Sustained Behavior Change Research Articles

Addressing the complexities of evaluating comprehensive sexuality education: an Italian case study

Abstract Background Existing evaluation methods for assessing sexuality education programs may not be suitable for Comprehensive Sexuality Education (CSE) interventions, which are globally indicated as the most effective approach for promoting sexual health and preventing STIs. This holds particular significance in countries, such as Italy, where CSE is not integrated into school curricula. In a pilot project funded by the Italian Ministry of Health since 2019 (EduForIST), we aimed to develop a composite evaluation framework to test the CSE intervention we implemented in lower and upper secondary schools over the past 4 years. Methods Based on the latest available evidence, evaluating a CSE intervention requires addressing various dimensions. These include assessing the quality of programs and their implementation, as well as measuring outcomes and impact. Through iterative consultations with experts and providers, methods, criteria, and metrics were chosen and tested for each dimension. Results Program quality was evaluated by an expert advisory board. Instruments for implementation quality assessment included: satisfaction survey among students; reflective journals and SWOT analysis drawn up by educators delivering intervention, exploring their perceptions, practices, and attitudes; surveys among teachers and parents, measuring knowledge, attitude, and practice on CSE, and observed changes among adolescents. A four-arm, Solomon, cluster design study was designed to evaluate outcomes in terms of changes in students’ knowledge. Clinical and behavioral indicators in the short, medium and long term were selected as measures of the impact of the intervention. Conclusions In the field of CSE implementation research, a multi-component approach to evaluation is needed to provide a solid basis for informing policymakers. The involvement of providers, recipients and contextual adults is essential in evaluating CSE interventions. However, assessing long-term impact requires long time frame. Key messages • Assessing CSE interventions requires a multi-component evaluation approach, considering the impact on the personal and emotional development of individuals in order to sustain behavior changes. • The proposed evaluation framework may inform scientific community, professionals, and decision-makers on effectiveness of interventions in settings where CSE is not yet included in school curricula.

Effectiveness of the educational training program for Japanese chief residents: A one‐year pilot study

AbstractBackgroundMulti‐institutional faculty development programs for chief residents were lacking in Japan. This study evaluated the effectiveness of the program for enhancing the knowledge and behaviors of chief residents at the national level.MethodsSix participants completed self‐assessment questionnaires at three points: before, immediately after, and 6 months post‐program. Knowledge and behavior changes were compared using the Mann–Whitney U test.ResultsSignificant improvements in knowledge were observed and maintained at 6 months. However, behavioral changes were limited, with significant improvements only in counseling skills.ConclusionThe program effectively increased knowledge but faced challenges in translating it into sustained behavioral change.

Eye of the Beholder: Prevalence of Binge Eating Disorder among Youth in Urban Coastal Karnataka, India

Abstract Introduction: Eating disorders (EDs) are on the rise and can result in medical and psychiatric morbidities in children, adolescents as well as during adulthood. It is crucial to understand the disease burden for its early diagnosis, intervention, and prevention. Our study was thus conducted over 5 months to estimate the prevalence of binge ED (BED) among adolescents and young adults in Mangalore, Karnataka. Materials and Methods: A total of 300 participants between the ages of 15 and 24 years were administered the Questionnaire on Eating and Weight Patterns - 5. Responses were categorized into “possible diagnosis of BED” and “possible diagnosis of bulimia nervosa (BN).” Results: The mean age of the participants was 19.4 ± 3.1 years and their mean body mass index was 22.7 ± 3.9 kg/m2. Among 300 participants, 15 (5.0%) had a possible diagnosis of BN, while 4 (1.3%) had a probable diagnosis of BED, both were found to be more among females than males. Sixty participants reported having loss of control over their food intake, of which only 26 (43.3%) reported being upset about it. However, on multivariate logistic regression, none of the sociodemographic factors were found to be significant in our study. Conclusion: It is essential to encourage healthy eating habits and physical activity at an early age along with the inclusion of screening for EDs in school health programs. Raising awareness among parents and children is crucial in bringing about sustained behavior change.

