Support Behavior Change Research Articles

Can Personalization Persuade? Study of Notification Adaptation in Mobile Behavior Change Intervention Application.

The growing ubiquity of smartphones and the ease of creating and distributing applications render the mobile platform an attractive means for facilitating positive behavior change at scale. Within the smartphone as a behavior change support system, mobile notifications play a critical role as they enable timely and relevant information distribution. In this paper we describe our preliminary investigation of the persuasiveness of mobile notifications delivered within a real-world behavior change intervention mobile app, which enabled users to set goals and define tasks related to those goals. The application aimed to motivate the users with notifications belonging to one of two groups—tailored and non-tailored, seeing them as sparks in the Fogg Behavior Model and personalizing them according to the users’ Big Five personality traits. Results indicate that customized messages may work for some individuals while working poorly for others. When analyzing users as a single group, no significant differences were observed, but when proceeding with the analysis on the individual level we found seven users whose personality traits notifications interact with in interesting ways. Our results offer two general insights: (1) Using personality-tailored messaging in a dynamic mobile domain as opposed to a static domain leads to different outcomes, and it seems that there is no one-to-one mapping between domains; (2) A major reason for most of our hypotheses being false may be that messages that are deemed as persuasive on their own are not what persuades people to perform an action. Unlike the clear-cut findings observed in other domains, we discover a rather nuanced relationship between the personalization and persuasiveness that calls for further exploration at the individual participant level.

Care home practitioners' perceptions of the barriers and facilitators for using off-the-shelf gaming technology with people with dementia.

Background: Off-the-shelf digital gaming technology has been shown to support the well-being of people with dementia. Yet, to date, it is rarely adopted within dementia care practice, particularly within care homes. Drawing on a descriptive, qualitative approach, this is the first study that has sought to explore care home practitioners’ perceptions of the barriers and facilitators for using gaming technology within their workplace. Method: Data were collected across eight focus groups in the south of England with a total of 39 care home workers. These were analysed inductively following the 6-stage thematic process as outlined by Braun and Clarke (2006). Findings: Three themes, constructed from the data suggested, the care environment, staff knowledge and skills for inclusive gaming, and staff perceptions about capabilities (their own and those of people with dementia) inhibited or facilitated the use of gaming technology in care homes. The findings were interpreted through a combination of the Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to provide theory-based insights into the mechanisms for supporting behaviour change and implementation within the care home context. Conclusions: We argue for the need to target wider institutional barriers alongside providing inclusive training for care staff on incorporating gaming technology within their person-centred care approaches. Through these mechanisms, they can be provided with the capabilities, opportunities and motivation to integrate gaming technology within their practice, and thus facilitate the process of culture change within care homes.

Tailoring mHealth Apps on Users to Support Behavior Change Interventions: Conceptual and Computational Considerations

Personalization is an important factor to increase the user experience (UX) and effectiveness of mHealth solutions. In this paper, we present an innovative approach to the personalization of mHealth apps. A profiling function has been developed based on the physical and psychological characteristics of users, with the final aim to cluster them acting as a guideline to the design and implementation of new functionalities to improve the overall acceptance degree of the app. A preliminary analysis case study has been proposed to evaluate the impact on user experience according to the state of the art to draw useful lessons for future works.

Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women (Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI)

IntroductionSouth Africa’s evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds...

Does State Tightness-Looseness Predict Behavior and Attitudes Early in the COVID-19 Pandemic in the USA?

