Theory-based Strategies Research Articles

Sustainable Implementation of Physician-Pharmacist Collaborative Clinics for Diabetes Management in Primary Healthcare Centers: A Qualitative Study

BackgroundAlthough physician-pharmacist collaborative clinics for diabetes management have been shown to be effective and cost-effective worldwide, there is limited understanding of the factors that influence their sustainable implementation. This study aims to identify the associated factors and provide sustainability strategy to better implement physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers in China.MethodsA sample of 43 participants were participated in face-to-face, in-depth, semi-structured interviews. Consolidated Framework for Implementation Research was used to identify facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers, and to explore discriminating factors between low and high implementation units. A sustainable strategy repository based on dynamic sustainability framework was established to inform further implementation.ResultsThis study demonstrated that clear recognition of intervention benefits, urgent needs of patients, adaptive and tailored plan, highly collaborative teamwork and leadership support were the major facilitators, while the major barriers included process complexity, large number and poor health literacy of patients in primary areas, inappropriate staffing arrangements, weak financial incentives and inadequate staff competencies. Six constructs were identified to distinguish between high and low implementation units. Sixteen strategies were developed to foster the implementation of physician-pharmacist collaborative clinics, targeting Intervention, Practice setting, and Ecological system.ConclusionThis qualitative study demonstrated facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers and developed theory-based strategies for further promotion, which has the potential to improve the management of diabetes and other chronic diseases in under-resourced areas.

The Power of Numeric Evidence in Science Communication

Advantages and disadvantages exist for presenting numeric information in science communication. On the one hand, public innumeracy and experts’ concerns about providing numbers suggest not always showing them. On the other hand, people often prefer getting them, and their provision can increase comprehension, trust, and healthy behaviors while reducing risk overestimates and supporting decision-making autonomy. Presenting numeric facts without considering their comprehensibility and usability, however, is like throwing good money after bad. We summarize research concerning three theory-based strategies that improve the understanding and use of numbers by decreasing cognitive effort (e.g., doing the math for the audience), being consistent with principles of numeric cognition, and providing affective meaning.

Blockchain and Game Theory-Based Strategies for Anti-Jamming and Eavesdropping in EH-CR Networks

Blockchain and Game Theory-Based Strategies for Anti-Jamming and Eavesdropping in EH-CR Networks

Comparing the effectiveness of two theory-based strategies to promote cognitive training adherence.

This study compared the effectiveness of two theory-based strategies to promote cognitive training adherence among older adults (Mage = 70 years, SD = 4.42, range = 64-84). Strategies incorporated either (a) elements of implementation intention formation or (b) positive message framing, both of which have been found to promote adherence to health behaviors in other domains. Participants (N = 120) were asked to engage in technology-based cognitive training at home comprised of seven gamified neuropsychological tasks. In Phase 1 (structured), participants were provided a schedule that required engagement in 1 hr of cognitive training 5 days each week over 2 months. In Phase 2 (unstructured), participants were instructed to engage with the intervention as much as they desired for 1 month. Contrary to expectations, neither the implementation intention nor positive message framing produced greater adherence relative to control as measured by the total number of training sessions completed in each phase. However, exploratory analysis indicated a greater likelihood of intervention engagement for participants assigned to the implementation intention condition on many days of the intervention, though the trajectory of engagement decline was similar for all three groups. Measures of cognition, attitudes/personality, and technology proficiency also did not predict adherence over either phase. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

StandUPTV: Preparation and optimization phases of a mHealth intervention to reduce sedentary screen time in adults

Recreational sedentary screen time (rSST) is the most prevalent sedentary behavior for adults outside of work, school, and sleep, and is strongly linked to poor health. StandUPTV is a mHealth trial that uses the Multiphase Optimization Strategy (MOST) framework to develop and evaluate the efficacy of three theory-based strategies for reducing rSST among adults. This paper describes the preparation and optimization phases of StandUPTV within the MOST framework. We identified three candidate components based on previous literature: (a) rSST electronic lockout (LOCKOUT), which restricts rSST through electronic means; (b) adaptive prompts (TEXT), which provides adaptive prompts based on rSST behaviors; and (c) earning rSST through increased moderate-vigorous physical activity (MVPA) participation (EARN). We also describe the mHealth iterative design process and the selection of an optimization objective. Finally, we describe the protocol of the optimization randomized controlled trial using a 23 factorial experimental design. We will enroll 240 individuals aged 23–64 y who engage in >3 h/day of rSST. All participants will receive a target to reduce rSST by 50% and be randomized to one of 8 combinations representing all components and component levels: LOCKOUT (yes vs. no), TEXT (yes vs. no), and EARN (yes vs. no). Results will support the selection of the components for the intervention package that meet the optimization objective and are acceptable to participants. The optimized intervention will be tested in a future evaluation randomized trial to examine reductions in rSST on health outcomes among adults.

