Behavior Change Process Research Articles

A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial.

BackgroundLatino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men.ObjectiveTo address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables.MethodsLatino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization.ResultsThis study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing.ConclusionsWe developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.Trial RegistrationClinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570International Registered Report Identifier (IRRID)DERR1-10.2196/23690

A Rationale for a Gamified E-Coach Application to Decrease the Consumption of Sugar Sweetened Beverages.

The design and implementation of applications for behavior change should be preceded by careful analysis of the behavior change process and the target population. We, therefore, present on the basis of a blended research approach a rationale, opportunities and basic requirements for an application that offers a program for reducing intake of sugar sweetened beverages (SSB) by adolescents. This paper discusses the role of e-coaching and gamification as two high-touch design patterns in the behavior change process. Both design patterns aim at supporting the individual in a transformational journey from a current state toward a desired state where the detrimental behavior should be replaced by healthy alternative behavior. First, an elementary behavior scheme is introduced that frames three empirical studies. In the first study (plenary focus groups; n = 13), participants advised to include system recommendations for alternative healthy behavior, stressed the need for personalization of the e-coach and showed strong appreciation for the inclusion of gamification elements. The second study (online survey; n = 249) showed that SSB-intake is highly contextual and that reasons for (limiting) consumption SSB varies greatly between individuals, which the e-coach application should take into account. In a final small-scale pilot study (n = 27), we observed the potential of the inclusion of gamification elements, such as challenges and rewards, to increase compliance to the self-monitoring process of SSB consumption. Building upon these insights and prior studies, we argue that an e-coach mimics the collaborative practice of the program; its main task is to enrich the interaction with cooperative conversational experiences, in particular with respect to the alignment between user and system, motivational encouragement, personalized advice, and feedback about the activities. In addition, we outline that gamification not only has the potential to increase self-monitoring of the target behavior, user engagement, and commitment with the intervention program, but also enables a designer to shift long-term negative outcome of excessive intake in real life to short-term consequences in a virtual environment. In future larger follow-up studies, we advise to integrate the two design patterns within a social network of virtual and human agents that play a variety of competitive, normative and supportive roles.

Lapse, Relapse, and Recovery in Physical Activity Interventions for Latinas: a Survival Analysis.

Physical activity (PA) research extensively focuses on initiation of PA, yet lapse and relapse among PA intervention participants are less well understood, particularly among minority populations such as Latinas in the USA. This study aimed to (1) determine the probability of lapse during two PA interventions for Latinas; (2) assess demographic, psychosocial, and environmental predictors of the amount of time until first lapse; and (3) identify factors predictive of lapse recovery. Data from 176 Latina intervention participants were pooled. Survival functions and Kaplan-Meier curves were used to illustrate probability of lapse. Cox proportional hazard models assessed predictors of time to lapse. Logistic regressions identified predictors of lapse recovery. The probability of lapse after 1month of starting to exercise was 18%, escalating to 34% after 4months. Predictors of earlier lapse included various psychosocial constructs (i.e., self-efficacy and various processes of change), but none of the measured environmental factors, and only one demographic factor (≥2 children under 18). Increased use of consciousness raising at 2months was associated with lower likelihood of lapse recovery, yet use of behavioral processes of change at 6 months was associated with higher likelihood of recovery. Lapsing may not be pre-determined by demographic and environmental characteristics. On the other hand, skills that can be learned through interventions, such as skills to improve self-efficacy, seem important in the delay or prevention of lapses. Results pertaining to lapse recovery are less clear.

Acceptance and Commitment Therapy for Major Depressive Disorder: Insights into a New Generation of Face-to-Face Treatment and Digital Self-Help Approaches.

