Theory-based Behavior Research Articles

Mobile Health Applications for Postpartum Depression Management: A Theory-Informed Analysis of Change-Use-Engagement (CUE) Criteria in the Digital Environment.

Postpartum Depression (PPD) is the most common childbirth complication, with approximately 15% of postpartum women experiencing depression symptoms. Mobile applications have potential to expand delivery of mental health interventions. However, our understanding of how these tools engage women with PPD and facilitate positive behavioral changes is limited. In our paper, we analyze 15 commercial PPD applications to understand their role as facilitators of change, engagement, and sustained use. Applications reviewed contained an average of four theory-based behavioral change techniques, and highest patient engagement level reached was to empower patients through patient-generated data. Heuristic violations were identified in areas including user control and freedom, aesthetic and minimalist design, and help and documentation. An inverse correlation was found between the number of theory-based behavior change features and patient engagement. Findings suggest underserved populations may suffer further limitations accessing relevant health resources in the current application market.

Application of the COM-B model to the correlates of children’s outdoor playing and the potential role of digital interventions: a systematic literature review

ABSTRACT Children’s reduced engagement in outdoor playing in recent years has contributed to increasing academic and practice interests in understanding this behavior, as well as investigating the effectiveness of combined social, physical and digital interventions on stimulating children’s outdoor playing. This paper provides a systematic review of recent empirical evidence on the correlates of the outdoor playing behavior of children, ages 4–12. In addition, the potential roles of digital interventions in stimulating children’s outdoor playing are explored. The COM-B behavior change model is used to establish relevant correlates and functions of digital interventions. COM-B model defines behavior as the result of an interaction between three components: capability, opportunity and motivation. This model provides a basis for designing effective behavior change interventions. This paper’s contribution is twofold: it presents the case for adding ‘digital environment’ as a new component of the COM-B model, and it further develops a conceptual framework of different functions of digital interventions aiming at stimulating children’s outdoor playing behavior. The findings contribute to the theory-based behavior change interventions stimulating children’s outdoor playing.

Targeting Physical Inactivity Using Behavioral Theory in Chronic, Disabling Diseases.

Physical inactivity and comorbidities (e.g., hypertension) result in poor prognoses among persons with chronic, disabling conditions including multiple sclerosis, Parkinson disease, and stroke. Theory can guide the design of behavior change interventions that can be delivered remotely for broad scale implementation. We hypothesize that theory-based behavior change interventions can increase physical activity and reduce comorbidities and associated consequences among persons with chronic, disabling conditions.

Promoting Health Behavior Change in the Preconception Period: Combined Approach to Intervention Planning.

BackgroundHalf of women begin pregnancy above the healthy weight range, increasing the risk of complications and adversely affecting the lifelong health of their babies. Maternal obesity remains the strongest risk factor for offspring obesity across childhood, adolescence, and adulthood. Previous research suggests that women should be encouraged to be within a healthy weight range before conception to improve health outcomes.ObjectiveWe outlined the intervention planning and design process to develop an evidence-informed eHealth intervention to promote weight management. The intervention, based on psychological theories and behavior change techniques, has been developed for women affected by overweight or obesity who intend to become pregnant. The Begin Better web application is part of an integrated program being evaluated in a clinical trial to assess if weight management before pregnancy can influence clinical outcomes for mothers and babies.MethodsOur intervention development process was guided by intervention mapping and person-based methods. This study documents steps 2 to 4 of a 6-step iterative intervention mapping approach informed by the Information-Motivation-Behavioral Skills model and the findings of a previous interview study. We defined behavior change objectives for each of the Information-Motivation-Behavioral Skills behavioral determinants as well as theory-based behavior change techniques and practical strategies. We also used persuasive system design principles to assist in translating these strategies into a digital environment.ResultsThe resultant intervention comprises nutritional and physical activity content along with psychological strategies, which are notably absent from mainstream weight management programs. Strategies to increase motivation, garner social support, and promote self-care are integral to maintaining engagement with the intervention, which aims to improve lifestyle behaviors and enhance well-being. Important elements include tracking mechanisms for percentage progress toward goals to enable feedback on behaviors and outcomes; in-application messages of praise on entry of goals or habits; and strategies to prompt habit formation and action planning via small, easily achievable steps toward positive change.ConclusionsDesign decisions and processes for idea generation about intervention content, format, and delivery are often not reported. In this study, we respond to this gap in the literature and outline a process that is potentially transferable to the development of other interventions.