We investigated how tightness-looseness, reflecting strictness of social norms, of state of residence in the USA predicts behaviors and attitudes related to COVID-19. Because individual-level tightness may better capture current attitudes during the pandemic, whereas state-level archival measures reflect historical factors, we assessed the extent to which tightness-looseness at both levels predicted adherence to public health guidelines and biases toward outgroups related to COVID-19. In Spring 2020, 544 mTurk participants, primarily from the 13 tightest and 13 loosest states, completed survey questions about health behaviors in response to COVID-19, endorsement of future policy changes, feeling of responsibility for lives, and attitudes toward groups marginalized during the pandemic (i.e., Asians, older adults). State-level results indicated some associations with attitudes toward Asians and older adults, but effects were not robust. Results based on individuals’ ratings of the tightness of their state indicated that higher levels of perceived tightness were associated with higher levels of protective self-reported public health behaviors (e.g., mask wearing, handwashing) during COVID-19, more endorsement of future policy changes to contain the pandemic, higher reported feelings of responsibility for one’s life, and stronger negative attitudes toward Asians. The relations between tightness and health outcomes persisted after controlling for political attitudes and demographics. Thus, individual, more than state, tightness-looseness accounted for some degree of public health behaviors (unique contribution of individual tightness: R2 = .034) and attitudes toward marginalized groups ( R2 = .020) early during the COVID-19 pandemic. The implications of these findings for interventions to support behavior change or combat anti-Asian bias are discussed.

Continuous Glucose Monitoring Plus an Online Peer Support Community Reinforces Healthy Behaviors in Hispanic Adults With Type 2 Diabetes.

Previous research has suggested beneficial glycemic outcomes for people with type 2 diabetes with the use of continuous glucose monitoring (CGM); yet, there is a dearth of data examining CGM in diverse populations. Additionally, the use of online peer support communities (OPSCs) can further support the application of CGM information to improve health behaviors. The purpose of this qualitative study was to assess participant experiences with a CGM+OPSC intervention. Semi-structured interviews were conducted after a 12-week combined CGM+OPSC intervention with Hispanic, Spanish-speaking people with type 2 diabetes not using insulin. The OPSC was managed by five trained bilingual peer facilitators. Interviews were conducted in Spanish. Audio recordings were translated and transcribed and then reviewed by the interviewer for accuracy. Emergent themes were identified through inductive thematic analysis. Twenty-six participants completed interviews. Three main themes emerged from the data: 1) CGM supports participants' understanding of the relationship between glucose levels and health behaviors such as healthy eating, being active, taking medication, stress reduction, and improving sleep; 2) the OPSC reinforced how to make healthy choices through personal experiments, collective learning, and social support; and 3) CGM+OPSC supports behavior change and increases confidence. When combined, CGM+OPSC interventions appear to create a positive feedback loop to reinforce and optimize healthy behaviors for diabetes self-management in individuals with type 2 diabetes who are not on insulin. The provision of such an intervention tailored to Hispanic, Spanish-speaking individuals has the potential to address the health care disparity seen in this population.

AMSOS: AMSTERDAM OSTEOARTHRITIS SELFMANAGEMENT STUDY - PROTOCOL FOR A DEVELOPMENT AND FEASIBILITY STUDY

Purpose: Osteoarthritis (OA) of the hip and knee can cause large limitations in daily functioning. Even though there is no cure yet, lifestyle changes can prevent aggravation, in which self-management plays an important role. In the treatment of patients, physiotherapists, exercise therapists and dieticians stimulate self-management. Online applications have shown to be promising in improving self-management of OA. However, for many professionals the needs of patients with OA regarding self-management remain unclear, but also how these applications can be applied and how effective feedback can be provided to support behavior change. In this study we aim to develop a methodology that supports physiotherapists, exercise therapists and dieticians in the promotion of self-management in OA patients by using an online application. The study will determine whether the developed methodology is feasible in clinical practice and in metropolitan context, namely in Amsterdam, with its associated urban problems and challenges. When feasible, a Randomized Controlled Trial will be performed to determine the effectiveness of the developed methodology. The outcomes of this study are: 1.To develop a user friendly methodology that guides physiotherapists and dieticians in implementing online applications in the treatment of patients with OA, in order to promote self-management; 2.To test whether the developed methodology is feasible in clinical practice and enables professionals in increasing the self-management to support behavior change of patients with OA.

Functional Mechanisms of Health Behavior Change Techniques: A Conceptual Review.

