Support Behavior Change Research Articles

Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT

BackgroundKnowledge regarding adherence is necessary to improve the specificity of exercise interventions during cancer treatment. We aimed to determine adherence to resistance and endurance training interventions in parallel; identify subgroups with similar adherence characteristics; and examine determinants of these subgroups.MethodsIn the Phys-Can randomised controlled trial, participants (n = 577, 81% women, mean(SD) age 59(12) years, and 50% with BMI ≥ 25 kg/m2) starting (neo-) adjuvant treatment for breast, colorectal or prostate cancer were randomized to 6-month of high (HI) or low-to-moderate intensity (LMI) supervised, group-based resistance training and individual home-based endurance training, with or without behavior change support. Adherence was calculated as performed exercise volume as a proportion of prescribed exercise volume (0–100%), overall (HI and LMI groups) and for frequency, intensity, type and time (FITT principles) (HI group). Adherence to resistance training was plotted against adherence to endurance training overall and for each FITT principle. K-means cluster analysis was used to identify subgroups with similar adherence characteristics. Potential determinants of subgroup membership were examined using multinomial logistic regression.ResultsWe found a positive curvilinear correlation between adherence to resistance and endurance training overall. A similar correlation was seen for adherence to frequency of resistance vs. endurance training in the HI group. In the HI group, adherence to resistance training intensity and time was > 80% for almost all participants. For endurance training adherence ranged from 0 to 100% for each of the FITT principles. Three clusters were identified, representing low, mixed, and high adherence to resistance and endurance training overall. Participants with higher age (Relative risk ratio [95% CI]; LMI: 0.86[0.77–0.96], HI: 0.83[0.74–0.93]), no behaviour change support (LMI: 0.11[0.02–0.56], HI: 0.20[0.05–0.85]), higher cardiorespiratory fitness (LMI: 0.81[0.69–0.94], HI: 0.80[0.69–0.92]), more fatigue (according to the reduced activity subscale of the MFI questionnaire) (LMI: 0.48[0.31–0.73], HI: 0.69[0.52–0.93]) or higher quality of life (LMI: 0.95[0.90–1.00], HI: 0.93[0.88–0.98]) were less likely to be in the low than the high adherence cluster whether randomised to LMI or HI training. Other determinants were specific to those randomised to LMI or HI training.ConclusionsIn an exercise intervention during cancer treatment, adherence to resistance and endurance training were positively correlated. Personalisation of interventions and additional support for some subgroups of participants may improve adherence.Trial registrationNCT02473003 (clinicaltrials.gov, Registered 16/06/2015).

Understanding Violence Against Women in the Caribbean Through an Exploration of Men's Perspectives.

Qualitative research with 60 males (16-80 years) from two Caribbean countries was carried out to explore men's perspectives on domestic violence (DV). An inductive latent/thematic approach to data analysis supported by analytic software led to five key domains being identified: (1) meanings of violence; (2) patrinormative culture; (3) normalization of violence; (4) male victimization; and (5) blame attribution and empathy. Patriarchal values, together with childhood exposure to violence, were found to reduce empathic capacity and contribute to the normalization of DV. In addition, the minimization of male victimization and the lack of behavior-change support services for men were identified as contributory factors.

Effects of self-management interventions with behavior-change support on long-term adherence in patients with chronic respiratory diseases: A systematic review

Effects of self-management interventions with behavior-change support on long-term adherence in patients with chronic respiratory diseases: A systematic review

Development of an app-based maintenance programme to promote skin protection behaviour for patients with work-related skin diseases

Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps: literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients’ needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way.

The Role of Leadership Political Skills in the Context of Organizational Change

In this research, we measured the impact of leaders’ political skills on employee behavioral support for organizational change and the latter's effect on change fatigue and change outcome. Organizations nowadays face dynamic environments that require constant change. Therefore, leaders should develop the political skills necessary to gain employee behavioral support for organizational change, manage employees' change fatigue, and ultimately achieve positive change outcomes. We based our study on a sample of 197 participants from Canadian organizations and used structural equation modeling to test our research hypotheses. We found that leader networking ability and apparent sincerity positively affect employees’ intentions to support change, whereas interpersonal influence and social astuteness do not. In turn, employees’ intentions to support change positively affect change outcome, although it has no significant effect on employees’ change fatigue. Finally, we found that change fatigue negatively affects change outcome. The findings have implications on organizations' HRD practices to facilitate effective change management efforts and have a theoretical contribution.

