Support Health Behavior Change Research Articles

Behind the software: The impact of Unobtrusiveness, Goal Setting and persuasive features on BMI.

Studies have demonstrated that interventions targeting weight loss and body mass index (BMI) reduction can be successful, although the specific factors that influence their effectiveness are still unclear. Behavior change support systems (BCSS) are an approach that aims to help users in their efforts to modify their behavior. A useful tool for assessing BCSS is the Persuasive Systems Design model (PSD), where different features and postulates can be employed. However, it is unknown whether the grouping of software features and design principles, along with behavioral traits, provide a better combination to achieve effective BMI reduction. This study investigates the impact of PSD features, postulates behind the design, and behavioral traits on BMI reduction after six months of utilizing a mobile health behavior change support system (mHBCSS). We examined a subset of 96 individuals from a randomized controlled trial using a mHBCSS for a period of six months. Data was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). We found that 15.3% in the variance of BMI reduction was explained by the ability of setting goals. Furthermore, users who perceive a system as highly persuasive are more likely to establish goals (R2=0.207). Among PSD features, Dialogue Support and Primary Task Support explained 54.9% of the variance in Perceived Persuasiveness. In addition, both Dialogue Support and Credibility Support have a mutual effect on Primary Task Support (R2=0.685). Finally, the system's unobtrusiveness explained 41.1% of the variance in Dialogue Support. PSD framework and behavior change theories provide significant influence on BMI reduction. Setting a clear and organized objective assists individuals in successfully pursuing their intended results. The findings of this study can help developers and health professionals decide which PSD features and postulates to include to make mHBCSS interventions targeting BMI reduction more effective.

Potential Use of Voice-Activated Personal Assistants in Diabetes Prevention and Management: An Exploratory Qualitative Study Using the Consolidated Framework for Implementation Research

Background Diabetes affects millions of people in the United States and poses significant health and economic challenges, but it can be prevented or managed through health behavior changes. Such changes might be aided by voice-activated personal assistants (VAPAs), which offer interactive and real-time assistance through features such as reminders, or obtaining health information. However, there are little data on interest and acceptability of integrating VAPAs into programs such as the National Diabetes Prevention Program (National DPP) or diabetes, self-management, education, and support (DSMES) services. Methods We conducted individual and small-group semi-structured interviews of National DPP and DSMES staff and program participants. We used rapid-turnaround qualitative thematic analysis to identify emerging themes using an adapted version of the Consolidated Framework for Implementation Research (CFIR). Results Nearly all program participants and staff had prior experience with VAPAs, but not in the context of these programs. Most program participants felt confident in their ability to use VAPAs but were concerned about their privacy and security. Program staff were optimistic about the feasibility of integrating VAPAs into existing programs given their ability to support healthy habit formation, but staff were less optimistic about using VAPAs to share health information. Program staff also felt that additional resources to support VAPA use would help ensure that VAPAs would not create an extra burden on staff and program participants. Implications Integrating VAPAs as a resource to enhance mobile applications already in use shows potential to support health behavior change. Future research should include how this technology could be further optimized to enhance utility.

Exploring the use of digital technology to support health behaviour change in young people under the care of a Complications of Excess Weight service: a qualitative patient-centred design study (Preprint)

Exploring the use of digital technology to support health behaviour change in young people under the care of a Complications of Excess Weight service: a qualitative patient-centred design study (Preprint)

Implementation of a digital behavior change intervention (eCHANGE) for weight loss maintenance support: a service design and technology transfer approach.

Obesity is a chronic disease, and while weight loss is achievable, long-term weight loss maintenance is difficult and relapse common for people living with obesity. Aiming to meet the need for innovative approaches, digital behavior change interventions show promise in supporting health behavior change to maintain weight after initial weight loss. Implementation of such interventions should however be part of the design and development processes from project initiation to facilitate uptake and impact. Based on the development and implementation process of eCHANGE, an evidence-informed application-based self-management intervention for weight loss maintenance, this manuscript provides suggestions and guidance into; (1) How a service design approach can be used from initiation to implementation of digital interventions, and (2) How a technology transfer process can accelerate implementation of research-based innovation from idea to market.

