Support Behavior Change Research Articles

Further analysis of determinants of Pentavalent and Measles immunizations dropouts among children under five years of age in Ethiopia from Mini-EDHS 2019

BackgroundGlobally, immunization prevents an estimated 2–3 million deaths from illnesses that can be prevented by vaccination. The predictors of Pentavalent and Measles immunization dropout were not investigated sufficiently. Therefore, this analysis was meant to determine the coverage, burden, and predictors of Pentavalent and Measles immunizations in Ethiopia.Materials and methodsThis study was a further analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019, conducted with a nationally representative sample. In this study, immunization data was collected from a total sample of 3208 children of which 2004 (34.8%) children who received pentavalent 1 were considered for this study. Univariable, bi-variable, and multilevel mixed effect analysis was done using STATA version 17 Software. The mixed-effect model with the lowest AIC and BIC (information criteria) was chosen. A factor was designated as a significant predictor of immunization dropout if its p-value was less than 0.05 at 95% CI. The best-fitting model among the fitted models was ultimately chosen using the Akaike and Bayesian Information Criteria (AIC and BIC).ResultThe mean age of the head of the household was 37.6. The majority (68.9%) of the residents were from rural areas and of the total population, 64.9% have no formal education. Being residents of Afar increased the odds of dropping out by 3.28 (AOR = 3.28; 95% CI: 1.12, 9.56), whereas being residents of Addis Ababa reduced their odds of dropping out from prentavalent 3 by 68.1% (AOR = 0.319; 95% CI: 0.122, 0.833) compared to their Tigray counterparts. The dropout rate of Pentavalent 1 to measles 1 vaccination was 4.33 times higher among residents of Afar (AOR = 4.33; 95% CI: 1.38, 13.56). As the level of wealth increases, the quintile increases from poorer to richer compared to those in the poorest wealth quantile category, and marital status also affects the immunization dropout rate of their children.ConclusionsImmunization coverage of Ethiopian children was low and the dropout from pentavalent 1 and measles vaccination was high compared to the national and international targets to improve immunization coverage and reduce dropout. So different cost-effective interventions like Education provision for the community, decision-making facilitation, behavioral change support, and multi-system participation were required to increase vaccination coverage and reduce the vaccine dropout among children in Ethiopia.

Enhancing User Engagement and Behavior Change in Healthy Eating Apps: A Human-Computer Interaction Perspective

Healthy eating apps have gained popularity as tools for promoting dietary improvements and supporting behavior change. Despite their potential, maintaining user engagement and achieving sustained behavior change remain significant challenges. This paper investigates how principles of Human-Computer Interaction (HCI) can be leveraged to address these challenges and enhance the effectiveness of healthy eating apps. By conducting a comprehensive review of relevant HCI methodologies and analyzing the functionalities of existing apps, the paper identifies key factors that influence user interaction and behavioral outcomes. The research highlights that incorporating HCI principles-such as personalized feedback, gamification, and social interaction-can lead to more engaging and effective apps. Personalized feedback helps users feel more understood and supported, while gamification elements increase motivation through rewards and challenges. Social interaction features foster community support and accountability, contributing to sustained engagement. The paper concludes with practical recommendations for app developers to integrate these HCI principles and outlines future research directions to further explore and refine strategies for enhancing user engagement and behavior change in healthy eating apps.

Digital Interventions for Symptoms of Borderline Personality Disorder: Systematic Review and Meta-Analysis.

