Promote Behavior Change Research Articles

Food Frequency Questionnaire Personalisation Using Multi-Target Regression.

Fondazione Bruno Kessler is developing a mobile app prototype for empowering citizens to improve their health conditions through different lifestyle interventions that will be incorporated into a mobile application for lifestyle promotion of the Province of Trento in the context of the Trentino Salute 4.0 Competence Center. The envisioned interventions are based on promoting behaviour change in various domains such as physical activity, mental health and nutrition. In particular, the nutrition component is a self-monitoring module that collects dietary habits to analyse them and recommend healthier eating behaviours. Dietary assessment is completed using a Food Frequency Questionnaire on the Mediterranean diet that is presented to the user as a grid of images. The questionnaire returns feedback on 11 aspects of nutrition. Although the questionnaire used in the application only consists of 24 questions, it still could be a bit overwhelming and a bit crowded when shown on the screen. In this paper, we tried to find a machine-learning-based solution to reduce the number of questions in the questionnaire. We proposed a method that uses the user’s previous answers as additional information to find the goals that need more attention. We compared this method with a case where the subset of questions is randomly selected and with a case where the subset is chosen using feature selection. We also explored how large the subset should be to obtain good predictions. All the experiments are conducted as a multi-target regression problem, which means several goals are predicted simultaneously. The proposed method adjusts well to the user in question and has the slightest error when predicting the goals.

Partisanship Unmasked? The Role of Politics and Social Norms in COVID-19 Mask-Wearing Behavior

AbstractPublic health officials have faced resistance in their efforts to promote mask-wearing to counter the spread of COVID-19. One approach to promoting behavior change is to alert people to the fact that a behavior is common (a descriptive norm). However, partisan differences in pandemic mitigation behavior mean that Americans may be especially (in)sensitive to information about behavioral norms depending on the party affiliation of the group in question. In July–August 2020, we tested the effects of providing information to respondents about how many Americans, co-partisans, or out-partisans report wearing masks regularly on both mask-wearing intentions and on the perceived effectiveness of masks. Learning that a majority of Americans report wearing masks regularly increases mask-wearing intentions and perceived effectiveness, though the effects of this information are not distinguishable from other treatments.

Testing the influence of visual framing on engagement and pro‐environmental action

AbstractAlthough images play a significant role in environmental communications, few studies have empirically examined whether positive or negative images are more effective at engaging attention and promoting behavior change. We conducted a 6‐week public experiment at the Florida Museum of Natural History in Gainesville, Florida, to test whether viewing a photography exhibit featuring images of the impacts of marine plastic pollution on ocean ecosystems (negative valence) or images of pristine ocean ecosystems (positive valence) would increase engagement, monetary donations to conservation, and pledges to help protect the ocean from plastic pollution. We tracked 1179 adults while observing the negative exhibit and 1304 adults while observing the positive exhibit. Of the adults tracked, significantly more engaged with the negative exhibit (270; 22.90%) than the positive exhibit (159; 12.19%). The mean number of pledges per visitor for the negative exhibit was significantly higher than for the positive exhibit. However, there was not a significant difference in donations between the two exhibits. These results suggest that environmental organizations that seek to capture attention should consider using images that show the negative impacts of human behavior on the environment.

An eHealth intervention (ManGuard) to reduce cardiovascular disease risk in male taxi drivers: protocol for a feasibility randomised controlled trial

BackgroundMen are at higher risk then women of developing cardiovascular disease (CVD), and male taxi drivers are a particularly high-risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which reported a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more acceptable and effective. The aim of this study is to assess the feasibility an eHealth intervention (ManGuard) to reduce CVD risk in male taxi drivers.MethodsA randomised wait-list controlled trial will be conducted with a sample of 30 male taxi drivers to establish feasibility, including recruitment, engagement, and retention rates. Program usability and participant satisfaction will be assessed by a survey completed by all participants at 3 months after allocation. Additionally, an in-depth qualitative process evaluation to explore acceptability of the intervention will be conducted with a subset of participants by semi-structured telephone interviews. Preliminary efficacy of ManGuard for improving key CVD-related outcomes will be assessed, including biomarkers (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and total/HDL cholesterol ratio), blood pressure, anthropometry (body mass index, body fat percentage, and waist circumference), physical activity (accelerometery, and self-report) and psychosocial status (health-related quality of life, self-efficacy, and social support). Outcomes will be assessed at baseline, 7 weeks, and 3 months after group allocation. The wait-list control group will be offered access to the intervention at the completion of data collection.DiscussioneHealth interventions show potential for promoting behaviour change and reducing CVD risk in men, yet there remains a paucity of robust evidence pertaining to male taxi drivers, classified as a high-risk group. This study uses a randomised controlled trial to assess the feasibility of ManGuard for reducing CVD risk in male taxi drivers. It is envisaged that this study will inform a fully powered trial that will determine the effectiveness of eHealth interventions for this high risk and underserved population.Trial registrationThis trial has been registered prospectively on the ISRCTN registry on 5 January 2022, registration number ISRCTN29693943

Moral framing in health promotion: lessons from an Indonesian case study.

