Support Behavior Change Research Articles

A look at engagement profiles and behavior change: A profile analysis examining engagement with the Aim2Be lifestyle behavior modification app for teens and their families

Mobile-Health is increasingly used to deliver lifestyle modification interventions; however, little is known about how users engage with these apps. This study aims to profile how teens engage with Aim2Be– a lifestyles behavior modification app), characterize engagement profiles, and examine which engagement profiles support changes in behaviors (diet, physical activity, screen time and sleep) and changes in the mediators targeted by the app. Data were collected from 301 teens (14.8 years, 49% boys, 68% Caucasian) living in Canada, from March to October 2018, who utilized the Aim2Be app for 4.5 months. App-analytics tracked teen engagement with the app features (selecting aims, completing tasks and quick wins, using the knowledge center and social wall, and accessing the virtual coach). Factor mixture modeling identified the following engagement profiles: Uninvolved (32%) did not use most app features; Dabblers (25%) minimally used the app features; Engaged (24%) had moderate-to-high use of app features; and Keeners (19%) had the highest use of all app features. Regression models showed that teens were more engaged with Aim2Be if their parents were involved and if they participated with their mothers and/or an educated parent. Finally, Keeners significantly improved on most mediators of behavior change and increased their fruit and vegetable intake. The findings suggest that parental engagement supported teen engagement of the Aim2Be app and high engagement was needed to support behavior change among teens. Gaining a greater understanding of the features that appeal to teens is necessary to support behavior change.

General population perspectives of dementia risk reduction and the implications for intervention: A systematic review and thematic synthesis of qualitative evidence.

BackgroundEvidence for the potential prevention of dementia through lifestyle risk factor modification is growing and has prompted examination of implementation approaches. Understanding the general population’s perspectives regarding dementia risk reduction is key to implementation. This may provide useful insights into more effective and efficient ways to help people change relevant beliefs, motivations and behaviour patterns. We conducted a systematic review and thematic synthesis of qualitative evidence to develop an integrated model of general population dementia risk reduction perspectives and the implications for intervention in research and implementation contexts.Methods and findingsWe searched electronic databases, supplemented by lateral search techniques, to identify studies published since 1995 reporting qualitative dementia risk reduction perspectives of the non-expert general population who do not have dementia. Thematic synthesis, incorporating an expert panel discussion, was used to identify overarching themes and develop an integrated model to guide intervention to support individuals to adopt and maintain dementia risk reduction behaviour patterns. Quality of included studies and confidence in review findings were systematically appraised. We included 50 papers, reflecting the views of more than 4,500 individuals. Main themes were: 1) The need for effective education about a complex topic to prevent confusion and facilitate understanding and empowerment; 2) Personally relevant short- and long-term benefits of dementia risk reduction behaviour patterns can generate value and facilitate action; 3) Individuals benefit from trusted, reliable and sensitive support to convert understanding to personal commitment to relevant behaviour change; 4) Choice, control and relevant self-regulatory supports help individuals take-action and direct their own progress; 5) Collaborative and empowering social opportunities can facilitate and propagate dementia risk reduction behaviour change; 6) Individual behaviour patterns occur in social contexts that influence beliefs through heuristic processes and need to be understood. Findings indicate that, for intervention: 1) education is key, but both content and delivery need to be tailored; 2) complementary interventions to support self-regulation mechanisms and social processes will increase education effectiveness; 3) co-design principles should guide intervention design and delivery processes; 4) all interventions need to be supported by context-specific data.ConclusionsThis systematic review and thematic synthesis provides a comprehensive, integrated model of the dementia risk reduction perspectives of the general population and intervention approaches to support behaviour change that can be applied in clinical trial and real-world implementation settings. Findings extend existing knowledge and may assist more effective intervention design and delivery.

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy: User-Centered Design Approach.

BackgroundTechnology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic).ObjectiveThe aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop.MethodsWe recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues.ResultsThe stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout.ConclusionsThis study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing.