Major depressive disorder (MDD) represents a key contributor to the global burden of mental illness given its relatively high lifetime prevalence, frequent comorbidity, and disability rates. Evidence-based treatment options for depression include pharmacotherapy and psychotherapy, such as cognitive behavioral therapy (CBT). Beyond traditional CBT, over 15years ago, Hayes proclaimed a new generation of contextualistic and process-orientated so-called third wave of CBT interventions, including acceptance and commitment therapy (ACT). Using mindfulness and acceptance as well as commitment and behavior change processes, the transdiagnostic ACT approach aims to increase psychological flexibility as universal mechanism of behavior change and to build a value-driven orientation in life. ACT for MDD can be provided as either stand-alone individual, group, or self-help formats (e.g., apps) or combined with other approaches like behavioral activation. To date, a steadily growing empirical support from outcome and process research suggests the efficacy of ACT, which appears to work specifically through the six proposed core processes involved in psychological flexibility, such as defusion. In view of an ongoing interest of clinicians in "third-wave" CBTs and the important role of clients' preferences in providing therapy choices that work, the purpose of this chapter is to give a brief overview on the application of ACT in the treatment of MDD in adults.

Disrupting the Complacency: Disaster Experience and Emergent Environmentalism

As climate change intensifies, scholars are beginning to ask whether firsthand experience with disaster will cause complacent people to develop greater environmental concern and engage in more proenvironmental behaviors. Will the disruption caused by experiencing a local environmental disaster be enough to motivate residents to change their values and behaviors? The aim of this study is to answer that question by analyzing qualitative interview data collected from 40 residents of Calgary, Alberta, who survived the devastating and costly 2013 southern Alberta flood. Despite normally high levels of climate change denial and complacency, findings indicate that the flood prompted residents to concern themselves more with climate change and the climate crisis and to begin adopting many household-level proenvironmental behaviors. The findings also point to important gender differences in both environmental concern and proenvironmental behaviors. Thus, the article establishes a social-psychological process of attitudinal and behavioral change, allowing us to better understand how jarring environmental events disrupt complacency.

2020-Vision: understanding climate (in)action through the emotional lens of loss

We are the midst of a climate emergency requiring urgent climate action that is as yet unforthcoming both on the scale and at the speed needed. This article considers this current state of inaction and how we might understand the processes of attitudinal and behavioural change needed through the emotional framework of loss. These issues are further explored through the additional lens of the year 2020, a year of tumultuous social change created by the COVID�19 pandemic. The article draws parallels with and looks to learn from the ways in which the collective loss experienced as a result of COVID�19 may offer a sense of hope in the fight not just against climate change but for climate justice. The article argues that appropriate leadership that guides widespread climate action from all is best sought from those groups already facing the loss of climate change and therefore already engaged in climate-related social action and activism, including youth and Indigenous peoples.

Relationship between Cognitive-Behavioral Processes and Stages of Change in Nutrient Use in Overweight Women Referring to Health Centers in Isfahan.

Background:The positive impact of post-needs assessment training on the correction of eating habits is remarkable. The aim of present study was to determine the relationship between cognitive-behavioral processes and stages of change in nutrient use in overweight women referring to health centers in Isfahan.Materials and Methods:The present study was a cross-sectional study conducted in 2017 during a three-month period. Using systematic random sampling, 260 overweight women referring to Isfahan comprehensive health centers were chosen. Data collection was performed by a four-part researcher-made questionnaire including demographic information form, stages of change of behavior, cognitive and behavioral processes questionnaire, and standard 168-item Food Frequency Questionnaire. After confirming its validity and reliability, it was completed by the researcher. Data were then entered N4 software perfect and analyzed using descriptive and analytical tests (ANOVA and Bonferroni Post-Hoc).Results:59.30% of the subjects were in an inactive and 40.70% in an active phase. There was a significant difference with respect to different stages of change and the use of all behavior change processes (F4= 11.42, p < 0.001). The rate of using cognitive and behavioral processes increased during the nutrient change behavior (p < 0.001).Conclusions:The results of the study showed that moving away from pre-contemplation stage to maintenance phase increases the rate of using these processes that is due to the stability and improvement of changed behavior. Therefore, health plans should be designed based on the stage of the target group.

