Promote Behavior Change Research Articles

Nudging Handwashing among Primary School Students in the Philippines: Evidence from a Cluster Randomized Trial.

Handwashing is key to preventing the transmission of various infectious diseases of which school-aged children are particularly susceptible. Traditional, information-messaging campaigns may increase handwashing awareness but have had limited success in promoting behavior change. Behavioral economics "nudges," which explicitly target the knowledge-behavior gap, is a promising alternative. We evaluate the impact of school-based nudges in the first fully powered cluster randomized controlled trial in the Philippines. Out of our sample of 132 eligible schools, we randomly assigned half to receive nudges, including contextual cues (painted footpath from toilet to handwashing station) and visible reminders (posters and eye sticker), and half to the control group. Four months after implementation, we measured handwashing with soap (HWWS) after toilet use among grades 1-6 students using direct observation and compared this outcome between treatment and control schools. We also assessed whether nudges increased soap availability. The intervention increased HWWS rates by 17.3% points (pp), [95% CI: 4.2, 30.4] in treatment schools from the control group mean of 11.7%. The effect size was comparable across gender and age groups. Access to functioning handwashing facilities with soap increased by 36% (+20.2 pp, 95% CI: 10.9, 29.4). Mediation analysis suggests the program simultaneously nudged students to wash hands with soap in classrooms that already had soap, and nudged teachers to provide soap where it was not already available. These findings demonstrate that behavioral nudges costing less than $70 per school can lead to significant increases in HWWS among students 4 months post-intervention.

SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial

BackgroundCaregivers’ influence on young children’s eating behaviors is widely recognized. Nutritional interventions that focus on the promotion of children’s healthy diet should actively involve parents, focusing on their feeding behaviors and practices.MethodsThis work aims to describe the development and study protocol of the SmartFeeding4Kids (SF4K) program, an online self-guided 7-session intervention for parents of young (2–6 years old) children. The program is informed by social cognitive, self-regulation, and habit formation theoretical models and uses self-regulatory techniques as self-monitoring, goal setting, and feedback to promote behavior change. We propose to examine the intervention efficacy on children’s intake of fruit, vegetables, and added sugars, and parental feeding practices with a two-arm randomized controlled with four times repeated measures design (baseline, immediately, 3 and 6 months after intervention). Parental perceived barriers about food and feeding, food parenting self-efficacy, and motivation to change will be analyzed as secondary outcomes. The study of the predictors of parents’ dropout rates and the trajectories of parents’ and children’s outcomes are also objectives of this work.DiscussionThe SmartFeeding4Kids program relies on technological resources to deliver parents’ self-regulation techniques that proved effective in promoting health behaviors. The study design can enhance the knowledge about the most effective methodologies to change parental feeding practices and children’s food intake. As a self-guided online program, SmartFeeding4Kids might overcome parents’ attrition more effectively, besides being easy to disseminate and cost-effective.Trial registrationThe study was registered in ClinicalTrials.gov (NCT04591496) on October 19, 2020.

The operating conditions framework: Integrating mechanisms and moderators in health behavior interventions.

Efficacious translational research in health psychology relies on specifying why intervention strategies change health behaviors and when, for what behaviors, and for whom, do these strategies promote change. Whereas interventions' mechanism of action (the why question) has attracted considerable attention, there is a need to conceptualize and integrate factors that moderate intervention effectiveness. Intervention effects on health behaviors are a function of 2 change processes: how effectively interventions change mechanisms of action (target engagement), and how effectively those mechanisms change behavior (target validity). We outline the Operating Conditions Framework (OCF) to articulate theoretical linkages between mechanisms and moderators and begin the process of specifying circumstances that promote target engagement and target validity. A review of 46 meta-analyses of behavioral interventions offers impetus for the OCF by revealing that heterogeneity of effect sizes is frequent, substantial, and largely unexplained in traditional moderator analyses. We present an approach to moderation grounded on the distinction between 2 foci-engagement moderation and validity moderation-and reveal that little is known about variation in how interventions change targets and how changing targets promotes behavior change. The OCF addresses this need by maintaining researchers' focus on mechanisms of behavior change but doing so while embracing the conditional nature of these processes. Because the OCF prioritizes consideration of contextual factors at the outset of a research program, early-phase translational research will be critical in specifying operating conditions and, ultimately, generating guidelines regarding why, when, for whom, and for what behaviors are intervention strategies effective. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies.