Mobile health behaviour change support system as independent treatment tool for obesity: a randomized controlled trial

Background/ObjectivesDigital health interventions are increasingly utilized as an adjunct to face-to-face counselling in the treatment of obesity. However, previous studies have shown inconsistent efficacy when digital interventions are used as stand-alone treatment. The purpose of this study was to investigate whether a mobile health behaviour change support system (mHBCSS) is effective in weight reduction and weight loss maintenance without additional counselling. Furthermore, changes in cardiometabolic risk factors were investigated.MethodsIn this randomized controlled trial, a mHBCSS intervention was conducted for 200 volunteers with obesity (BMI 30–40 kg/m² and age 18–65 years). The study participants were randomly assigned into two groups: immediate access to mHBCSS intervention or wait-list control with access to mHBCSS after 6 months. Anthropometric and metabolic traits were also measured. The primary outcome was weight loss from the baseline to the 6-month visit.ResultsAmong 200 participants (88.5% women), mean BMI (SD) was 34.3 kg/m² (2.8) and age 46.5 years (9.5). The retention rate was 98.5% and 89.0% at the 6- and 12-month visits, respectively. At the 6-month visit, those with immediate access to mHBCSS had significantly greater weight loss (−2.5%, 95% CI −3.4 to −1.6, p < 0.001) compared with the wait-list control group (0.2%, 95% CI –0.4 to 0.9, p = 0.466; between groups p < 0.001). Weight loss was maintained until the 12-month time point in the mHBCSS group (−2.1%, 95% CI −3.3 to −0.9, p = 0.001). The usage of mHBCSS had no significant effect on metabolic traits.ConclusionThe mHBCSS as a stand-alone treatment of obesity results in weight reduction and weight loss maintenance with remarkable adherence rate. Further studies are needed to establish how to best implement the scalable and resource-efficient mHBCSS into the standard care of obesity to achieve optimal weight loss results.

Developing evidence-based patient-focused learning materials to support health behaviour change for people living with psoriatic arthritis

ObjectivesIn psoriatic arthritis (PsA), self-management is important for patient function and quality of life. Behaviour change can be difficult, patients could benefit from high-quality support to initiate change. Our aim...

Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review.

The Transtheoretical Model of Change identifies key stages in behavior change, including a maintenance stage occurring when a behavior has been upheld for at least 6months. Health and wellness coaching has demonstrated support for health behavior change, but maintenance of gains has received little attention. Our rapid systematic literature review characterizes both the research exploring sustained gains with health and wellness coaching and what is known about sustained gains after the completion of a health and wellness coaching engagement. Guided by The Cochrane Rapid Reviews Methods Group "Interim Guidance," we drew 231 studies from the 2018 and 2020 Sforzo et al "Compendium of the health and wellness coaching literature," and "Addendum…" appendices. Initial screening and coding for inclusion and exclusion criteria yielded 28 studies for data extraction. We examined studies across outcome categories (physiological, behavioral, psychological, and health risk assessment) to determine whether outcome measures were: not sustained; partially sustained; fully sustained; or improved from immediate post-intervention to a later follow-up period. Twenty-five of the 28 studies reviewed demonstrated partially, or fully, sustained or improved outcomes in one or more variables studied, with sustained gains demonstrated across outcome categories, strengthening confidence in HWC as a facilitator of lasting change.

A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial.

Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.

Usability Testing of a Multi-Level Modeling Framework for Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health.

The JITAI is an intervention design to support health behavior change. We designed a multi-level modeling framework for JITAIs and developed a proof-of-concept prototype (POC). This study aimed at investigating the usability of the POC by conducting two usability tests with students. We assessed the usability and the students' workload and success in completing tasks. In the second usability test, however, they faced difficulties in completing the tasks. We will work on hiding the complexity of the framework as well as improving the frontend and the instructions.

The Impact of Social Media Interventions on Weight Reduction and Physical Activity Improvement Among Healthy Adults: Systematic Review.