Lifestyle and Health Behavior Change in Traditional Acupuncture Practice: A Systematic Critical Interpretive Synthesis

Introduction: Behavioral factors are the leading cause of ill-health worldwide. Diet, physical activity, smoking, and alcohol consumption are the focus of public health targets on promotion of healthy behavior. The science of behavior change is rapidly growing and has largely evolved within mainstream health care treatments. Traditional Chinese Medicine includes self-care practices that encourage healthy behavior alongside treatments such as acupuncture. Exploring behavior change within traditional acupuncture could potentially highlight new techniques and approaches, and contribute to developing models of behavior change. Aims: In this review, the authors aimed to critically appraise research exploring health behavior change within traditional acupuncture, to highlight gaps in the field, identify questions, and enable theory development. Design/Method: The authors were guided by a critical interpretive synthesis (CIS) method to explore a diverse mixture of research including qualitative and quantitative articles. Eight databases were searched up to October 2017 for articles published in English. Eleven thousand four hundred eighty-eight articles were identified (7,149 after deduplication). Titles and abstracts were screened by one reviewer (10% by a second reviewer). Eligible articles were selected using a Population, Intervention, Comparison, Outcome framework. CIS methods, including purposive sampling of eligible articles and a reflexive, dialectic process of critiquing evidence and theory, were used to synthesize the evidence. Results: Several articles examined the prevalence and patterns of behavior change and support for change, although methods varied and reliability of results was limited. There was more evidence concerning diet/exercise than alcohol/smoking. Aspects of acupuncturists' work identified as potential key elements for promoting behavior change included: individualized advice based on symptoms; holistic/biopsychosocial explanations; therapeutic relationship; simultaneous treatment of behavior-limiting symptoms; and patients' physical involvement with intervention. A logic model of the process of behavior change was developed, proposing that perceived support, mutual understanding, and active participation may facilitate change. Possible moderators included: single/multicomponent acupuncture; setting; patient/practitioner characteristics; treatment experience; timing; and treatment duration. Conclusion: These findings suggest behavior change work is a significant part of traditional acupuncture practice, although more reliable evidence is needed to understand the effectiveness, prevalence, and patterns of this work (in particular the patterns suggesting acupuncturists are more likely to work on changes to diet and physical activity than alcohol and smoking behaviors, and more likely to support changes in long-term compared with acute conditions). The proposed model of behavior change should be developed and tested with a view to refining the model and elaborating the suggested links with a wider theory of behavior and behavior change. This review was preregistered with PROSPERO as "Health behaviour change in traditional acupuncture treatment: a protocol for a critical interpretive synthesis": CRD42018099766.

Parent Perspectives on Implementing Health Behavior Recommendations for Their Infants

Little is known about the influence of parental values, preferences, and child achievement and health expectations on parent choices for their child’s rearing practices. We aimed to explore parents’ perceptions of immediate and future impact of health behavior decisions for their child and to understand factors associated with child-specific health behavior decisions. This pilot study included interviews with 25 parents of 9–24-month-old children attending well child care visits at a primary care practice. Questions assessed parental perceptions and attitudes in making health behavior changes now for their child’s future health. Themes suggest parents perceive many factors are involved, and intricately connected, in health behavior decision-making. Although almost all parents believed there is a connection between the foods they feed their child and achieving their goals, only half are willing to make a change. In addition, parents failed to consider the impact of the health practices they currently have with their children to influence the future acquisition of life skills and of healthy versus obesogenic behaviors. Our results add to the understanding of the process of health behavior change through anticipatory guidance. Study findings will be used to guide next steps towards refining our understanding of health and lifestyle change decisions made by parents.

Brief Theory-based Intervention to Improve Physical Activity in Men with Psychosis and Obesity: A Feasibility Study

Introduction: Physical activity (PA) is recommended to improve physical health in people with psychosis, however, most of them are inactive. Objectives: The objectives of the study were to assess the feasibility of a four-week brief theory-based intervention to improve PA in men with psychosis and obesity. Methods: A Quasi- experimental pre- post design evaluating the feasibility, the participation, and the intervention drop-out rate was conducted. PA, sedentary time, motivational processes of change, and anthropometric measures were evaluated. Results: A total of 38 men with psychotic disorders were approached and 32% participated (n = 12). Among these 12 participants, 75% had schizophrenia, their mean age was 33.2 ± 10.2, and mean Body Mass Index: 35.8 ± 7.7 kg/m2. Besides, all 12 participants (100%) completed the intervention. Participants reported a high satisfaction rate in the intervention. Following the intervention, PA level was increased with a moderate effect size. Similarly, an increase in behavioral processes of change was observed with a moderate effect size. Discussion and conclusion: Hence, the brief theory-based intervention was feasible and could probably improve the PA level in men with psychosis and obesity.