In this article we illuminate the important, yet typically underreported, role played by moral framing in public health messaging. We present case studies from West Java, Indonesia to demonstrate how moral framing is used to motivate health volunteers and to promote behavior change in line with government health policies. We used qualitative research including participant observation, job shadowing, interviews and focus groups with health promotion workers and community members. Findings were analyzed using thematic and discourse analysis. We identified three moral frameworks typically used to encourage shifts in normative health practices in Indonesia: Islamic values, right to health, and evidence-based public health policy, represented as indicative of modernity. Health workers tailor these moral frameworks to audiences in their health promotion work. While the immediate goal is to meet health performance targets, the broader goal is to generate forms of health citizenship commensurate with Indonesia's political environment of democratic decentralization. COVID-19 presents an opportune moment for the public health community to reevaluate the power of moral framing in health messaging, and how it can be used both as a compelling means of establishing community norms toward the common good, as seen in our Indonesia case study, and also as a mechanism used by counterpublics to challenge these norms and appeal to alternative values and versions of reality.

Desenvolvimento de um site responsivo para promover mudanças comportamentais em usuários de computador

ABSTRACT The increase in the use of technology for prolonged periods, both inside and outside of work, is associated with a sedentary lifestyle, a risk factor for several health problems. Change in this behavior can be promoted with the use of technologies. We aim to develop an interactive responsive website to promote behavioral changes in computer users. From a literature review, modifiable risk factors associated with health problems in computer users were identified. Messages were created to increase knowledge and promote behavioral changes in users. These messages include recommendations regarding breaks, adjustments in the workplace, physical exercise, hydration, among others. The messages are personalized, and the user includes personal information and current lifestyle habits. All this information was implemented in an interactive responsive website developed in JavaScript language and Node.js engine. The responsive website was developed, including the proposed features, and is available online. Future studies can evaluate the effectiveness of the responsive website in promoting behavioral changes among computer users, improving their health and quality of life.

Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis.

Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.

Clinic Based, Patient Choice Driven Lifestyle Intervention Lowers HbA1c In Type 2 Diabetes

The hyperglycemia associated with type 2 diabetes (T2D) results in substantially increased morbidity and mortality risk. Though efficacious pharmacotherapies exist, glycemic control remains poor with 33-49% of patients not meeting targets for glycemic control as quantified by HbA1c. While traditional lifestyle interventions have been shown to improve health outcomes, adherence is low. PURPOSE: This study sought to determine the efficacy of a clinic-based, menu-driven intervention on measures of glycemia and cardiovascular health. METHODS: Patients with T2D (n = 20; 56.7 ± 12y; 33.7 ± 7.2 BMI) with an HbA1c of 7.5-10% not requiring injectable insulin were recruited from an outpatient, family medicine clinic in Phoenix, AZ and underwent a quasi-experimental 3-month lifestyle intervention. In addition to behavioral counseling, subjects were given a daily menu of exercise and nutritional options and had to choose one option from each category. Exercise options: Moderate intensity (MOD) 3 x 10-minute bouts, MOD 1 x 30-minute bout, 2 minutes every hour at a high or MOD, and 10 x 1-minute bouts of high intensity (RPE 17-19). The dietary choices included: apple cider vinegar, psyllium husk powder, unsalted tree nuts, avocados, or extra virgin olive oil. Behavioral health counseling utilized motivational interviewing, acceptance and commitment therapy, and problem-solving therapy to promote behavior change. The intervention was administered to patients by medical assistants in a family medicine clinic and overseen by exercise physiologists and physicians. Wilcoxon Signed Rank tests were used to analyze pre- and post-intervention differences. RESULTS: A reduction in HbA1c of 0.5% was observed after the intervention (8.6 ± 0.9 vs. 8.1 ± 1.2% respectively; p = 0.05). Additionally, there was a reduction in waist circumference (115.5 ± 12.6 vs. 112.5 ± 15.2 cm; p = 0.014), body weight (97.7 ± 21.9 vs. 95.6 ± 23.9 kg; p = 0.016), and BMI (33.7 ± 7.2 vs 32.8 ± 7.5 kg/m2; p = 0.028). CONCLUSIONS: Our pilot data suggest that a lifestyle intervention administered by medical assistants in a family medicine clinic demonstrates improvements in glycemic control, waist circumference, and BMI in T2D. These results remain to be verified in a randomized controlled trial setting. Funding: Dignity Health/ASU Strategic Initiatives Program