A sedentary lifestyle and being overweight or obese are well-established cardiovascular risk factors and contribute substantially to the global burden of disease. Changing such behavior is complex and requires support. Social media interventions show promise in supporting health behavior change, but their impact is unclear. Moreover, previous reviews have reported contradictory evidence regarding the relationship between engagement with social media interventions and the efficacy of these interventions. This review aimed to critically synthesize available evidence regarding the impact of social media interventions on physical activity and weight among healthy adults. In addition, this review examined the effect of engagement with social media interventions on their efficacy. CINAHL and MEDLINE were searched for relevant randomized trials that were conducted to investigate the impact of social media interventions on weight and physical activity and were published between 2011 and 2021 in the English language. Studies were included if the intervention used social media tools that provided explicit interactions between the participants. Studies were excluded if the intervention was passively delivered through an app website or if the participants had a known chronic disease. Eligible studies were appraised for quality and synthesized using narrative synthesis. A total of 17 papers reporting 16 studies from 4 countries, with 7372 participants, were identified. Overall, 56% (9/16) of studies explored the effect of social media interventions on physical activity; 38% (6/16) of studies investigated weight reduction; and 6% (1/16) of studies assessed the effect on both physical activity and weight reduction. Evidence of the effects of social media interventions on physical activity and weight loss was mixed across the included studies. There were no standard metrics for measuring engagement with social media, and the relationship between participant engagement with the intervention and subsequent behavior change was also mixed. Although 35% (6/16) of studies reported that engagement was not a predictor of behavior change, engagement with social media interventions was found to be related to behavior change in 29% (5/16) of studies. Despite the promise of social media interventions, evidence regarding their effectiveness is mixed. Further robust studies are needed to elucidate the components of social media interventions that lead to successful behavior change. Furthermore, the effect of engagement with social media interventions on behavior change needs to be clearly understood. PROSPERO International Prospective Register of Systematic Reviews CRD42022311430; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=311430.

The Prevalence and Perceived Utility of Mobile Health Technology Among Recently Incarcerated Homeless Adults.

Mobile technologies can deliver physical and mental health services for recently incarcerated homeless adults (RIHAs). The purpose of this study was to examine the prevalence and perceived utility of mobile technology to support health behavior change among RIHAs. Participants (n = 324) from an ongoing clinical trial at a homeless shelter in Texas were included in the current descriptive cross-sectional analyses. Over one fourth (28.4%) of participants had an active cell phone. Nearly 90 percent (88.6%) of participants reported at least weekly use of the internet, 77 percent used email (77.2%), and more than half used Facebook (55.2%). Although most participants (82.8%) believed that smartphone applications (apps) could help change their behavior, only a quarter (25.1%) had used an app for this purpose. These findings highlight the potential for smartphone-based intervention technologies, and future studies should examine whether smartphone apps that address mental health and health behaviors are feasible among RIHAs.

Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment

Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change.

Usage of digital, social and goal-setting functionalities to support health behavior change: A mixed methods study among disadvantaged women during or after pregnancy and their healthcare professionals

ObjectiveWe aimed to gain insight into how and to what extent social (i.e. private/group chat) and goal-setting (e.g. rewards) functionalities in digital interventions for health behavior change were used by clients and nurses in a preventive care program for disadvantaged women during or after pregnancy, and which factors influenced usage. MethodsWe collected quantitative and qualitative data on usage of these functionalities in ‘Kindle’, a mHealth intervention to prepare for health behavior change. ResultsWe found that nurses (n = 5) and clients (n = 20) scarcely used both functionalities. They sent 862 messages in the social functionality whose security they appreciated, but habitually used WhatsApp likewise. Moreover, nurses were hesitant to let their clients interact in the group chat. Clients formulated 59 personal goals, which they found difficult to do. Nurses rewarded 846 points for clients’ progress on goal attainment, but found it hard to determine how many points to reward. Clients and nurses indicated that the functionality made it more fun and easy to discuss clients’ personal goals. ConclusionsTo conclude, digital, social and goal-setting functionalities were used to a limited extent by nurses and clients, and need optimization before implementation to support disadvantaged groups to change their health behavior.

