Sustained Behavior Change Research Articles

Fostering sustainable development goals through gamification

Abstract Modern challenges require modern solutions. The recent introduction of gamification in businesses’ organisational processes represents a change of route for managerial and accounting practices. In this context, the challenges addressed by the United Nations Agenda 2030 are still marginal and difficult to achieve for many businesses. Following the experience of an innovative small-medium enterprise named ‘AWorld’, this study aims to explore how gamification can be both a tool of contribution and accountability towards sustainable development goals. Specifically, by tracking the progress and offering rewards, gamification can provide a tangible incentive to motivate sustained engagement and behaviour change. A case study has been developed and insights collected and triangulated through an interview with the corporate president. Findings revealed how incorporating gamification in the small- and medium-sized enterprises context is a valuable way to promote sustainable development goals and foster a sense of communal responsibility towards sustainable behaviours among employees and external individuals.

Factors impacting emergency department clinicians’ peripheral intravenous catheter practice: A qualitative analysis

BackgroundPeripheral intravenous catheters (PIVCs) are commonly used devices in emergency departments (EDs), and yet relatively little is known about factors influencing Australian clinicians’ adherence to the national PIVC quality and safety Standard. AimsTo explore attitudes and experiences of ED clinicians around PIVC insertion and care processes. MethodsThis study used an exploratory qualitative approach to analyse written responses to open-ended questions included in an online national (mixed data) survey. Snowballing methods were used to gather responses. Deductive analysis was used to analyse open-ended questions regarding practice and Standard adherence. ResultsThere were 340 written responses, mainly from nurses in public EDs, who reported suboptimal practices regarding idle catheters, lack of patient participation in care, antecubital fossa insertion, multiple insertion attempts, inadequate site preparation, poor documentation and insufficient review of PIVC. The main factors inhibiting ED clinicians from adhering to the Standard includes inadequate knowledge, perceptions of infeasibility, disbelief in evidence, ambiguous responsibilities, habitual practice, insufficient training, lack of recognition of good practice and inadequate engagement. ConclusionThe factors that impact ED clinicians’ PIVC Standard adherence are complex and multifactorial. Strategies and interventions are needed to facilitate the implementation of the Standard into daily practice and achieve sustainable behaviour change.

Development and evaluation of a tailored mHealth parenting program for multicultural families: a three-arm cluster randomized controlled trial.

Health management of children during early childhood requires substantial information. Multicultural families find it difficult to obtain and use parenting-relevant information for their young children. This study aimed to develop, implement, and evaluate a tailored Health parenting program and lay-health workers' support to improve children's health in multicultural families in Korea. In this study, we employed the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model as the conceptual framework, guiding the creation of a tailored mHealth application supplemented by a lay-health worker support module. The efficacy of the program was assessed through an experimental three-arm cluster randomized controlled trial. A total of 101 participants were stratified into three distinct groups as follows: (1) Experimental Group A, which received the mHealth program alongside the lay-health worker support component; (2) Experimental Group B, exposed solely to the mHealth program; and (3) Control Group, devoid of any intervention. Within these groups, 101 marriage migrant women hailing from Vietnam, the Philippines, and China were incorporated, with each group comprising 33, 30, and 38 participants, respectively. The study's primary endpoint encompassed a comprehensive assessment of health-promoting behaviors, proficiency in eHealth literacy, and the family strength. The analysis revealed noteworthy interactions among the three distinct groups over the course of time, with implications for health-promotion behaviors (p = 0.041), eHealth literacy (p = 0.037), and family strength (p = 0.044). Specifically, the experimental groups exhibited substantially elevated levels of the specified outcome variables when contrasted with the control group. Notably, the positive effects persisted even up to 12 weeks subsequent to the conclusion of the intervention, underscoring the program's capacity to foster enduring improvements in the observed metrics. This study highlights the benefits of offering contextually appropriate information to target groups constrained by challenges in information access, evaluation, and utilization. Notably, drawing from their positive experiences in this process, we underscore the importance of employing lay health workers. These workers play a crucial role in fostering and ensuring sustained behavioral changes.