Borderline personality disorder (BPD) is a mental health condition with insufficient care availability worldwide. Digital mental health interventions could reduce this treatment gap. Persuasive system design (PSD) is a conceptual framework outlining elements of digital interventions that support behavior change. This systematic review aims to characterize digital interventions targeting BPD symptoms, assess treatment efficacy, and identify its association with intervention features, including PSD elements. A systematic review of automated digital interventions targeting symptoms of BPD was conducted. Eligible studies recruited participants aged ≥18 years, based on a diagnosis of BPD or one of its common comorbidities, or as healthy volunteers. OVID Embase, OVID MEDLINE, OVID PsycINFO, and the Cochrane Central Register for Controlled Trials were searched on July 19, 2022, and February 28, 2023. Intervention characteristics were tabulated. A meta-analysis of randomized controlled trials (RCTs) determined treatment effects separately for each core symptom of BPD using Hedges g. Associations between the treatment effect and intervention features, including PSD elements, were assessed by subgroup analysis (Cochran Q test). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the National Institutes of Health Quality Assessment Tool for pre-post studies. A total of 40 (0.47%) publications out of 8520 met the inclusion criteria of this review, representing 6611 participants. Studies comprised examinations of 38 unique interventions, of which 32 (84%) were RCTs. Synthesis found that included interventions had the following transdiagnostic treatment targets: severity of BPD symptoms (4/38, 11%), suicidal ideation (17/38, 45%), paranoia (5/38, 13%), nonsuicidal self-injury (5/38, 13%), emotion regulation (4/38, 11%), and anger (3/38, 8%). Common therapeutic approaches were based on dialectical behavioral therapy (8/38, 21%), cognitive behavioral therapy (6/38, 16%), or both (5/38, 13%). Meta-analysis found significant effects of digital intervention for both symptoms of paranoia (Hedges g=-0.52, 95% CI -0.86 to -0.18; P=.01) and suicidal ideation (Hedges g=-0.13, 95% CI -0.25 to -0.01; P=.03) but not overall BPD symptom severity (Hedges g=-0.17, 95% CI -0.42 to 0.10; P=.72). Subgroup analysis of suicidal ideation interventions found that evidence-based treatments such as cognitive behavioral therapy and dialectical behavior therapy were significantly more effective than alternative modalities (Cochran Q=4.87; P=.03). The degree of human support was not associated with the treatment effect. Interventions targeting suicidal ideation that used reminders, offered self-monitoring, and encouraged users to rehearse behaviors were associated with a greater reduction in ideation severity. Evidence suggests that digital interventions may reduce the symptoms of suicidal ideation and paranoia and that the design of digital interventions may impact the efficacy of treatments targeting suicidal ideation. These results support the use of transdiagnostic digital interventions for paranoia and suicidal ideation. PROSPERO CRD42022358270; https://tinyurl.com/3mz7uc7k.

Delivery of Supported Self-Management in Primary Care Asthma Reviews: Insights From the IMP2ART Programme.

Supported self-management (SSM) for asthma reduces the risk of asthma attacks and improves asthma control and quality of life. SSM optimally includes patient-centred communication and behaviour change support, however, the extent to which this occurs in routine primary care is unclear. This project was nested within the IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme; a UK-wide trial evaluating an implementation strategy (including healthcare professional (HCP) training on behaviour change strategies and patient-centred care) to improve support for asthma self-management. To provide an understanding of how healthcare professionals deliver SSM in UK clinical practice; through assessing time spent on SSM strategies, how and to what extent patient-centred care and behaviour change discussions are delivered, and to explore whether factors such as mode of review or implementation support influence delivery. We conducted an observational study using video-recordings of 12 HCPs delivering routine face-to-face and telephone asthma reviews (n = 64) in a sample of general practices participating in the IMP2ART trial (implementation n = 4; control n = 6). Analytical methods included: ALFA Toolkit Multi-Channel Video Observation (to code and quantify tasks undertaken); the Patient-Centred Observation Form; and The Behaviour Change Counselling Index (to assess patient-centeredness and behaviour change counselling used by HCPs). HCPs mostly spent time during routine asthma reviews discussing: an individual's asthma condition and management (average of 27.8% of consultation time); collaboratively reviewing and completing a personalised asthma action plan (6.3%) and training for practical self-management activities (5.4%). Areas of patient-centred care delivery and behavioural discussions included: creating and maintaining relationships, discussing asthma action plans and medication reconciliation. Professionals in IMP2ART implementation group practices delivered more SSM strategies. Comparison of face-to-face and remote consultations found no significant differences in HCP delivery of SSM. HCPs in UK primary care spent half the time in both face-to-face and remote asthma reviews delivering components of SSM suggesting that either mode of delivery may be acceptable. Reviews carried out in IMP2ART implementation group practices demonstrated more behaviour change and collaborative SSM strategies compared to those in the control group. Asthma UK Centre for Applied Research (AUKCAR) PPI members were involved throughout, including project conception, providing feedback on participant-facing documents, and discussing implications of study findings.