Empowerment for behaviour change through social connections: a qualitative exploration of women’s preferences in preconception health promotion in the state of Victoria, Australia

BackgroundHealth behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women’s understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period.MethodsThis qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework.ResultsNine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making.ConclusionsWomen valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

Relationship between emotion regulation strategies and total conviction in promoting behavior change.

Research conducted in the recent past have proposed total conviction as a factor associated with cognitive reappraisal that may produce changes in emotion and behavior. However, the factors that influence total conviction are not yet clearly identified. In this study, we focused on daily emotion regulation strategies and examined the relationship between emotion regulation strategies and total conviction. A total of 42 undergraduate and graduate students participated in this study. They measured their tendency toward daily emotion regulation strategies and then engaged in the cold pressor task (CPT) which is a distress tolerance task. Participants were then presented with information that encouraged them to engage in the task while enduring distress, creating a context for cognitive reappraisal of the task. Thereafter, they engaged in a second CPT. Finally, the degree of total conviction to the information that prompted reappraisal was measured. The results showed that total conviction in the experimental situation predicted behavior change. We found that the tendency to use routine cognitive reappraisal was not associated with total conviction, while the tendency to use expressive suppression would have a negative effect on total conviction. Furthermore, the expressive suppression tendency was found to moderate the relationship between total conviction and behavior change. These results indicate that the occurrence of total conviction in cognitive reappraisal leads to behavior change, though the tendency toward daily cognitive reappraisal is not related to the occurrence of total conviction in the experimental setting. The results also suggest that daily expressive suppression inhibits total conviction, particularly in situations where cognitive reappraisal is required.

Development and Validation of An Evaluation Scale for Audiovisual Production for Health Interventions - ZIKAMOB

According to the World Health Organization, intervention actions and Health Education achieve better performance when based on Behavior Change Theories associated with new technologies. This work aimed to build and validate an Audiovisual Production Assessment Scale (APAS) for use in educational interventions. One hundred videos of up to 90 seconds in length, produced by high school students from Northeast Brazil, were analyzed. The APAS contains twenty statements, grouped into five sections, some of which are based on the Social Cognitive Theory (observational learning; facilitators) and others, such as the halo effect and cognitive comfort, were proposed by Daniel Kahneman. It was found that, of the twenty statements, 15 of them had no significant difference between different evaluators; having obtained a value of 0.941 for Cronbach&amp;#39;s Alpha, showing excellent internal reliability of the APAS. On average, 22 (33.8%) videos received a score greater than 60 points, indicating that they have the potential to significantly contribute to population behavior change in relation to the prevention of mosquito-borne arboviruses; 28 (41.3%) contribute satisfactorily; 15 (22.9%), partially and from one to two videos were scored with values lower than 19 points. Altogether, 12% of the videos received maximum scores in relation to the total score and subjective score. The APAS is, therefore, an example of an effective tool for assessing audiovisual content that can be used in educational interventions in health, with good internal reliability. The scale allows evaluating any content, classifying the production into categories that reveal its potential to promote behavior change.

Exploring Environmental and Geographical Factors Influencing the Spread of Infectious Diseases with Interactive Maps

Environmental problems due to human activities such as deforestation, urbanisation, and large scale intensive farming are some of the major factors behind the rapid spread of many infectious diseases. This in turn poses significant challenges not only in as regards providing adequate healthcare, but also in supporting healthcare workers, medical researchers, policy makers, and others involved in managing infectious diseases. These challenges include surveillance, tracking of infections, communication of public health knowledge and promotion of behavioural change. Behind these challenges lies a complex set of factors which include not only biomedical and population health determinants but also environmental, climatic, geographic, and socioeconomic variables. While there is broad agreement that these factors are best understood when considered in conjunction, aggregating and presenting diverse information sources requires effective information systems, software tools, and data visualisation. In this article, we argue that interactive maps, which couple geographical information systems and advanced information visualisation techniques, provide a suitable unifying framework for coordinating these tasks. Therefore, we examine how interactive maps can support spatial epidemiological visualisation and modelling involving distributed and dynamic data sources and incorporating temporal aspects of disease spread. Combining spatial and temporal aspects can be crucial in such applications. We discuss these issues in the context of support for disease surveillance in remote regions, utilising tools that facilitate distributed data collection and enable multidisciplinary collaboration, while also providing support for simulation and data analysis. We show that interactive maps deployed on a combination of mobile devices and large screens can provide effective means for collection, sharing, and analysis of health data.

