The impact of theory on the effectiveness of worksite physical activity interventions: a meta-analysis and meta-regression

Socioeconomic inequalities in effectiveness of and compliance to workplace health promotion programs: an individual participant data (IPD) meta-analysis

BACKGROUND

This individual patient data (IPD) meta-analysis aimed to investigate socioeconomic inequalities in effectiveness on healthy behavior of, and compliance to, workplace health promotion programs.

METHODS

Dutch (randomized) controlled trials were identified and original IPD were retrieved and harmonized. A two-stage meta-analysis was conducted where linear mixed models were performed per study (stage 1), after which individual study effects were pooled (stage 2). All models were adjusted for baseline values of the outcomes, age and gender. Intervention effects were assessed on physical activity, diet, alcohol use, and smoking. Also, we assessed whether effects differed between participants with low and high program compliance and. All analyses were stratified by socioeconomic position.

RESULTS

Data from 15 studies (n = 8709) were harmonized. Except for fruit intake (beta: 0·12 [95% CI 0·08 0·15]), no effects were found on health behaviors, nor did these effects differ across socioeconomic groups. Only participants with high compliance showed significant improvements in vigorous and moderate-to-vigorous physical activity, and in more fruit and less snack intake. There were no differences in compliance across socioeconomic groups.

CONCLUSIONS

Workplace health promotion programs were in general not effective. Neither effectiveness nor compliance differed across socioeconomic groups (operationalized by educational level). Even though stronger effects on health behavior were found for participations with high compliance, effects remained small. The results of the current study emphasize the need for new directions in health promotion programs to improve healthy behavior among workers, in particular for those in lower socioeconomic position.

Variability and effectiveness of comparator group interventions in smoking cessation trials: a systematic review and meta-analysis

AIMS

To examine variability and effectiveness of interventions provided to comparator (control) groups in smoking cessation trials.

METHODS

Systematic review with meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for smoking cessation, with or without stop-smoking medication. We searched the Cochrane Tobacco Addiction Group Specialized Register for RCTs with objective outcomes measured at ≥ 6 months. Study authors were contacted to obtain comprehensive descriptions of their comparator interventions. Meta-regression analyses examined the relationships of smoking cessation rates with stop-smoking medication and behavior change techniques.

RESULTS

One hundred and four of 142 eligible comparator groups (n = 23 706) had complete data and were included in analyses. There was considerable variability in the number of behavior change techniques delivered [mean = 15.97, standard deviation (SD) = 13.54, range = 0-45] and the provision of smoking cessation medication (43% of groups received medication) throughout and within categories of comparator groups (e.g. usual care, brief advice). Higher smoking cessation rates were predicted by provision of medication [B = 0.334, 95% confidence interval (CI) = 0.030-0.638, P = 0.031] and number of behavior change techniques included (B = 0.020, 95% CI = 0.008-0.032, P < 0.001). Modelled cessation rates in comparator groups that received the most intensive support were 15 percentage points higher than those that received the least (23 versus 8%).

CONCLUSIONS

Interventions delivered to comparator groups in smoking cessation randomized controlled trials vary considerably in content, and cessation rates are strongly predicted by stop-smoking medication and number of behavior change techniques delivered.

Diarrhoeal disease knowledge among diarrhoea patient housholds: findings from the randomised controlled trial of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) mobile health program

OBJECTIVE

The objective of this study was to evaluate the impact of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) handwashing with soap and water treatment mobile health (mHealth) program on diarrhoeal disease knowledge among diarrhoea patients and their household members in urban Dhaka, Bangladesh.

METHODS

A cluster-randomised controlled trial of the CHoBI7 mHealth program was conducted among diarrhoea patient households in Dhaka, Bangladesh. Patients were randomised to three arms: standard recommendation on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (weekly voice and text messages) (no home visits); and health facility delivery of CHoBI7 plus two home visits and mHealth. An open-ended questionnaire was administered to 1468 participants 12 years of age or older on diarrhoeal disease transmission and prevention. These items were combined to form a diarrhoeal disease knowledge score measured at baseline and at a 1 week, 6 month and 12 month follow-up.