Terms around Female Same-Sex Sexual Relationships: Resource for Social Behavior Change Communication Interventions Targeting Women Who Have Sex with Women in Tanzania

Social behavioral change communication interventions in Tanzania target populations engaging in high- risk sex behaviors and practices: anal intercourse, sex work, injecting drugs and male same sex relationships excluding women who have sex with women (WSW) or women who identify lesbians. In this paper, I describe terms used in reference to female same-sex sex or sexual relationships, important in health social behavior change communication targeting WSW in Tanzania. Data presented are part of cross-sectional descriptive and retrospective formative study among WSW conducted in Dar-es-Salaam region, Tanzania in 2021. WSW aged 18 and above, stayed in Dar-es-Salaam for six months or more; had had sexual contact with a woman in the past year participated in this study. Participants were recruited via snowball method. Community leaders/members and managers of NGOs/institution supporting WSW were purposively selected to take part in this study. Researchers used four methods to generated data needed for this study: focus group discussion, in-depth interviewing, observation and collecting WSW’s life stories. Content data analysis was conducted to create categories of terms around female same-sex sex or sexual relationships reported by study participants. Four categories of terms around female same-sex sex or sexual relationships emerged: terms referring to women who identify WSW or lesbians; terminologies referring to female same-sex sex; terms referring to female same-sex-related behaviors and practices; and terminologies referring to items/materials used during female same-sex sex. I conclude WSW in Dar-es-Salaam have coined terms that express their socially- created world. I recommend social behavior change communication programmers in the health education and promotion context to use these terms in developing comprehensive and WSW-friendly research protocols for sustainable behavior change among WSW and the public towards making female same-sex sex safe for reduced ....

Apathy as a determinant of health behaviors in older adults: Implications for dementia risk reduction.

Long-term improvements in physical inactivity and other behavioral risk factors are integral to dementia risk reduction; however, sustained behavior change is challenging. Apathy, depression, and fatigue may impact engagement in health behaviors, but their presentation overlaps. This study investigates whether these symptoms are differentially associated with multiple health behaviors. In 1037 community-dwelling older adults without dementia (aged 70-90, 55% women), regression analyses examined apathy, depression, and fatigue as predictors of health behaviors (physical activity, diet, alcohol, smoking) and a behavioral risk index. Apathy was associated with reduced physical activity and alcohol use, and one or multiple behavioral risk factors. No or inconsistent relations were found between depression or fatigue and health behaviors. Apathy is relevant to multiple health behaviors and should be considered when designing health promotion for older adults, including interventions for dementia risk reduction. Findings highlight the importance of distinguishing apathy from comorbid symptoms. Novel theory-based perspective on behavioural risk factors for dementia.Higher apathy predicted less physical activity and alcohol use, and increased odds of lifestyle risk factors.Depressive symptoms were not associated with any health behavior.Apathy may be a determinant of multiple health behaviors in older adults, distinct from depression and fatigue.Considering apathy in precision prevention of dementia appears warranted.

EDUKASI BAHAYA BULLYING KALANGAN PELAJAR DI SMPN 3 PELALAWAN

This article discusses education about the dangers of bullying at SMPN 3 Pelalawan. The goal is to increase student awareness of the negative effects of bullying. Activities involve students and use interactive lecture methods. The main focus includes understanding the concepts, signs, and handling of bullying. The results showed an increase in students' understanding of the concept of bullying to 85%, and the ability to recognize signs from 60% to 80%. 75% of students are also able to mention steps to prevent and deal with bullying. This success creates a safer and more inclusive school environment. The article recommends approaches such as open and in-depth discussion to overcome resistance. In the Future suggests focusing on in-person interactions, such as group discussions and simulated bullying. Engaging teachers, parents and measuring long-term impact is important for sustainable behavior change. With a more adaptive approach, it is hoped that this activity will remain effective in overcoming bullying in the future

취침 전 스마트기기 사용 감소를 위한 디자인 개입 연구

Due to the rapid proliferation of various smart devices in recent times, the usage of smart devices has been increasing rapidly. Particularly, the time spent using smart devices before bedtime constitutes a significant portion of overall smart device usage. Excessive use of smart devices before bedtime has negative effects on physical, mental, and social aspects. Therefore, in this study, we propose methods for bringing a behavior change based on behavioral theory, going beyond technology-based physical interventions, with the aim of reducing the usage time of smart devices before sleep. To achieve this, we designed two types of design-led interventions based on the feedback and feedforward concepts of behavioral theory and conducted a three-week long experiment. These proposed interventions were provided to the participants in each experimental group at a specific time (before going to bed). Based on the differences between the two groups, the study discussed the effectiveness of design-led interventions for instigating sustainable behavior change. This study holds significance as it offers practical guidance essential for the development of models and applications that may effectively utilise this particular design strategy.