Organizational Health Literacy in Schools: Concept Development for Health-Literate Schools.

(1) Background: Health literacy is considered a personal asset, important for meeting health-related challenges of the 21st century. Measures for assisting students’ health literacy development and improving health outcomes can be implemented in the school setting. First, this is achieved by providing students with learning opportunities to foster their personal health literacy, thus supporting behavior change. Second, it is achieved by measures at the organizational level promoting social change within the proximal and distal environment and supporting the school in becoming more health-literate. The latter approach is rooted in the concept of organizational health literacy, which comprises a settings-based approach aiming at changing organizational conditions to enhance health literacy of relevant stakeholders. The HeLit-Schools project aims to develop the concept of health-literate schools, describing aspects that need to be addressed for a school to become a health-literate organization. (2) Method: The concept development builds on existing concepts of organizational health literacy and its adaptation to the school setting. (3) Results: The adaptation results in the HeLit-Schools concept describing a health-literate school with eight standards. Each standard depicts an area within the school organization that can be developed for fostering health literacy of school-related persons. (4) Conclusions: The HeLit-Schools concept offers an approach to organizational development for sustainably strengthening health literacy.

Facilitators and barriers to providing culinary nutrition, culinary medicine and behaviour change support: An online cross-sectional survey of Australian health and education professionals.

An Australia wide cross-sectional online survey examined facilitators and barriers of health and education professionals to providing culinary nutrition (CN) and culinary medicine (CM) education and behaviour change support in usual practice, in addition to identifying continuing professional development (CPD) needs in this domain. Survey items included socio-demographic characteristics, cooking and food skills confidence, nutrition knowledge (PKB-7), fruit and vegetable intake (FAVVA) and CPD needs. Data were summarised descriptively. Of 277 participants, 65% were likely/somewhat likely to participate in CN CPD. Mean (SD) cooking and food skill confidence scores were 73 (17.5) and 107.2 (24), out of 98 and 147, respectively. Mean PKB-7 score was 3.7 (1.4), out of 7. Mean FAVVA score was 98 (29), out of 190. Gaps in knowledge and limited time were the greatest modifiable barriers to providing CM/CN education and behaviour change support in practice. Health and education professionals are interested in CPD conducted by dietitians and culinary professionals to enhance their knowledge of CM/CN and behaviour change support.

A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients

ABSTRACT The purpose of the pilot study was to determine the effectiveness of wearable activity trackers alone or in combination with behaviour change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. A sample of 44 adults (68% female and mean age 55) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behaviour change strategies (i.e., goal setting, behaviour goal review, adaptive feedback) delivered by a trained health coach (FB+) for 12 weeks. Moderate and vigorous PA (MVPA), steps, and sedentary time (ST) were assessed using ActiGraph wGT3X-BT. The FB+ group significantly increased PA [+1854 (2518) steps/day, p < .01] and MVPA [+26 (34) mins/day, p < .05], and decreased their ST [−63 (73) mins/day, p < .01]. The FB group significantly increased MVPA [+11 (16) mins/day, p < .05], and decreased their ST [−87 (117) mins/day, p < .01]. Participants in FB+ had a significantly greater increase in MVPA/day compared to FB only with a between-group effect size of 0.6 (p < .05). Using Fitbit for self-monitoring is effective in increasing PA and reducing ST among pre-hypertensive and hypertensive participants. Additional behaviour change support amplified the intervention effectiveness for promoting MVPA.

Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms.