Intervention development and optimisation of a multi-component digital intervention for the monitoring and management of hypertensive pregnancy: the My Pregnancy Care Intervention

BackgroundHypertensive disorders of pregnancy affect around 10% of pregnancies and remain a major cause of maternal and foetal morbidity and mortality. Trials have shown that self-monitoring blood pressure during pregnancy is safe, but self-monitoring alone does not improve blood pressure control or pregnancy outcomes. This study aimed to develop and optimise a multicomponent intervention to support blood pressure monitoring, hypertension management and urine testing within current care pathways.MethodsRelevant literature, input from patient and public contributors (PPI) and stakeholder groups, and the researcher’s previous experience were used to develop an initial intervention. Think-aloud interviews and focus groups with women from diverse backgrounds with lived experience of hypertension in pregnancy and healthcare professionals provided feedback on the intervention prototype (n = 29). The MRC Framework for Developing Complex Interventions guided the processes to optimise the intervention’s acceptability and maximise engagement. A detailed tabulation of participants’ views and logic models was produced using the COM-B model of Behaviour Change.ResultsThe prototype intervention was acceptable and viable to both pregnant women with experience of hypertensive pregnancy and healthcare professionals. Emerging themes centred on how the intervention could be optimised within current National Health Service care pathways and the lives of pregnant women to support behaviour change. Key target behaviours to support the intervention included increasing understanding of blood pressure management, engagement with the intervention, monitoring blood pressure and urine and taking appropriate actions based on those readings. This informed the development of recommendations involving clear action timelines for women and evidence-based guidance to support decision-making by healthcare professionals. The findings were used to produce the multi-component My Pregnancy Care intervention, consisting of a smartphone application and an information leaflet to support blood pressure self-monitoring and proteinuria self-testing, self-management of antihypertensive medication and smartphone application use.ConclusionsThis research provided comprehensive insight into the needs of pregnant women with hypertension and their healthcare teams regarding self-monitoring and management of blood pressure. This supported the development of a tailored multi-component digital intervention that addresses barriers to blood pressure self-management by being user-friendly, persuasive and acceptable. It is hoped that the intervention will support the monitoring and management process, collaboration between healthcare professionals and women, clinical action and improved clinical outcomes.

Feasibility of a custom-tailored, evidence-based, theory-informed, intervention to prevent burnout and reduce stress for healthcare professionals: protocol for a single-arm trial

BackgroundHealthcare professionals face high levels of occupational stress, time pressure, workload, and poor organizational support. This makes them particularly vulnerable to burnout. The COVID-19 pandemic has further exacerbated this situation. This single-arm, multicenter, mixed-methods feasibility study pilots the LAGOM program: A tailored, evidence-based intervention to prevent burnout and reduce stress among healthcare professionals.MethodsParticipants will include healthcare professionals (N = 30) working at Charité–Universitätsmedizin Berlin and Immanuel Hospital, Berlin. LAGOM focuses on support for individual behavior change and personal resources and also addresses the organizational level. The intervention´s feasibility will be evaluated through a non-randomized feasibility trial with a mixed methods process evaluation. The exploratory primary study aims are to assess the acceptability and feasibility of the (1) evaluation procedures and of the (2) intervention content and structure using study records, standardized questionnaires, protocol checklists, and diaries. Exploratory effectiveness analysis will take place as well. Further, semi-structured interviews (n = 3 to 6) and electrophysiological measurements (n = 20) will be conducted.DiscussionCustom-tailored, well-implemented multi-level interventions are needed to prevent burnout and reduce stress among healthcare professionals. Long-term strategies are warranted to sustainably implement effective programs. This feasibility study helps to refine trial procedures and content of the LAGOM program for a randomized controlled trial to evaluate the intervention’s effectiveness.Trial registrationGerman Clinical Trials Register: DRKS00032014, registered 17th October 2023.

Persuasive software features as antecedents to perceived compliance within physical activity behavior change support systems

ABSTRACT Although behavior change support systems (BCSS) have the potential to improve compliance using persuasive software features, there is a dearth of empirical evidence on how these features impact perceived compliance. This study aimed to investigate how and to what extent the persuasiv systems design (PSD) principles in physical activity BCSS influence perceived compliance. Quantitative data from 403 participants (165 users and 238 prospective users of BCSS designed for PA) was analyzed using partial least squares structural equation modeling. Results revealed differences in how the PSD principles impact perceived compliance between users and prospective users. Perceptions of dialogue support, credibility support, and social support were more relevant to prospective users than to users. Thus, designers should pay more attention to these principles to attract and engage prospective users of BCSS. Conversely, primary task support was more relevant to users than to prospective users. This indicates that once prospective users transition to active users, the focus should shift towards providing persuasive features that facilitate the performance of the primary task. These findings underscore the importance of developing intelligent BCSS that can adapt to the evolving needs and preferences of users at different stages of their interactions with a system.