Mobile intervention to promote correct hand hygiene at key times to prevent COVID-19 in the Swiss adult general population: study protocol of a multiphase optimisation strategy

IntroductionBehaviour change is key to the public health measures that have been issued in many countries worldwide to contain COVID-19. Public health measures will only take preventive effect if people...

Delivering a Group-Mediated Weight Loss and Activity Program to Older Adults With Chronic Pain in the MORPH Study

Chronic pain in aging is a potent cause and consequence of obesity, inactivity, and prolonged sedentary behavior, making these especially important targets for behavioral intervention. This study aimed to refine a theory-based group-mediated diet and sedentary behavior intervention for older adults with chronic pain. Participants (N=28) attended 12 weekly group meetings generally in home via WebEx and used an mHealth self-monitoring app as they attempted to move more often and reduce caloric intake. Relative to a control condition, the program produced improvements in physical function (η^2=.08), pain intensity (η^2=.12), sedentary time (η^2=.07), and weight loss (η^2=.21). Key findings related to effective remote group intervention delivery included: (1) the importance of a self-efficacy-enhancing technology orientation; (2) the value of small group bonding activities to seed communication; and (3) the impact of software choice on interpersonal communication. We will discuss the value of these findings for future remote intervention design.

Changes in commuting behaviours in response to the COVID-19 pandemic in the UK

BackgroundThe UK Government restrictions on non-essential work in response to the coronavirus disease 2019 (COVID-19) pandemic forced millions of working aged-adults into an unplanned lifestyle change. We present data on changes in commuting behaviour in response to COVID-19 and describe the facilitators and barriers to switching commuting behaviours, with a specific focus on cycling and walking. MethodsAn online survey queried individuals’ transport mode to/from work before and when becoming aware of COVID-19, when restrictions were in place and the transport mode they may use once restrictions are lifted. Free-form text responses were collected on why they may switch to a sustainable commute mode in the future and what would help/allow them to achieve this. Quantitative and qualitative data on those who commuted by car (single occupant) and public transport (bus/rail/park & ride) were analysed and presented separately. ResultsOverall, 725 car and public transport commuters responded; 72.4% were car commuters and 27.6% were public transport commuters before COVID-19. Of the car commuters, 81.9% may continue travelling by car once restrictions are lifted while 3.6% and 6.5% might change to walking and cycling, respectively. Of the public transport commuters, 49.0% might switch modes. From the free-form text responses three themes were identified: (a) perceived behavioural control towards cycling and walking (infrastructure and safety of roads, distance, weather) (b) key motivators to encourage a switch to cycling and walking (provision to support cycling, personal and environmental benefits); (c) the demands of current lifestyle (job requirements, family and lifestyle commitments). ConclusionThese UK data show how the COVID-19 pandemic has been an “external shock” causing some individuals to reassess their commuting mode. This provides an opportunity for theory-based behaviour change interventions tackling motivations, barriers and beliefs towards changing commute mode.

Using an Integrated Social Cognition Model to Explain Green Purchasing Behavior among Adolescents.