The clinical champion approach is a highly utilized implementation strategy used to mitigate barriers and improve outcomes of implementation efforts. Clinical champions are particularly effective at addressing provider-level barriers and promoting provider-behavior change. Yet, the specific causal pathways that explain how clinical champions impact provider behavior change have not been well-explicated. The current paper applies behavior change models to develop potential causal pathway mechanisms. The proposed mechanisms are informed by previous literature involving clinical champions and empirically supported behavior change models. These models are applied to link specific attributes to different stages of behavior change and barriers for providers. Two unique pathway mechanisms were developed, one that explicates how providers develop intention to use EBPs, while the other explicates how providers transition to EBP use and sustainment. Clinical champions may promote intention development through behavioral modeling and peer buy-in. In contrast, champions promote behavioral enactment through skill building and peer mentorship. Clinical champions likely play a critical role in reducing provider implementation barriers for providers across various phases of behavior change. The proposed pathways provide potential explanations for how clinical champions promote provider behavior change. Future research should prioritize empirically testing causal pathway mechanisms.

Supporting Behavior Change After AECOPD - Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel.

After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study’s aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients’ key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence – including but not limited to patients’ perspective – and health professionals’ perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.

How is the NHS Low-Calorie Diet Programme expected to produce behavioural change to support diabetes remission: An examination of underpinning theory.

In 2020, the National Health Service Low-Calorie Diet Programme (NHS-LCD) was launched, piloting a total diet (TDR) replacement intervention with behaviour change support for people living with Type 2 Diabetes (T2D) and excess weight. Four independent service providers were commissioned to design and deliver theoretically grounded programmes in localities across England. 1) to develop a logic model detailing how the NHS-LCD programme is expected to produce changes in health behaviour, and (2) to analyse and evaluate the use of behaviour change theory in providers' NHS-LCD Programme designs. A documentary review was conducted. Information was extracted from the NHS-LCD service specification documents on how the programme expected to produce outcomes. The Theory Coding Scheme (TCS) was used to analyse theory use in providers' programme design documents. The NHS-LCD logic model included techniques aimed at enhancing positive outcome expectations of programme participation and beliefs about social approval of behaviour change, to facilitate programme uptake and behaviour change intentions. This was followed by techniques aimed at shaping knowledge and enhancing the ability of participants to self-regulate their health behaviours, alongside a supportive social environment and person-centred approach.Application and type of behaviour change theory within service providers' programme designs varied. One provider explicitly linked theory to programme content; two providers linked 63% and 70% of intervention techniques to theory; and there was limited underpinning theory identified in the programme design documents for one of the providers. The nature and extent of theory use underpinning the NHS-LCD varied greatly amongst service providers, with some but not all intervention techniques explicitly linked to theory. How this relates to outcomes across providers should be evaluated. It is recommended that explicit theory use in programme design and evidence of its implementation becomes a requirement of future NHS commissioning processes.

User Perceptions of eHealth and mHealth Services Promoting Physical Activity and Healthy Diets: Systematic Review.

BackgroundPhysical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence.ObjectiveWe aimed to explore users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases.MethodsWe conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data.ResultsWith an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users’ preferences, an overarching theme—eHealth and mHealth services provide value but need to be tailored to individual needs—and 5 subthemes—interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable—emerged.ConclusionsNew evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services.

Implementation of Healthy Conversation Skills to support behaviour change in the Bukhali trial in Soweto, South Africa: A process evaluation

BackgroundTo address the need for preconception health interventions in low- and middle-income countries, the Healthy Life Trajectories Initiative (HeLTI) was launched in Soweto, South Africa to optimise young women's physical and mental health to establish healthier trajectories for themselves and, where relevant, the next generation. As part of HeLTI trial, the Bukhali intervention utilises the Healthy Conversation Skills (HCS) approach to promote behaviour change with 18–28-year-old women. The aim of this article is to report on the process evaluation of implementing HCS, to identify implementation challenges, and make recommendations for HCS adaptations. MethodsData were collected from intervention session records (participants’ response to setting behaviour change goals, community health workers (CHWs) impression of their HCS use; n ​= ​7418), individual in-depth interviews with participants (n ​= ​35), focus groups (3) and debrief sessions (13) with CHWs who deliver the intervention. ResultsThe findings indicated that the HCS approach was not implemented as originally intended. Challenges were reported regarding participants' willingness to set behaviour change goals, and prioritise health and health behaviour change, as well as participants’ exposure to trauma, influencing their ability to prioritise health behaviour change. While CHWs were able to identify strengths of the HCS approach, there were challenges with contextual adaptation, especially using HCS in a multilingual setting such as Soweto. Recommendations for contextual adaptations of the HCS approach in Soweto, South Africa include simplification of certain HCS tools, language adaptions for a multilingual setting, adapting training to fit in with time constraints of a trial, and adopting a trauma-informed perspective to health behaviour change. ConclusionsThis article extends our understanding of challenges to health behaviour change for young women in a low-income setting, highlighting the role of trauma, and the need for a trauma-informed perspective to understand behaviour change in this context.(PACTR201903750173871, Registered March 27, 2019).