Making Wearable Technology Available for Mental Healthcare through an Online Platform with Stress Detection Algorithms: The Carewear Project

Over the past years, mobile health (mHealth) applications and specifically wearables have become able and available to collect data of increasing quality of relevance for mental health. Despite the large potential of wearable technology, mental healthcare professionals are currently lacking tools and knowledge to properly implement and make use of this technology in practice. The Carewear project is aimed at developing and evaluating an online platform, allowing healthcare professionals to use data from wearables in their clinical practice. Carewear implements data collection through self-tracking, which is aimed at helping people in their behavioral change process, as a component of a broader intervention or therapy guided by a mental healthcare professional. The Empatica E4 wearables are used to collect accelerometer data, electrodermal activity (EDA), and blood volume pulse (BVP) in real life. This data is uploaded to the Carewear platform where algorithms calculate moments of acute stress, average resting heart rate (HR), HR variability (HRV), step count, active periods, and total active minutes. The detected moments of acute stress can be annotated to indicate whether they are associated with a negative feeling of stress. Also, the mood of the day can be elaborated on. The online platform presents this information in a structured way to both the client and their mental healthcare professional. The goal of the current study was a first assessment of the accuracy of the algorithms in real life through comparisons with comprehensive annotated data in a small sample of five healthy participants without known stress-related complaints. Additionally, we assessed the usability of the application through user reports concerning their experiences with the wearable and online platform. While the current study shows that a substantial amount of false positives are detected in a healthy sample and that usability could be improved, the concept of a user-friendly platform to combine physiological data with self-report to inform on stress and mental health is viewed positively in our pilots.

Effect of “Speak Up” educational tools to engage patients in advance care planning in outpatient healthcare settings: A prospective before-after study

BackgroundTools for advance care planning (ACP) are advocated to help ensure patient values guide healthcare decisions. Evaluation of the effect of tools introduced to patients in clinical settings is needed. ObjectiveTo evaluate the effect of the Canadian Speak Up Campaign tools on engagement in advance care planning (ACP), with patients attending outpatient clinics.Patient involvement: Patients were not involved in the problem definition or solution selection in this study but members of the public were involved in development of tools. The measurement of impacts involved patients. MethodsThis was a prospective pre-post study in 15 primary care and two outpatient cancer clinics. The outcome was scores on an Advance Care Planning Engagement Survey measuring Behavior Change Process on 5-point scales and Actions (0−21-point scale) administered before and six weeks after using a tool, with reminders at two or four weeks. Results177 of 220 patients (81%) completed the study (mean 68 years of age, 16% had cancer). Mean Behavior Change Process scores were 2.9 at baseline and 3.5 at follow-up (mean change 0.6, 95% confidence interval 0.5 to 0.7; large effect size of 0.8). Mean Action Measure score was 3.7 at baseline and 4.8 at follow-up (mean change 1.1, 95% confidence interval 0.6–1.5; small effect size of 0.2). Practical valuePublicly available ACP tools may have utility in clinical settings to initiate ACP among patients. More time and motivation may be required to stimulate changes in patient behaviors related to ACP.

Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial.

ObjectiveUnderstanding the mechanisms of action of psychological treatments is a key first step in refining and developing more effective treatments. The present study examined hypothesized mediators of change of enhanced cognitive behavior therapy (CBT‐E) and interpersonal psychotherapy for eating disorders (IPT‐ED).MethodA series of mediation studies were embedded in a randomized controlled trial (RCT) comparing 20 weeks of CBT‐E and IPT‐ED in a transdiagnostic, non‐underweight sample of patients with eating disorders (N = 130) consecutively referred to the service. Three hypothesized mediators of change in CBT‐E (regular eating, weighing frequency, and shape checking) and the key hypothesized mediator of IPT‐ED (interpersonal problem severity) were studied.ResultsThe data supported regular eating as being a mediator of the effect of CBT‐E on binge‐eating frequency. The findings were inconclusive regarding the role of the other putative mediators of the effects of CBT‐E; and were similarly inconclusive for interpersonal problem severity as a mediator of the effect of IPT‐ED.DiscussionThis research highlights the potential benefits of embedding mediation studies within RCTs to better understand how treatments work. The findings supported the role of regular eating in reducing patients' binge‐eating frequency. Other key hypothesized mediators of CBT‐E and IPT‐ED were not supported, although the data were not inconsistent with them. Key methodological issues to address in future work include the need to capture both behavioral and cognitive processes of change in CBT‐E, and identifying key time points for change in IPT‐ED.

