Motivate Behavior Change Research Articles

A Gamified Approach to Engage Sustainable User Behavior in Product Service System Solutions

Product service system solutions encourage to share products, reducing manufacturing processes and increasing the product life. Therefore, this might contribute to offer more sustainable solutions to users, by considering the complete socio-ecological system, the context, the stakeholder relationship, among other aspects. Where the sustainability behavior of consumers and the data provided for new information and technology (ICT) devices are key factors in the development of solutions with a higher sustainability performance. Moreover, game elements and ICT have been used in different fields to engage users. The aim of this research is to investigate if a gamified approach motivates a substantiable behavior change in users of product service system solutions. Based on a literature review, a model is proposed and applied to a product service system case of a shared laundry facility in Sweden. The model was evaluated with experts semi-structured interviews and a survey with users of the shared laundry facility. Concluding that a gamified approach has a potential to motivate behavior change towards sustainability in product service system. In future research, the proposed model will be adapted to be tested in other product service system cases, with the purpose to improve it for its application in industry and education. 
 Keywords: strategic sustainable development, game elements, product development, smart PSS, behavior change.
 

Use of Biological Feedback as a Health Behavior Change Technique in Adults: Scoping Review.

Recent advancements in personal biosensing technology support the shift from standardized to personalized health interventions, whereby biological data are used to motivate health behavior change. However, the implementation of interventions using biological feedback as a behavior change technique has not been comprehensively explored. The purpose of this review was to (1) map the domains of research where biological feedback has been used as a behavior change technique and (2) describe how it is implemented in behavior change interventions for adults. A comprehensive systematic search strategy was used to query 5 electronic databases (Ovid MEDLINE, Elsevier Embase, Cochrane Central Register of Controlled Trials, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global) in June 2021. Eligible studies were primary analyses of randomized controlled trials (RCTs) in adults that incorporated biological feedback as a behavior change technique. DistillerSR was used to manage the literature search and review. After removing 49,500 duplicates, 50,287 articles were screened and 767 articles were included. The earliest RCT was published in 1972 with a notable increase in publications after 2000. Biological feedback was most used in RCTs aimed at preventing or managing diabetes (n=233, 30.4%), cardiovascular disease (n=175, 22.8%), and obesity (n=115, 15%). Feedback was often given on multiple biomarkers and targeted multiple health behaviors. The most common biomarkers used were anthropometric measures (n=297, 38.7%), blood pressure (n=238, 31%), and glucose (n=227, 29.6%). The most targeted behaviors were diet (n=472, 61.5%), physical activity (n=417, 54.4%), and smoking reduction (n=154, 20.1%). The frequency and type of communication by which biological feedback was provided varied by the method of biomarker measurement. Of the 493 (64.3%) studies where participants self-measured their biomarker, 476 (96.6%) received feedback multiple times over the intervention and 468 (94.9%) received feedback through a biosensing device. Biological feedback is increasingly being used to motivate behavior change, particularly where relevant biomarkers can be readily assessed. Yet, the methods by which biological feedback is operationalized in intervention research varied, and its effectiveness remains unclear. This scoping review serves as the foundation for developing a guiding framework for effectively implementing biological feedback as a behavior change technique. Open Science Framework Registries; https://doi.org/10.17605/OSF.IO/YP5WAd. RR2-10.2196/32579.

The Last Mile-Community Engagement and Conditional Incentives to Accelerate Polio Eradication in Pakistan: Study Protocol for a Quasi-Experimental Trial.