Is community-led total sanitation programme ending open defecation? A sustainability perspective from stakeholders in Ghana

Community-led total sanitation (CLTS) is an intervention widely employed by developing countries to end open defecation (OD) in line with SDG Target 6.2. Following its adoption in Ghana, many communities have been declared open defecation-free (ODF), but little is known about their sustainability. This study sought to determine the sustainability of the ODF status of communities after 2 to 10 years of certification across eight regions in Ghana. Qualitative data were collected using semi-structured interviews with 26 practitioners and implementers, focus group discussions and direct observations in 22 communities. The data were manually transcribed and thematically analysed. The results revealed four major sustainability factors: motivational, behavioural change, leadership and financial. While motivational factors included improved health, pride, comfort and convenience, leadership factors involved supportive traditional and active natural leaders, and behavioural change entailed understanding the consequences of OD and latrine rebuilding. Financial factors encompassed access to sanitation funds. Regional and district league tables were found to be influencing the sustainability factors of the programme. Based on the findings, policymakers and implementers of the CLTS programme should intensify persuasive education focusing on sustainable behavioural change towards OD and post-ODF follow-ups alongside league tables to motivate sustained ODF communities while providing a friendly loan schedule for communities willing to pay.

Interdisciplinary Brain-based Learning Strategies in Addressing Liver Fluke Disease and Cultural Dietary Practices among Early Childhood Students

Liver fluke disease remains a critical public health issue in Southeast Asia, driven by cultural dietary practices involving raw or undercooked freshwater fish. This study evaluates the impact of an interdisciplinary brain-based learning intervention aimed at increasing awareness and modifying dietary behaviors among early childhood students in Central Northeast Thailand. A quasi-experimental design was employed, involving 122 students from four provinces. The intervention incorporated brain-based learning activities such as storytelling, songs, and visual aids to enhance engagement. Pre- and post-tests, behavioral observations, and attitudinal surveys were conducted to assess the program’s effectiveness. Post-intervention results indicated significant improvements in knowledge about liver fluke transmission, symptoms, and prevention, alongside positive changes in behavior, such as increased avoidance of raw fish consumption and improved hygiene practices. Attitudinal surveys showed a shift in preferences toward safer eating habits. These findings suggest integrating brain-based learning with culturally relevant health education can foster sustainable behavior change in early childhood populations. Further research is recommended to explore this approach’s long-term impacts and scalability.

Using Theory and Practice to Develop Lottery Ticket Warning Messages as a Means of Promoting More Responsible Gambling

Background Playing the lottery is considered a public health concern in many countries due to financial losses associated with it, but also due to other harmful health and social problems. Focus of the article Informed by both theory and practice, this article focuses on developing lottery ticket warning messages targeting players harmed by excessive spending to promote sustainable behavior change. Research Question What should be communicated in lottery ticket warning messages targeting people at risk to facilitate behavior change and maintain it? Approach We bridge the gap between theory and practice and illustrate how theoretical models and current communications can shape messages. Specifically, we identify and examine lottery ticket warning messages and analyze their relative congruence to prevailing theories to assess the potential effectiveness of the messages and to recommend warning labels for lottery tickets. In addition, we incorporate knowledge used by cognitive psychologists in counselling to create warnings more likely to motivate and sustain behavior change. Importance to the Social Marketing Field Merging academic theory with existent communications ensures better knowledge translation and potentially better outcomes. Introducing verified techniques from Cognitive Behavior Therapy into social marketing initiatives could be a step forward into triggering behavior change. Methods A literature review was conducted to identify and select theoretical models appropriate to guide communications for lottery tickets harmful consumption. Searches were conducted to identify initiatives aiming at persuading and helping at-risk individuals to change their behavior in a healthy manner. Social marketing campaign messages were then compared with theoretical paradigms to identify ways in which campaign messages could be improved. Results Results show campaign messages were relatively consistent with some aspects of the theoretical models. Warning messages provide information that is relevant to the target audience and describe the severity and vulnerability of irresponsible consumption. They also attempt to decrease perceived costs and increase perceived self-efficacy in a variety of ways. Some also attempt to modify cognitive distortions the audience has in respect to chances of winning. However, initiatives should also increase consumers’ perceptions of the response-efficacy by emphasizing their agency, and further enhance individuals’ perception of self-efficacy by incorporating strategies from the Cognitive Model. Recommendations for Research and Practice Academics and practitioners can build on each other’s knowledge on an ongoing basis. By making it default to always consider both theory and practice, initiatives are likely to become more effective. Managers responsible for developing warning messages and implementing social marketing campaigns can experiment with the various theoretical approaches to determine which are comparatively more effective for their situations. Limitations Future research is needed to test the comparative effectiveness of these theories as a basis of creating persuasive warning messages.