BackgroundHealthy behaviors are crucial for maintaining a person’s health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life.ObjectiveThis systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives.MethodsWe searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies.ResultsWe included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs.ConclusionsThe use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots).Trial RegistrationPROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739

Let’s build an app for that

The promotion of physical activity behavior change among adults with cancer is a research priority. Within this field, increasing attention is being devoted to the use of health technology, which includes mobile phones and applications, or apps, to support and deliver physical activity behavior change interventions. While building a mobile app is a popular proposal among exercise oncology researchers, little practical information exists on how this process should be done or what considerations researchers should take in collaboration with participants and industry. The present article provides an overview of recent experiences with app development in exercise oncology and outlines several recommendations for future research. Methods and Results: After forming an interdisciplinary team of researchers, industry partners, and exercise oncology program participants, an iterative, user-centered app improvement process was followed to collect feedback and make meaningful changes to an existing mobile health app for its use in exercise oncology. Participant feedback was summarized and addressed collaboratively via open discussion and detailed action plans. Changes made include enhanced introductory materials for the app and improvements to usability and personalization. Some requests remain to be addressed in future updates. Two challenges identified during the app improvement process were balancing the unique needs and priorities of all parties, as well as addressing the variable feedback from a variable population of adults with cancer. Conclusions and significance: A multidisciplinary participant-oriented app improvement process led to meaningful updates to the mobile application of interest, preparing researchers to carry out an evaluation of its effectiveness within exercise oncology. Furthermore, based on lessons learned, the research team present key recommendations to consider in future mobile app research before, during, and after the development process.

Promotion of behavioural change for health in a heterogeneous population.

Public health policy often involves implementing cost-efficient, large-scale interventions. When mandating or forbidding a specific behaviour is not permissible, public health professionals may draw on behaviour change interventions to achieve socially beneficial policy objectives. Interventions can have two main effects: (i) a direct effect on people initially targeted by the intervention; and (ii) an indirect effect mediated by social influence and by the observation of other people’s behaviour. However, people’s attitudes and beliefs can differ markedly throughout the population, with the result that these two effects can interact to produce unexpected, unhelpful and counterintuitive consequences. Public health professionals need to understand this interaction better. This paper illustrates the key principles of this interaction by examining two important areas of public health policy: tobacco smoking and vaccination. The example of antismoking campaigns shows when and how public health professionals can amplify the effects of a behaviour change intervention by taking advantage of the indirect pathway. The example of vaccination campaigns illustrates how underlying incentive structures, particularly anticoordination incentives, can interfere with the indirect effect of an intervention and stall efforts to scale up its implementation. Recommendations are presented on how public health professionals can maximize the total effect of behaviour change interventions in heterogeneous populations based on these concepts and examples.

Examination of students' willingness to change behaviour regarding meat consumption

The aim of this study was to assess the behaviour of Swiss students regarding meat consumption by analysing their current consumption habits, attitudes and knowledge, acceptance of meat alternatives and willingness to reduce meat intake. Data were collected through an online survey conducted in universities and universities of applied sciences among German- and French-speaking students in Switzerland (n = 498). By segmenting the student population using an adapted transtheoretical model of change, four distinct clusters were identified: passive (14.7%), curious (6%), awoken (44.7%) and active consumers (34.6%). The results provide a deeper insight into Swiss students' dietary patterns, attitudes and knowledge concerning the impact of meat consumption as along with concrete practical interventions to target the different clusters and initiate and promote behaviour change regarding meat consumption. The ideal recommendations depend on the current stage of behaviour change. However, to reduce meat consumption, policy makers need to set specific, quantifiable goals within defined time frames while involving a variety of stakeholders.

Outcomes of a National, Cross-Sector Antimicrobial Stewardship Training Initiative for Pharmacists in England.