University peer health coaches’ perceptions of learning and applying motivational interviewing

Introduction: Peer-led health coaching is a realistic and sustainable way to support health behaviour change on university campuses. Motivational Interviewing (MI) is an effective framework to guide behaviour change conversations in peer health coaching sessions. However, research on the perceptions of peer coaches who provide health coaching using MI is scarce. Objective: The aims of this study were to examine (1) university peer health coaches’ experiences as peer educators after participating in the training and implementation of MI; and (2) university peer health coaches’ supervision experiences as they learn to use MI for health coaching. Design: Cross-sectional in-depth qualitative study using Interpretative Phenomenological Analysis (IPA). Setting: Peer health coaching programme in a mid-sized southwestern US university. Method: Five peer health coaches were interviewed about their training, implementation and supervision of using MI in a university health coaching programme. IPA was used to analyse the findings. Results: We identified four main themes: (1) learning MI, (2) using MI, (3) challenges of time and availability and (4) supervision and peer support. Results illustrated the developmental processes peer health coaches perceive as they develop their MI skills. Individual and group supervision supported MI growth and development while also building a sense of community. Conclusion: Apart from challenges in learning and using MI, supervision was an important factor that helped peer health coaches develop. Future research should investigate training methods and supervision strategies to improve the quality of peer health coach programmes.

Lifestyle and health behaviour change support in traditional acupuncture: a mixed method survey study of reported practice (UK)

AimsComplementary medicine therapists such as traditional acupuncturists are a large resource for supporting public health targets to improve health behaviours. Our objectives were to determine the prevalence and patterns of UK acupuncturists’ provision of lifestyle change support, test theory-based hypotheses about facilitators and barriers to supporting lifestyle changes and to explore associated characteristics and attitudes.MethodsA mixed methods design in which British Acupuncture Council members (Sept 2019-April 2020) completed an online questionnaire assessing prevalence of lifestyle change support, typical patterns across patients and behaviours, Theory of Planned Behaviour constructs, practitioner characteristics and open-text responses regarding additional behaviours and clinical decisions to introduce lifestyle change.ResultsThree hundred fifty-two traditional acupuncturists participated (Mean age = 51.5 years, SD 9.9; 81.8% (n = 288) female). 57.7% (n = 203) reported offering support for lifestyle change during their most recent consultation. 91.7% (n = 323) reported supporting lifestyle change ‘always or most of the time’ for patients with chronic conditions and 67.9% (n = 239) reported this for patients with acute conditions. The pattern of typical support for different health behaviours ranged from 44.6% (n = 157) for smoking reduction (acute conditions) to 95.2% (n = 335) for diet support (chronic conditions). A linear regression model found that frequency of support for lifestyle change in acute patients was predicted by acupuncturists’ attitudes to both clinical role and importance of health behaviours, confidence in their ability to provide lifestyle change support and use of fewer behaviour change techniques. The decision to first offer lifestyle change support was guided by perceived patient receptiveness, whether presenting condition/diagnosis were likely to improve with lifestyle change and whether a strong therapeutic relationship was established.ConclusionsTraditional acupuncturists’ reports suggest their work supports key public health targets for promoting healthy behaviours. Less frequent support for alcohol/smoking may reflect user characteristics but may suggest training needs for acupuncturists. Increase could be made for support in acute presentations, however the importance of patient receptiveness, linking advice to condition, and therapeutic alliance should be explored further. There may be important differences between acupuncture practice and mainstream healthcare (e.g. high level of contact, longer visits, holistic approach) which impact mechanisms of action of behaviour change.

Addressing opioid medication misuse at point of service in community pharmacy: A study protocol for an interdisciplinary behavioral health trial

Background>1 in 3 of the 9 million individuals engaged in opioid medication misuse obtain legitimate opioid prescriptions and fill these in community pharmacies, which are subsequently misused. This study is testing the efficacy of a pharmacist-led intervention—Brief Intervention-Medication Therapy Management (BI-MTM)—compared to standard medication counseling (SMC) to address opioid medication misuse. MethodsDesign. This study is a single-blinded 2-group parallel randomized trial within 13 community pharmacies that will enroll 350 individuals. Participant Recruitment. Pharmacy staff approach patients and ask about interest in completing a brief confidential screening tool, which includes opioid medication misuse assessment. Interested patients who report misuse are asked to provide informed consent. Enrolled patients are assessed for behavioral and physical health at enrollment, 2-months post-enrollment, and 6-months post-enrollment. Interventions. Following baseline assessment, participants are randomized (1:1 ratio) to: SMC, a medication information/counseling intervention or BI-MTM, an intervention comprised by 4 evidence-based components: medication therapy management, brief intervention, naloxone dispensing, and patient navigation. Analyses. Primary analyses involve estimating 3-level generalized linear mixed models to relate repeated assessments across time of opioid medication misuse (i.e., the Prescription Opioid Misuse Index) to the intervention. ConclusionStudy results will provide the first critical step towards integrating a highly accessible, low-cost approach to managing risks related to opioid use. Community pharmacies provide an incredibly important setting in which patients can receive high quality care to support health behavior change. Successfully completing this project sets the stage for a large-scale effectiveness study. (NCT#: NCT05141266).

Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review.

BackgroundDigitally enabled care along with an emphasis on self-management of health is steadily growing. Mobile health apps provide a promising means of supporting health behavior change; however, engagement with them is often poor and evidence of their impact on health outcomes is lacking. As engagement is a key prerequisite to health behavior change, it is essential to understand how engagement with mobile health apps and their target health behaviors can be better supported. Although the importance of engagement is emphasized strongly in the literature, the understanding of how different components of engagement are associated with specific techniques that aim to change behaviors is lacking.ObjectiveThe purpose of this systematic review protocol is to provide a synthesis of the associations between various behavior change techniques (BCTs) and the different components and measures of engagement with mobile health apps.MethodsThe review protocol was structured using the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and the PICOS (Population, Intervention, Comparator, Outcome, and Study type) frameworks. The following seven databases will be systematically searched: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, ScienceDirect, Cochrane Library, and Web of Science. Title and abstract screening, full-text review, and data extraction will be conducted by 2 independent reviewers. Data will be extracted into a predetermined form, any disagreements in screening or data extraction will be discussed, and a third reviewer will be consulted if consensus cannot be reached. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools; descriptive and thematic analyses will be conducted to summarize the relationships between BCTs and the different components of engagement.ResultsThe systematic review has not yet started. It is expected to be completed and submitted for publication by May 2022.ConclusionsThis systematic review will summarize the associations between different BCTs and various components and measures of engagement with mobile health apps. This will help identify areas where further research is needed to examine BCTs that could potentially support effective engagement and help inform the design and evaluation of future mobile health apps.Trial RegistrationPROSPERO CRD42022312596; https://tinyurl.com/nhzp8223International Registered Report Identifier (IRRID)PRR1-10.2196/35172

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).

A theory-based video intervention to enhance communication and engagement in online health communities: two experiments

ABSTRACT Background Online communities and social networking sites have great potential for supporting health behavior change. However, interventions vary greatly in participants’ engagement rates and, consequently, their effectiveness. Theory-based interventions in real-world contexts are needed to further increase engagement and effectiveness. Methods We experimentally tested whether a video intervention teaching Self-Determination-Theory-based communication strategies increases need-supportive communication strategy use over one week (Study 1, N = 76) and perceived need support, engagement, and goal attainment in a behavior change intervention supported by a forum-based online community (Study 2, N = 537). In Study 2, participants chose a goal (increasing either fruit or vegetable consumption or increasing moderate or vigorous physical activity) and joined an online community for 2 weeks. Data from both experiments were analyzed with mixed models and follow-up tests. Results In Study 1, participants in the intervention but not in the control group showed an increase in the number of need-supportive communication strategies used both immediately and one week after the intervention (condition × time interaction, partial η 2 = 0.31). In Study 2, participants who watched the intervention video had a higher number of postings and reported a higher subjective forum use frequency (but not a higher number of logins) compared to participants who watched the control video. However, the effect on the subjective forum visit frequency was not robust. There were no intervention effects on perceived need support, goal attainment, or secondary outcomes. The results might be explained by low application of need-supportive communication strategies. Conclusion A brief video intervention may be a suitable, low-cost intervention to promote need-supportive communication strategy use, benefitting both engagement and behavior change. Future studies should incorporate additional means to further improve communication strategy uptake and engagement in online communities.

SMART Recovery for Youth: A Qualitative Study Exploring the Potential of a Mutual-Aid, Peer Support Health Behaviour Change Program for Young People

SMART Recovery for Youth: A Qualitative Study Exploring the Potential of a Mutual-Aid, Peer Support Health Behaviour Change Program for Young People