4 C's Approach to Meaningful and Lasting Positive Behavior Change.

Making intentional and sustainable positive behavior changes is difficult for most individuals. Knowledge and even expert coaching have shown meager results in guiding individuals towards a healthier diet and lifestyle. It is clear from the current research that additional approaches, which can help stem the tide of obesity and other chronic diseases, are needed. This article introduces a systematic process-based approach which focuses on the 4C's, Clarity, Commitment, Compassion, and Consistency. It is essential for individuals to have Clarity before they begin their health journey. Clarity must address, what do I want to change, why, and how am I going to make the change. Commitment highlights the importance of following a process-based approach that focuses on small incremental changes which over time can lead to remarkable results. Compassion is the necessary ingredient which allows individuals to continue the journey despite setbacks. By staying committed to the process, by practicing self-compassion, and by finding a healthy community, the individual is slowly able to achieve Consistency in achieving and then maintaining a healthier diet and lifestyle.

Food Is Medicine: A Presidential Advisory From the American Heart Association.

Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans. Food Is Medicine may be defined as the provision of healthy food resources to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. Although the field has promise, relatively few studies have been conducted with designs that provide strong evidence of associations between Food Is Medicine interventions and health outcomes or health costs. Much work needs to be done to create a stronger body of evidence that convincingly demonstrates the effectiveness and cost-effectiveness of different types of Food Is Medicine interventions. An estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical care for chronic disease. For many of these diseases, diet is a major risk factor, so even modest improvements in diet could have a significant impact. This presidential advisory offers an overview of the state of the field of Food Is Medicine and a road map for a new research initiative that strategically approaches the outstanding questions in the field while prioritizing a human-centered design approach to achieve high rates of patient engagement and sustained behavior change. This will ideally happen in the context of broader efforts to use a health equity-centered approach to enhance the ways in which our food system and related policies support improvements in health.

Technology-Enabled Interventions for Sustaining Behaviour Change in Adolescents: A Scoping Review for Research Gaps

Long-term behaviour change for adolescents plays an important role in improving the adolescent's future health. However, long-term behaviour changes are rarely sustained. This study aims to inform human-computer interaction researchers of the current state of research regarding the designing of technology-enabled interventions for sustaining behaviour change for adolescents, as well as provide recommendations for future research directions. Through a scoping review, 22 interventions were identified and analysed to report the behaviour change strategies, characteristics, levels of influence, and formats of technology used, as well as the frameworks used to develop these interventions. Based on the review's findings, three research gaps were identified: (1) the exploration of approaches to restructuring the environment; (2) the exploration of the effects of varying levels of social interactivity between people; and (3) the development of frameworks for building interventions.

When sustainability aligns with adolescent motives: development and validation of the Sustainability Motive-Alignment Scale (SMAS)

The sustainability motive-alignment hypothesis posits that adolescents will be motivated to act sustainably when they view sustainable behavior as aligned with their motives for autonomy and peer status. Based on this hypothesis, we developed the Sustainability Motive-Alignment Scale (SMAS), a brief self-report scale of individual differences in sustainability motive-alignment. In four studies across two relatively individualistic (U.S., Netherlands) and two relatively collectivistic countries (China, Colombia), the SMAS was reliable and valid as a single-factor scale; measurement invariant in terms of age and genders but measurement noninvariant in terms of culture, suggesting cultural differences in adolescents’ construals of sustainability motive-alignment; and positively associated with measures of sustainable attitudes, norms, self-efficacy, behavior, and climate change knowledge. Thus, sustainability motive-alignment can be assessed as a conceptually distinct psychological dimension underlying adolescents’ sustainable tendencies. We hope that our brief, psychometrically sound instrument will spark developmentally informed research on the psychological underpinnings of adolescent sustainability.

Time Perspective, Dietary Behavior, and Glycemic Control in Patients With Type 2 Diabetes.

Dietary behavior is a key component in the self-management of patients with Type 2 diabetes (T2DM), as it is essential for glycemic control and preventing diabetic complications. However, it is challenging for patients with diabetes to make sustainable dietary behavior changes and achieve long-term optimal glycemic control. Dietary behavior changes involve present efforts to achieve future benefits. The primary aim of this study was to investigate the relationships among time perspective, dietary behaviors, and health outcomes in patients with T2DM. Based on the temporal self-regulation theory and previous research, the secondary aim of the study was to explore how time perspective influences dietary behaviors. Following convenient sampling ( N = 329), a cross-sectional study was conducted in patients with T2DM between November 2021 and October 2022. Data were collected using self-reported questionnaires and the retrieval of clinical information from medical records. Hierarchical regression and path analysis were used to explore the relationships among study variables. Our analyses showed that a future-oriented time perspective was associated with better dietary behavior but was not significantly related to hemoglobin A1c. Hierarchical regression analysis also demonstrated that having a more future-oriented time perspective was associated with healthier dietary behavior after controlling covariates. Based on the theory and path analysis, there was an indirect effect of future time perspective on dietary behavior through self-control capacity and intention. The study reveals that a future-oriented time perspective can promote healthier dietary behavior when providing care for patients with T2DM. As a theoretical framework, the temporal self-regulation theory offers references for researchers and clinicians to take into consideration patients' time perspectives and their intentions and self-control capacity when developing interventional programs to improve dietary behaviors.

Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes.

Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients' self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients' self-management behaviors. This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients' adoption of self-management behaviors, as well as elicit suggestions for improvement. This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients' reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients' attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change.

Optimistic narrative future visions: a communication tool for promoting sustainable (plastic) behavior.

Plastic pollution is a pressing global issue, necessitating a focus on consumer behavior to curb this problem at its source. To effectively promote sustainable practices, communication strategies that employ future visions have gained attention. This study examines the effects of a narrative video intervention depicting an optimistic future vision concerning single-use plastic bag consumption in South Africa, compared to a representation of the prevailing status quo. Using a preregistered within-subject design, we assess the psychological and emotional responses to two scenarios of which one is illustrating adaptive behaviors toward reduced plastic bag usage, and the other showcasing current consumption patterns. Parametric analyses revealed a shift in emotional states, characterized by a greater experience of positive emotions and a reduced experience of negative emotions following the exposure to the optimistic future scenario video, as compared to the status quo video. Moreover, engagement with the optimistic future scenario was associated with higher levels of perceived behavioral control and behavioral intentions. No significant changes were found regarding sense of responsibility. These findings point to the potential of optimistic future visions to influence individuals at psychological and emotional levels. This renders optimistic future vision communication as an effective tool for sustainable behavior change, particularly in relation to the sustainable use of plastic shopping bags.

O.5.2-9 Development of an active lifestyle intervention to promote physical activity sustainably in stroke patients: study design

Abstract Purpose Physical inactivity is a major public health concern and a growing problem among stroke patients. Despite existing interventions, current approaches are not successful in promoting physical activity sustainably in stroke patients, particularly when transitioning from clinical care to the home environment. In co-creation with patients and healthcare professionals, this study develops an active lifestyle intervention, tailored to patients' personal, social, and environmental determinants, to promote an active lifestyle in their own living environment. Methods A co-creative design-based approach will be used for the development of an active lifestyle intervention. The design process involved collaboration with stroke patients, physiatrists, physiotherapists, lifestyle coaches and health behavior professionals. A classic design thinking process will be used to structure the research activities in five phases: empathize, define, ideate, prototype, and test phases. To gather the needs and requirements for the intervention, interviews (n = 15) and focus group sessions (n = 15) will be held. An iterative process of prototyping will lead to a final version of the active lifestyle intervention. Results At the conference, our team will be able to present the design of the study, focusing in particular on the aspect of engaging patients to co-create the design-based intervention so that patients’ personal, social and environmental determinants for sustained behavior change in the home environment can be adhered to. Conclusion Designing an active lifestyle intervention together with patients and professionals, using the co-creative design-based approach, will help to gain deeper insights in the specific needs and requirements of stroke patients transitioning from clinical care to the home environment.

Training of Health Care personnel on Obstetric Violence: An Experience in Togo using the Forum Theatre Technique

Obstetrical Violence (OV) refers to all the disrespectful treatments and mistreatments inflicted on women during pregnancy and childbirth by health professionals. It can be physical, psychological or discriminatory, related to a lack of consent or respect, an abandonment of care or detention in the health structure in case of unpaid fees [1]. In Togo, OV is multifactorial and contributes to maintaining high maternal mortality by reducing attendance at health facilities [2]. We set up a training program for OV using a participatory technique called forum theater [3], with the nursing staff of maternity hospitals in the Maritime and Plateaux regions. Our study evaluated the potential of forum theater to raise awareness of OV among health care personnel and promote sustainable behavior change. We conducted 15 workshops with 391 professionals (55% of midwives and 25% of birth attendants). Participants completed a questionnaire before and after the intervention, assessing theoretical knowledge about OV and the frequency of violence that could be seen in the services. Participants reported a 33% increase of OV observed in their daily lives (p<0.05), including twice as physical violence and discrimination. This before-and-after difference was even more pronounced for the midwives, with an 80% increase (p<0.05). All concluded that they would change their behavior towards patients. Forum theater thus shows promise for improving providers’ ability to recognize and respond to VO. It is an effective tool to improve the attendance figures at health facilities and reduce maternal mortality in Togo.