Poliomyelitis is a condition of great concern and is endemic in only two countries of the world: Pakistan and Afghanistan. Community mobilization plays a vital role in raising awareness and can help reduce polio vaccine refusals. The objective of this study will be to decrease polio vaccine refusals and zero-dose vaccines by motivating behavior change through the provision of conditional-collective-community-based incentives (C3Is) based on a reduction in polio vaccine refusals. The project will adopt a pretest/post-test quasi-experimental design with two intervention high-risk union councils (HRUCs) and two control union councils (UCs) of peri-urban (Karachi) and rural (Bannu) settings in Pakistan. A participatory community engagement and demand creation strategy with trust-building community mobilization with C3Is, to reduce vaccine refusals and improve polio immunization coverage in two HRUCs, will be used. These UCs will be divided into clusters based on the polio program framework and community groups will be formed in each cluster. These community groups will carry out awareness activities and will be given serial targets to reduce vaccine refusals and those who qualify will be provided C3Is. The project intends to create a replicable model that the government can integrate within health systems for long-term sustainability until the goal of eradication of poliovirus is achieved. The evaluation will be carried out by an independent data collection and analysis team at baseline and endline (after 12 months of intervention). The trial is registered with linicalTrials.gov with number NCT05721274.

Motivation for Behavior Change among Women with Recent Gestational Diabetes and Their Partners-A Qualitative Investigation among Participants in the Face-It Intervention.

Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples' interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples' motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other's perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.

Patient experiences with micronutrient and overall nutrition management after bariatric surgery: identifying facilitators and barriers to implementing care.

Adherence to perioperative guideline recommendations for prophylactic supplementation and regular biochemical monitoring is suboptimal. However, little is known about the patient perspective on this postoperative challenge. To qualitatively explore patient experiences of postoperative micronutrient management and identify patient-reported barriers and facilitators to the provision of nutrition care. Two tertiary public hospitals in Queensland, Australia. Semi-structured interviews were conducted with 31 participants 12 months after bariatric surgery. Inductive analysis of interview transcripts was performed using applied thematic analysis, and deductive analysis was performed by aligning interview themes against the Theoretical Domains Framework and the Capability, Motivation, and Opportunity Behavior Change Wheel Framework. Participants' perceptions of engagement with the bariatric surgery multidisciplinary team greatly influenced their experience with overall nutrition care, including but not exclusive to micronutrient care. At times, this engagement negatively impacted patients' experiences with their nutrition care and related to varied acceptance of healthcare advice from the team or, at times, an unmet desire for person-centered communication styles. Engaging person-centered care techniques had a positive influence on patient experience with micronutrient and overall nutrition care. Micronutrient management (taking supplements and having regular blood tests) was broadly accepted and enabled by the presence of established medication and blood test routines preoperatively. However, challenges did exist and were practical in nature. Incorporating education on habit-forming techniques was identified as a facilitator to assist with micronutrient management. Although participants mostly accept embedding micronutrient management into their life, developing interventions that focus on habit-forming skills and that enable multidisciplinary teams to provide person-centered care is recommended to enhance care after surgery.

Energy gamification: design and development of a user interface tool to upgrade social experience and energy literacy.

Gamification consists of applying typical elements of game-playing environments to other areas of activity. In various fields such as medicine, education, or business, gamification has been explored as an efficient vehicle to foster real-life predetermined targets or improve a real-life action's effectiveness. Amidst the current energy transition, gamification has emerged as a promising strategy to make the energy transition exciting to end-users, bridging information gaps, increasing learning, and motivating behaviour change. This study presents the design and development of a gamified solution as part of the Smart2B H2020 project. The primary objective is to create an excellent user-engagement experience while encouraging and fostering energy literacy and behaviour change. Leveraging the increasing digitalization of the energy sector, the developed gamified module will feature a user interface (UI) tool that promotes healthy competition between users, primarily driven by changes in energy consumption behaviour. The monthly and overall leader boards will translate energy savings into an in-game virtual point-based system, reinforcing the intrinsic value of energy conservation. The gamified elements and mechanisms, such as missions, interactive tasks or challenges, instant feedback, achievements, and badges, will progressively guide users in understanding their energy consumption patterns and how they can be improved. Drawing from social engineering and educational perspectives, the pilot sites within the Smart2B project will maximize user interaction and engagement to motivate real behaviour change. By highlighting the design and development aspects of our gamified solution, we aim to provide more insights into the process that was followed to create an effective and impactful tool for promoting sustainable energy consumption practices among end-users.

Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa.

Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.

Resting state functional connectivity as a predictor of brief intervention response in adults with alcohol use disorder: Apreliminary study.

Brief interventions for alcohol use disorder (AUD) are generally efficacious, albeit with variability in response. Resting state functional connectivity (rsFC) may characterize neurobiological indicators that predict the response to brief interventions and is the focus of the current investigation. Forty-six individuals with AUD (65.2% female) completed a resting state functional magnetic resonance imaging (fMRI) scan immediately followed by a brief intervention aimed at reducing alcohol consumption. Positive clinical response was defined as a reduction in alcohol consumption by at least one World Health Organization (WHO) risk drinking level at 3-month follow-up. rsFC was analyzed using seed-to-voxel analysis with seed regions from four networks: salience network, reward network, frontoparietal network, and default mode network. At baseline, responders had greater rsFC between the following seed regions in relation to voxel-based clusters than non-responders: (i) anterior cingulate cortex (ACC) in relation to left postcentral gyrus and right supramarginal gyrus (salience network); (ii) right posterior parietal cortex in relation to right ventral ACC (salience network); (iii) right interior frontal gyrus (IFG) pars opercularis in relation to right cerebellum and right occipital fusiform gyrus (frontoparietal); and (iv) right primary motor cortex in relation to left thalamus (default mode). Lower rsFC in responders vs. nonresponders was seen between the (i) right rostral prefrontal cortex in relation to left IFG pars triangularis (frontoparietal); (ii) right IFG pars triangularis in relation to right cerebellum (frontoparietal); (iii) right IFG pars triangularis in relation to right frontal eye fields and right angular gyrus (frontoparietal); and (iv) right nucleus accumbens in relation to right orbital frontal cortex and right insula (reward). Resting state functional connectivity in the frontoparietal, salience, and reward networks predicts the response to a brief intervention in individuals with AUD and could reflect greater receptivity or motivation for behavior change.

An interpretative phenomenological analysis of EFL learning motivation of first-year undergraduates

Introduction. The COVID-19 pandemic (hereinafter referred to as the ‘pandemic’) caused many countries’ educational systems to temporarily switch to online instruction, with no time to prepare teachers, students and learning materials. This study is aimed at tracing the changes in motivational behavior to study English as a foreign language (EFL) of ten first-year Russian undergraduates majoring in Physical Education and Sports (they experienced face-to-face learning which was abruptly changed into the online mode). Materials and Methods. For this purpose, Interpretative Phenomenological Analysis (IPA) of semi-structured interviews with the targeted (non-randomized) homogeneous sample of students was conducted. Using a bottom-up analysis, the codes were cataloged to identify some patterns. Results. It was found that students were generally positive about online learning and their motivation to learn EFL remained positive. The following themes were revealed: 1. Positive feeling towards English course at university; 2. Having the image of their L2 selves with English as a means of obtaining important professional information; 3. Being motivated by group-mates and other students’ progress in English language acquisition; 4. Feeling positive about the move to online instruction as more diverse authentic materials are available in the classroom; 5. Becoming more independent in learning. Conclusions. The researchers conclude that while students were generally positive about distance learning, their EFL motivation was affected as the direct drivers had changed. After entering the university, students were motivated by direct factors of influence – their former classmates and their new groupmates’ progress in learning English. After switching to online learning, these factors were substituted by understanding their own value as independent learners, since students had to be more active in finding and processing learning materials. The attitude to the English language as a means of getting professional information remained unchanged and stable. Linguistic competence is understood as an advantage in their future career, and not as a means of direct communication. A positive attitude towards online learning is based on its practical benefits (time saved on the way to university, more comfortable learning from home, etc.). Fears and insecurities associated with problems in teaching Physical Education online during the pandemic do not affect their attitude and motivation to study other academic subjects.