Mobile health platform based on user-centered design to promote exercise for patients with peripheral artery disease

BackgroundPeripheral artery disease (PAD) is a cardiovascular disease that can be improved by risk factor modification. Mobile health (mHealth) intervention is an effective method of healthcare delivery to promote behavior changes. An mHealth platform can encourage consistent involvement of participants and healthcare providers for health promotion. This study aimed to develop an mHealth platform consisting of a smartphone application (app) synchronized with a wearable activity tracker and a web-based portal to support exercise intervention in patients with PAD.MethodsThis study was conducted based on an iterative development process, including analysis, design, and implementation. In the analysis phase, a literature review and needs assessment through semi-structured interviews (n = 15) and a questionnaire-based survey (n = 138) were performed. The initial prototype design and contents were developed based on the users’ requirements. In the implementation phase, multidisciplinary experts (n = 4) evaluated the heuristics, following which the mHealth platform was revised. User evaluation of the usability was performed by nurses (n = 4) and patients with PAD (n = 3).ResultsThrough the development process, the functional requirements of the platform were represented through visual display, reminder, education, self-monitoring, goal setting, goal attainment, feedback, and recording. In-app videos of exercise and PAD management were produced to provide information and in-app automatic text messages were developed for user motivation. The final version of the platform was rated 67.86 out of 100, which indicated “good” usability.ConclusionsThe mHealth platform was designed and developed for patients with PAD and their healthcare providers. This platform can be used to educate and promote individualized exercise among patients with PAD.

Inducible Nitric Oxide Synthase Inhibition in the Medial Prefrontal Cortex Attenuates the Anxiogenic-Like Effect of Acute Restraint Stress via CB1 Receptors.

Stress exposure can result in several proinflammatory alterations in the brain, including overexpression of the inducible isoform of nitric oxide synthase (iNOS) in the medial prefrontal cortex (mPFC). These changes may be involved in the development of many psychiatric conditions. However, it is unknown if iNOS in mPFC plays a significant role in stress-induced behavioral changes. The endocannabinoid (ECB) system is also influenced by stress. Its activation seems to be a counter regulatory mechanism to prevent or decrease the stress-mediated neuroinflammatory consequences. However, it is unclear if the ECB system and iNOS interact to influence stress consequences. This study aimed to test the hypothesis that the anti-stress effect of iNOS inhibition in mPFC involves the local ECB system, particularly the CB1 cannabinoid receptors. Male Wistar rats with guide cannula aimed at the mPFC were submitted to acute restraint stress (RS) for 2 h. In the following morning, rats received bilateral microinjections of vehicle, AM251 (CB1 antagonist; 100 pmol), and/or 1400W (iNOS selective inhibitor; 10−4, 10−3, or 10−2 nmol) into the prelimbic area of mPFC (PL-mPFC) before being tested in the elevated plus-maze (EPM). iNOS inhibition by 1400W prevented the anxiogenic-like effect observed in animals submitted to RS. The drug did not promote behavior changes in naive animals, demonstrating a stress-dependent effect. The 1400W-anti-stress effect was prevented by local pretreatment with AM251. Our data suggest that iNOS inhibition may facilitate the local endocannabinoid signaling, attenuating stress effects.

Correlations between objective and self-reported step count adherence following total knee replacement: A longitudinal repeated-measures cohort study.