Breast cancer survivors' experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study.

Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors. In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis. A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers. Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors' lymphedema self-management behaviors.

Feeling good working with you: Perspective-taking as a strategy to increase team member satisfaction

To deal with evolving customer demands, employees in hospitality organizations are increasingly working in multiple teams (i.e., multiple team membership [MTM]), which can be stressful and demanding, thereby affecting important attitudes, such as team member satisfaction. Yet, little research has focused on understanding theory-based strategies that can enhance positive feelings toward their team members. Drawing from the egocentric bias theory and the positive-negative asymmetry effect, we advance a multilevel model focused on perspective-taking as an intervention to increase team member satisfaction via empathy. Using an experience sampling method approach, 650 daily observations from 65 hospitality interns working in multiple teams were collected over ten consecutive workdays. The results showed that engaging in perspective-taking led to increases in empathy toward team members over time, which led to increases in team member satisfaction. Emotional stability was a moderator that changed the effect of perspective-taking. The current paper offers theoretical and practical contributions.

Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance.

Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge being the prominent role of parents and carers who act as intermediaries between prescribers and paediatric patients. In this Perspective article concentrating on healthcare of the United Kingdom, we describe this complicated interplay of different decision stakeholders (patients, parents and prescribers), outline four dimensions of decision challenges (social, psychological, systemic and specific diagnostic and treatment challenges) and provide a number of theory-based strategies for supporting different stakeholders during the decision process, ultimately with the aim of improving antimicrobial stewardship. Key decision challenges for patients and carers include limited knowledge and experience of managing infections, which were exacerbated during the COVID-19 pandemic and frequently result in health anxiety and inappropriate health-seeking behaviours. Challenges for medical prescribers span societal pressures from prominent patient litigation cases, cognitive biases, and system pressures to specific diagnostic problems (e.g., age limitations of current clinical scoring systems). Strategies for mitigating decision challenges in paediatric infection management will need to include a range of context- and stakeholder-specific actions, including improvements of integrated care and public health education as well as better clinical decision tools and access to evidence-based guidelines.

Supplemental Material for Comparing the Effectiveness of Two Theory-Based Strategies to Promote Cognitive Training Adherence

Supplemental Material for Comparing the Effectiveness of Two Theory-Based Strategies to Promote Cognitive Training Adherence

Strategies for implementing an ePRO-based symptom management program (eSyM) across six cancer centers.

12017 Background: Electronic patient-reported outcome (ePRO)-based symptom management can improve cancer care outcomes. However, implementation is challenging as it requires 1) tremendous technical resources to integrate ePROs into the electronic health record (EHR), 2) substantial buy-in from clinicians and patients, 3) between visit symptom management, and 4) institutional investment to support engagement. Methods: The SIMPRO Consortium developed and deployed eSyM, an EHR-integrated ePRO-based symptom management program for medical oncology and surgery patients, at 6 cancer centers between September 2019-March 2022. Site teams document new and changes to implementation strategies monthly using REDCap (data collection is ongoing). Strategies are itemized using the Expert Recommendations for Implementation Change (ERIC) list and mapped to the Consolidated Framework for Implementation Research (CFIR) list of barriers. The SIMPRO Coordinating Center (Dana-Farber) reviews all ERIC-CFIR classifications for consistency. Results: To date, 162 distinct strategies have been documented. On average, sites have implemented 23 strategies, 5 preparing for go-live and 18 remaining active beyond go-live. Preparation of clinical staff, training, and routine program evaluation are consistent high impact strategies. Other adaptive strategies have varied across sites, including various approaches to patient and provider engagement. Foundational strategies have been deployed by the coordinating center to support the multi-center initiative. Conclusions: Methodical deployment using theory-based implementation strategies may foster adoption of novel health care delivery systems by patients, clinicians, and institutions. Attention to the specific high-value strategies identified by the SIMPRO Consortium could support similar ePRO deployment at other institutions. [Table: see text]

Design of a Remote Coaching Program to Bridge the Gap From Hospital Discharge to Cardiac Rehabilitation: Intervention Mapping Study.

