Health Behavior Change Theories Research Articles

Abstract IA22: Using risk assessment tools to motivate behavior change

Abstract Epidemiology identifies risk factors for cancer and other diseases based on the idea that conveying such information to healthcare providers, the general public, and policy makers will result in population-wide improvements in healthy behaviors and, consequently, population-wide improvements in health outcomes. These actions assume that the audience understands and uses the information to make health-related decisions. However, the language of epidemiology, which is steeped in probabilistic thinking, is not necessarily the language of the general public. Furthermore, growing evidence suggests that the language of epidemiology is not particularly well-understood by policy makers or even, disconcertingly, by some healthcare providers. This presentation will accomplish three objectives. First, it will demonstrate how a user-friendly, Internet-based, personalized risk assessment tool that uses established principles of risk communication and is grounded in health behavior change theories can increase motivation to change behavior. It will accomplish this in the context of using Your Disease Risk to inform women about the association between physical activity and breast cancer risk. Second, it will illustrate the development of a novel personalized risk assessment tool that increases understanding of the link between lifestyle behaviors and overall health and wellness. Specifically, it translates cumulative incidence data about five diseases that cause significant morbidity and mortality (i.e., colon cancer, breast cancer (women), heart disease, diabetes, and stroke) into a tool that conveys personalized risk estimates in a comprehensible and useful way for laypeople from diverse socio-demographic backgrounds. The premise is that illustrating how a single behavior can affect the likelihood of developing several diseases could foster a more coherent and meaningful picture of the behavior's importance in reducing health risks and could increase motivation to engage in the behavior. The behavioral context for this study is also physical activity. Third, this presentation discuss the limits of tools that convey only risk information and do not help users bridge the gap between wanting to change their behavior and having the knowledge, skills, and confidence to actually initiate and maintain such changes. Citation Format: Erika A. Waters. Using risk assessment tools to motivate behavior change. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr IA22.

Stages of change in audiology: comparison of three self-assessment measures

Objective: In a clinical setting, theories of health behaviour change could help audiologists and other hearing health care professionals understand the barriers that prevent people with hearing problems to seek audiological help. The transtheoretical (stages of change) model of health behaviour change is one of these theories. It describes a person’s journey towards health behaviour change (e.g. seeking help or taking up rehabilitation) in separate stages: precontemplation, contemplation, preparation, action, and, finally, maintenance. A short self-assessment measure of stages of change may guide the clinician and facilitate first appointments. This article describes correlations between three stages of change measures of different lengths, one 24-item and two one-item. Design: Participants were recruited through an online hearing screening study. Adults who failed the speech-in-noise recognition screening test and who had never undergone a hearing aid fitting were invited to complete further questionnaires online, including the three stages of change measures. Study sample: In total, 224 adults completed the three measures. Results: A majority of the participants were categorised as being in one of the information- and help-seeking stage of change (contemplation or preparation). The three stages of change measures were significantly correlated. Conclusions Our results support further investigating the use of a one-item measure to determine stages of change in people with hearing impairment.

Health Behavior Change Theories in Physical Activity Pins on Pinterest: A Content Analysis

Health Behavior Change Theories in Physical Activity Pins on Pinterest: A Content Analysis

Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis.

BackgroundThere is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory.ObjectivesThe objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT.MethodsA content analysis was conducted on pins collected from Pinterest identified with the search terms “nutrition infographic” and “healthy eating infographic.” The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05).ResultsThe mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT.ConclusionsThese findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information.

Environmental and psychosocial correlates of objectively measured physical activity among older adults.