Strengthening pro-environmental behaviors such as green purchasing behavior is important for environmental sustainability. An integrated social cognition model which incorporates constructs from habit theory, health action process approach (HAPA), and theory of planned behavior (TPB) is adopted to understand Iranian adolescents’ green purchasing behavior. Using a correlational-prospective design, the study recruited Iranian adolescents aged between 14 and 19 years (N = 2374, n = 1362 (57.4%) females, n = 1012 (42.6%) males; Mean (SD) age = 15.56 (1.22)). At baseline (T1), participants self-reported on the following constructs: past behavior; habit strength (from habit theory); action planning and coping planning (from HAPA); and intention, perceived behavioral control, subjective norm, and attitude (from TPB) with respect to green purchasing behavior. Six months later (T2), participants self-reported on their actions in terms of purchasing green goods. Our findings reported direct effects of perceived behavioral control, subjective norms, attitude, and past behavior on intention; intention and perceived behavioral control on green purchase behavior; intention on two types of planning (i.e., action and coping planning); both types of planning on green purchase behavior; and past green purchase behavior and habits on prospectively measured green purchase behavior. These results indicate that adolescent green purchasing behavior is underpinned by constructs representing motivational, volitional, and automatic processes. This knowledge can help inform the development of theory-based behavior change interventions to improve green purchasing in adolescents, a key developmental period where climate change issues are salient and increased independence and demands in making self-guided decisions are needed.

The impact of the motivating structured walking activity for intermittent claudication training for physiotherapists on therapeutic empathy and motivational interviewing

Purpose: Walking exercise is a key treatment strategy for people with Intermittent Claudication (IC). Guidance recommends 30-50min of walking exercise, three times/week but adherence is often poor. The MOtivating Structured walking Activity for Intermittent Claudication (MOSAIC) intervention is a novel, physiotherapist-led behavioural treatment, underpinned by Motivational Interviewing (MI) and incorporating theory-based Behaviour Change Techniques (BCT), which aims to support people with IC meet walking guidance.

Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis

Background Antimicrobial resistance (AMR) is increasingly pervasive due to multiple, complex prescribing and consuming behaviours. Accordingly, behaviour change is an important component of response to AMR. Little is known about the best approaches to change antibiotic use practices and behaviours. Aim This project aims to develop a context-specific behaviour change strategy focusing on promoting appropriate prescription practices following the World Health Organization recommendations for surgical prophylaxis in an orthopaedic surgery unit in Egypt. Method The project included a formative qualitative research study with 31 in-depth interviews with orthopaedic surgeons that was based on the Theoretical Domains Framework (TDF) and an intervention that was developed to following the Behaviour Change Wheel (BCW) in a knowledge co-production workshop with ten public health experts that ensured that the theory based intervention was a culturally acceptable, practical and implementable intervention. Results The prescription of surgical prophylaxis was influenced by eight TDF domains from which workshop participants selected five to be included in the behaviour change intervention including, knowledge, belief in consequences (mistrust towards infection prevention and control measures), environmental factors (lack of prescription guidelines), professional role and reinforcement (a lack of appropriate follow up actions influenced prescription of surgical prophylaxis). The appropriate set of behaviour change functions of BCW and related activities to improve the current practices included education, enablement, persuasion, environmental restructuring and restriction. Conclusion The study showed that a theory based, and context specific intervention can be created by using the TDF and BCW together with knowledge-co creation to improve the prescription of surgical prophylaxis in and Egyptian orthopaedic unit. The intervention needs to piloted and scaled up.

The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a cluster-randomized controlled trial.

Oral diseases are preventable through the building of good oral health behaviors. Theory-based behavior change was key to the efficacy of oral health promotion since conventional promotion strategies achieved only short-lived and limited improvements. The objective of the study was to investigate the efficacy of a peer-led oral health intervention based on the health belief model (HBM) and the social cognitive theory (SCT) on oral self-care behaviors among Hong Kong adolescents. One thousand one hundred and eighty-four adolescents in 12 schools participated and were randomly assigned to either intervention or control group, utilizing a cluster-randomized controlled trial design. Brushing/flossing frequency, HBM/SCT constructs, oral health knowledge, and dental anxiety were measured at baseline and 6-month follow-up. Changes in behaviors were assessed using mixed-effects model and the mediators of behavioral change were identified with parallel multiple mediation analysis. At 6 months, the intervention group showed a significant increase in the frequency of brushing and flossing compared with the control group. Self-efficacy was identified as mediator between treatment condition and behavioral changes of brushing and flossing. Combining theories of HBM and SCT is a promising avenue for efficacy in oral health behaviors. The effects were mediated through cognitive variables, which provided guidance for both theory and health intervention development.