Psychometric validity of the Thai version of the Motivation for Healthy Eating Scale in patients with acute coronary syndrome.

Motivation plays a crucial role in lifestyle modifications for disease control and preventing recurrent cardiac events. Higher motivation levels are associated with improved health outcomes, including adherence to a healthy diet and sustained behavior change. However, there is a lack of evaluation of instruments for assessing motivation to adhere to diet recommendations, specifically among patients in Thailand. This study aimed to assess the psychometric validity of the Thai version of the Motivation for Healthy Eating Scale (MHES) in patients with acute coronary syndrome in Thailand. The study was conducted between May and August 2022, involving 200 patients with acute coronary syndrome selected through multistage random sampling from tertiary care institutions in Bangkok, Thailand. The scale was translated from English to Thai using the back-translation method. Principal Component Analysis (PCA) and Cronbach's alpha were employed to evaluate the validity and reliability of the scale. The Thai version of the MHES demonstrated satisfactory reliability with a Cronbach's alpha coefficient of 0.73. The analysis revealed four factors consisting of 16 items: 1) 'integrated and integrated regulation' with seven items, 2) 'intrinsic and external regulation' with three items, 3) 'introjected regulation' with three items, and 4) 'amotivation' with three items. These factors collectively explained 66.78% of the total variance. The findings indicate that the Thai version of the MHES is a reliable and valid instrument for assessing motivation related to dietary behavior among Thai patients with acute coronary syndrome. Nurses and healthcare professionals can use this scale to evaluate the motivation of dietary behavior among this population, thereby facilitating targeted interventions and promoting positive health outcomes.

Sustainable Marketing and its Impact on Society: A Study of Marketing Strategies and Opportunities Promoting Eco-Friendly Lifestyle

In the face of growing environmental concerns and the need for more sustainable practices, businesses increasingly recognize the importance of incorporating sustainability into their marketing strategies. This research paper aims to explore the concept of sustainable marketing and its impact on society, specifically focusing on marketing strategies that promote eco-friendly lifestyles. Through an in-depth analysis of existing literature, case studies, and empirical evidence, this paper investigates how sustainable marketing initiatives shape consumer behavior and foster positive societal changes. The study also examines the various opportunities and challenges businesses encounter while implementing eco-friendly marketing strategies, shedding light on the potential benefits for both the environment and business performance.

Play-able: using play to realise the intent of social design

Design - by its relational nature of connecting people, places and things - is an intrinsically social practice. However, the marked shift from prioritising commercial design objectives to creating constructive opportunities for collective engagement and social change has resulted in the emergence of social design. Viewed as a discursive moment and not a discipline, social design embraces different design approaches and participatory processes; as such, it is not defined by a pre-determined design process or outcome, but rather by its intent of engendering responsibility and social behaviour change. Within this context then, the aim of the paper is to reflect on the way in which play enables designers to realise the intent of their social design practice. To address the aim, the paper first contextualises social design and presents a conceptual framework of play. Secondly, the paper presents South African vignettes of the city and the higher-education design classroom to highlight the practical value play affords design to aid the understanding of social problems in general and advancing agency and ownership for sustained social behaviour change, in particular.

Conventional and living guideline for schizophrenia: barriers and facilitating factors in guideline implementation

This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An online survey was performed under participation of mental healthcare professionals (medical doctors, psychologists/psychotherapists, psychosocial therapists, caregivers) in 17 hospitals for psychiatry in Southern Germany and a professional association for German neurologists and psychiatrists. 524 participants opened the survey, 439 completed the demographic questions and commenced the content-related survey and 309 provided complete data sets. Results indicate a higher occurrence of knowledge-related barriers for the living guideline. The print version is associated with more attitude-related and external barriers. Older professionals reported more attitude-related barriers to a living guideline compared to younger professionals. Differences between professions regarding barriers were found for both formats. Various barriers exist for both guideline formats and a need for facilitators was expressed across professions. Many of the mentioned obstacles and facilitators can be more easily addressed with living guidelines. However, also living guidelines face barriers. Thus, the introduction of these new formats alone cannot lead to sustainable behavior change regarding guideline adherence. Yet, living guidelines seem to be a cornerstone to improved and tailored guideline implementation as they facilitate to keep recommendations up to date and to address the need of individual professional groups.