BackgroundHealth behavior change is among the top recommendations for improving health of patients with lifestyle-related chronic diseases. An array of behavior change techniques (BCTs) have been developed to support behavior change initiation and maintenance. These BCTs often show limited success when they are not informed by theory, leading to a mismatch between the intention of the BCT and patients’ needs or expectations. Previous studies have identified a number of resources (domains) which patients may require to initiate and maintain health behavior change. Indeed, not yet well established is how BCTs address these resources, i.e., the functional mechanisms of BCTs.PurposeProvide a theoretical framework of the functional mechanisms of BCTs for developing and implementing successful interventions for health behavior change.MethodsConceptual review, including literature analysis and synthesis as well as conceptualization of a new model based on the synthesis.ResultsThrough the integration of dual-process models as well as reward and motivation proceeding, i.e., affective, emotional, or intuitive neurobiological cues, into the rational framework of rather linear cognitive or task-related decision progress, we categorize previously identified resources into three distinct sets: external, internal reflective, and internal affective resources. Based on this triad, we classify BCTs according to their functional mechanisms into facilitating (=providing external resources), boosting (=strengthening internal reflective resources), and nudging (=activating internal affective resources). Consequently, we present a simplified Behavior Change Resource Model (BCRM) that is centered on patients’ resources.ConclusionThe model can be applied to develop health behavior change interventions, which promote engagement and empowerment. Future studies should aim at testing the applicability and practicality of the BCRM.

Integrating Behavioral Science and Design Thinking to Develop Mobile Health Interventions: Systematic Scoping Review

BackgroundMobile health (mHealth) interventions are increasingly being designed to facilitate health-related behavior change. Integrating insights from behavioral science and design science can help support the development of more effective mHealth interventions. Behavioral Design (BD) and Design Thinking (DT) have emerged as best practice approaches in their respective fields. Until now, little work has been done to examine how BD and DT can be integrated throughout the mHealth design process.ObjectiveThe aim of this scoping review was to map the evidence on how insights from BD and DT can be integrated to guide the design of mHealth interventions. The following questions were addressed: (1) what are the main characteristics of studies that integrate BD and DT during the mHealth design process? (2) what theories, models, and frameworks do design teams use during the mHealth design process? (3) what methods do design teams use to integrate BD and DT during the mHealth design process? and (4) what are key design challenges, implementation considerations, and future directions for integrating BD and DT during mHealth design?MethodsThis review followed the Joanna Briggs Institute reviewer manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Studies were identified from MEDLINE, PsycINFO, Embase, CINAHL, and JMIR by using search terms related to mHealth, BD, and DT. Included studies had to clearly describe their mHealth design process and how behavior change theories, models, frameworks, or techniques were incorporated. Two independent reviewers screened the studies for inclusion and completed the data extraction. A descriptive analysis was conducted.ResultsA total of 75 papers met the inclusion criteria. All studies were published between 2012 and 2021. Studies integrated BD and DT in notable ways, which can be referred to as “Behavioral Design Thinking.” Five steps were followed in Behavioral Design Thinking: (1) empathize with users and their behavior change needs, (2) define user and behavior change requirements, (3) ideate user-centered features and behavior change content, (4) prototype a user-centered solution that supports behavior change, and (5) test the solution against users’ needs and for its behavior change potential. The key challenges experienced during mHealth design included meaningfully engaging patient and public partners in the design process, translating evidence-based behavior change techniques into actual mHealth features, and planning for how to integrate the mHealth intervention into existing clinical systems.ConclusionsBest practices from BD and DT can be integrated throughout the mHealth design process to ensure that mHealth interventions are purposefully developed to effectively engage users. Although this scoping review clarified how insights from BD and DT can be integrated during mHealth design, future research is needed to identify the most effective design approaches.

Knowledge of liver fibrosis stage among adults with NAFLD/NASH improves adherence to lifestyle changes.