Do brief motivational interventions increase motivation for change in drinking among college students? A two-step meta-analysis of individual participant data.

Brief motivational interventions (BMIs) are one of the most effective individually focused alcohol intervention strategies for college students. Despite the central theoretical role of motivation for change in BMIs, it is unclear whether BMIs increase motivation to change drinking behavior. We conducted a two-step meta-analysis of individual participant data (IPD) to examine whether BMIs increase motivation for change. N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). We included 15 trials of BMI (N = 5903;59% women, 72% White) from Project INTEGRATE. The BMIs included individually-delivered motivational interviewing with personalized feedback (MI + PF), stand-alone personalized feedback (PF), and group-based motivational interviewing (GMI). Different measures and responses used in the original trials were harmonized. Effect size estimates were derived from a model that adjusted for baseline motivation and demographic variables for each trial (step 1) and subsequently combined in a random-effects meta-analysis (step 2). The overall intervention effect of BMIs on motivation for change was not statistically significant (standard mean difference [SMD]: 0.026, 95% CI: [-0.001, 0.053], p = 0.06, k = 19 comparisons). Of the three subtypes of BMIs, GMI, which tended to provide motivation-targeted content, had a statistically significant intervention effect on motivation, compared with controls (SMD: 0.055, 95% CI: [0.007, 0.103], p = 0.025, k = 5). By contrast, there was no evidence that MI + PF (SMD = 0.04, 95% CI: [-0.02, 0.10], k = 6, p = 0.20) nor PF increased motivation (SMD = 0.005, 95% CI: [-0.028, 0.039], k = 8, p = 0.75), compared with controls. Post hoc meta-regression analysis suggested that motivation sharply decreased each month within the first 3 months postintervention (b = -0.050, z = -2.80, p = 0.005 for k = 14). Although BMIs provide motivational content and normative feedback and are assumed to motivate behavior change, the results do not wholly support the hypothesis that BMIs improve motivation for change. Changing motivation is difficult to assess during and following interventions, but it is still a theoretically important clinical endpoint. Further, the evidence cautiously suggests that changing motivation may be achievable, especially if motivation-targeted content components are provided.

CHANGES IN HEALTH BEHAVIORS FOLLOWING A HYPERTENSION DIAGNOSIS: THE KOREAN GENOME AND EPIDEMIOLOGY STUDY (2003-2018)

Objective: The management of hypertension requires a healthy lifestyle. However, it is unclear if individuals change their health behaviors after being diagnosed with hypertension. Thus, we aimed to evaluate the changes in smoking, alcohol consumption, exercise, and obesity following hypertension diagnosis using data from a community-based cohort. Design and method: We analyzed 5091 participants without hypertension at baseline from the Korean Genome and Epidemiology Study between 2003 and 2018. Participants were classified into the hypertension diagnosis group if they were diagnosed with hypertension by a physician during follow-up. Biennial health check-ups were used to measure health behaviors including smoking, drinking, exercise, and obesity. Generalized estimating equations were used to assess the differences by group and time and group-by-time interactions. Results: The group diagnosed with hypertension was more obese than the group not diagnosed with hypertension (p &lt; 0.001). However, smoking (p &lt; 0.001) and alcohol consumption (p &lt; 0.001) decreased over time in all participants, and exercise (p &lt; 0.001) increased. A group-by-time interaction was observed for smoking, with the group diagnosed with hypertension exhibiting greater reductions in smoking over time (p = 0.005). There were no significant interactions found for other behaviors. Conclusions: Our study provides limited evidence that a hypertension diagnosis alone may not be enough to encourage behavior change, except for smoking reduction. Thus, strategies to motivate behavior change need to be identified, given the importance of a healthy lifestyle in hypertension management.