To determine how physically active individuals are following total knee replacement (TKR) and how accurately they self-report their step count adherence compared to objective measure following TKR. Observational cohort study, nested within the PATHway randomised-clinical trial. Participants (n=102) who had recently undergone TKR were recruited for the main trial. Only participant data from the intervention group were used for this study (n=51). Participants in the intervention group received an activity tracker to monitor their physical activity and fortnightly health-coaching sessions for 3months. Adherence was objectively measured as percentage of steps completed divided by the amount prescribed by the health coach. Participants were asked to self-report their adherence on a 1-10 numerical rating scale during health coaching sessions. Data from 44 participants were available, resulting in a total of 224 paired measurements. Participant step count increased over the first 8weeks of follow-up, and plateaued from 8weeks onwards at approximately 7500 steps/day. About two-thirds (65.8%) of participants accurately self-reported their step count adherence up until 12weeks, the remaining one-third (34.2%) underestimated their adherence. Paired t-tests demonstrated statistically significant differences between the paired measurements from weeks 2 to 10. Participants were generally active and completed the step goal most occasions. Two-thirds accurately self-reported their step goal adherence. Self-reported measures should be combined with an objective measure of adherence for greater accuracy. A further understanding of how people engage with activity trackers can be used to promote behaviour change in physiotherapy-led interventions.

ManGuard an eHealth intervention to reduce cardiovascular risk in male taxi drivers: a pilot randomised controlled trial protocol

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy, Northern Ireland Background Men are at higher risk then women of developing cardiovascular disease (CVD) and male taxi drivers are a particularly high risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and a sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which had a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more user-friendly and effective. Purpose The aim of this study is to assess the feasibility of a randomised controlled trial (RCT) of an eHealth intervention – ManGuard – to reduce CVD risk in male taxi drivers. Methods A wait-list controlled trial of 30 male taxi drivers in Belfast, Northern Ireland, will be assigned randomly to an intervention or usual care group. The ManGuard Application comprises seven modules: i) introduction and goal setting, ii) being active iii) eating well, iv) managing stress, v) smoking, vi) alcohol and vii) keep accelerating, the latter to be used as a re-cap module. This trial will establish feasibility, including recruitment, engagement and retention rates, program usability and participant satisfaction, as well as preliminary efficacy of ManGuard in improving key outcomes. Primary outcome is to determine the feasibility of an eHealth intervention for reducing CVD risk in male taxi drivers by assessing the following outcome measures: o Acceptability, recruitment, retention and engagement rates o Usability and participant satisfaction, process evaluation and survey The secondary outcome is to evaluate the preliminary efficacy of ManGuard compared to usual care in improving the following outcomes: o Clinical indices: CVD biomarkers (cholesterol, glucose), blood pressure, anthropometry (BMI, waist circumference, body fat percentage) o Physical activity o Psychosocial status: health related quality of life, self-efficacy, social support An in-depth qualitative process evaluation to explore acceptability of the intervention will also be conducted. Trial registration: This trial has been registered prospectively on the ISRCTN registry on 5 January 2022 Conclusion eHealth interventions have been shown to promote behaviour change and reduce CVD risk in men, but there is a lack of robust evidence for this in male taxi drivers, a high-risk group. This study aims to assess the feasibility of a future RCT assessing the impact of ManGuard on CVD risk in male taxi drivers. This study will inform a fully-powered trial that will provide robust evidence for eHealth interventions for this underserved population.

P119 Mass Media as a Means of Engagement and Reach During Alcohol Free for 40 (AFF40)

<h3>Objective</h3> To report the process evaluation findings as it relates to mass media methods used to recruit and engage participants in Alcohol Free for 40 (AFF40). <h3>Use of Theory or Research</h3> The social marketing theory was used to promote voluntary behavior change and promote health strategies for participant adoption. Effective social marketing campaigns used a variety of medias such as social, mass, and digital. <h3>Target Audience</h3> Adults 21 and older looking to abstain from alcohol to improve their overall health. <h3>Program Description</h3> AFF40 is an annual 40-day voluntary alcohol abstinence challenge that is hosted by the Ochsner Eat Fit^TM team of registered dietitians. Participants are challenged to abstain from alcohol consumption for 40 days to promote better health. Strategic planning is used to develop, implement, and evaluate media content (recruitment and program related) across multiple communication channels. <h3>Evaluation Methods</h3> Process evaluation included the tracking of reach, engagement rates, impressions, reactions, downloads, and pageviews from multiple media sources. <h3>Results</h3> During the four months of recruitment and program implementation, the AFF40 Facebook and Instagram pages published 62 posts, reached 104,080 people, recorded 530 new page follows, and had an engagement rate of 6.97% (engagement/reach*100). The AFF40 Facebook group had 934 active members and 4,189 reactions. The AFF40 website registered 719 unique pageviews and the Ochsner blog resulted in 4,796 unique pageviews across six alcohol related articles. Print media garnered 750,000 impressions across 3 newspaper articles. A 2-month span of radio segments (5 times per day each week) added 276,500 impressions. Six television news segments aired with indeterminable reach. <h3>Conclusions</h3> Using technology in the form of mass media allowed for wide participant reach and program engagement in AFF40. Future community-based program efforts may consider the use of multiple communication channels in recruiting, engaging, and disseminating program information. We believe the use of multiple channels, rather than singular, was key to program success in promoting behavior change. <h3>Funding</h3> Ochsner Health

Tailored Motivational Interviewing in Adolescent HIV Clinics: Primary Outcome Analysis of a Stepped Wedge Implementation Trial.

