarker testing of children in smoking families is an acceptable and promising tool for education, counseling, and motivation of parents to protect their children from TSE. Additionally, biomarker testing allows objective assessment of population-level child TSE.

Nudging Consumers toward Better Food Choices: Policy Approaches to Changing Food Consumption Behaviors

ABSTRACTThe high prevalence of obesity and its associated illnesses, such as cancer, heart disease and diabetes, has sparked interest in finding ways to encourage consumers to make healthier food choices. At the public level, providing information about why and how to choose a healthy diet has been the typical approach to encouraging behavioral change. Information can also influence food producers and marketers to develop and promote more healthful products, creating an environment in which it is easier for consumers to make healthier dietary choices. Nevertheless, information may not always be effective in improving food choices. One explanation is that nutrition information is complex and difficult to convey in a clear, actionable manner. Also, knowledge, while necessary, may not be sufficient to motivate behavior change. Even when consumers understand nutrition information, competing preferences for tastier, less expensive, or more convenient foods may lead them to make other choices. Findings from psychology, marketing, and behavioral economics research suggest approaches that may enhance the effectiveness of informational approaches and complement informational efforts. More research is needed to further develop these strategies and evaluate their effectiveness.

Motivational Interviewing for Adolescents in the Emergency Department

Motivational interviewing (MI) is defined as a collaborative, patient-centered counseling style used to strengthen motivation for behavioral change by evoking an individual’s own reasons for change. It has been extensively used to address substance use and has shown effectiveness in facilitating a variety of healthy behaviors among a wide range of age groups and in an array of settings. To review the literature involving the use of MI for adolescents in the emergency department (ED), we performed a literature search using PsycINFO, PubMed, and Google-Scholar and identified 16 randomized controlled studies targeting 7 health behaviors. Of these, 31% (n = 5) targeted alcohol use alone; 12.5% (n = 2) targeted aggression and violence, marijuana use, tobacco use, linkage to outpatient services for mental health treatment, alcohol use, and aggression; and 1 study targeted seatbelt and helmet use. Overall results suggest that using MI with adolescents in the ED is feasible and more effective at reducing risk behaviors than ED treatment as usual.

Self-efficacy enhancement can facilitate hypnotic tapering in patients with primary insomnia

Self-efficacy plays an important role in motivating behavior change. The present study implemented a self-efficacy enhancement procedure to examine its influence on hypnotic tapering. Twenty-four long-term hypnotic users underwent a self-efficacy enhancement procedure prior to undergoing a systematic gradual tapering program, and another 24 hypnotic users underwent the systematic tapering program only to serve as a control group. Self-efficacy in tapering off hypnotics was significantly increased following the self-efficacy enhancement procedure. The increase could predict the percentage of dosage reduction after controlling for baseline self-efficacy level. Further, patients in the self-efficacy enhancement group showed a greater percentage of dosage reduction than those in the control group. In terms of sleep parameters, the program resulted in shorter waking time after sleep onset than the control program, but did not show significant effects on the other sleep parameters. The findings support the facilitating effect of self-efficacy enhancement on hypnotic tapering.

Hearing care for elders: a personal reflection on participatory action learning with primary care providers.

This report is a reflective critical narrative of the authors' experience with an interdisciplinary collaboration of primary care providers (PCPs) and hearing health care providers (HHCPs) that followed the principles of participatory action research/learning. The goal for this report is to describe the 1st author's observed barriers to PCPs' willingness to learn about hearing health care and the subsequent facilitators to learning. A team of PCPs and HHCPs created the "Communication: Hearing Loss in Elders" educational module. The module included (a) prereading developed from a combination of literature reviews and contextual factors and (b) a case study. The authors present the list of topics included in the module, and they reflect on why and how these topics were deemed important by the team. In particular, 2 topics were identified for motivating PCPs' behavior regarding hearing health care: (a) the overlap in symptoms and possible causation among depression, dementia, and hearing loss and (b) how hearing can affect efficiency of care regarding other health issues. This personal reflective narrative gives the authors' opinions about what can make for a successful collaboration and presents some hypotheses regarding information that may motivate behavior change with regard to hearing care.

Cardiology and accountable care.

Cardiovascular disease is the leading cause of death in the United States and accounts for ≈17% of national health expenditures and 30% of Medicare spending.1 Among physician groups and professional societies, cardiologists have been among those leading efforts to create evidence-based guidelines and to measure quality of care. In the post-health reform era, national efforts have expanded beyond quality to include innovative delivery models, such as the patient-centered medical home (PCMH), the medical neighborhood, and accountable care organizations (ACOs). This next generation of care models and the payment strategies that support them incentivize efficiency, patient-centeredness, and care coordination with an emphasis on primary care. We propose strategies for cardiologists to create collaborative opportunities within these new models drawing from examples from around the country within the context of a framework developed by the American College of Physicians.2 Pursuing these approaches or others along similar lines will enable cardiologists to lead and to be active participants in shaping delivery system transformation. These innovative delivery models share similar features. The PCMH is a model of care that emphasizes additional support for primary care providers within a patient-centered team, whereas a medical neighborhood represents a broader collection of primary care doctors, specialists such as cardiologists, hospitals, and other stakeholders within a region that seek to reduce fragmented care by sharing accountability.2,3 The ACO, too, is a broader care delivery arrangement, but in this case, groups of providers are accountable for the quality, cost, and overall care of a particular population, typically defined by the payer. In the Medicare Shared Savings Program (MSSP), an ACO model for Medicare beneficiaries, the ACO can capture shared savings if it reduces its healthcare expenditures and meets certain quality performance standards, nearly half of which are related to cardiovascular disease.4 Within the …