Influencing residential electricity consumption with tailored messages: long-term usage patterns and effects on user experience

BackgroundTo transition our energy system toward sustainable production and consumption, it is important to successfully engage consumers to become active participants in this process. One form this can take is manual demand response, where end users respond to fluctuations in energy production and help balance the grid through adjustment of their consumption. This paper presents a trial of such a system that took place with tenants in subsidized housing in Catalonia, Spain. The aim of the trial was to motivate the load shifting behavior of the participants by forecasting expected consumption curves and tailoring suggestions for optimized behavior. The forecasts and suggestions were based on the users’ past consumption patterns and the hourly day-ahead electricity prices. This information was made available to the users on a web-based platform, and participants were actively informed with text messages sent to their mobile phones in case of attractive saving potentials for the following day. The trial was carried out in 2 phases from November 2019 to May 2020 (Phase 1) and from August to October 2020 (Phase 2). Data were collected on interaction with the platform, the perceived user experience of the platform and text messages, and the perceived energy saving success.ResultsOur results showed that there is a general interest of the participants in the concept, but that there are also important barriers to integrating load shifting behavior into everyday life. The biggest barriers here are limitations in the flexibility potential of households and limited perceived benefits. Feedback from our participants also suggests high acceptance and relevance of more automated demand-side management (DSM) concepts.ConclusionsBased on this, we recommend paying special attention to the accommodation of varying flexibility potential in manual demand response (DR) programs, ensuring that communicated benefits are sufficiently attractive to motivate behavior change, and consideration of a phase of manual DR as an entry point to automated DSM.

The association between viewing cigarette health warning labels and intention to quit smoking among Chinese adult smokers: support for including health outcome content and culturally specific messages

BackgroundTailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants’ intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices.MethodsA cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data.ResultsAfter viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01–1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14–1.69) and 1.29 (95% CI 1.04–1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample.ConclusionsFindings of this study provide evidence of an association between all four pictorial HWL themes and smokers’ intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.

The influence of cognitive and affective components of the sentinel event on alcohol use following a brief intervention with trauma patients.

Alcohol-related injury is a sentinel event, an unanticipated medical event that may prompt a re-evaluation of health behaviors, such as alcohol use. Few studies have examined the psychological components of the sentinel event that motivate behavior change. In the present study, we examined the influence of cognitive and affective components of an alcohol-related injury on changes in alcohol use following a brief intervention. Injured patients (n = 411) who were drinking prior to their injury admission were recruited from three urban Level I trauma centers and randomized to receive brief advice or brief motivational intervention with or without a 1-month booster session. Assessments were completed at baseline and 3-, 6-, and 12-month follow-ups. Three groups were created based on endorsement (yes/no) of items assessing cognitive and affective components of the injury event: neither component, the cognitive component only, and both the cognitive and affective components. Mixed-effects models indicated that participants who endorsed both the cognitive and affective components had greater reductions in peak alcohol use from baseline to 3-month follow-up than those who did endorsed neither component. By contrast, participants who endorsed the cognitive component, but not the affective component, had greater increases in average drinks per week and percentage of days of heavy drinking from 3- to 12-month follow-ups than those who endorsed neither component. These results provide preliminary support for further consideration of an affective component of alcohol-related injuries that may motivate subsequent reductions in drinking following a sentinel event.

Towards understanding the mechanism through which reward and punishment motivate or demotivate behaviours

ABSTRACT Persuasive gamified systems are effective tools for motivating behaviour change using various persuasive strategies. In line with the reinforcement theory, some persuasive gamified systems employ reward and punishment in their design to achieve the intended behavioural outcome. Research has argued both in favour and against using these strategies in behaviour change applications due to mixed results with respect to their effectiveness. However, there is a lack knowledge about how interventions using these strategies could motivate or demotivate behaviours. Therefore, this paper explores the mechanism through which Reward and Punishment motivate or demotivate behaviours with respect to their strengths and weaknesses. The results of large-scale exploratory studies (N = 1768) uncover important strengths and weaknesses that could facilitate or hinder the effectiveness of Reward and Punishment at motivating behaviour change. These include their ability to engage users and make behaviour fun, reinforce commitments to goals, and reveal some consequences of bad behaviour. We also compared the perceived effectiveness of reward and punishment quantitatively.