What Lies Behind Teaching and Learning Green Chemistry to Promote Sustainability Education? A Literature Review.

In this qualitative study, we aim to identify suitable pedagogical approaches to teaching and learning green chemistry among college students and preservice teachers by examining the teaching methods that have been used to promote green chemistry education (GCE) and how these methods have supported green chemistry learning (GCL). We found 45 articles published in peer-reviewed scientific journals since 2000 that specifically described teaching methods for GCE. The content of the articles was analyzed based on the categories of the teaching methods used and the revised version of Bloom’s taxonomy. Among the selected articles, collaborative and interdisciplinary learning, and problem-based learning were utilized in 38 and 35 articles, respectively. These were the most frequently used teaching methods, alongside a general combination of multiple teaching methods and teacher presentations. Developing collaborative and interdisciplinary learning skills, techniques for increasing environmental awareness, problem-centered learning skills, and systems thinking skills featuring the teaching methods were seen to promote GCL in 44, 40, 34, and 29 articles, respectively. The results showed that the integration of green chemistry teaching (GCT), e.g., with sustainable education, promoted GCL by fostering environmental consciousness and behavioral change and cognitive processes in a sustainable direction.

Predictors of hand hygiene behaviours among primary and secondary school children in a rural district setting in Zimbabwe: a cross-sectional epidemiologic study

Abstract Hand hygiene is one of the most effective and efficient ways of controlling faecal–oral diseases. However, little is known about the predictors of hand hygiene behaviours among school children. A predesigned checklist guide was used to observe hygiene behaviours of 460 pupils from four rural schools in Shamva South district, Zimbabwe. A pretested questionnaire was administered to obtain demographic data of the observed school children. Membership of a Water, Sanitation and Hygiene (WASH) club, age, gender and the level of education were associated with hand hygiene practices (p &amp;lt; 0.05). The findings indicated that investing in hand hygiene behaviour change processes among school children using the promotion, formation, resuscitation and empowerment of WASH clubs in schools is important in disease prevention among communities in developing countries.

Effect of a technology-supported physical activity intervention on health-related quality of life, sleep, and processes of behavior change in cancer survivors: A randomized controlled trial.

This pilot trial tested the effect of adding a multi-level, technology-based physical activity intervention module to a standard survivorship care plan for breast and colorectal cancer survivors. The objective of this analysis was to determine whether the physical activity module improved health-related quality of life, sleep, and factors key to lasting behavior change (eg, social support, self-efficacy). Breast and colorectal cancer survivors (n = 50) were enrolled alongside a support partner. Survivors were assigned to receive a standard survivorship care plan either alone or augmented by a 12-week multi-component physical activity module. The module included a Fitbit tracker (with the physical activity data integrated into the electronic health record for clinician review) and customized email feedback. Physical activity was measured using the ActiGraph GT3X+. Psychosocial outcomes included the SF-36, FACT, ISEL, PROMIS sleep measures, and physical activity beliefs. Data were analyzed using linear mixed modeling. Cancer survivors were aged 54.4 ± 11.2 years and were 2.0 ± 1.5 years from diagnosis. Relative to comparison, the intervention was associated with moderate-to-large improvements in physical health (effect size: d = 0.39, 95% CI = 0.0, 0.78), mental health (d = 0.59, 95% CI = 0.19, 0.99), sleep impairment (d = 0.62, 95% CI = -1.02, -0.22), and exercise self-efficacy (d = 0.60, 95% CI = 0.20, 1.0). The intervention delivered meaningful improvements in survivors' quality of life, social support, and sleep impairment. If replicated in a larger sample, adding a technology-supported physical activity module to survivorship care plans may be a practical strategy for supporting healthy survivorship. ClinicalTrials.gov#: NCT02677389.

Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): A systematic review

The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval −0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.