Developmental Evaluation of the CHOICE+ Champion Training Program

<strong>Context:</strong> Mealtimes in residential care homes are important for social engagement and can encourage resident relationships. Yet, training programs to improve mealtime care practices in residential care settings remain limited in learning approaches and scope. <strong>Objectives:</strong> To determine whether a one-day Champion Training session would improve participants’ knowledge, skills, and confidence to implement a relationship-centred mealtime program (CHOICE+) in their homes. <strong>Methods:</strong> The study employed a pre-/post-test design to evaluate a train-the-trainer model using paper-based questionnaires. Thirty-four participants attended the training session; 25 participants completed pre/post training questionnaires based on Kirkpatrick’s evaluation model. Training included: 1) program implementation manual, 2) best-practices document, 3) educational resources and evaluation tools, 4) presentation on theory-based implementation strategies and behaviour change techniques, and 5) group discussion on applying strategies and techniques, problem-solving for implementation facilitators and barriers. <strong>Findings:</strong> More than half of attendees worked as Food Service Managers or Registered Dietitians. Participants identified several organizational factors that could impact their home’s readiness to implement CHOICE+, though they felt training to be acceptable and feasible for their homes. Participants reported increase in knowledge (8.4 ± 1.1), confidence (8.3 ± 1.4), and commitment (8.8 ± 1.4) to implement the relationship-centred mealtime program. There was no association with pre-training readiness, leadership, or home characteristics. <strong>Limitations:</strong> Generalizability is limited due to small sample size. Follow-up interviews on results of training could not be conducted due COVID-19 pandemic research restrictions. <strong>Implications:</strong> Champion Leader training is an effective and feasible learning approach to up-skill staff on change management and relationship-centred mealtime practices in residential care.

Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention.

While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called “Baby steps”, in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country’s needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention’s effect on women’s activity levels during and after pregnancy needs to be studied.

The Development of an Electronic Clinical Decision and Support System to Improve the Quality of Antenatal Care in Rural Tanzania: Lessons Learned Using Intervention Mapping

It is widely recognised that high quality antenatal care is a key element in maternal healthcare. Tanzania has a very high maternal mortality ratio of 524 maternal deaths per 100,000 live births. Most maternal deaths are due to preventable causes that can be detected during pregnancy, and antenatal care therefore plays an important role in reducing maternal morbidity and mortality. Unfortunately, quality of antenatal care in Tanzania is low: Research has shown that healthcare workers show poor adherence to antenatal care guidelines, and the majority of pregnant women miss essential services. Digital health tools might improve the performance of healthcare workers and contribute to improving the quality of antenatal care. To this end, an electronic clinical decision and support system (the Nurse Assistant App) was developed and implemented in Tanzania in 2016 to provide digital assistance during antenatal care consultations to healthcare workers. The current study systematically evaluated the development and implementation process of the Nurse Assistant App in Magu District, Tanzania, with the aim of informing future programme planners about relevant steps in the development of a digital health intervention. Desk research was combined with semi-structured interviews to appraise the development process of the digital health tool. We employed the criteria stipulated by Godin et al., which are based on the six steps of Intervention Mapping [IM; Bartholomew Eldredge et al.]. Findings indicated that five of the six steps of IM were completed during the development and implementation of the Nurse Assistant App. Tasks related to community engagement, adjustment to local context, implementation in the practical context in collaboration with local partners, and rigorous evaluation were accomplished. However, tasks related to identifying theory-based behaviour change methods were not accomplished. Based on the lessons learned during the process of developing and implementing the Nurse Assistant App, we conclude that programme developers are recommended to (1) engage the community and listen to their insights, (2), focus on clear programme goals and the desired change, (3), consult or involve a behaviour change specialist, and (4), anticipate potential problems in unexpected circumstances.