Development of a group-based behaviour change intervention for people with severe obesity informed by the social identity approach to health.

Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.

The Feasibility and Acceptability of a Clinical Pharmacist-delivered Intervention to Reduce Bothersome Health Symptoms from Polypharmacy and Alcohol Use and Communicate Risk among People with HIV: Pilot Study Protocol.

Among persons with HIV (PWH), unhealthy alcohol use and polypharmacy contribute to bothersome symptoms (e.g., fatigue, dizziness, memory loss). However, effective risk communication targeting these associations is challenging. The HIV and Alcohol Research center focused on Polypharmacy (HARP) is conducting a pilot study that will generate feasibility and acceptability data on a clinical pharmacist-delivered counseling intervention targeting the modification of unhealthy alcohol use and polypharmacy in PWH. Counseling is guided by the Information-Motivation-Behavioral Skills-Motivational Interviewing (IMB-MI) model. Herein, we describe the study protocol. This pilot uses a one-group pre-test/post-test design. We will recruit 50 participants from those who participated in the consented cohort of the Veterans Aging Cohort Study. Participants must be prescribed ≥ 5 long-term medications, have a self-reported Alcohol Use Disorders Identification Test score > 0, and be living with HIV. We will exclude those with moderate-severe alcohol use disorder as identified by an Alcohol Symptom Checklist score ≥ 4. Data are collected using three self-administered surveys (baseline, immediately after booster intervention, and 30-days post-intervention), two PEth blood tests (baseline, 30 days post-intervention), and medication data from the electronic health record (baseline). The intervention includes a 60-minute IMB-MI-based counseling session followed by a booster session 2 weeks later. Some participants will also be asked to participate in a qualitative interview to provide feedback on the intervention. The pilot investigates the impact of an intervention on alcohol consumption and the use of multiple medications among PWH, exploring how best to reduce bothersome symptoms, communicate risk, and support behavior change in this population.

Preventing type 2 diabetes in Portugal: a novel person-centered digital intervention

Abstract Introduction Diabetes, particularly type 2 diabetes (T2D), stands as one of the leading noncommunicable diseases worldwide. In Portugal, the prevalence of diabetes has surged, with T2D affecting 14% of adults in 2021. Its repercussions extend beyond individual health, deeply impacting familial, social, and community dynamics, presenting a significant public health challenge globally. Objectives The VA|PREVENTION project (https://doi.org/10.54499/2022.02969.PTDC) aims to assess the (cost-) effectiveness and implementation of an innovative person-centered digital intervention to prevent T2D among high-risk adults. Methodology A comprehensive approach encompasses the Behavior Change Wheel for intervention design, scalability principles, the WHO guidelines for digital health interventions, co-design, and the ISO framework for usability assessment. Evaluation will be pursued through a type 1 hybrid effectiveness-implementation study (randomized controlled trial), supplemented by qualitative and economic studies. Results The web application prototype features Ema, an automated virtual human coach (VHC), educational menus and a dashboard (version 1.0). Co-design included 2 workshops with 11 representatives of end-users and health professionals. Ema uses standardized techniques from an ontology to support behavior change, based on an initial assessment of low-level target behaviors (e.g. walking, fruit consumption, and reducing red meat intake), and barriers to performing these behaviors. Ema communicates in a helpful-cooperative style using a synthetic voice in European Portuguese, with its speech also appearing as subtitles on the interface. Users interact with Ema by pressing buttons or entering data, such as the daily number of steps. Ethics approval was granted for usability assessment with end-users. Conclusions The project is expected to yield health, scientific, technological, and policy impacts, powered by an exploitation and sustainability roadmap. Key messages • Innovative type 2 diabetes prevention through a scalable web app with a virtual human coach. • Comprehensive and robust approach for developing and evaluating the digital behavior change intervention.

Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial.

Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.