Neighborhood environments can support or hinder physical activity especially as health declines with age. This study puts psychological theories of health behavior change in context with built environment research to better understand the interplay of environmental and psychosocial characteristics impacting older adults' sedentary behavior and physical activity. The Active Streets, Active People study recruited 193 older adults living in a highly walkable neighborhood in Vancouver, British Columbia, Canada. Participants completed questionnaires on attitudes toward walking, behavioral control for walking, and perceived built environment variables. To assess behavior, participants wore an ActiGraph GT3X + accelerometer for 7 consecutive days. Regression-based path analysis was conducted to examine whether the link between the perceived environment and behavior is mediated by psychosocial variables. In total, 174 participants had valid accelerometry data (Mage = 70.3, SD = 7.2) and demonstrated a daily average of 525.7 min of sedentary behavior (SD = 65.1) as well as high levels of total physical activity (M = 254.3, SD = 65.1 min/day). Mediation analysis revealed that perceived street connectivity and diversity of land use were negatively related to sedentary behavior, but only indirectly through behavioral control. Similarly, effects of street connectivity and diversity of land use on physical activity were mediated by behavioral control. Results highlighted that the perceived built environment is important for physical activity and sedentary behavior, largely because these environmental perceptions are positively linked to older adults' confidence in walking. By integrating environmental and psychosocial correlates of preventive health behaviors within a theoretical structure, the psychosocial mechanisms through which the environment affects activity can be better understood. (PsycINFO Database Record

Challenges and Creative Strategies in Undergraduate Nursing Education in Maternal-Child Health.

Maternal-child health (MCH) is an integral part of most nursing undergraduate curricula. However, there are variations in implementation related to classroom and clinical experiences. The purpose of this article is to describe recent trends in MCH education, explore potential challenges, and highlight creative solutions for MCH nursing education. Perinatal nursing requires a solid skill base and sound knowledge base in many subjects, including health promotion and behavior change theory. Educators need to provide students with a firm educational foundation to meet both workforce demands and the needs of childbearing women, infants, and families.

Developing an evidence-based fall prevention curriculum for community health workers.

This perspective paper describes processes in the development of an evidence-based fall prevention curriculum for community health workers/promotores (CHW/P) that highlights the development of the curriculum and addresses: (1) the need and rationale for involving CHW/P in fall prevention; (2) involvement of CHW/P and content experts in the curriculum development; (3) best practices utilized in the curriculum development and training implementation; and (4) next steps for dissemination and utilization of the CHW/P fall prevention curriculum. The project team of CHW/P and content experts developed, pilot tested, and revised bilingual in-person training modules about fall prevention among older adults. The curriculum incorporated the following major themes: (1) fall risk factors and strategies to reduce/prevent falls; (2) communication strategies to reduce risk of falling and strategies for developing fall prevention plans; and (3) health behavior change theories utilized to prevent and reduce falls. Three separate fall prevention modules were developed for CHW/P and CHW/P Instructors to be used during in-person trainings. Module development incorporated a five-step process: (1) conduct informal focus groups with CHW/P to inform content development; (2) develop three in-person modules in English and Spanish with input from content experts; (3) pilot-test the modules with CHW/P; (4) refine and finalize modules based on pilot-test feedback; and (5) submit modules for approval of continuing education units. This project contributes to the existing evidence-based literature by examining the role of CHW/P in fall prevention among older adults. By including evidence-based communication strategies such as message tailoring, the curriculum design allows CHW/P to personalize the information for individuals, which can result in an effective dissemination of a curriculum that is evidence-based and culturally appropriate.

Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine.

Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of eHealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the “chronic care management” challenge in both traditional and mHealth settings.

Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps.

BackgroundThousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories.ObjectiveThis study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps.MethodsThe research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems.ResultsA total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps.ConclusionsMobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice.

The Handbook of Health Behavior Change (4th ed.)

The fourth edition of the Handbook of Health Behavior Change, edited by Riekert, Ockene, and Pbert (2014), provides updated information and evidence, from over 60 contributing authors, concerning health behavior change, health management, and the obstacles and avenues to both. The text is divided into six sections: (1) Theoretical Models of Health Behavior Change; (2) Barriers to and Facilitators of Lifestyle Change and Disease Management; (3) Lifestyle Change/Disease Prevention Interventions; (4) Chronic Disease Management Interventions; (5) Community, System, and Provider Interventions to Support Health Behavior Change; and (6) Health Behavior Change Research Methodology. The authors provide the reader with a spectrum of theories and interventions ranging from individual to population-based models, each framed with current empirical literature. The reader is given the opportunity to compare and contrast each theory or intervention method as the authors present each in an objective, well-articulated manner. The stated goal of this fourth edition is to provide relevant contemporary information pertaining to theories, challenges, and interventions to promoting and maintaining health behavior change to both researchers and practitioners alike. The authors and editors achieved their goal by using a thoughtful progression from overarching theories of health behavior change to specific examples of interventions and research methodology, in a manner that is both commonsensical and easy to follow. This edition improves on previous editions by incorporating chapters addressing current practices in health behavior change, focusing on “the need to implement and disseminate interventions in real-world setting” (Preface). More so than previous editions, this version underscores the persistence of health disparities over a vast array of health conditions and a pressing need to work toward eliminating such disparities.