External Factors Influencing the Implementation of Policy, System, and Environmental Change Strategies Within Cooperative Extension.

Introduction. Multilevel approaches are important to promote the adoption of healthier practices at the individual and community levels. Cooperative Extension pairs policy, systems, and environmental (PSE) change approaches with direct education programs focused on individual and community health. This study sought to understand Family and Consumer Sciences (FCS) Extension agents' perceptions of PSE change supports, benefits for their communities, and resources and partnerships important for implementation. Method. The Consolidated Framework for Implementation Research was used to develop a survey to assess outer setting domains related to PSE work. In addition to close-ended questions, the survey included several open-ended, qualitative questions exploring the benefits, resources, and relationships required to implement PSE changes. The surveys were collected online from FCS agents in two states. Descriptive statistics were calculated, open responses were coded, and key themes were established. Results. FCS agents (n=116) indicated high levels of agreement about having necessary support from state-level specialists (71%) and the overall Extension organization (64%). The largest gaps in support were reported as grant or external funding sources, time, and county programming funds. Half of the sample agreed that PSE training was adequate, but only 38.5% reported previously participating in PSE-specific training. Open-ended question responses revealed diverse relationships and numerous benefits of PSE work, including more sustainable health behavior changes and greater local Extension visibility. Discussion. Our findings corroborate previous work and identify potential gaps that future interventions can address to better support Extension and public health professionals when implementing PSE work at the community level.

Enhancing stroke knowledge among youth: Insights from Stroke Busters

IntroductionCommunity stroke education has shown promising results with sustained stroke knowledge and behavioral changes; however less is known about the effects of targeted education towards youth. We developed an interactive educational program for high school students, Stroke Busters, that focuses on stroke prevention, recognizing warning signs, and the importance of seeking prompt care. MethodsThis is a prospective cohort study where students are offered a stroke education program, ‘Stroke Busters’, through the Yale Pathways to Science Program, a Science, Technology, Engineering and Math (STEM) pipeline program for high school students living near New Haven, Connecticut. Students filled out a stroke knowledge survey before, after, and 8-months-post program. Data from four separate sessions were collected (two 5-day programs and two 1-day programs) and scores were compared. Students who returned to help teach were also evaluated with an additional post-test. ResultsThe average pre-program score was 36.9% and post-program was 62.5% (N=67, p<0.001) across all sessions. Between sessions, scores were not significantly different. 8-month post-program scores (n=5) were not significantly different from immediate post-program scores. Students in the role of teaching-assistant had post-program scores of 85.7%. DiscussionHigh school students who participated in Stroke Busters retained stroke knowledge for up to 8 months. The 1-day program showed similar results to the 5-day program, which suggests providing shorter programs to high school students may represent a more feasible opportunity for community stroke prevention. Additionally, including students in a teaching role is a promising way to increase enthusiasm and stroke knowledge for youth. ConclusionStroke Busters was successfully able to educate high school youth about stroke and programs of both 1 and 5-day are equally effective.

How policy satisfaction affects residents’ low-carbon behavior: the mediating role of place attachment

ABSTRACT Policy interventions can effectively promote the public’s low-carbon behaviors (LCBs), provided the public already understands and perceives the policy. The extent to which the public gets to know the policy is easily overlooked in relevant studies. Based on a survey conducted in Hangzhou, China, this paper compares the residents’ satisfaction with the policies promoting LCBs. Furthermore, the impact of different levels of policy satisfaction on the willingness to engage in LCBs with place attachment as a mediator is also investigated. The results show that respondents’ policy satisfaction is moderately high, with female respondents (3.479) slightly higher than males (3.430). The policy satisfaction, from high to low, is administrative regulations (3.515), technical interventions (3.463), information tools (3.457), and economic incentives (3.384). Policy satisfaction has a significant effect on willingness to engage in LCBs and place attachment, and place attachment has a positive effect on willingness to engage in LCBs. Place attachment plays a partial mediating role in the influence path of policy satisfaction on the willingness of LCBs. The study provides insights for policymakers on enhancing policy dissemination and engagement, particularly in the context of gender differences, and offers a comprehensive view of the dynamics driving sustainable behavior change in urban China.