Mechanisms of impact of web-based support and self-monitoring to augment and maintain physical activity levels: a qualitative study exploring participants' interactions with the e-coachER, a web-based support programme for people attending exercise referral schemes.

e-coachER was a web-based intervention designed to support uptake and maintenance of physical activity for people attending exercise referral schemes (ERS) for weight loss, diabetes, hypertension, osteoarthritis or a history of depression/low mood. The aim of this study was to explore the mechanisms of impact of the e-coachER intervention, specifically how participants interacted with e-coachER and the key mediators of increased physical activity. This was a qualitative one-on-one interview study. Interviews were audio-recorded and transcribed and analysed using thematic analysis. UK primary care ERS. A purposive sample of adult patients randomised to the intervention arm of the e-coachER randomised controlled trial. Twenty-six participants (20 female), who had logged on to e-coachER at least once were recruited, resulting in a total of 38 interviews (mean duration 48 min). Four broad, inter-related themes were generated from the data (1) catalyst for change, (2) goals and aspirations, (3) support and (4) engagement with the e-coachER programme. Most participants who took part in e-coachER were already motivated to improve their health and perceived e-coachER as an additional source of motivation and accountability. Many felt that the opportunity to set goals and self-monitor supported participant's competence and autonomy by enabling them to progress at their own pace. Many participants reported on how e-coachER helped them to foster a sense of relatedness by encouraging them to seek support from others. Finally, e-coachER was regarded as being generally accessible and engaging. Despite this, some found it too simplistic, and others found it hard to maintain engagement over time. The e-coachER intervention seemed to be generally motivating in the early stages of initiating behaviour change, but engagement waned over time. Our findings highlight how important an online package might be in supporting behaviour change while also highlighting the challenges of achieving sustained physical activity changes. ISRCTN15644451.

Development, usability, and preliminary efficacy of a virtual reality experience to promote healthy lifestyle behaviors in children: pilot randomized controlled trial.

Virtual reality (VR) shows promise for supporting behavior change in children. This study used user-centered design to translate key tenets of behavioral health interventions into VR for children aged 6-12 years and their caregivers and examined the feasibility, acceptability, and preliminary efficacy of the VR experience in a pilot parallel, two-group randomized controlled trial (RCT). The VR experience incorporates psychoeducational content from evidence-based behavioral health interventions using voiceover and an interactive go-kart game related to the concepts of "food as fuel" and nutrition guidelines. Study 1 involved usability testing with n=5 child-caregiver dyads, which informed technical and content refinements to the experience. Study 2 involved children aged 6-12 years with body mass index (BMI) ≥85th percentile for age and sex who were comfortable speaking English and their caregivers with BMI ≥25 kg/m2. After participants completed baseline assessments in lab on eating-related behavioral cognitions and behaviors, participants were randomly assigned to the 10-minute VR experience or a control condition (i.e., nutrition education video and mobile phone food game), and were unblinded to condition. Child and caregivers completed assessments immediately post-intervention (eating-related behavioral cognitions) and at 2-week follow-up (behaviors, caregiver readiness to change). The objectives were to evaluate the feasibility, usability, and acceptability of the VR experience, and examine the preliminary efficacy of VR compared to the control condition on the primary outcomes of child behavioral cognitions and behaviors. Non-parametric tests examined differences in change scores across conditions as well as overall and within-group changes in outcomes. Twenty-seven child-caregiver dyads (14 in VR, 13 in control) were enrolled (child mean age =10.4 years; 14 girls). Caregivers reported good usability and excellent immersion in the virtual environment. Children reported significantly greater acceptability of VR compared to control (P=0.02). Child self-efficacy for healthy eating, self-efficacy for physical activity, attitudes toward healthy eating, and behavioral intentions for healthy eating increased from pre- to post-test in both conditions. From baseline to 2-week follow-up, all children reported greater weekly vegetable servings and more active days in the past week. Children in the VR condition had greater change in attitudes towards healthy eating from pre- to post-test compared to children in the control condition [effect size r=0.44, 95% confidence interval (CI): 0.03-0.72]. Readiness to help child change significantly increased for caregivers in the VR condition from pre- to 2-week follow-up, but did not change for caregivers in the control condition. No adverse events were reported. A VR program to promote healthy eating among children shows high feasibility and acceptability, and high potential for improving child and caregiver behavioral cognitions in this pilot RCT. Future work should examine the impact of repeated exposure to the experience over time, and examine long-term effects. ClinicalTrials.gov Identifier: NCT04845568.