Relationship between Perceived UX Design Attributes and Persuasive Features: A Case Study of Fitness App

Research shows that a well-designed user interface is more likely to be persuasive than a poorly designed one. However, there is a limited understanding of the relationship between user-experience (UX) design attributes and users’ receptiveness to the persuasive features of a persuasive technology aimed at motivating behavior change. To bridge this gap, we carried out an online case study among 228 participants from Canada and the United States to investigate the relationship between perceived UX design attributes and users’ receptiveness to persuasive features. The study serves as exploratory work by focusing on a single prototype (homepage of a fitness app); four commonly researched UX design attributes (perceived aesthetics, perceived usability, perceived credibility, and perceived usefulness); and six commonly employed persuasive features (Goal-Setting/Self-Monitoring, Reward, Cooperation, Competition, Social Comparison, and Social Learning) illustrated on storyboards. The results of the Partial Least Square Path Modeling show that perceived usefulness, followed by perceived aesthetics, has the strongest relationship with users’ receptiveness to the persuasive features of a fitness app. Specifically, perceived usefulness and perceived aesthetics have a significant relationship with users’ receptiveness to all but two of the six persuasive features, respectively, as well as with the overall perceived persuasiveness of the fitness app. These findings are supported by participants’ comments on the perceived UX design attributes of the fitness app and the persuasive features illustrated on the storyboards. However, perceived usability and perceived credibility have weak or non-significant relationships with users’ receptiveness to the six persuasive features. The findings suggest that designers should prioritize utilitarian benefits (perceived usefulness) and hedonic benefits (perceived aesthetics) over perceived usability and perceived credibility when designing fitness apps to support behavior change.

Healthy Eating and Active Lifestyles for Diabetes (HEAL-D), a culturally tailored self-management education and support program for type 2 diabetes in black-British adults: a randomized controlled feasibility trial

IntroductionBlack-British communities are disproportionately affected by type 2 diabetes (T2D). Structured education programs are a core component of T2D healthcare but they are less successful in people from minority ethnic...

Mobile health assisted self-monitoring is acceptable for supporting weight loss in rural men: a pragmatic randomized controlled feasibility trial

BackgroundAddressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men’s desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss.MethodsIn a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40–69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis.ResultsOf 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported.ConclusionsThis National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial.Trial registrationThe trial was prospectively registered with ClinicalTrials NCT03329079. 11/1/2017.

Perspective of volunteer staff on the effectiveness of peer-support programs: a case study

Purpose This study aims to explore perceived effectiveness in the Warriors' Ascent program through interviews of volunteer staff, to leverage improvements in the design and delivery of programs through peer-volunteers. Design/methodology/approach Focused interviews were conducted to explore peer-volunteer perspectives on program effectiveness. The alignment of themes and statements emerging from interviews was explored in detail relative to the program curriculum. Findings Five main themes emerged, with alignment for 86% of the peer-volunteers’ commentary and program curriculum. Areas of non-alignment may present opportunities for program growth. Practical implications Analysis of peer-volunteer perspectives on practical activities and overall program effectiveness identified options to enhance program delivery. Warriors’ Ascent and both existing and emerging organizations (such as those who will serve distressed frontline pandemic workers) are essential social resources poised to evolve by encompassing appreciation and more effective use of non-professional volunteer support staff. Originality/value Peer-volunteers supporting behavior change programs are an emerging focus for research. Peer-volunteers contribute unique perspectives, common experiences and building of relations with a program’s participants serving as an effective agent of change contributing toward healthier lifestyles. Considering the influences of peer-volunteers during program evaluation allows triangulation among sources of information and offers additional opportunities for influencing program growth.

Supporting behaviour change in younger-onset dementia: mapping the needs of family carers in the community