Why Users Comply with Wearables: The Role of Contextual Self-Efficacy in Behavioral Change

ABSTRACT Wearables provide great opportunities for improving personal health, but research challenges their capacity to evoke behavioral change effectively. Realizing the full potential of wearables requires a better understanding of users’ behavior change processes. Based on self-efficacy theory, we investigate how wearables influence users’ perceptions of their self-efficacy and subsequent health behavior. Using narrative interviews with twenty-five long-term wearable users, we show that wearables can have both positive and negative effects on users’ perceptions of their self-efficacy and that these perceptions are subject to internal and external contexts, which can positively or negatively affect users’ compliance. We also find that the internal context may have a compounding or neutralizing effect on self-efficacy, despite an adverse external context. Our study shows the contextual and transient nature of self-efficacy, thus contributing to self-efficacy theory and research on wearables and offering practical design implications.

62. THE IMPACT OF A MULTI-MODAL RESIDENCY CURRICULUM TO PROVIDE RESIDENTS WITH DATA ON THEIR PRACTICE HABITS

Background The Accreditation Council on Graduate Medical Education (ACGME) requires that residency programs regularly provide trainees with data on their practice habits (DOPH). Many programs including ours have struggled to deliver meaningful DOPH to trainees. Methods We created a DOPH curriculum following Kern's six-step approach and evaluated its impact using quality improvement methodology. We conducted a needs assessment, defined project goals, and convened a group of stakeholders representing the residents, residency program, GME office, and hospital. Interventions were implemented over two years (Figure 1) and were continuously assessed using plan-do-study-act (PDSA) cycles to evaluate curriculum impact on 2 levels of Kirkpatrick's framework. Behavior change process measures selected were provision of individualized and group resident DOPH data. The high stakes outcome measure of ACGME resident survey DOPH rating was evaluated annually. Results Following a needs assessment, the interventions chosen were providing: 1) individualized resident reports in inpatient and outpatient settings (note productivity, diagnoses seen, developmental and depression screening), 2) group reports in inpatient and outpatient settings (residency and hospital-wide data), and 3) consistent DOPH messaging. Educational strategies for content sharing included housestaff meetings, semiannual reviews, email, and newsletters. By fall 2019, 99% of residents were provided individualized data on note productivity and diagnoses seen and 94% were provided ambulatory data on developmental and depression screening rates. During 2018-2019, group DOPH was presented in > 16 housestaff meetings. ACGME resident survey DOPH scores by year were 2.1 (2016), 1.8 (2017), 2.4 (2018), and 4.9 (2019). Conclusion We successfully created a DOPH curriculum incorporating individualized and group data in both inpatient and outpatient settings. These interventions yielded a substantial increase in the ACGME resident survey DOPH rating. We recommend a multi-modal educational strategy for programs seeking ways to provide DOPH.

How Behavioral Interventions Can Reduce the Climate Impact of Energy Use

Kristian S. Nielsen is a research associate in the Department of Zoology at University of Cambridge. He received a PhD from Copenhagen Business School in 2019 with a dissertation focused on the role of self-regulation in environmental behavior change. His current research focuses on bridging research in behavioral science and biodiversity conservation as part of an interdisciplinary project called Nudging for Nature. His other research interests revolve around behavior change as a climate change mitigation strategy, the dynamics of the behavior change process, self-regulation and self-control, and sustainable clothing consumption. Sander van der Linden is Reader in Social Psychology in Society and director of the Cambridge Social Decision-Making Lab in the Department of Psychology at the University of Cambridge. He is also a fellow in Psychological and Behavioral Sciences at Churchill College, Cambridge and the editor-in-chief of the Journal of Environmental Psychology. His research on the psychology of human judgment and decision-making, especially in the context of climate change, has received numerous awards including the Rising Star award from the Association for Psychological Science and the Sage Early Career Award from the Society for Personality and Social Psychology . Paul C. Stern is president of the Social and Environmental Research institute and was previously a principal staff officer at the US National Academy of Science, Engineering, and Medicine where he directed its Board on Environmental Change and Society. He is a fellow of the American Association for the Advancement of Science and the American Psychological Association. His research interests include the integration of social science into research and practice for governing environmental change and into risk assessment and management. Among his publications are Environmental Problems and Human Behavior (coauthor) and Understanding Risk: Informing Decisions in a Democratic Society (coeditor).