Background & AimsThough lifestyle interventions can reverse disease progression in people with non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis (NAFLD/NASH), unawareness about disease severity might compromise behavioural changes. Data from this first international cross‐sectional survey of individuals with NAFLD/NASH were used to identify correlates of both unawareness about fibrosis stage and its association with adherence to lifestyle adjustments.MethodsAdults with NAFLD/NASH registered on the platform Carenity were invited to participate in an online 20‐min, six‐section survey in Canada, France, Germany, Italy, Spain and the United Kingdom to describe their experience with NAFLD/NASH and its care (N = 1411). Weighted binary and multinomial logistic regressions were performed to estimate the effect of explanatory variables on unawareness of fibrosis stage and poor adherence to lifestyle changes respectively.ResultsIn the study group, 15.5% had obesity and 59.2% did not know their fibrosis stage. After multiple adjustments, individuals with a body mass index (BMI) ≥35 were over twice as likely to not know their fibrosis stage. People with a BMI >30 had a threefold higher risk of having poor adherence to lifestyle changes. Unawareness about fibrosis stage was also significantly associated with poor adherence to lifestyle adjustments.ConclusionsAs fibrosis stage is becoming the main predictor of NAFLD progression, improving patient–provider communication—especially for people with obesity—about liver fibrosis stage, its associated risks and how to mitigate them, is needed. Training for healthcare professionals and promoting patient educational programmes to support behaviour changes should also be included in the liver health agenda.

A feasibility study of teaching motivational interviewing in a fully online environment using a virtual client

ABSTRACT Supporting behaviour change is important in health promotion and disease prevention. Motivational Interviewing (MI) is a core behaviour change counselling skill for health professionals to support people to make and maintain behaviour changes. MI is taught across many university courses and as continuing professional development. There is a need to provide repeatable MI training for health professionals and students that is accessible, affordable, and standardised and allows practise opportunities. This study tested the feasibility of asynchronous online MI training and using a virtual client interaction for practising MI skills. Postgraduate students (n = 22) from university health courses participated in the study. Participants completed questionnaires and interacted with a virtual client prior to and post-online training. Outcomes included MI skills (analysed using the Motivational Interviewing Treatment Integrity (MITI) code, version 4.2.1), attitudes towards behaviour change counselling, and acceptability of the online course. System usability of the virtual client interaction was evaluated using the System Usability Scale. There was a statistically significant improvement in both Relational and Technical MITI Scores, and in attitudes towards behaviour change counselling, from Pre-Course to Post-Course. Participants viewed the online course positively. System usability scored in the 90–95 percentile range. Results support the feasibility of providing MI training online and using virtual clients to facilitate the process. Further research is needed on the transferability of MI skills learned online to real world settings.

Designing Digital Health Technology to Support Patients Before and After Bariatric Surgery: Qualitative Study Exploring Patient Desires, Suggestions, and Reflections to Support Lifestyle Behavior Change.

BackgroundA patient’s capability, motivation, and opportunity to change their lifestyle are determinants of successful outcomes following bariatric surgery. Lifestyle changes before and after surgery, including improved dietary intake and physical activity levels, have been associated with greater postsurgical weight loss and improved long-term health. Integrating patient-centered digital technologies within the bariatric surgical pathway could form part of an innovative strategy to promote and sustain healthier behaviors, and provide holistic patient support, to improve surgical success. Previous research focused on implementing digital technologies and measuring effectiveness in surgical cohorts. However, there is limited work concerning the desires, suggestions, and reflections of patients undergoing bariatric surgery. This qualitative investigation explores patients’ perspectives on technology features that would support behavior changes during the pre- and postoperative periods, to potentially maintain long-term healthy lifestyles following surgery.ObjectiveThis study aims to understand how digital technologies can be used to support patient care during the perioperative journey to improve weight loss outcomes and surgical success, focusing on what patients want from digital technologies, how they want to use them, and when they would be of most benefit during their surgical journey.MethodsPatients attending bariatric surgery clinics in one hospital in the North of England were invited to participate. Semistructured interviews were conducted with purposively sampled pre- and postoperative patients to discuss lifestyle changes and the use of digital technologies to complement their care. The interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data. Ethical approval was obtained from the National Health Service Health Research Authority.ResultsA total of 20 patients were interviewed (preoperative phase: 40% (8/20); postoperative phase: 60% (12/20). A total of 4 overarching themes were developed and related to the optimization of technology functionality. These centered on providing tailored content and support; facilitating self-monitoring and goal setting; delivering information in an accessible, trusted, and usable manner; and meeting patient information-seeking and engagement needs during the surgical pathway. Functionalities that delivered personalized feedback and postoperative follow-up were considered beneficial. Individualized goal setting functionality could support a generation of digitally engaged patients with bariatric conditions as working toward achievable targets was deemed an effective strategy for motivating behavior change. The creation of digital package of care checklists between patients and clinicians was a novel finding from this study.ConclusionsPerceptions of patients undergoing bariatric surgery validated the integration of digital technologies within the surgical pathway, offering enhanced connectedness and support. Recommendations are made relating to the design, content, and functionality of digital interventions to best address the needs of this cohort. These findings have the potential to influence the co-design and integration of person-centered, perioperative technologies.