The Role of Health Communication in Addressing Stunting in Bandung Regency

Based on data from the Indonesian Ministry of Health, the prevalence of stunting in Bandung Regency in 2022 reached around 31%, which is higher than the national figure in Indonesia. This stunting issue can have negative impacts on the health, education, and future productivity of affected children. Therefore, addressing stunting in Bandung Regency is crucial to improve the quality of life for children and the community as a whole. The aim of this study is to describe the process and role of Health Communication in addressing stunting in Bandung Regency. A qualitative research method was used, where data was collected through a literature review of various relevant sources, such as journals and reports. The research found that health communication can play a significant role in addressing stunting by providing accurate and targeted information, motivating behavior change, and increasing community participation in health programs. At the initial stage, health communication can help increase the community's understanding of the importance of nutrition and healthy eating habits, as well as provide information and support to parents in providing adequate nutrition for their children. The study concludes that effective health communication can help address the problem of stunting in Bandung Regency and can provide significant benefits for health practitioners, researchers, and the government in making more effective policies to address this problem

Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan.

Human papillomavirus (HPV) vaccines effectively prevent cervical cancer, most of which results from undetected long-term HPV infection. HPV vaccine introduction is particularly sensitive and complicated given widespread misinformation and vaccination of young girls before their sexual debut. Research has examined HPV vaccine introduction in lower- and middle-income countries (LMICs), but almost no studies attend to HPV vaccine attitudes in central Asian countries. This article describes the results of a qualitative formative research study to develop an HPV vaccine introduction communication plan in Uzbekistan. Data collection and analysis were designed using the Capability, Opportunity, and Motivation for Behaviour change (COM-B) mode for understanding health behaviours. This research was carried out with health workers, parents, grandparents, teachers, and other social influencers in urban, semi-urban, and rural sites. Information was collected using focus group discussions (FGDs) and semi-structured in-depth interviews (IDIs), and data in the form of participants' words, statements, and ideas were thematically analysed to identify COM-B barriers and drivers for each target group's HPV vaccine-related behaviour. Represented through exemplary quotations, findings were used to inform the development of the HPV vaccine introduction communication plan. Capability findings indicated that participants understood cervical cancer was a national health issue, but HPV and HPV vaccine knowledge was limited among non-health professionals, some nurses, and rural health workers. Results on an opportunity for accepting the HPV vaccine showed most participants would do so if they had access to credible information on vaccine safety and evidence. Regarding motivation, all participant groups voiced concern about the potential effects on young girls' future fertility. Echoing global research, the study results highlighted that trust in health workers and the government as health-related information sources and collaboration among schools, municipalities, and polyclinics could support potential vaccine acceptance and uptake. Resource constraints precluded including vaccine target-aged girls in research and additional field sites. Participants represented diverse social and economic backgrounds reflective of the country context, and the communication plan developed using research insights contributed to the Ministry of Health (MoH) of the Republic of Uzbekistan HPV vaccine introduction efforts that saw high first dose uptake.

COVID‐19 and climate change: The social‐psychological roots of conflict and conflict interventions during global crises