Objectives Almost 10% of people with dementia experience a younger-onset of disease (before 65 years). Changes in behaviour are common, as are delays in diagnosis and limited access to appropriate support and services. This study aimed to explore the specific behaviour support needs of families living with younger-onset dementia. Methods Seventy-one families of people with younger-onset dementia were surveyed to understand the experience of family carers regarding difficult-to-manage behaviour changes, confidence in identifying and implementing behaviour support strategies, use of specific behaviour support strategies, and use of formal and informal support services regarding behaviour changes. Results Survey responses were received from family members of people living with behavioural variant frontotemporal dementia (n = 28), semantic dementia (n = 17), and Alzheimer’s disease (n = 23). Over 90% of family carers reported difficult-to-manage behaviours which fell into four main domains: (1) aggression, (2) compulsive behaviour, (3) disinhibition and inappropriate social behaviour, and (4) apathy. A range of preventative and responsive strategies, with an emphasis on de-escalation strategies were identified and carers reported variable confidence in managing behaviour changes or in accessing formal support strategies. Conclusions Difficult-to-manage behaviour changes in community-dwelling people with younger-onset dementia are common. The existing agency of families should be recognised and built upon with better access to specific behaviour support services to increase competence and confidence in providing behaviour support and ultimately improve quality of life for them and their family member with dementia.

Experiences of using a digital type 2 diabetes prevention application designed to support women with previous gestational diabetes

BackgroundGestational diabetes mellitus (GDM) is diagnosed during pregnancy, and women with a history of GDM are at a higher risk of developing type 2 diabetes mellitus (T2DM). Prevention strategies focused on lifestyle modification help to reduce long-term complications. Self-management technology-based interventions can support behaviour change and diabetes control. The Baby Steps programme, a randomised controlled trial intervention offering group education and access to a mobile web application, was evaluated to explore user experience of the app and barriers and facilitators to app usability.MethodsTen semi-structured interviews and four focus group discussions were conducted with 23 trial participants between 2018 and 2019. Interviews and focus group discussions were audiotaped, transcribed and independently analysed. The analysis was informed by thematic analysis, with the use of the Nvivo 12 software.ResultsThemes identified were: (1) GDM and post-pregnancy support from healthcare services; (2) Impact of Baby Steps app on lifestyle changes; (3) Facilitators and barriers to the usability of the Baby Steps app. The Baby Steps app served as a motivator for increasing self-management activities and a tool for monitoring progress. Peer support and increased awareness of GDM and T2DM enhanced engagement with the app, while poor awareness of all the components of the app and low technical skills contributed to low usability.ConclusionsThis study documents experiences from existing GDM support, user experiences from using the Baby Steps app, and the barriers and facilitators to app usability. The app was both a motivational and a monitoring tool for GDM self-management and T2DM prevention. Peer support was a key trait for enhanced engagement, while barriers were low technical skills and poor awareness of the app components. A digital app, such as the Baby Steps app, could strengthen existing face-to-face support for the prevention of T2DM. The results also have wider implications for digital support technologies for all self-management interventions. Further research on the effect of specific components of apps will be required to better understand the long term impact of apps and digital interventions on self-management behaviours and outcomes.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.

Identifying critical features of type two diabetes prevention interventions: A Delphi study with key stakeholders.

AimsThis study aims to identify critically important features of digital type two diabetes mellitus (T2DM) prevention interventions.MethodsA stakeholder mapping exercise was undertaken to identify key end-user and professional stakeholders, followed by a three-round Delphi procedure to generate and evaluate evidence statements related to the critical elements of digital T2DM prevention interventions in terms of product (intervention), price (funding models/financial cost), place (distribution/delivery channels), and promotion (target audiences).ResultsEnd-user (n = 38) and professional (n = 38) stakeholders including patients, dietitians, credentialed diabetes educators, nurses, medical doctors, research scientists, and exercise physiologists participated in the Delphi study. Fifty-two critical intervention characteristics were identified. Future interventions should address diet, physical activity, mental health (e.g. stress, diabetes-related distress), and functional health literacy, while advancing behaviour change support. Programs should be delivered digitally or used multiple delivery modes, target a range of population subgroups including children, and be based on collaborative efforts between national and local and government and non-government funded organisations.ConclusionsOur findings highlight strong support for digital health to address T2DM in Australia and identify future directions for T2DM prevention interventions. The study also demonstrates the feasibility and value of stakeholder-led intervention development processes.