Stages of change in adults who have failed an online hearing screening.

Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

A Dyadic Action Control Trial in Overweight and Obese Couples (DYACTIC).

BackgroundEnhancing physical activity in overweight and obese individuals is an important means to promote health in this target population. The Health Action Process Approach (HAPA), which was the theoretical framework of this study, focuses on individual self-regulation variables for successful health behavior change. One key self-regulation variable of this model is action control with its three subfacets awareness of intentions, self-monitoring and regulatory effort. The social context of individuals, however, is usually neglected in common health behavior change theories. In order to integrate social influences into the HAPA, this randomized controlled trial investigated the effectiveness of a dyadic conceptualization of action control for promoting physical activity.Methods/DesignThis protocol describes the design of a single-blind randomized controlled trial, which comprises four experimental groups: a dyadic action control group, an individual action control group and two control groups. Participants of this study are overweight or obese, heterosexual adult couples who intend to increase their physical activity. Blocking as means of a gender-balanced randomization is used to allocate couples to conditions and partners to either being the target person of the intervention or to the partner condition. The ecological momentary intervention takes place in the first 14 days after baseline assessment and is followed by another 14 days diary phase without intervention. Follow-ups are one month and six months later. Subsequent to the six-months follow-up another 14 days diary phase takes place.The main outcome measures are self-reported and accelerometer-assessed physical activity. Secondary outcome measures are Body Mass Index (BMI), aerobic fitness and habitual physical activity.DiscussionThis is the first study examining a dyadic action control intervention in comparison to an individual action control condition and two control groups applying a single-blind randomized control trial. Challenges with running couples studies as well as advantages and disadvantages of certain design-related decisions are discussed. This RCT was funded by the Swiss National Science Foundation (PP00P1_133632/1) and was registered on 27/04/2012 at http://www.isrctn.com/ISRCTN15705531.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1321) contains supplementary material, which is available to authorized users.

Development and validation of the attitudes toward outdoor play scales for children

The natural world has long been associated with health and described as a therapeutic landscape, and a growing body of research demonstrates the benefits of interacting with nature for mental and physical health. However, concern is growing that children have lost connection to the natural world and spend less time outdoors, despite the known health benefits of doing so. It is likely that healthy behaviors related to engagement with nature are mediated by beliefs about the value and safety of play in nature. While the literature abounds with qualitative examinations of children's attitudes toward outdoor play, there exist few instruments to quantitatively measure these attitudes. Informed by health behavior change theories, we describe the development and validation of the Attitudes toward Outdoor Play (ATOP) scales. As part of a community-academic partnership project called More Than a Pretty Place, the development of the ATOP scales unfolded in stages: (1) item generation based on a comprehensive literature review and consensus among the project team, (2) interviews with environmental educators, (3) initial pilot testing, (4) scale refinement, (5) administration during 2012 and 2013 to a sample of school children ages 9–13 (n = 362) in Milwaukee, WI, USA, and (6) quantitative psychometric evaluation. Two distinct scales emerged: ATOP-benefits (alpha = 0.79) and ATOP-fears (alpha = 0.79). Validity analyses found that both scales correlated as expected with measures of engagement in outdoor play, parental support for outdoor play, and sedentary behaviors. The ATOP scales are reliable and valid instruments for measuring attitudes toward outdoor play that may mediate children's outdoor activity in natural settings. The ATOP scales could be useful for evaluating the effects of programming, such as environmental education programming, on improving children's attitudes toward the benefits of nature and reducing their fears, and may predict more distal outcomes including engagement in outdoor activity.

The influence of social networking sites on health behavior change: a systematic review and meta-analysis.