AbstractThe current study reviews key social psychological mechanisms related to conflict and conflict resolution that manifest within both the coronavirus pandemic and climate change crises. The uncertainty, scale, and nature of both global crises generate various forms of individual‐ and group‐level conflicts that, mediated by psychological and cultural phenomena, impede beneficial action and sustainable adaptation. Specifically, we highlight five social psychological mechanisms (i.e., cognitive dissonance, responsibility diffusion, compassion fatigue, dehumanization, and competitive beliefs) known to interact with, produce, and amplify intrapersonal, interpersonal, and/or intergroup conflicts. We draw attention to how these mechanisms have been activated by the pandemic in ways that share important similarities with climate change and present evidence‐informed approaches to combating their contribution to conflict (i.e., motivating behavior change, implementing accountability mechanisms, creating collective action opportunities, fostering intergroup contact, and promoting perspective‐taking). By engaging social psychological research to better understand both the roots of conflict as well as outline potential individual, community, and societal responses that can help alleviate conflict during these global crises, we can increase our ability to successfully navigate and in some cases avoid future conflicts caused by climate change.This article is categorized under: Perceptions, Behavior, and Communication of Climate Change &gt; Behavior Change and Responses

Health care professionals’ experiences of supporting persons with metabolic risk factors to increase their physical activity level – a qualitative study in primary care

Objective To be regularly physically active is of major importance for the health of people with metabolic risk factors. Many of these persons are insufficiently active and in need of support. This study aimed to explore barriers and facilitators perceived by health care professionals’ within Swedish primary care in their work to support persons with metabolic risk factors to increase their physical activity. Design A qualitative design with focus group discussions was used. The data were analysed using qualitative content analysis with a manifest, inductive approach. Setting Primary health care in five Swedish healthcare regions. Subjects Nine physiotherapists, ten physicians and five nurses participated in six digital focus group discussions including two to six participants. Results Barriers and facilitators to supporting persons with metabolic risk factors to increase their physical activity were found within four generic categories, where the barriers and facilitators related to each generic category: ‘Patient readiness for change’, ‘Supporting the process of change’, ‘The professional role’, and ‘The organisation of primary care’. Conclusion The findings suggests that barriers and facilitators for supporting patients with metabolic risk factors can be found at several levels within primary care, from individual patient and the health care professionals to the organisational level. In the primary care setting, this should be highlighted when implementing support to increase physical activity in people with metabolic risk factors. KEY POINTS Health care professionals within primary care are in a position to support people with metabolic risk factors to increase their physical activity. Barriers and facilitators to support the patients should be addressed at several levels within primary care. The study highlights factors on multiple levels such as professional responsibility, organisational prioritisation and resources, and the challenge to motivate behaviour change.

A collaborative approach to designing an online nutrition education program for people with multiple sclerosis

Purpose People with multiple sclerosis (pwMS) want disease-specific dietary advice to reduce the confusion around diet. This study used co-design principles to develop an online nutrition education program for pwMS. Methods Mixed-methods (multiphase sequential design). Phase 1: online survey (n = 114 pwMS) to explore preferred content and characteristics of a nutrition program and develop a draft program. Phase 2: feedback on the draft program from stakeholders (two meetings; n = 10 pwMS and multiple sclerosis (MS) health professionals) and pwMS (two workshops; n = 6) to produce a full program prototype. Phase 3: cognitive interviews (n = 8 pwMS plus 1 spouse) to explore acceptability and ease of comprehension of one module of the program, analysed using deductive content analysis. Results Preferred topics were included in the program, which were further developed with consumer feedback. Cognitive interviews produced four themes: (1) positive and targeted messaging to motivate behaviour change; (2) “not enough evidence” is not good enough; (3) expert advice builds in credibility; and (4) engaging and appropriate online design elements are crucial. Conclusions Positive language appears to improve motivation to make healthy dietary changes and engagement with evidence-based nutrition resources. To ensure acceptability, health professionals can use co-design to engage consumers when developing resources for pwMS. IMPLICATIONS FOR REHABILITATION Co-designed nutrition education programs can help people achieve high-quality diets in line with recommendations, but very few programs exist for people with multiple sclerosis (MS), and none were co-designed The participatory research in this study was instrumental in ensuring that important information regarding program acceptability was identified Co-design can ensure that the language is appropriate for the target audience, and positive language appeared to improve motivation in people with MS to engage with the online nutrition education program Where practical and feasible, health professionals should collaborate with MS consumers when developing resources, and use positive, empowering language