Using the Theoretical Domains Framework to investigate clinicians’ behavioural determinants of antimicrobial prescribing in Qatar

Abstract Introduction A recent systematic review by Talkhan et al demonstrated the need for theoretically based behaviour change interventions in this area. [1] For development of such complex interventions, emphasis should be placed on using theory to systematically identify behavioural determinants of antimicrobial prescribing. Aim To identify and quantify clinicians’ behavioural determinants of antimicrobial prescribing in Qatar. Methods This cross-sectional survey is part of a multi-phase explanatory, sequential mixed methods PhD project in Qatar. Questionnaires were distributed (online and paper based) to all doctors (~4,000) and pharmacists (~400) within Hamad Medical Corporation (HMC, the main healthcare provider). The questionnaire was developed with reference to the Determinants of Implementation Behaviour Questionnaire (a generic questionnaire derived from the 14 theoretical domains of the Theoretical Domains Framework, TDF). [2] Each item was presented as a 5-point Likert scale (scored 5=Strongly agree to 1=Strongly disagree). Personal and practice demographics were also collected for data contextualisation. The draft questionnaire was reviewed for face/content validity by an expert panel of six researchers in Qatar and the UK with experience in the use of the TDF, followed by ‘Think aloud’ testing and piloting. Analysis investigated the behavioural determinants and influential factors through descriptive, principal component analysis (PCA) and inferential analysis. Ethics approval was granted from a UK university and HMC. Results In total, 535 responses were received, 339 (63.4%) from doctors and 196 (36.6%) from pharmacists. Respondents were predominantly male, 346 (64.7%). Just over half (n=285, 53.3%) had ≤ 5 years’ experience as health professionals. PCA showed a three component (C) solution with components incorporating a number of questionnaire items labelled: ‘Guidelines compliance’ (C1 with 8 items), ‘Influences on prescribing’ (C2 with 7 items) and ‘Self-efficacy’ (C3 with 5 items) in prescribing/recommendation activity. A scale score for each respondent was calculated through summation of Likert scores for the relevant questionnaire items within each component. These scales had high internal reliability (Cronbach’s alpha all &amp;gt;0.7) showing consistency in response between component items indicating statistical appropriateness for developing scales. The median score (possible scale range, midpoint) for each scale was C1, 32 (8 to 40, 24), C2, 26 (7 to 35, 21) and C3, 20, (5 to 25, 15). By way of example Table 1 shows levels of agreement for items in C2. This shows lower levels of agreement than C1 scale with the median scale score (26) closer to the midpoint (21) indicating that respondents had less positive views. Inferential analysis using these scale scores and free text analysis is in progress. Conclusion A theoretical basis was used throughout providing insights to behavioural determinants for the development of a theory-based behaviour change intervention. Preliminary results suggest that social influences, staff development and quality monitoring may be useful targets for behaviour change interventions to improve antimicrobial prescribing practice. Limitations include potential social desirability bias and focus on one healthcare organisation/country in the Middle East which may limit generalisability of findings. More in-depth exploration is required to select and test appropriate linked theory-based behaviour change techniques.

Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial.

Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called "Health Scouts" to promote engagement in HIV treatment and prevention services. The study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters, n = 1,054 participants at baseline; 20 control clusters, n = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic outcomes of self-reported linkage to HIV care, antiretroviral therapy (ART) use, and male circumcision, and the primary biologic outcome of HIV viral suppression (<400 copies/mL). Secondary outcomes included HIV testing coverage, HIV incidence, and consistent condom use. The primary intent-to-treat analysis used log-linear binomial regression with generalized estimating equation to estimate prevalence risk ratios (PRR) in the intervention versus control arm. A total of 2,533 (45% female, mean age: 31 years) and 1,903 (46% female; mean age 32 years) residents completed the mid-study and end-study surveys, respectively. At mid-study, there were no differences in outcomes between arms. At end-study, self-reported receipt of the Health Scouts intervention was 38% in the intervention arm and 23% in the control arm, suggesting moderate intervention uptake in the intervention arm and substantial contamination in the control arm. At end-study, intention-to-treat analysis found higher HIV care coverage (PRR: 1.06, 95% CI: 1.01 to 1.10, p = 0.011) and ART coverage (PRR: 1.05, 95% CI: 1.01 to 1.10, p = 0.028) among HIV-positive participants in the intervention compared with the control arm. Male circumcision coverage among all men (PRR: 1.05, 95% CI: 0.96 to 1.14, p = 0.31) and HIV viral suppression among HIV-positive participants (PRR: 1.04, 95% CI: 0.98 to 1.12, p = 0.20) were higher in the intervention arm, but differences were not statistically significant. No differences were seen in secondary outcomes. Study limitations include reliance on self-report for programmatic outcomes and substantial contamination which may have diluted estimates of effect. A novel community health worker intervention improved HIV care and ART coverage in an HIV hyperendemic setting but did not clearly improve male circumcision coverage or HIV viral suppression. This community-based, implementation strategy may be a useful component in some settings for HIV epidemic control. ClinicalTrials.gov NCT02556957.

What the guide does not tell you: reflections on and lessons learned from applying the COM-B behavior model for designing real life interventions

Substantial inconsistency exists in the effectiveness of existing interventions to improve heart failure (HF) self-care, which can be partially explained by the fact that self-management interventions often lack theoretical models that underpin intervention development. The COM-B behavior model is a comprehensive theoretical framework that can be used to develop effective, theory-based interventions. The aim of this article is to highlight the challenges and practical solutions when applying the COM-B model to HF self-care, in order to provide useful support for researchers intending to use the model for designing behavior change interventions. "The Behaviour Change Wheel" handbook provides a step-by-step guide to understand and change behavior. When following the guide, some practical and methodological challenges were encountered. Lessons learnt to overcome these challenges are reported. Although the handbook is a comprehensive guide for designing behavior change interventions, a number of challenges arose. For example, the descriptions provided in the guide were not always sufficient to make solid judgments on how to categorize determinants; narrowing down intervention possibilities to a manageable number and prioritizing potential behavior change techniques over others involved a certain amount of subjectivity in an otherwise highly systematic and structured approach. For the encountered challenges, solutions are provided to illustrate how the model was applied practically to design theory-based behavior change interventions. This article provides a useful reference for researchers' use of the COM-B behavior model, as it outlines challenges that may occur and potential solutions to overcome them.

Using Intervention Mapping to Developmentally Adapt an Online HIV Risk Reduction Program for Adolescent Men Who Have Sex with Men

Adolescent men who have sex with men (AMSM) experience a dramatic health disparity in HIV, accounting for over 80% of new diagnoses among youth. Current evidence-based HIV prevention programs, however, focus primarily on adults and heterosexual youth, thereby missing the unique experiences and socio-environmental contexts of AMSM aged 13-18. To address these gaps, we used the Intervention Mapping (IM) protocol to developmentally adapt an existing evidence-based online HIV risk reduction program (i.e., Keep it Up!/KIU!), originally designed for young adult MSM aged 18-29, into a new intervention called SMART Squad. Using a hybrid of IM creation and adaptation tasks, we specified three behavioral outcomes and identified corresponding performance objectives for SMART Squad based on the original goals of KIU!. We constructed matrices of change objectives using determinants from the Information-Motivation-Behavioral Skills model, modifying them for the younger population with additional theoretical and empirical evidence and expert review. SMART Squad activities were operationalized from theory-based behavior change methods matched to the change objectives and guided by program themes, components, and scope imported from KIU!. The final SMART Squad intervention comprises 6 episodes/modules delivered in 2 sessions plus 2 booster episodes occurring 1 and 3months after the main program. It is currently being evaluated nationally as part of a stepped-care package of 3 programs, in which the receipt and sequencing of interventions is tailored to individual AMSM development and needs. Despite substantial changes to KIU!, IM was a useful method for retaining the hypothesized essential elements of the eHealth HIV risk reduction program. Challenges and recommendations for future researchers and practitioners are discussed.