Researching masculinities and food protein practices: A trio of more-than-human participatory workshops

Whilst there is research around men and masculinities as they relate to practices of caring in the ecological crisis, less is written about methodologies that can address intersectional challenges, and ways of engagement that can support behaviour change. A process-based workshop methodology is discussed for researching the male-gendered and material performances of environmental caring related to personal food protein consumption practices. It works creatively to address relational inequalities in status both between different masculine positionalities and different food proteins. It contributes to more-than-human participatory methodologies by exploring male-gender – food protein relations, via positioning and inviting practical-engagement with foodstuff as a process for destabilising social and cultural hierarchies attached to thinking about, as well as preparing, cooking and eating, different food proteins. We argue that novel research findings can emerge around individual, collective and community responses to the ecological crisis through the careful methodological attention to masculine inequalities.

Towards optimum smoking cessation interventions during pregnancy: a household model to explore cost-effectiveness.

Background and AimsPrevious economic evaluations of smoking cessation interventions for pregnant women are limited to single components, which do not in isolation offer sufficient potential impact to address smoking cessation targets. To inform the development of more appropriate complex interventions, we (1) describe the development of the Economics of Smoking in Pregnancy: Household (ESIP.H) model for estimating the life‐time cost‐effectiveness of smoking cessation interventions aimed at pregnant women and (2) use a hypothetical case study to demonstrate how ESIP.H can be used to identify the characteristics of optimum smoking cessation interventions.MethodsThe hypothetical intervention was based on current evidence relating to component elements, including financial incentives, partner smoking, intensive behaviour change support, cigarettes consumption and duration of support to 12 months post‐partum. ESIP.H was developed to assess the life‐time health and cost impacts of multi‐component interventions compared with standard National Health Service (NHS) care in England. ESIP.H considers cigarette consumption, partner smoking and some health conditions (e.g. obesity) that were not included in previous models. The Markov model's parameters were estimated based on published literature, expert judgement and evidence‐based assumptions. The hypothetical intervention was evaluated from an NHS perspective.ResultsThe hypothetical intervention was associated with an incremental gain in quitters (mother and partner) at 12 months postpartum of 249 [95% confidence interval (CI) = 195–304] per 1000 pregnant smokers. Over the long‐term, it had an incremental negative cost of £193 (CI = –£779 to 344) and it improved health, with a 0.50 (CI = 0.36–0.69) increase in quality‐adjusted life years (QALYs) for mothers, partners and offspring, with a 100% probability of being cost‐effective.ConclusionsThe Economics of Smoking in Pregnancy: Household model for estimating cost‐effectiveness of smoking cessation interventions aimed at pregnant women found that a hypothetical smoking cessation intervention would greatly extend reach, reduce smoking and be cost‐effective.

Persuasive Strategies and Their Implementations in Mobile Interventions for Physical Activity: A Systematic Review

Unhealthy lifestyle behaviors such as spending too many hours sitting and inadequate physical activity (PA) can contribute to different chronic diseases. Research has revealed the capabilities of digital technology interventions such as persuasive technologies (PTs) for providing health support and encouraging healthy behavior changes to assist people in preventing chronic diseases and having healthier lifestyles. Thus, the use of mobile technology to deliver PT interventions has dramatically increased, especially for promoting PA and reducing sedentary behavior (SB) by employing various persuasive strategies (PSs). This paper provides a systematic review of 16 years of research from 2006 to 2021. The review aims to (1) explore the various ways each strategy is implemented on mobile-based PTs for PA and SB, (2) evaluate the effectiveness of different ways of implementing the PSs on mobile-based PT interventions for PA and SB, (3) provide a comparison of the different ways of implementing each PS, (4) show the weaknesses and strengths of the interventions based on the strategies and implementations, (5) highlight the limitations and pitfalls of the existing research, and (6) give recommendations and directions for future research.