An Approach to a Novel Device Agnostic Model Illustrating the Relative Change in Physical Behavior Over Time to Support Behavioral Change

Today, there is a lack of useful visual presentations of data showing progress over long time periods for users of physical activity self-monitoring devices. The aim of this paper was to present a novel theoretical model that describes the relative change in physical behavior over time and to provide examples of model application with previously collected data. Physical behavior, which includes both sedentary behavior and physical activity, was categorized into four dimensions and further processed and adjusted to fit the novel model. The model was visualized both theoretically and by using example data for two out of 20 participants, illustrating the relative change compared to baseline and trendlines for all dimensions. This approach to a novel device agnostic model can visualize the data over time and is intended to be used on an individual basis by users that need support for physical behavioral change. The model, which is based on earlier research, has flexibility and was developed to be used as a complement for data processing, to future and currently available self-monitoring devices within this arena. In the future, the novel model should be studied to see if it is valid, tested with larger samples over longer study periods, and tested for use with other self-monitoring devices to ensure its usefulness and trustworthiness.

Evaluation of Digital Interventions for Physical Activity Promotion: Protocol for a Scoping Review.

BackgroundDigital interventions (DIs) could support physical activity (PA) promotion, according to recent reviews. However, it remains unclear if and how DIs for PA promotion are evaluated; thus, it is unclear if they support behavior change in real-world settings. A mapping of evidence from published reviews is required to focus on the evaluation of DIs for PA promotion.ObjectiveThe aim of our study is to investigate evaluation strategies for any outcome in the context of DIs for PA promotion by conducting a scoping review of published reviews.MethodsOur scoping review adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The information sources include bibliographic databases (MEDLINE, PsycINFO, and CINAHL) and the bibliographies of the selected studies. The electronic search strategy was developed and conducted in collaboration with an experienced database specialist. The electronic search was conducted in English with no limits up to March 19, 2021, for sources with the terms digital intervention AND evaluation AND physical activity in titles or abstracts. After deduplication, 300 reviews selected from 4912 search results were assessed for eligibility by 2 authors working independently. The inclusion criteria were (1) healthy or clinical samples (population), (2) DIs for PA promotion (intervention), (3) comparisons to any other intervention or no intervention (comparison), (4) evaluation strategies (methods, results, or frameworks) for any outcome in the context of DIs for PA promotion (outcome), and (5) any published review (study type). According to the consensus reached during a discussion, 40 reviews met the inclusion criteria—36 from the electronic search and 4 from the manual search of the bibliographies of the 36 reviews. All reviews reported the evaluation strategies for any outcomes in the context of DIs for PA promotion in healthy or clinical samples. Data coding and the quality appraisal of systematic reviews are currently being performed independently by 2 authors.ResultsOur scoping review includes data from 40 published reviews (1 rapid review, 9 scoping reviews, and 30 systematic reviews). The focus of data coding is on evaluation strategies in the context of DIs for PA promotion and on the critical appraisal of the included systematic reviews. The final consensus regarding all data is expected in early 2022.ConclusionsInterventions for PA promotion that are supported by digital technologies require evaluation to ensure their efficacy in real-world settings. Our scoping review is needed because it addresses novel objectives that focus on such evaluations and are not answered in the published reviews identified in our search. The evaluation strategies addressing DIs for PA promotion will be mapped to synthesize the results that have been reported in published reviews so far.International Registered Report Identifier (IRRID)DERR1-10.2196/35332

Supporting Behavior Change in Sedentary Adults via Real-time Multidimensional Physical Activity Feedback: Mixed Methods Randomized Controlled Trial.