BackgroundRemote coaching might be suited for providing information and support to patients with coronary artery disease (CAD) in the vulnerable phase between hospital discharge and the start of cardiac rehabilitation (CR).ObjectiveThe goal of the research was to explore and summarize information and support needs of patients with CAD and develop an early remote coaching program providing tailored information and support.MethodsWe used the intervention mapping approach to develop a remote coaching program. Three steps were completed in this study: (1) identification of information and support needs in patients with CAD, using an exploratory literature study and semistructured interviews, (2) definition of program objectives, and (3) selection of theory-based methods and practical intervention strategies.ResultsOur exploratory literature study (n=38) and semistructured interviews (n=17) identified that after hospital discharge, patients with CAD report a need for tailored information and support about CAD itself and the specific treatment procedures, medication and side effects, physical activity, and psychological distress. Based on the preceding steps, we defined the following program objectives: (1) patients gain knowledge on how CAD and revascularization affect their bodies and health, (2) patients gain knowledge about medication and side effects and adhere to their treatment plan, (3) patients know which daily physical activities they can and can’t do safely after hospital discharge and are physically active, and (4) patients know the psychosocial consequences of CAD and know how to discriminate between harmful and harmless body signals. Based on the preceding steps, a remote coaching program was developed with the theory of health behavior change as a theoretical framework with behavioral counseling and video modeling as practical strategies for the program.ConclusionsThis study shows that after (acute) cardiac hospitalization, patients are in need of information and support about CAD and revascularization, medication and side effects, physical activity, and psychological distress. In this study, we present the design of an early remote coaching program based on the needs of patients with CAD. The development of this program constitutes a step in the process of bridging the gap from hospital discharge to start of CR.

IoDM: A Study on a IoT-Based Organizational Deception Modeling with Adaptive General-Sum Game Competition

Moving target defense (MTD) and decoy strategies, measures of active defense, were introduced to secure both the proactive security and reactive adaptability of internet-of-things (IoT) networks that have been explosively applied to various industries without any strong security measures and to mitigate the side effects of threats. However, the existing MTD and decoy strategies are limited to avoiding the attacker’s reconnaissance and initial intrusion attempts through simple structural mutations or inducing the attackers to a static trap based on the deceptive path and lack approaches to adaptively optimize IoT in consideration of the unique characteristic information by the domain of IoT. Game theory-based and decoy strategies are other options; however, they do not consider the dynamicity and uncertainty of the decision-making stages by the organizational agent related to the IoT domains. Therefore, in this paper, we present a type of organizational deception modeling, namely IoT-based organizational deception modeling (IoDM), which considers both the dynamic topologies and organizational business fingerprints customized in the IoT domain and operational purpose. For this model, we considered the practical scalability of the existing IoT-enabled MTD and decoy concepts and formulated the partially incomplete deceptive decision-making modeling for the cyber-attack and defense competition for IoT in real-time based on the general-sum game. According to our experimental results, the efficiency of the deceptive defense of the IoT defender could be improved by 70% on average while deriving the optimal defense cost compared to the increased defense performance. The findings of this study will improve the deception performances of MTD and decoy strategies by IoT scenarios related to various operational domains such as smart home networks, industrial networks, and medical networks. To the best of our knowledge, this study has employed social-engineering IoT knowledge and general-sum game theory for the first time.

Promoting the practice of exclusive breastfeeding: a philosophic scoping review

BackgroundThe World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study was to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding.MethodsA scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo, and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2001—2022.ResultsThe online search yielded 1,682 articles, however, only 44 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n = 1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 13), social cognitive theories (n = 18) and represented 16 countries. Theories of self-efficacy and planned behaviour were the most used theories.ConclusionsThis review suggests that theories and models are increasingly being used to promote exclusive breastfeeding. Orienting exclusive breastfeeding programmes within theoretical frameworks is a step in the right direction because theories can sensitize researchers and practitioners to contextually relevant factors and processes appropriate for effective exclusive breastfeeding strategies. Future research should examine the efficacy and effectiveness of theory-informed exclusive breastfeeding programmes over time. Such information is important for designing cost-effective EBF programmes.

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.

Changing healthcare professionals' non-reflective processes to improve the quality of care

RationaleTranslating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation. ObjectivesTo combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed. MethodsSixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes. ResultsFrom a psychological perspective ‘habit’ is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them. ConclusionCombining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.

Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial.

BackgroundThe prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process.ObjectiveThis 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer.MethodsParticipants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated.ResultsThis study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing.ConclusionsThis study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance.Trial RegistrationClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610International Registered Report Identifier (IRRID)DERR1-10.2196/34502

Sustainability of INFORM: A Complex Team-Based Improvement Intervention in Long-Term Care