(1) Background: Pharmacists play a pivotal role in tackling Antimicrobial resistance through antimicrobial stewardship (AMS) and are well placed to lead behaviour change interventions across the healthcare system; (2) Methods: A cross-sector AMS training initiative for pharmacists was implemented across England, with three cohorts between 2019–2021. Each cohort took part in an introductory workshop, followed- by a workplace-based quality improvement project supported by peer-assisted learning sessions. Completion of training was determined by an end of training assessment after three to four months. Outcome data and learner survey results were collated, anonymised, and analysed by the training provider. (3) Results: In total, 118 pharmacists participated in the introductory workshop, 70% of these subsequently undertook an improvement project, and 48% engaged workplace stakeholders in the process. Interventions were designed by 57% of learners and 18% completed a at least one Plan-Do-Study-Act cycle. Approximately a quarter of learners met the requirements for a Certificate of Completion. Knowledge quiz scores were obtained from 115 learners pre-training and 28 learners post-training. Paired t-tests conducted for 28 learners showed a statistically significant improvement in mean score from 67.7% to 81.1% (p < 0.0001). Sixty-two learner survey responses were received during the training and 21 follow-up survey responses 6 to 12 months post training. Of the 21 responses to the follow-up survey, ongoing quality improvement work and improvement outcomes were reported by nine and six learners, respectively. (4) Conclusions: The delivery of workplace-based training at scale can be challenging, however this study demonstrates that coupling learning with workplace implementation and peer support can promote behaviour change in learners. Further study into the impact of providing pharmacists across sectors and geographies with access to this type of training will help inform ongoing workforce development interventions.

Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach.

BackgroundThere is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed.ObjectiveWe present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania.MethodsA participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW.ResultsThe relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs.ConclusionsThe participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion.Trial RegistrationInternational Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570

The Role of Tailored Public Health Messaging to Young Adults during COVID-19: "There's a lot of ambiguity around what it means to be safe".

The COVID-19 global incidence rate among young adults (age 19-40) drastically increased since summer 2020, and young adults were often portrayed by popular media as the "main spreader" of the pandemic. However, young adults faced unique challenges during the pandemic due to working in high-risk, low-paying essential service occupations, as well as having higher levels of financial insecurity and mental burden. This qualitative study aims to examine the attitudes and perceptions of health orders of young adults to better inform public health messaging to reach this demographic and increase compliance to public health orders. A total of 50 young adults residing in British Columbia, Canada, were recruited to participate in focus group in groups of four to six. Focus group discussions were conducted via teleconferencing. Thematic analysis revealed four major themes: 1) risks of contracting the disease, 2) the perceived impact of COVID-19, 3) responsibility of institutions, 4) and effective public health messaging. Contrary to existing literature, our findings suggest young adults feel highly responsible for protecting themselves and others. They face a higher risk of depression and anxiety compared to other age groups, especially when they take on multiple social roles such as caregivers and parents. Our findings suggest young adults face confusion due to inconsistent messaging and are not reached due to the ineffectiveness of existing strategies. We recommend using evidence-based strategies proven to promote behaviour change to address the barriers identified by young adults through tailoring public health messages, specifically by using positive messaging, messaging that considers the context of the intended audiences, and utilizing digital platforms to facilitate two-way communication.

Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory

Background: Osteoarthritis is the most common chronic disease among elders, and it crucially requires self-management. This study aimed to qualitatively examine exercise experiences of elderly Medicaid beneficiaries with osteoarthritis receiving exercise intervention based on self-determination theory (SDT).Methods: Eight elders who received a community-based exercise intervention were interviewed three times. Using the interview transcriptions and field notes, researchers conducted an interpretative phenomenological analysis based on SDT to explore the motivational process of exercise compliance.Results: Three meaningful profiles (non-compliant, intermitter, and compliant) were identified along with satisfaction with needs (autonomy, competence, and relatedness) that motivate exercise compliance based on SDT. Compliance of exercise is primarily initiated by external regulation and followed by the internalization process of recognizing and accepting the value of the behavior.Conclusions: The concepts of SDT could be used to explore factors associated with motivation and gradual behavior change among elderly Medicaid beneficiaries with osteoarthritis. Autonomy, competence, relatedness, external regulation, and identified regulation control may be applied to establish a strategy that promotes behavior change by satisfying the psychological needs and internalizing the behavior of these elders.

Using the Replicating Effective Programs Framework to Adapt an Outpatient Rehabilitation Program for the Post-Acute Nursing Home Setting