Fit in your genes: an introduction to genes and epigenetics for forensic practitioners

Purpose This paper aims to provide a brief and accessible introduction to genetics and epigenetics for forensic practitioners. It provides two primers which define key genetic concepts and explain what epigenetic mechanisms actually are. The primers are provided alongside sections that focus on genetic research relevant to forensic practice, with a range of key messages that support the call to contextualise harmful behaviour and build better awareness of gene-environment relationships. Design/methodology/approach This is an opinion paper. Findings Select and seminal studies from the genetic literature that have forensic practice relevance are cited. These include studies from candidate gene research and epigenetic research. They highlight a number of key themes, including the way neurodevelopment and behaviour are contextually adjusted to fit certain environments, with epigenetic changes being an underpinning biological mechanism that facilitates this. Research limitations/implications This article aims to introduce forensic practitioners to basic concepts in genetics and epigenetics so that they are able to engage with the relevant literature and understand the far-reaching implications for forensic practice. Practical implications It is becoming increasingly useful for forensic practitioners to appreciate how life experiences are encoded into biology through epigenetics. This paper highlights the potential of genetic and epigenetic research to provide major contributions to real-world practice in the coming years. It provides a modern biopsychosocial perspective on harmful behaviour and helps deepen the understanding of our efforts to support behaviour change. It offers ways to think of social and rehabilitative initiatives in biological terms. Originality/value This paper is one of few modern texts that focusses on the relevance of genetic and epigenetic research in applied forensic practice. It aims to introduce relevant concepts in an accessible manor. It intends to introduce biologically informed ways of understanding harmful behaviour within context and with attention to its function. It contributes to a de-pathologising narrative.

Linking Psychological Capital and Behavioral Support for Change: The Roles of Openness to Change and Climate for Innovation.

Employees’ behavioral support for change is seen as a key factor for the success of organizational changes. Given the assumed importance, the study developed a multilevel conditional mediation model and examined whether psychological capital influences behavioral support for change and if so, how the effect occurs. Results from a sample of 69 team leaders and 319 followers showed that the positive impact of psychological capital on openness to change was stronger in teams high in climate for innovation and that the mediating role played by openness to change in the relationship of psychological capital to behavioral support for change was significant when climate for innovation was high.

Fighting Hypertension In The Digital Age - A Lifestyle Intervention To Promote Physical Activity

PURPOSE: Although activity trackers are widely utilized, little is known about the effectiveness of activity trackers alone or combined with additional behavior change strategies to promote healthy lifestyles in individuals with pre-hypertension or hypertension. The purpose of the study was to determine the effectiveness of wearable activity trackers alone or in combination with behavior change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. METHODS: A sample of 44 adults with pre-hypertension or hypertension (68% female) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behavior change strategies delivered by a trained health coach (FB+) for 12 weeks. Activity behaviors were assessed using ActiGraph wGT3X-BT, and psychological measures of social support, self-efficacy, self-regulation, and self-motivation were assessed using validated questionnaires. Compliance of wear time and daily activity data were tracked by Fitbit. The within-group and between-group effect size of Cohen’s d for change scores were calculated in the PA outcomes and psychological measures. The effect of the intervention on change in PA was tested with multiple linear regression controlling for demographic variables. RESULTS: Participants in FB+ had higher adherence with an average of 70.4 valid days (at least 10 h/day) out of 84 days in total compared to FB (65.0 days). The FB+ group showed significant increases in daily steps (+1854 steps/day, p < .01), moderate and vigorous physical activity (MVPA; +26 mins/day, p < .05), and decreases in sedentary time (-63 mins/day, p < .01). A similar pattern was found in participants from the FB but with smaller change from baseline to post-intervention (steps: +764/day, p < .1; MVPA: +10 mins/day, p < .05; sedentary time: -89 mins/day, p < .01). Participants from FB+ had significantly greater increases in MVPA/day compared to FB only group with a between-group effect size of 0.6 (p < .05). CONCLUSIONS: The study indicated that the usage of Fitbit for self-monitoring is effective in increasing PA and reducing sedentary time among pre-hypertensive and hypertensive participants. Additional behavior change support amplified the intervention effectiveness for promoting MVPA.

Digital Lifestyle Medicine: Designing, Delivering, and Scaling for Impact.