Comparative study on health behaviors among adolescents with chronic allergic disease before and during COVID-19 using data from the Korean Youth Health Panel Surveys

BackgroundThis study aimed to investigate the changes in the health behaviors and subjective health perception of adolescents with chronic allergic disease, including atopic dermatitis, asthma, and allergic rhinitis, amidst the coronavirus disease 2019 (COVID-19) pandemic in South Korea.MethodsThis study used the 15th (2019) and 17th (2021) raw data obtained from the Korea Youth Risk Behavior Web-based Survey (KYRBWS), conducted by the Ministry of Health and Welfare of South Korea. Data were analyzed using multiple logistic regression with complex sampling using weighted values. Odds ratios with 95% confidence intervals for six health behaviors and subjective health perception were used as the major variables.ResultsSix health behaviors (dietary habits, weight gain, smoking, alcohol consumption, sleep time, and physical activity) changed substantially during COVID-19. There was an increase in the duration of sedentary activities, a slight increase in BMI, and improvements in mental health. Concurrently, there was a decrease in alcohol consumption, sleep duration, and the consumption of sweetened beverages. Despite these improvements in big six health behaviors, adolescents with chronic illnesses continue to perceive themselves as unhealthy.ConclusionsThese findings suggest that the follow-up and monitoring of health behaviors and subjective health perception in adolescents with chronic allergic diseases during the COVID-19 pandemic are necessary. Understanding the mechanisms underlying sustained behavioral change can inform the development of interventions to promote healthy behavior after the pandemic has passed.

Fast Fashion, Sustainability, and Nudge Theory: Examining the Effects of Choice Architecture on Consumption of Sustainable Fashion over Fast Fashion

This study considers ways to increase the consumption of sustainable fashion given the significant environmental and social damages associated with the industry. A series of experiments were conducted examining the impacts of choice architecture (nudges) under field conditions in collaboration with one of Israel’s largest shopping centers. This study sought to identify which interventions at the retail level successfully motivate sustainable fashion behavioral change regarding purchases and willingness to pay more, along with agreement with several statements regarding the climate crisis and sustainable fashion. Among the types of nudges examined in this field study were providing information, increasing accessibility to sustainable alternatives and appealing to social identity in relation to demographics and green self-image. This study found that offering alternatives to consumers constituted the most effective way to “nudge” consumers toward more sustainable purchasing behavior. Nonetheless, this does not negate the contribution of providing information and strengthening social norms regarding sustainable fashion. Additionally, in all groups, most participants reported that they did not know how to distinguish between sustainable and non-sustainable fashion, nor did they believe that the clothes they purchased were actually sustainable. The findings emphasize the need for policies that will increase the accessibility of sustainable fashion.

Modeling engagement with a digital behavior change intervention (HeartSteps II): An exploratory system identification approach

ObjectiveDigital behavior change interventions (DBCIs) are feasibly effective tools for addressing physical activity. However, in-depth understanding of participants’ long-term engagement with DBCIs remains sparse. Since the effectiveness of DBCIs to impact behavior change depends, in part, upon participant engagement, there is a need to better understand engagement as a dynamic process in response to an individual’s ever-changing biological, psychological, social, and environmental context. MethodsThe year-long micro-randomized trial (MRT) HeartSteps II provides an unprecedented opportunity to investigate DBCI engagement among ethnically diverse participants. We combined data streams from wearable sensors (Fitbit Versa, i.e., walking behavior), the HeartSteps II app (i.e. page views), and ecological momentary assessments (EMAs, i.e. perceived intrinsic and extrinsic motivation) to build the idiographic models. A system identification approach and a fluid analogy model were used to conduct autoregressive with exogenous input (ARX) analyses that tested hypothesized relationships between these variables inspired by Self-Determination Theory (SDT) with DBCI engagement through time. ResultsData from 11 HeartSteps II participants was used to test aspects of the hypothesized SDT dynamic model. The average age was 46.33 (SD=7.4) years, and the average steps per day at baseline was 5,507 steps (SD=6,239). The hypothesized 5-input SDT-inspired ARX model for app engagement resulted in a 31.75 % weighted RMSEA (31.50 % on validation and 31.91 % on estimation), indicating that the model predicted app page views almost 32 % better relative to the mean of the data. Among Hispanic/Latino participants, the average overall model fit across inventories of the SDT fluid analogy was 34.22 % (SD=10.53) compared to 22.39 % (SD=6.36) among non-Hispanic/Latino Whites, a difference of 11.83 %. Across individuals, the number of daily notification prompts received by the participant was positively associated with increased app page views. The weekend/weekday indicator and perceived daily busyness were also found to be key predictors of the number of daily application page views. ConclusionsThis novel approach has significant implications for both personalized and adaptive DBCIs by identifying factors that foster or undermine engagement in an individual’s respective context. Once identified, these factors can be tailored to promote engagement and support sustained behavior change over time.

Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial.

Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers. This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel "CommitFit" mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers. This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates "CommitFit," which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits. Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025. This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit. DERR1-10.2196/63505.

Educational Programs for Patients with Diabetes: Challenges and Effectiveness

Diabetes self-management education (DSME) is integral to managing diabetes, a chronic condition affecting millions globally. DSME programs aim to equip patients with essential knowledge and skills to manage their diabetes effectively and enhance their quality of life. This review assesses the challenges and effectiveness of current DSME programs. Key challenges include a lack of individualization, cultural and socioeconomic barriers, inadequate health literacy, and difficulties in achieving sustained behavioral change. Despite these challenges, DSME programs have shown potential in improving clinical outcomes, enhancing quality of life, and being cost-effective. Effective strategies to improve DSME include personalizing education to meet individual needs, integrating behavioral support techniques, addressing cultural and socioeconomic factors, and utilizing digital technologies. Addressing these challenges through tailored, evidence-based approaches and ongoing support can enhance the impact of DSME programs. Future research should focus on refining these strategies and exploring innovative methods to optimize diabetes education. Keywords: Diabetes self-management education (DSME), Diabetes management, Patient education, Behavioral change

A cardiac-rehab behaviour intervention to reduce sedentary time in coronary artery disease patients: the SIT LESS randomized controlled trial

BackgroundHigh sedentary times (ST) is highly prevalent in patients with coronary artery disease (CAD), highlighting the need for behavioural change interventions that effectively reduce ST. We examined the immediate and medium-term effect of the SIT LESS intervention on changes in ST among CAD patients enrolled in cardiac rehabilitation (CR).MethodsCAD patients participating in CR at 2 regional hospitals were included in this randomized controlled trial (1:1, stratified for gender and hospital). The control group received CR, whereas SIT LESS participants additionally received a 12-week hybrid behaviour change intervention. The primary outcome was the change in accelerometer-derived ST from pre-CR to post-CR and 3 months post-CR. Secondary outcomes included changes in ST and physical activity characteristics, subjective outcomes, and cardiovascular risk factors. A baseline constrained linear mixed-model was used.ResultsParticipants (23% female; SIT LESS: n = 108, control: n = 104) were 63 ± 10 years. Greater ST reductions were found for SIT LESS compared to control post-CR (-1.7 (95% confidence interval (CI): -2.0; -1.4) versus − 1.1 (95% CI: -1.4; -0.8) h/day, pinteraction=0.009), but not at 3 months post-CR (pinteraction=0.61). Besides, larger light-intensity physical activity (LIPA) increases were found for SIT LESS compared to control post-CR (+ 1.4 (95% CI: +1.2; +1.6) versus + 1.0 (95% CI: +0.8; +1.3) h/day, pinteraction=0.020). Changes in other secondary outcomes did not differ among groups.ConclusionSIT LESS transiently reduced ST and increased LIPA, but group differences were no longer significant 3 months post-CR. These findings highlight the challenge to induce sustainable behaviour changes in CAD patients without any continued support.Trial registrationNetherlands Trial Register: NL9263. Registration Date: 24 February 2021.

Promoting pro-environmental behaviour spillover through chatbots

Given proper facilitation, pro-environmental behaviour in tourist destinations may spill over to the daily lives of tourists. Recent advancements in conversational artificial intelligence (AI) may lead to the emergence of more effective technology that will encourage people to become more environmentally friendly. However, limited research has been devoted to understanding the complexity of using such technologies for pro-social nudging. This study applies rigorous scale development procedures to test how advanced conversational AI, like chatbots, can be effective in encouraging pro-environmental behaviour spillover. The conceptual model introduces seven factors that predict people’s intention to use the chatbot and three factors that predict their intention to embrace the target behaviour. Performance expectancy and timing were the most significant in predicting the intention of individuals to adopt the technology. Efficiency and government support were the chief drivers of the intention to adopt pro-environmental behaviour. The findings suggest that although introducing a technology-mediated nudging mechanism can trigger people’s intention to behave pro-environmentally, other factors must be fulfilled in order to ensure sustained behaviour change in society.