<h3>Research Objectives</h3> To adapt a successful outpatient rehabilitation program targeting the prevention of mobility decline among older adults for the post-acute nursing home setting within the Veterans Health Administration (VHA) using the Replicating Effective Programs (REP) Framework. <h3>Design</h3> Program development. <h3>Setting</h3> Community Living Center (CLC), the post-acute nursing home setting within VHA. <h3>Participants</h3> Veterans receiving post-acute CLC rehabilitative care. <h3>Interventions</h3> We used the REP framework to guide adaptation of the Live Long Walk Strong (LLWS) program for the CLC setting. The original LLWS program treats physiologic impairments associated with mobility decline, promotes behavior change, and links patients to physical activity programs to foster long-term maintenance of health and function. LLWS produces large clinically meaningful improvements in mobility when implemented as an outpatient program for community-dwelling older adults. We adapted the program for the CLC by working through the phases of the REP framework. In the Pre-conditions phase, we identified local champions, developed an understanding of CLC processes, and identified existing resources. In the Pre-implementation phase, we engaged a broader group of stakeholders (CLC providers, CLC administrators, home health agencies), addressed electronic health record logistics, and trained staff. In the Implementation phase, we completed Plan-Do-Study-Act (PDSA) cycles and refined the protocol. <h3>Main Outcome Measures</h3> Preliminary feasibility. <h3>Results</h3> The adapted version of LLWS includes novel elements and bridges the inpatient CLC stay and subsequent three months post-discharge. The inpatient component focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, lower extremity strength and power, and trunk muscle endurance. The care transition and virtual (i.e., telehealth) post-discharge components focus on case management and engagement in physical activity programs. Coaching and behavior change are a consistent focus throughout the program. The adapted program is being rolled out as a clinical demonstration project and demonstrates preliminary feasibility. <h3>Conclusions</h3> The REP framework provides a useful guide for adapting rehabilitative programs to meet the needs of new populations. <h3>Author(s) Disclosures</h3> No conflicts of interest to report.

COVID-19 Vaccine Sentiments Among African American or Black Adolescents in Rural Alabama

Considering the urgent need to increase vaccine uptake in Alabama, a rural state with the lowest rates of COVID-19 vaccination in the country, we conducted an exploratory study to elucidate sentiments toward vaccination among African American or black adolescents. We conducted in-depth interviews with 15–17 year olds in rural Alabama (N = 28). About 54% of our sample were female. Nearly a third lived with an older family member; 18% knew someone who contracted COVID-19. Using Rapid Qualitative Analysis, 3 COVID-19 vaccine-related themes emerged: influence of community leaders and older family members, fear of side effects and misinformation, and institutional distrust. To address COVID-19 vaccine hesitancy among rural African American or black adolescents, we suggest adopting a socioecological approach to public health messaging that addresses misinformation and government distrust and is delivered by local influencers with the social capital necessary to promote behavior change, namely older family members and Church officials.

Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework.

In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors® (ADCES7®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories. We searched apps using the search terms: "diabetes," "blood sugar," "glucose," and "mood" from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract. We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension. Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.

COVID‐19‐Related Knowledge, Protective Behaviors and the Moderating Role of Primary Sources of Information: Findings from a Cross‐Sectional Online Survey in the United States

Research ObjectiveTo assess the moderating effects of primary sources of COVID‐19 information on the association between knowledge and protective behaviors against COVID‐19.Study DesignThis is a secondary analysis of data from a cross‐sectional online COVID‐19 survey conducted among US adults in April 2020 using advertisement‐based recruitment on social media. A total of 6518 people completed the survey. Linear regression analysis was performed on COVID‐19 knowledge and protective behavior scores. An interaction term between knowledge and primary source of information was included in order to examine any moderating effects of the information source on the relationship between knowledge and protective behaviors. The analysis was adjusted for demographic and socio‐economic factors and was conducted using R software (version 3.6.3).Population StudiedAdult population (age > 18) living in the United States.Principal FindingsOverall, higher level of COVID‐19‐related knowledge was associated with higher level of self‐reported engagement in protective behaviors. More specifically, our results indicate that the primary source of information modified the association between knowledge and protective behaviors. The most effective sources of information to translate incremental knowledge into higher engagement in protective behaviors were interpersonal communication and social media. Official sources such US government, CDC, and WHO websites had significantly weaker effects. Our results also showed that respondents with lower knowledge scores preferred social media or interpersonal communication as their primary source for seeking COVID‐19‐related information.ConclusionsThis study shows the important role that the different COVID‐19 information sources can play on influencing people's engagement in protective behaviors while delivering the COVID‐19‐related knowledge.Implications for Policy or PracticeOverflowing information and misinformation are influencing people's degree of engagement in protective behaviors against COVID‐19. Policy makers should carefully monitor the use of different information sources by the public so that they can effectively target, influence decision‐making, and promote behavior change to fight the current pandemic and the infodemic concurrently.

Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study.

BackgroundSMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research.ObjectiveThis study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program.MethodsA bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank.Results76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification.ConclusionsThis study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users.

The importance of message framing in rule compliance by visitors during wildlife tourism

AbstractA conundrum of wildlife tourism is balancing wildlife conservation and tourist satisfaction. Mountain gorillas (Gorilla beringei) are a flagship species for biodiversity and there is worldwide interest in gorilla trekking safaris. This tourism provides substantial revenue to the government and local communities for gorilla protection, but puts them in danger of zoonotic diseases. To minimize disease transmission, health guidelines are in place for visitors whereby they are asked to remain 7 m from the endangered apes and stay in a cohesive group. Unfortunately, tourists often do not follow these rules and consequently their behavior puts gorillas at risk. The pre‐trekking messages presented to tourists in Bwindi Impenetrable National Park, Uganda were changed to determine if the way messages are stated affects visitor adherence to rules. Tourists (n = 389) either received strategic messages that were positively or negatively framed in relation to expectations to follow specific rules to adhere to health guidelines, and tourist behavior was measured, such as the nearest distance they were to gorillas, and their cohesiveness. Using generalized linear mixed models, it was found that framing messages affected tourist behavior. Tourists who received a negatively framed message had a higher adherence to rules than those who received a positive or control message. They were 75% further from the gorillas (7.26 vs. 4.52 m), more cohesive (0.40 vs. 0.81 m to each other), and approached the gorillas less (0.34 vs. 1.32 times) than the control message. These findings demonstrate that communicating in different ways promotes changes in behavior by tourists, which reduces the chances of epizootic respiratory infections being passed to vulnerable animals. Strategic message framing should be widely considered as a cost‐effective mechanism to promote behavior change during ecotourism.

Physician Communication Coaching: How Psychologists can Elevate Skills and Support Resident Education, Professionalism, and Well-being.

Many factors influence resident physician communication, including rigorous training demands that can contribute to professionalism issues or burnout. The University of Rochester Physician Communication Coaching program launched for attendings in 2011, and expanded to residency programs within 11 clinical departments of our institution. In this model, psychologists serve as coaches, drawing on their expertise in communication skills, behavior change, and wellness promotion. These coaches conduct real-time observation of patient encounters, coding communication with an expanded Cambridge-Calgary Patient-Centered Observational Checklist. Residents receive a written report with individualized feedback. From 2013 to 2020, 279 residents were coached. Since 2018, residents have been formally surveyed for feedback (n = 70 surveys completed; 61% response rate), with 97% rating the experience Very Helpful or Helpful. Of the 70 completed surveys, 54 (77%) included qualitative feedback that has also been positive. Due to the feasibility and growing demand for communication coaching from other residency and fellowship programs, in 2018 two authors (SM and LD-R) developed a 2-year, part-time program to train communication coaches.

Predicting People’s Motivation to Engage in Urban Possum Control

Initiatives such as education, incentives, and regulations are used to change people’s behaviour and thereby achieve policy objectives. Understanding and predicting the willingness of people to change their behaviour in response to an initiative is critical in assessing its likely effectiveness. We present a framework proposed by Kaine et al. (2010) for understanding and predicting the motivation of people to change their behaviour in response to a policy initiative. The framework draws on the marketing concept of ‘involvement’, a measure of motivation. Through application to a predator control case study, we show how the framework may be used to predict people’s responses to a policy initiative and how these predictions might help agencies develop strategies to promote behaviour change.

Normative appeals motivate people to contribute to collective action problems more when they invite people to work together toward a common goal.

A common method to promote behavior change, particularly in contexts related to collective action, is to reference a social norm and ask people to comply with it. We argue that such appeals will be more effective when they couch the norm as an invitation to work with others toward a common goal. In six experiments, we found that working-together normative appeals, which invited people to "join in" and "do it together," increased interest in (Experiments 1, 4, and 5) and actual charitable giving (Experiment 2), reduced paper-towel use in public restrooms (Experiment 3), and increased interest in reducing personal carbon emissions (Experiment 6). By contrast, normative-information appeals, which included the same normative information but no reference to working together, did not affect interest or behavior. Mediation analyses suggest that working-together normative appeals were more effective because they fostered a feeling in participants that they were working together with others, which increased motivation, while inducing less social pressure, which undermined effectiveness. Results show how the very collective nature of collective action problems can be leveraged to promote personal behavior change and help solve societal problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).