Youth continue to have the poorest outcomes along the HIV prevention and care continua. Motivational Interviewing (MI) may promote behavior change and reduce perceived stigma, but providers often demonstrate inadequate MI competence. This study tested Tailored Motivational Interviewing (TMI), a set of implementation strategies designed to improve MI competence in youth HIV providers. Ten HIV clinics in the Adolescent Trials Network for HIV/AIDS Interventions. In a stepped wedge design, 10 clinics (N = 151 providers) were randomized in 5 clusters every 3 months to receive TMI for a 12-month implementation period. Sites were rerandomized within each cluster to receive communities of practice guidance with or without internal facilitator support in the sustainment period. Standard patient assessments were coded every 3 months for 36 months. Nesting was addressed using mixed-effects regression models, with random effects for providers and sites. TMI resulted in significantly improved MI competence over baseline. Despite small reductions in competence in the sustainment window, competence was still significantly improved over baseline, with no difference between the 2 sustainment conditions. TMI may be an important tool to capacitate the HIV HealthForce to end the HIV epidemic in young people.

Well-Being and Health in Kidney Failure: A Scoping Review.

Kidney failure (KF) is associated with impaired physical function, reduced health-related quality of life, increased health care costs, and high rates of cardiovascular complications and mortality. Among individuals with KF, well-being and related constructs, such as positive affect, optimism, self-efficacy, and resilience, may have both mental and physical health benefits, independent of the effects of negative emotions and affective syndromes. However, there has been minimal review of these characteristics in people with KF. We conducted a scoping review, using a semi-systematic approach, to summarize the relationships between well-being characteristics and renal health, the potential mechanisms mediating these relationships, and the effects of interventions that promote positive constructs on adherence and health outcomes. We conducted database searches using PubMed and PsycINFO until November 2020. Articles were included if they examined (1) relationships between a well-being construct and health outcome in patients with KF, (2) potential biologic or behavioral mediators, or (3) interventions that target positive psychologic constructs as outcomes or mediators in KF and (4) were written in English or Spanish. Among patients with KF, well-being constructs are associated with increased health-related quality of life, reduced morbidity and complications, and increased survival. Potential mechanisms mediating these associations include reduced inflammation, improved autonomic and endothelial function, and improved health behavior adherence. Psychologic and psychosocial interventions promoting well-being have primarily focused on improving self-efficacy to promote behavior change, with limited study of interventions to promote positive psychologic constructs in this population. Further research is needed to better understand the relationship between well-being constructs and health, specific to KF populations. This could inform the development of needed interventions that harness the promotion of other positive characteristics to improve well-being and health.

A Theory-based Educational Intervention to Promote Behavior Change and Physical Activity Participation in Middle-aged Women

Introduction: Promoting physical activity (PA) behavior by education can help people to create and maintain an active lifestyle until old age. This study aimed to design and evaluate a theory-based educational intervention to promote behavior change and PA in middle-aged women. Methods: This randomized controlled trial was conducted on 73 middle-aged women in Jovein, Iran, from January to November 2018. A researcher-made questionnaire based on the volition phase constructs of the Health Action Process Approach (HAPA) model was used. Randomly, one health base and one health house were assigned to the intervention group and one health base and one health house were assigned to the control group, and the participants were randomly selected from these centers. Both the groups completed the questionnaires before, immediately after, and 3 months after the educational intervention. The educational intervention was held in three 60-min sessions among three groups of approximately 17 participants. PA maintenance was measured 6 months after the intervention. Results: Immediately and 3 months after the intervention, the mean scores of all the volition phase constructs significantly increased in the intervention group compared to the control group (P &lt; 0.05). Three and 6 months after the intervention, the number of people who had at least 150 min of moderate PA per week was significantly higher in the intervention group compared to the control group (P &lt; 0.05). Conclusion: The educational intervention based on the volition phase constructs of the HAPA increased PA intention and facilitated the transition from an inactive lifestyle to an active lifestyle among middle-aged women.