Assessing Knowledge, Attitudes and Behaviours toward Salt and Sugar Consumption in the Central Division of Fiji

Objectives: This study aimed to assess salt and sugar-related knowledge, attitudes and behaviours (KAB) of adults in the Central Division of Fiji. Methods: A randomised stratified sample of 700 adults were selected. Questions on salt and sugar-related KABs were developed. The survey took place from March to June 2022. For analyses, population and sample weights were applied, and differences between predefined subgroups (sex, age, ethnicity and area) were compared using weighted chi-square tests. Results: 534 adults participated (response rate 76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognised that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, almost 40% reported adding salt or salty sauces when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) adding sugar to drinks daily. Conclusions: Despite having positive knowledge and attitudes, many people reported behaviours likely to contribute to excess salt and sugar intake, highlighting the need for interventions that support behaviour change and the creation of healthier food environments.

Impact of a Clinical Placement on Pre-Professional Health Students Perceived Knowledge, Skills, and Confidence in the Delivery of Behaviour Change and Physical Activity Support

Background: Clinical placements may provide an appropriate setting for health professional students to learn and apply skills for supporting clients to improve their physical activity. Methods: A mixed methods study was conducted with pre-professional health students completing clinical placement at one of two interprofessional community clinics. Surveys assessed student self-reported perceived skills, knowledge, and confidence for behaviour change and physical activity support pre- and post-placement (unmatched n=40). Interviews were conducted with students (n=18) and clinical educators (n=4). Change in student knowledge, skills, and confidence were assessed using non-parametric tests; qualitative data underwent inductive thematic analysis. Results: Post-placement, unmatched participants perceived knowledge and understanding (p = 0.017), skills (p = 0.001), and confidence (p = 0.004) in behaviour change significantly increased. Perceived confidence in providing physical activity behavior change support for low-risk (p = 0.022) and complex conditions (p = 0.009) significantly improved. Qualitative data emphasised the importance of clinical educators and direct clinical experiences in preparing students for future practice. Conclusion: Student-facilitated interprofessional clinical placements may be important for developing pre-professional knowledge, skills, and confidence in delivering behaviour change and physical activity support. Further exploration of clinical placement opportunities for strengthening pre-professional health students training in physical activity promotion and behaviour change is recommended.

Social networks as facilitators and barriers to behavior change among U.S. South Asian adult participants of a culturally adapted, group lifestyle intervention

ObjectivesThis qualitative study aimed to characterize how social networks influence cardiovascular health behaviors among U.S. South Asian adults in a culturally adapted, group lifestyle intervention. MethodsA purposive sample of participants (n = 24) from the South Asian Healthy Lifestyle Intervention (SAHELI) randomized trial’s intervention arm participated in semi-structured process evaluation interviews. Specific open-ended questions were used to probe participants’ behavior changes, personal social networks, and social support for behavior change. The team transcribed interviews and identified themes using inductive and deductive coding, based on a theoretical model of social influence. ResultsAmong 24 participants (67 % female, mean age 50.5 years, 88 % foreign-born, 50 % with limited English proficiency), three themes emerged: 1) SAHELI participants and their family members provided bidirectional social support for behavior change; 2) intervention participants provided social support to one another; and 3) participants faced resistance to change from some community members. ConclusionsBehavior changes initiated during SAHELI diffused to participants’ close family members. Several social network influences varied by participant gender, English language proficiency, and network member type. Practice ImplicationsHealth professionals should ask patients about how their social networks facilitate or hinder behavior changes. Gender and cultural factors may modify how social networks influence behavior change.