BackgroundIncreasing physical activity (PA) behavior remains a public health priority, and wearable technology is increasingly being used to support behavior change efforts. Using wearables to capture and provide comprehensive, visually persuasive, multidimensional feedback with real-time support may be a promising way of increasing PA in inactive individuals.ObjectiveThis study aims to explore whether a 6-week self-monitoring intervention using composite web-based multidimensional PA feedback with real-time daily feedback supports increased PA in adults.MethodsA 6-week, mixed methods, 2-armed exploratory randomized controlled trial with 6-week follow-up was used, whereby low to moderately active (PA level [PAL] <2.0) adults (mean age 51.3 years, SD 8.4 years; women 28/51, 55%) were randomly assigned to receive the self-monitoring intervention (36/51, 71%) or waiting list control (15/51, 29%). Assessment of PA across multiple health-harnessing PA dimensions (eg, PAL, weekly moderate to vigorous intensity PA, sedentary time, and steps), psychosocial cognitions (eg, behavioral regulation, barrier self-efficacy, and habit strength), and health were made at the prerandomization baseline at 6 and 12 weeks. An exploratory analysis of the mean difference and CIs was conducted using the analysis of covariance model. After the 12-week assessment, intervention participants were interviewed to explore their views on the program.ResultsThere were no notable differences in any PA outcome immediately after the intervention; however, at 12 weeks, moderate-to-large effects were observed with a mean difference in PAL of 0.09 (95% CI 0.02-0.15; effect size [Hedges g] 0.8), daily moderate-intensity PA of 24 (95% CI 0-45; Hedges g=0.6) minutes, weekly moderate-to-vigorous intensity PA of 195 (95% CI 58-331; Hedges g=0.8) minutes, and steps of 1545 (95% CI 581-2553; Hedges g=0.7). Descriptive analyses suggested that the differences in PA at 12 weeks were more pronounced in women and participants with lower baseline PA levels. Immediately after the intervention, there were favorable differences in autonomous motivation, controlled motivation, perceived competence for PA, and barrier self-efficacy, with the latter sustained at follow-up. Qualitative data implied that the intervention was highly informative for participants and that the real-time feedback element was particularly useful in providing tangible, day-to-day behavioral support.ConclusionsUsing wearable trackers to capture and present sophisticated multidimensional PA feedback combined with discrete real-time support may be a useful way of facilitating changes in behavior. Further investigation into the ways of optimizing the use of wearables in inactive participants and testing the efficacy of this approach via a robust study design is warranted.Trial RegistrationClinicalTrials.gov NCT02432924; https://clinicaltrials.gov/ct2/show/NCT02432924

Autonomy support in a couples weight loss trial: Helping yourself while helping others.

Self-determination theory proposes that autonomy-supportive environments produce better health outcomes, and evidence demonstrating the importance of autonomy support for health behavior change has become increasingly clear. The bulk of the previous research has focused on the effects of receiving autonomy support, whereas the present study focuses on the potential impact of providing autonomy support for improving the weight loss and relationship satisfaction of the support provider. Sixty-four couples were randomized to a standard weight loss intervention or to an intervention that included training to enhance autonomy support behavior (e.g., empathic responding, accepting personal choices, etc.). Groups met weekly for 6 months, with assessments at baseline, 3, 6, and 12 months. The assessment of provided autonomy support was based on ratings of videotaped interactions of the couple discussing weight loss issues and on partner report of the autonomy support they received. The results did not show any condition effects; however, the results for both conditions indicated that beyond receiving autonomy support, providing autonomy support was associated with greater sustained weight loss for the support provider, and for men greater relationship satisfaction over time. The results confirm the importance of couples-based interventions and autonomy support for behavior change. In addition, it appears that providing autonomy support is useful for both the recipient and the provider. These results point to the need for developing targeted interventions to facilitate the provision of autonomy support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improving treatment for people with cognitive impairment and substance misuse issues: Lessons from an inclusive residential treatment program pilot in Australia