Content analysis of behavior change techniques in maternal and infant health apps.

Maternal and infant health (MIH) mobile applications (apps) are increasingly popular and frequently used for health education and decision making. Interventions grounded in theory-based behavior change techniques (BCTs) are shown to be effective in promoting healthy behavior changes. MIH apps have the potential to be useful tools, yet the extent to which they incorporate BCTs is still unknown. The objective of this study was to assess the presence of BCTs in popular MIH apps available in the Apple App and Google Play stores. Twenty-nine popular MIH apps were coded for the presence of 16 BCTs using the mHealth app taxonomy. Popular MIH apps whose purpose was to provide health education or decision-making support to pregnant women or parents/caregivers of infants were included in the final sample. On an average, the reviewed apps included seven BCTs (range 2-16). Techniques such as personalization, review of general or specific goals, macro tailoring, self-monitoring of goals, and health behavior linkages were most frequently present. No differences in the presence of BCTs between paid and free apps were observed. Popular MIH apps typically included only a minority of BCTs found to be useful for health promotion. However, apps developed by healthcare developers incorporated a higher number of BCTs within the app content. Therefore, app developers and policymakers may consider strategies to increase health expert involvement in app design and content delivery.

Development of a complex community pharmacy intervention package using theory-based behaviour change techniques to improve older adults\u2019 medication adherence

BackgroundTo improve the effectiveness of interventions targeting non-adherence in older adults, a systematic approach to intervention design is required. The content of complex interventions and design decisions are often poorly described in published reports which makes it difficult to explore why they are ineffective. This intervention development study reports on the design of a community pharmacy-based adherence intervention using 11 Behaviour Change Techniques (BCTs) which were identified from previous qualitative research with older patients using the Theoretical Domains Framework.MethodsUsing a group consensus approach, a five-step design process was employed. This focused on decisions regarding: (1) the overall delivery format, (2) formats for delivering each BCT; (3) methods for tailoring BCTs to individual patients; (4) intervention structure; and (5) materials to support intervention delivery. The APEASE (Affordability; Practicability; Effectiveness/cost-effectiveness; Acceptability; Side effects/safety; Equity) criteria guided the selection of BCT delivery formats.ResultsFormats for delivering the 11 BCTs were agreed upon, for example, a paper medicines diary was selected to deliver the BCT ‘Self-monitoring of behaviour’. To help tailor the intervention, BCTs were categorised into ‘Core’ and ‘Optional’ BCTs. For example, ‘Feedback on behaviour’ and ‘Action planning’ were selected as ‘Core’ BCTs (delivered to all patients), whereas ‘Prompts and cues’ and ‘Health consequences’ were selected as ‘Optional’ BCTs. A paper-based adherence assessment tool was designed to guide intervention tailoring by mapping from identified adherence problems to BCTs. The intervention was designed for delivery over three appointments in the pharmacy including an adherence assessment at Appointment 1 and BCT delivery at Appointments 2 and 3.ConclusionsThis paper details key decision-making processes involved in moving from a list of BCTs through to a complex intervention package which aims to improve older patients’ medication adherence. A novel approach to tailoring the content of a complex adherence intervention using ‘Core’ and ‘Optional’ BCT categories is also presented. The intervention is now ready for testing in a feasibility study with community pharmacists and patients to refine the content. It is hoped that this detailed report of the intervention content/design process will allow others to better interpret the future findings of this work.