Improving Nursing Home Care Through Feedback On perfoRMance Data (INFORM) was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a standard approach to feedback) to increase nursing home (NH) care aides’ involvement in formal communications about resident care (formal interactions [FI], the primary outcome). Here, we report the extent to which FI was sustained 2.5 years following withdrawal of intervention supports. We also report on several determinants of sustainability. We analyzed data from 18 NHs (46 units, 529 care aides) in the control group, 19 NHs (60 units, 731 care aides) in the basic assisted feedback group (BAF), and 14 homes (41 units, 537 care aides) in the enhanced assisted feedback group (EAF). We assessed sustainability of FI, using repeated measures, hierarchical mixed models, adjusted for care aide, care unit and facility variables. In EAF, FI scores increased from T1 (baseline) to T2 (end of intervention) (1.30–1.42, p=0.010), remaining stable at T3 (long-term follow-up) (1.39 p=0.065). FI scores in BAF increased from T1 to T2 (1.33–1.44, p=0.003) and continued to increase at T3 (1.49, p<0.001). In the control group, FI did not change from T1 to T2 (1.25–1.24, p=0.909), but increased at T3 (1.38, p=0.003). Better culture, evaluation and fidelity enactment significantly increased FI at long-term follow-up. Theory-informed feedback provides long lasting benefits in care aides' involvement in FI. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment may facilitate sustained improvement.

Working Out with F.I.D.O. (Frequency, Intensity, Duration, &amp; Outcomes): A Feasibility Randomized Controlled Trial

Abstract Objective: Dog owners walk more per week compared to non-dog owners; however, 60% of dog owners are still not walking their dogs at intensities sufficient to reap optimal health benefits. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of a 9-week randomized controlled trial involving a program of six weekly scheduled instructor-led group dog walks supplemented with theory-based strategies to encourage increased dog walking among dog owners in Greater Victoria, BC. Methods: Participants were 17 adults aged 18+, who owned at least one healthy and friendly dog aged six months+, who were not meeting recommended moderate-to-vigorous physical activity (MVPA) guidelines. Data were collected using pedometers, self-report measures, and a program evaluation survey. Results: Feasibility outcomes included 74 interested responses, 23% recruitment rate ( n = 17), 94% retention rate ( n = 16), and 94% adherence rate ( n = 15). Program participants were overall (very) satisfied with the program. Total weekly step counts and average daily step counts, MVPA dog walking, and MVPA with dog (i.e., all leisure time physical activity with dog - e.g., hiking, swimming, biking, playing Frisbee) increased at the end of the program and at follow-up, resulting in large effect sizes when compared to the waitlist-control group. Conclusions: This six-week group dog walking program was feasible, acceptable, and efficacious in encouraging increased dog walking and MVPA among dog owners. It is recommended for future studies to refine initial recruitment strategies, reimburse medical/veterinarian clearance costs to reduce cost-related barriers to participation, and offer a variety of options for program delivery (e.g., different locations/schedules/seasons, online programs, multi-site study) to accommodate more participants.

Food Storage on the Appalachian Trail: A Theory of Planned Behavior Approach to Understanding Backpacker Bear Canister Use

Improper food storage fuels human-bear conflicts in parks and protected areas around the globe. Bear-resistant food storage canisters provide an extremely effective solution for reducing food-related human-bear conflicts, especially for overnight visitors in backcountry settings. However, the success of this intervention depends on recreationists’ willingness to use and comply with such food storage methods. This study used internet-based surveys to identify Appalachian Trail backpackers’ attitudes, norms, perceived behavioral control, and intentions regarding the use of bear canisters through an application of the Theory of Planned Behavior. Results indicate attitudes and subjective norms provide potential leverage points for messaging under voluntary conditions; messaging incorporating attitudes, subjective norms, and perceived behavioral control may help influence food storage behavior under required conditions. Specific recommendations for effective, theory-based interpretation strategies aimed at reducing human-black bear conflicts on the Appalachian Trail are provided.

Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.

Lung cancer screening with low-dose computed tomography (CT) could help avert thousands of deaths each year. Since the implementation of screening is complex and underspecified, there is a need for systematic and theory-based strategies. Explore the implementation of lung cancer screening in primary care, in the context of integrating a decision aid into the electronic health record. Design implementation strategies that target hypothesized mechanisms of change and context-specific barriers. The study had two phases. The Qualitative Analysis phase included semi-structured interviews with primary care physicians to elicit key task behaviors (e.g., ordering a low-dose CT) and understand the underlying behavioral determinants (e.g., social influence). The Implementation Strategy Design phase consisted of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Three key task behaviors and four behavioral determinants emerged from 14 interviews. Implementation strategies were designed to target multiple levels of influence. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy toward ordering a low-dose CT, increasing social influence toward performing shared decision making and using the decision aid, and addressing key facilitators to using the decision aid. This study contributes knowledge about theoretical determinants of key task behaviors associated with lung cancer screening. We designed implementation strategies according to causal pathways that can be replicated and tested at other institutions. Future research is needed to evaluate the effectiveness of these strategies and to determine the contexts in which they can be effectively applied.