Our aim was to evaluate the use and effectiveness of interventions using social networking sites (SNSs) to change health behaviors. Five databases were scanned using a predefined search strategy. Studies were included if they focused on patients/consumers, involved an SNS intervention, had an outcome related to health behavior change, and were prospective. Studies were screened by independent investigators, and assessed using Cochrane's 'risk of bias' tool. Randomized controlled trials were pooled in a meta-analysis. The database search retrieved 4656 citations; 12 studies (7411 participants) met the inclusion criteria. Facebook was the most utilized SNS, followed by health-specific SNSs, and Twitter. Eight randomized controlled trials were combined in a meta-analysis. A positive effect of SNS interventions on health behavior outcomes was found (Hedges' g 0.24; 95% CI 0.04 to 0.43). There was considerable heterogeneity (I(2) = 84.0%; T(2) = 0.058) and no evidence of publication bias. To the best of our knowledge, this is the first meta-analysis evaluating the effectiveness of SNS interventions in changing health-related behaviors. Most studies evaluated multi-component interventions, posing problems in isolating the specific effect of the SNS. Health behavior change theories were seldom mentioned in the included articles, but two particularly innovative studies used 'network alteration', showing a positive effect. Overall, SNS interventions appeared to be effective in promoting changes in health-related behaviors, and further research regarding the application of these promising tools is warranted. Our study showed a positive effect of SNS interventions on health behavior-related outcomes, but there was considerable heterogeneity. Protocol registration The protocol for this systematic review is registered at http://www.crd.york.ac.uk/PROSPERO with the number CRD42013004140.

Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

Purpose: The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET). Methods: Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept. Results: Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven “tool box” for designing complex BET programmes to promote PA. Conclusion: The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET.Implications for RehabilitationIrrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity.Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge.Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity.To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.

Combining Users’ Needs With Health Behavior Models in Designing an Internet- and Mobile-Based Intervention for Physical Activity in Cardiac Rehabilitation

BackgroundInternet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions.ObjectiveThe aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention.MethodsWe explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data.ResultsWe chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail.ConclusionsWe applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input.Trial RegistrationClinicaltrials.gov NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6M5FqT9Q2).

Diet behaviour among young people in transition to adulthood (18–25 year olds): a mixed method study

Background: Young people (18–25 years) during the adolescence/adulthood transition are vulnerable to weight gain and notoriously hard to reach. Despite increased levels of overweight/obesity in this age group, diet behaviour, a major contributor to obesity, is poorly understood. The purpose of this study was to explore diet behaviour among 18–25 year olds with influential factors including attitudes, motivators and barriers. Methods: An explanatory mixed method study design, based on health Behaviour Change Theories was used. Those at University/college and in the community, including those Not in Education, Employment or Training (NEET) were included. An initial quantitative questionnaire survey underpinned by the Theory of Planned Behaviour and Social Cognitive Theory was conducted and the results from this were incorporated into the qualitative phase. Seven focus groups were conducted among similar young people, varying in education and socioeconomic status. Exploratory univariate analysis was followed by multi-staged modelling to analyse the quantitative data. ‘Framework Analysis’ was used to analyse the focus groups. Results: 1313 questionnaires were analysed. Self-reported overweight/obesity prevalence was 22%, increasing with age, particularly in males. Based on the survey, 40% of young people reported eating an adequate amount of fruits and vegetables and 59% eating regular meals, but 32% reported unhealthy snacking. Based on the statistical modelling, positive attitudes towards diet and high intention (89%), did not translate into healthy diet behaviour. From the focus group discussions, the main motivators for diet behaviour were ‘self-appearance’ and having ‘variety of food’. There were mixed opinions on ‘cost’ of food and ‘taste’. Conclusion: Elements deemed really important to young people have been identified. This mixed method study is the largest in this vulnerable and neglected group covering a wide spectrum of the community. It provides evidence base to inform tailored interventions for a healthy diet within this age group.