Evaluating the feasibility and utility of telephonic motivational interviewing in older adults

Older adults face unique barriers and challenges related to physical activity (PA) participation. Motivational interviewing (MI) is a commonly used health coaching strategy to support behavior change that holds potential for older adults. Previous research on MI strategies has focused primarily on face-to-face delivery, limiting insights regarding virtual programs. ObjectivesThe purpose of this study was to determine if MI could be delivered telephonically with high fidelity and high acceptability in older adult participants. The study is designed to inform future trials evaluating its effectiveness in supporting virtual PA programs. MethodsThis study evaluated the feasibility and acceptability of telephonic MI among older adults that enrolled in an online version of the Walk with Ease program. ResultsOf 39 participants referred, 29 enrolled and 27 provided feedback. Participants were highly accepting and adherent, with 74 % of patients attending at least five of six sessions, and 96 % of participants indicating satisfaction with the MI provided. Coaches improved program enjoyment by helping set effective goals and providing ongoing accountability. ConclusionsEvaluations documented adequate fidelity and high acceptability of telephonic delivery, and motivation results revealed large, significant increases in autonomous regulation (quality of motivation). InnovationTelephonic MI using non-healthcare professional coaches is feasibly delivered with high fidelity, and is acceptable to older adult participants. The innovative delivery format offers novel opportunities supporting virtual and telehealth interventions to reduce chronic disease risk among older adults.

Interwoven Lives: The Impact of Social Support and Behavioral Changes on Health Behaviors among the Chinese Residents

Objectives: It is found that there is a growing level of mortality among people with diabetic diseases. However, factors like social support and positive behavior change tend to play a substantial role in dealing with such mental worries. Methods: Based upon the given thoughts, this research examines the impact of social support and behavioral changes on health behavior in the form of diabetic health worries. For this purpose, the study will collect the sample using the survey questionnaire technique. A sample of 357 respondents has empirically been analyzed by applying advanced statistical techniques, such as testing for the reliability and validity of the latent constructs and relative items, discriminant validity, and structural equation modeling techniques. Results: The study findings confirm that the latent constructs are significantly represented by the latent items of social support, behavioral changes, and health behaviors, respectively. Moreover, the findings through structural equation modeling reveal a significant and productive impact of social support and behavioral changes in improving the health behaviors like low mental worries of and diabetes. Conclusion: The study provides some meaningful policy implications in determining how the role of social support and behavioral changes would be reflected in the form of low diabetic health worries. Besides, a few limitations have also been expressed.

MHealth learning strategies to support behaviour change in individuals using wheelchairs and/or scooters: a systematic review.

The purpose of this systematic review of the literature is to build understanding of the key elements and recommendations for the design of mHealth technology for individuals using wheelchairs and/or scooters and identify key features associated with the use of mHealth to support healthy behaviour changes for this population. Eight major electronic databases were systematically searched to identify mobile health (mHealth) interventions, which targeted adult WC/S users. Independent reviewers used Endnote and Covidence to manage articles meeting review criteria and to exclude duplicates. A quality assessment was conducted on each included article. Nine articles describing studies with diverse study designs met criteria to be included in this review. Several interactive application intervention features, such as participant collaboration and goal setting, and key technical features to support mHealth app development and utilisation were identified. Results found intuitive and simple designs of mHealth apps, with the ability to customise to support learning styles and preferences, support usability and acceptability by participants. More research is needed to evaluate best practices to support initial training of end-users, mHealth apps' ability to support long-term behaviour change and maintenance, and the understanding of active ingredients in complex interventions that include mHealth apps. Both interactive mHealth application intervention and technical features support healthy behaviour change among individuals using wheelchairs and scooters.

A Qualitative Exploration of the Impact, Management, and Existing Psychological Support Available for Adults Living with Skin Conditions.

Skin conditions carry a significant physical, psychological, and social burden. People with skin conditions often engage in health-threatening behaviours that can worsen symptoms and increase cardiovascular disease risk. However, access to dedicated psychological and behaviour-change support is limited. The impact, management, and existing psychological support available to adults living with skin conditions was qualitatively explored to inform the development of a psychologically supportive digital intervention. Qualitative research involving a hybrid inductive- deductive approach was performed. Data collection and analysis were theoretically informed by the Common-Sense Model of Self-Regulation. Eight synchronous online group interviews with 43 English-speaking adults (≥ 18 years) with a range of skin conditions were conducted. Data were analysed using Reflexive Thematic Analysis. Three superordinate themes are outlined: (i) visibility underpinning life course impairment, (ii) seeking control amid uncertainty, and (iii) existing support for people with skin conditions. Skin conditions carry a substantial psychological burden, yet dermatology service provision is sub-optimal and patients often resort to seeking support from unreliable sources. Psychological support can have benefits, but barriers exist. This study reinforces the need for high-quality psychological support, and that patients wanted digital means to support effective self- management.