A social media game to increase physical activity among older adult women: protocol of a randomized controlled trial to evaluate CHALLENGE

BackgroundOlder adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count.MethodsWe will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews.DiscussionBy taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad.Trial registrationClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.

Application of artificial intelligence technology in monitoring students' health: Preliminary results of Syiah Kuala Integrated Medical Monitoring (SKIMM).

Health promoting university is a holistic approach to health that uses higher education settings to create a learning environment that improves the health and well-being of the campus community in a sustainable manner. The utilization of technology such as artificial intelligence (AI) could be one of the main success factors in the implementation of health-promoting universities to increase the effectiveness and efficiency of all stages of activities carried out in health promotion and prevention efforts. Integrated monitoring with the utilization of AI in this program is conducted to evaluate the health status of the students. The Syiah Kuala Integrated Medical Monitoring (SKIMM) has three components of continuous health status evaluation: vital signs, nutritional status, and burnout status. Health status monitoring was conducted continuously for three months among medical students at the Faculty of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia. This system uses the WhatsApp application as a platform to monitor health status. Student health monitoring in this program consists of two main activities: the health measurement phase and the health monitoring phase. The use of the SKIMM system to monitor students' vital signs, nutritional status and burnout status through the use of AI significantly raises students' awareness to conduct timely self-examination and enables sustainable healthy lifestyle behavior change. The adoption of AI technology allows for continuous health promotion to the entire academic community, including students in implementing the health promoting university.

Interventions to reduce sedentary behaviour in adults with type 2 diabetes: A systematic review and meta-analysis.

Treatment and management of Type 2 Diabetes (T2D) includes physical activity, nutrition, and pharmacological management. Recently, the importance of reducing and breaking up sedentary behaviour has become recognized. This review aimed to summarize and synthesize the effectiveness of interventions in reducing and/or breaking up sedentary behaviour and cardiometabolic biomarkers in adults with T2D. A study protocol was preregistered on PROSPERO (CRD42022357281) and a database search (PubMed, EMBASE, Scopus, Web of Science, PsycINFO, SPORTDiscus, CINAHL, and Cochrane Library) was conducted on 16/09/2022 and updated on 03/01/2024. This review followed PRISMA guidelines and study quality was assessed with the Cochrane risk of Bias Tools. Twenty-eight articles were included in the review. The meta-analysis of short-term (Range: 3 hours- 4 days) sedentary behaviour interventions found significant improvement in continuous interstitial glucose measured for 24 hours after the sedentary behaviour intervention compared to control (SMD:-0.819,95%CI:-1.255,-0.383,p<0.001). Similarly, there was a significant improvement in postprandial interstitial glucose after the sedentary behaviour intervention compared to control (SMD:-0.347,95%CI:-0.584,-0.110,p = 0.004). Ten out of eleven longer-term (Range: 5 weeks- 3 years) sedentary behaviour interventions improved at least one measure of sedentary behaviour compared to control. Eight out of eight longer-term sedentary behaviour interventions improved at least one cardiometabolic biomarker compared to control. Reducing sedentary behaviour, independent of physical activity, can improve glycemic control in adults with T2D. Further, sedentary behaviour may be a feasible/ sustainable behaviour change.

‘I’m really glad I did do it and that on balance the extra work was worth it’: A COM-B framework of final year trainees experiences of attaining secondary accreditation in Cognitive Behavioural Therapy on a clinical psychology programme in the UK

Clinical Psychology trainees undertaking the specialised Cognitive Behavioural Therapy (CBT) pathway develop robust CBT competencies and gain secondary accreditation with the British Association for Cognitive and Behavioural Psychotherapy upon qualification from doctoral training. This paper outlines final year trainees’ reflections on their experience of undertaking the pathway. A COM-B model of behaviour change was adopted to consider the process of implementation and avenues for development. Overall, trainees reported being pleased to have left the doctorate with well-honed competencies in CBT. The trainees reported varied opportunities to develop skills, a significant increase in their capability, referred to multiple forms of intrinsic and extrinsic motivations and reported commitment to sustainable behaviour change. Issues relating to working with complexity and across the lifespan were highlighted as areas for further consideration.