Towards Developing a Voice-activated Self-monitoring Application (VoiS) for Adults with Diabetes and Hypertension.

The integration of motivational strategies and self-management theory with mHealth tools is a promising approach to changing the behavior of patients with chronic disease. In this manuscript, we describe the development and current architecture of a prototype voice-activated self-monitoring application (VoiS) which is based on these theories. Unlike prior mHealth applications which require textual input, VoiS app relies on the more convenient and adaptable approach of asking users to verbally input markers of diabetes and hypertension control through a smart speaker. The VoiS app can provide real-time feedback based on these markers; thus, it has the potential to serve as a remote, regular, source of feedback to support behavior change. To enhance the usability and acceptability of the VoiS application, we will ask a diverse group of patients to use it in real-world settings and provide feedback on their experience. We will use this feedback to optimize tool performance, so that it can provide patients with an improved understanding of their chronic conditions. The VoiS app can also facilitate remote sharing of chronic disease control with healthcare providers, which can improve clinical efficacy and reduce the urgency and frequency of clinical care encounters. Because the VoiS app will be configured for use with multiple platforms, it will be more robust than existing systems with respect to user accessibility and acceptability.

Theory-based habit modeling for enhancing behavior prediction in behavior change support systems

Psychological theories of habit posit that when a strong habit is formed through behavioral repetition, it can trigger behavior automatically in the same environment. Given the reciprocal relationship between habit and behavior, changing lifestyle behaviors is largely a task of breaking old habits and creating new and healthy ones. Thus, representing users’ habit strengths can be very useful for behavior change support systems, for example, to predict behavior or to decide when an intervention reaches its intended effect. However, habit strength is not directly observable and existing self-report measures are taxing for users. In this paper, building on recent computational models of habit formation, we propose a method to enable intelligent systems to compute habit strength based on observable behavior. The hypothesized advantage of using computed habit strength for behavior prediction was tested using data from two intervention studies on dental behavior change (N = 36 and N = 75), where we instructed participants to brush their teeth twice a day for three weeks and monitored their behaviors using accelerometers. The results showed that for the task of predicting future brushing behavior, the theory-based model that computed habit strength achieved an accuracy of 68.6% (Study 1) and 76.1% (Study 2), which outperformed the model that relied on self-reported behavioral determinants but showed no advantage over models that relied on past behavior. We discuss the implications of our results for research on behavior change support systems and habit formation.

Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE.

BackgroundLong-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed.ObjectiveThis study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance.MethodsThis study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches.ResultsA total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief.ConclusionsCombining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance.Trial RegistrationClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988

Analyzing Dietary Behaviors Self-reported by People With Diabetes Using a Behavior Change Technique Taxonomy

ObjectiveWe aimed to explore both the dietary-related behavior change techniques (BCTs) adults with type 2 diabetes (T2D) described to enact themselves and the BCTs they perceived their dietitians to enact within consultations. DesignQualitative study involving semistructured telephone interviews with adults who consulted with a dietitian after their T2D diagnosis. Participants shared their experience of dietary behavior change and interactions with dietitians. SettingTelephone-based interviews from an Australian university setting. ParticipantsTwenty-one adults (12 females and 9 males) aged 36–75 years were self-selected and invited by email. Phenomenon of InterestDietary behavior changes reportedly enacted after a T2D diagnosis by participants and their dietitians. AnalysisTranscripts were analyzed through thematic content analysis according to the BCT taxonomy. ResultsParticipants described several BCTs such as problem-solving and self-monitoring (behavior), which helped their dietary behavior change. Participants perceived their dietitians to use BCTs, including goal setting (outcome), self-monitoring (behavior), and instruction on how to perform the behavior. These participants who had consulted with a dietitian reported additional techniques than those prescribed in the consultation process. Conclusions and ImplicationsAdults with T2D undertake a variety of BCTs to support dietary behavior change. Dietitians can draw on behavior change taxonomies to support behavior change in clients.