Digital Lifestyle Medicine (DLM) is a consumer-centric model of care which elevates the importance of daily behaviors in preventing and reversing chronic disease using virtual and digital modalities to reach patients in the context where lifestyle behaviors occur and empower them to stay well. DLM is health care reimagined, designed to inspire patients to live their best life by enabling skill-building, self-efficacy, and sustainable behavior change supported by peers, scientific-evidence, and a multidisciplinary team of lifestyle medicine (LM) clinicians. Importantly, it requires insights and collaboration from healthcare experts and technology entrepreneurs to provide a profoundly different "user experience" layered with context, relevance, and scalability. Using examples from our DLM practice, we describe how key components of LM practice, including a multidisciplinary care team, behavior change support, health coaching, and peer support, are prime for digital delivery. We conclude by providing preliminary patient outcomes to date, key success factors, and opportunities for enhancement and expansion to inform the adoption and successful implementation of DLM across the collective of LM practice.

Music Tempo: A Tool for Regulating Walking Cadence and Physical Activity Intensity in Overweight Adults?

This study investigated if music tempo can prompt a desired walking cadence, and if music can provide a stimulus to regulate physical activity intensity in a longitudinal physical activity intervention with free-living adults. Overweight adults (n = 37; 94.26 ± 17.11 kg; 49.63 ± 12.37 years) were randomly assigned to an intervention (IG, n = 17) or usual care group (UC, n = 20) as part of a novel nine-month walking intervention. IG participants walked to self-selected music with a predetermined tempo and received a behavioural change support programme. At baseline, four-, six- and nine-months participants were asked to walk around an elliptical track at their habitual pace (0–2 min) and then in time to a predetermined tempo (2–8 min) designed to elicit moderate intensity. Cadence response (steps/min) was assessed and intensity (heart rate (bpm) recorded using wireless telemetry. A repeated measures general linear model (GLM) examined differences between groups over time (p < 0.05). All data is presented as means ± SD. At each assessment point both groups displayed an immediate cadence adjustment in response to music tempo (p < 0.01) i.e., habitual cadence vs. 3 METs target cadence (p < 0.05) and 3 METs target cadence vs. 5 METs target cadence (p < 0.05). Additionally, IG participants displayed an increased habitual cadence (0–2 min) at each assessment point (p < 0.05; 110 ± 9, 121.80 ± 7.5, 121.46 ± 10, 121.93 ± 7 steps/min respectively). UC participant’s habitual cadence was unchanged from 0–9 months (p > 0.05; 120 ± 10, 116 ± 13, 119 ± 12 and 119 ± 9 steps/min respectively). Music tempo may be a useful regulatory tool to prompt the free-living individual to reach an appropriate stride rate to achieve a walking pace that is at least moderate intensity. It also appears that results may be trainable as throughout the study an increased habitual walking cadence was observed, in the absence of music.

Climate change policy support, intended behaviour change, and their drivers largely unaffected by consensus messages in Germany

How can communication contribute to reducing greenhouse gas emissions through behaviour change and policy support? The existing literature emphasises informing people about the scientific consensus on climate change, but the underlying research has been conducted mainly in the US, where prior beliefs in human-made climate change are lower than in many other countries with the highest per-capita emissions. We test consensus messages in an ‘extended gateway belief model’ using a pre-registered survey experiment on a representative quota sample of the German population (N = 1171). Our data show that consensus messages are likely to have no or only minimal effects on perceived scientific agreement, intended behaviour change and policy support. Still, in line with prior research, we find that perceived scientific agreement, belief in climate science, efficacy beliefs, and worry about climate change predict policy support and intended behaviour change. These results demonstrate that effective communication needs tailoring to its local context.

Working With Values: An Overview of Approaches and Considerations in Implementation.

Acceptance and commitment training (ACT) has received support for addressing a number of difficulties within clinical behavior analysis, organizational settings, caregiver support, and other behavior change efforts. ACT is distinguished from many other approaches in its emphasis on values: aspects of life that clients find meaningful and important. Working with values lets behavior analysts draw on the functional properties of language to influence behavior. These techniques can help organize behavior to be influenced by long-term reinforcers, even in the face of short-term aversives, which may arise in the course of behavior change. Many exercises have been developed within the values arena with various strengths and limitations. This article provides an overview of commonly used approaches and aspects relevant to implementation. Considerations related to scope of practice, social desirability in responding, and aversive private events are also discussed.