Effects of an Individually Tailored Web-Based Chronic Pain Management Program on Pain Severity, Psychological Health, and Functioning

BackgroundIt is estimated that 30% of adults in the United States experience daily chronic pain. This results in a significant burden on the health care system, in particular primary care, and on the workplace. Chronic pain management with cognitive-behavioral psychological treatment is effective in reducing pain intensity and interference, health-related quality of life, mood, and return to work. However, the population of individuals with chronic pain far exceeds the population of therapists that can provide this care face-to-face. The use of tailored, Web-based interventions for the management of chronic pain could address limitations to access by virtue of its unlimited scalability.ObjectiveTo examine the effects of a tailored Web-based chronic pain management program on subjective pain, activity and work interference, quality of life and health, and stress.MethodsEligible participants accessed the online pain management program and informed consent via participating employer or health care benefit systems; program participants who completed baseline, 1-, and 6-month assessments were included in the study. Of the 645 participants, the mean age was 56.16 years (SD 12.83), most were female (447/645, 69.3%), and white (505/641, 78.8%). Frequent pain complaints were joint (249/645, 38.6%), back (218/645, 33.8%), and osteoarthritis (174/654, 27.0%). The online pain management program used evidence-based theories of cognitive behavioral intervention, motivational enhancement, and health behavior change to address self-management, coping, medical adherence, social support, comorbidities, and productivity. The program content was individually tailored on several relevant participant variables.ResultsBoth pain intensity (mean 5.30, SD 2.46), and unpleasantness (mean 5.43, SD 2.52) decreased significantly from baseline to 1-month (mean 4.16, SD 2.69 and mean 4.24, 2.81, respectively) and 6-month (mean 3.78, SD 2.79 and mean 3.78, SD 2.79, respectively) assessments (P<.001). The magnitude of the 6-month effects were large. Trends for decreases in pain interference (36.8% reported moderate or enormous interference) reached significance at 6 months (28.9%, P<.001). The percentage of the sample reporting fair or poor quality of life decreased significantly from 20.6% at baseline to 16.5% at 6 months (P=.006).ConclusionsResults suggest that the tailored online chronic pain management program showed promising effects on pain at 1 and 6 months posttreatment and quality of life at 6 months posttreatment in this naturalistic study. Further research is warranted to determine the significance and magnitude of the intervention’s effects in a randomized controlled trial.

Active Assistance Technology Reduces Glycosylated Hemoglobin and Weight in Individuals With Type 2 Diabetes: Results of a Theory-Based Randomized Trial

Type 2 diabetes is an individual health challenge requiring ongoing self-management. Remote patient reporting of relevant health parameters and linked automated feedback via mobile telephone have potential to strengthen self-management and improve outcomes. This research involved development and evaluation of a mobile telephone-based remote patient reporting and automated telephone feedback system, guided by health behavior change theory, aimed at improving self-management and health status in individuals with type 2 diabetes. This research comprised a randomized controlled trial. Inclusion criteria were diagnosis of type 2 diabetes, elevated glycosylated hemoglobin (HbA1c) levels (range, 6.5-11%) or use of oral diabetes medication, and 30-70 years of age. Intervention subjects (n=24) participated in remote patient reporting of health status parameters and linked health behavior change feedback. Control participants (n=24) received standard of care including diabetes education and healthcare provider counseling. Patients were followed for approximately 10 months. Intervention participants achieved, compared with controls and controlling for baseline, a significantly greater mean reduction in HbA1c of -0.40% (95% confidence interval [CI] -0.67% to -0.14%) versus 0.036% (95% CI -0.23% to 0.30%) (P<0.03) and significantly greater weight reduction of -2.1 kg (95% CI -3.6 to -0.6 kg) versus 0.4 kg (95% CI -1.1 to 1.9 kg). Nonsignificant trends for greater intervention compared with control improvement in systolic and diastolic blood pressure were observed. Sophisticated information technology platforms for remote patient reporting linked with theory-based health behavior change automated feedback have potential to improve patient outcomes in type 2 diabetes and merit scaled-up research efforts.

OP0022-HPR Developing an Intervention on the Internet for Health Enhancing Physical Activity Behavior in Individuals with Rheumatoid Arthritis: Patients’ Experiences and Innovations

BackgroundDespite the growing evidence for the benefits of physical activity in the population of rheumatoid arthritis (RA), the majority does not meet the recommendations of health enhancing physical activity (HEPA)....