BackgroundApproximately half of the substance dependence treatment population is estimated to have a cognitive impairment, which reduces participation, retention, and post-treatment outcomes. Cognitive behaviour change approaches are less effective for this population and cognitive remediation strategies have been found to improve outcomes. Evidence on modified programs to remove environmental barriers for treatment seekers with disability does not exist. ObjectiveA modified residential substance misuse treatment program in New South Wales, Australia, was piloted and evaluated to address this knowledge gap. MethodOf 67 residents who received treatment during the evaluation period, 33 were screened as having cognitive impairment. Twelve residents took part in an interview and 10 staff in a focus group to understand their views of the pilot program. Resident characteristics and retention rates and themes about program benefits and challenges are reported. ResultsTreatment completion was up to five times higher for residents with cognitive impairment after the new program was implemented. The pilot program provided simplified written and visual materials and concrete examples and introduced a daily virtues program to embed new learning and support behaviour change. Resources to allow staff to engage more intensively with residents and provision of ongoing staff training were viewed as essential for program success. ConclusionsEnvironmental adaptations, including a combination of conventional treatment modalities with accessible design and person-centred principles, removed barriers to treatment for residents with cognitive impairment. Creating a climate where respect, tolerance and peer support were normalised was likely to have been particularly beneficial for these residents.

Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme

BackgroundPsoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.ObjectivesTo (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.DesignMixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.SettingPrimary care, secondary care and online surveys.ParticipantsPeople with psoriasis and health-care professionals who manage patients with psoriasis.ResultsPrevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.LimitationsThe duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.ConclusionsRecognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.Future workPatient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.

Abstract P048: Feasibility Of A Remotely Delivered Mobile Health Exercise Intervention For Cardiometabolic Health: A Pilot Trial

Introduction: Lifestyle interventions incorporating exercise and nutrition can help prevent and manage cardiometabolic disease. However, not all interventions readily reach individuals who are most in need. A mobile health (mHealth) exercise program could be a cost-effective approach to broadening accessibility and providing support for physical activity behavior change. We tested the feasibility and acceptability of a mHealth exercise intervention in this 8-week pilot study. Hypothesis: A remotely delivered mHealth lifestyle program involving a wearable sensor, mobile application and social support is feasible and acceptable in sedentary adults. Methods: A total of 84 sedentary (&lt; 30 min/week of exercise) adults (females 31.5 ± 11.3 yr, males 34.1 ± 28.9 yr, mean ± SD) were randomized (1:1:1) to 8 weeks of increasing physical activity behavioral support: Level 1 (wellness education, n=26), Level 2 (wellness education + pre-recorded exercise videos, n=30), or Level 3 (wellness education + livestream group exercise, n=28). Participants used a chest strap sensor (Myzone MZ-3) during exercise and a mobile application for interaction. A weekly email was used to deliver wellness education and encourage physical activity. Level 2 exercise videos and Level 3 livestream (Zoom) group classes were 35 min long, instructor-led, delivered 3x/wk and designed to meet national guidelines for weekly physical activity. Participants were surveyed at baseline and 8 weeks. Feasibility was defined through accrual and attrition; acceptability through sensor use (3x/wk encouraged) and survey data. Results: Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Preliminary analysis indicated 65% retention at 8-week follow-up. Participants were primarily Hispanic/Latinx (47%), 71% had 2-year college or more education, 45% reported income below federal poverty thresholds, and 36% reported qualifying for public assistance. Program acceptability varied by group with weekly median sensor use of 1 day/wk (Level 1), 2 days/wk (Level 2) and 3 days/wk (Level 3). Good-to-high program enjoyment was reported by 90% of Level 3 and 83% of Level 2 participants. Conclusions: This pilot study demonstrates that a livestream group-based or video-based exercise program is feasible and acceptable in sedentary adults. A randomized controlled trial investigating health-related outcomes using this mHealth program is warranted.

Digital justice: A rapid evidence assessment of the use of mobile technology for offender behavioural change

The increasing availability and use of mobile technology have allowed for innovative solutions to address a range of issues, especially in relation to health behaviour change. Such technological advances have also created opportunities within the justice context and the past decade has seen the development and use of mobile technology in the criminal justice system. Yet, little systematic research exists in this area. This study begins to fill this gap, through a rapid evidence assessment of the use of technologies, especially mobile applications and text message reminders, which support behaviour change amongst people in the criminal justice system.