How the LiveWell Dorset lifestyle behaviour change service influences older adults’ physical activity behaviour: A generic qualitative study

ObjectivesThere is uncertainty around the most effective characteristics and components of interventions to increase older adults' physical activity (PA) levels. This study aimed to explore how LiveWell Dorset (LWD), a lifestyle behaviour change support service based in Dorset, South-West England, influences older adults’ PA behaviour. Study designA qualitative study using a generic approach. MethodsSemi-structured telephone interviews were held with 12 individuals aged 55 to 65 who had accessed LWD's support to increase their PA levels, to gather their views and experiences of the service. A thematic analysis of the interview data was conducted using a hybrid approach that incorporated both inductive and deductive processes. Additionally, interview content was coded for behaviour change techniques using the Behaviour Change Technique Taxonomy version 1. ResultsA number of key factors were identified that highlighted how the LWD service influences older adults’ PA behaviour. These included using a broad range of promotional and behaviour change strategies to facilitate initial engagement, providing opportunities for service users to receive social support from both professionals and peers, and emphasising person-centredness and empathy in interactions with service users. ConclusionsThe findings provide valuable information regarding the needs and preferences of older adults when attempting to influence their PA behaviour, and on the reportedly helpful components of interventions that aim to do so. The findings also support the need for future research into previously highlighted topics of interest such as the roles of systemic and contextual factors and professional empathy on PA intervention engagement and outcomes.

Evaluating mobile health technologies: does the traditional randomized controlled trial serve our needs?

Mobile health technologies are increasingly used by cardiovascular nurses and allied health clinicians to support behaviour change and self-care in patients. Randomized controlled trials provide rigorous methodology for evaluation but progress slowly, so the technology is often outdated by completion. A helpful modification to the trial design includes identification of the behaviour intervention principles involved and concurrently track in-app usage data, allowing updates to be made. These data collected alongside user experiences enables analysis of effects on outcomes and determination of the relative influence of component parts. Cardiovascular and mental health mHealth strategies are used to exemplify these recommendations.

MomHealth: A Feasibility Study of a Multibehavioral Health Intervention for Pregnant and Parenting Adolescent Mothers.

IntroductionIn 2016, 209,809 babies were born to mothers 15 – 19 years of age, for a live birth rate of 20.3 per 1,000 in this age group. Many health issues surround adolescent mothers and their infants, many of which can be addressed through behavioral change. The main purpose of this study was to examine the feasibility, acceptability, usability, and relevance of momHealth, an innovative multiple health behavior change (MHBC) education and support mHealth intervention, focused on breastfeeding, healthy eating and active living, and depression prevention among pregnant and parenting adolescents. We also evaluated the proposed online surveys and physical outcome measures for feasibility and acceptability (burden, time, ease of use).MethodsA one-group quasi-experimental longitudinal design was used to examine the intervention components and the breastfeeding, diet/activity, and depression outcome measures. Nine iPad-delivered education modules, text messaging, and virtual individual and group support were provided for 12 weeks, beginning at 32 weeks of pregnancy, with follow-up to three months postpartum. Data on the main behaviors and outcomes were collected at three in-home visits, one telephone call soon after birth, and ten postpartum weekly and biweekly online surveys.ResultsAlthough recruitment and attrition presented challenges, six participants enrolled in the study during prenatal clinic visits; all were pregnant with their first child, single, and had a mean age of 17.7 years (SD = 1.4). Intervention participation ranged from 59% to 91% for educational module completion, text message reading, and individual virtual support meetings and three virtual peer support groups were held. Intervention acceptability, relevance, and delivery was supported by reports of clear and relevant content, reasonable time burden, iPad ease of use, and acceptable intervention length. Data collection was reported as convenient and non-burdensome, but the diet recall method and activity monitoring challenged some.ConclusionsThis was the first MHBC research in adolescent pregnant women designed to improve breastfeeding outcomes, healthy eating/active living, and depression prevention. Findings demonstrated strengths and challenges of the interventions and methods, support feasibility and acceptability of momHealth, and informed the recruitment and intervention protocols of our pilot randomized trial.