RESULTS

At baseline, when participants were asked to report three ways diarrhoeal diseases were spread 37% (546/1468) of participants reported by water, 13% (187/1468) by lack of handwashing and 4% (53/1468) by food not being covered properly. At baseline when asked to name three ways diarrhoeal diseases could be prevented, 35% (515/1468) of participants reported safe water, and 16% (228/1468) reported handwashing with soap. At the 12-month follow-up, the overall diarrhoeal disease knowledge score was significantly higher in the mHealth with no home visits arm (score coefficient: 0.69, 95% Confidence Interval: 0.36, 1.01, P < 0.0001) and the mHealth with two home visits arm (score coefficient: 1.18, 95% CI: 0.87, 1.49, P < 0.0001) compared with the standard recommendation arm.

CONCLUSION

The CHoBI7 mHealth program significantly increased knowledge of diarrhoeal disease transmission and prevention among diarrhoea patients and their household members 12 months after in-person visits for program delivery were conducted.

What Makes Opportunistic GP Interventions Effective? An Analysis of Behavior Change Techniques Used in 237 GP-Delivered Brief Interventions for Weight Loss

BACKGROUND

Evidence shows that clinician-delivered brief opportunistic interventions are effective in obesity, and guidelines promote their use. However, there is no evidence on how clinicians should do this, and guidelines are not based on clinical evidence.

PURPOSE

A trial (Brief Interventions for Weight Loss [BWeL]) showed that brief opportunistic interventions on obesity that endorsed, offered, and facilitated referral to community weight management service (CWMS) led to 77% agreeing to attend, and 40% attending CWMS, as well as significantly greater weight loss than control at 12 months. We assessed which behavior change techniques (BCTs) doctors used that were associated with CWMS attendance.

METHODS

We coded 237 recorded BWeL interventions using the behavioral change techniques version one taxonomy. We also coded the BWeL training video to examine delivery of recommended BCTs. Mixed effects logistic regression assessed the association between each BCT, the total number of BCTs, and delivery of recommended BCTs, with patient's agreement to attend and actual CWMS attendance.

RESULTS

Of 237 patients, 133 (56%) agreed to attend and 109 (46%) attended. Thirteen BCTs were used more than eight times but none of the 13 were associated with increased attendance. One, "practical social support," was significantly associated with increased patient agreement (odds ratio [OR] = 4.80, 95% confidence interval [CI] = 1.15, 20.13). Delivery of recommended BCTs and the total number of BCTs used were both associated with increased agreement (OR = 1.56, 95% CI = 1.09, 2.23 and OR = 1.34, 95% CI = 1.03, 1.75, respectively), but not attendance at CWMS (OR = 1.20, 95% CI = 0.98-1.47 and OR = 1.08, 95% CI = 0.94-1.24, respectively).

CONCLUSIONS

There is no evidence that particular BCT can increase the effectiveness of brief opportunistic interventions for obesity in adults. However, using more BCTs and delivery of recommended BCTs may increase agreement to attend community weight management services.

The Efficacy of Workplace Interventions on Improving the Dietary, Physical Activity and Sleep Behaviours of School and Childcare Staff: A Systematic Review

There is a need for effective interventions that improve the health and wellbeing of school and childcare staff. This review examined the efficacy of workplace interventions to improve the dietary, physical activity and/or sleep behaviours of school and childcare staff. A secondary aim of the review was to assess changes in staff physical/mental health, productivity, and students’ health behaviours. Nine databases were searched for controlled trials including randomised and non-randomised controlled trials and quasi-experimental trials published in English up to October 2019. PRISMA guidelines informed screening and study selection procedures. Data were not suitable for quantitative pooling. Of 12,396 records screened, seven articles (based on six studies) were included. Most studies used multi-component interventions including educational resources, work-based wellness committees and planned group practice (e.g., walking groups). Multiple outcomes were assessed, findings were mixed and on average, there was moderate risk of bias. Between-group differences in dietary and physical activity behaviours (i.e., fruit/vegetable intake, leisure-time physical activity) favoured intervention groups, but were statistically non-significant for most outcomes. Some of the studies also showed differences favouring controls (i.e., nutrient intake, fatty food consumption). Additional robust studies testing the efficacy of workplace interventions to improve the health of educational staff are needed.

Core Processes: How to Use Evidence, Theories, and Research in Planning Behavior Change Interventions

Psychology is not only a basic behavioral science but also an applied discipline that is used to solve societal problems. In a problem-driven context, the search for existing literature, the correct application of appropriate theories, and the collection of additional research data are basic tools essential for the systematic development of any theory- and evidence-based behavior change intervention. The processes of brainstorming, literature review, theory selection and application, and data collection are “Core Processes” that can be used in different phases/steps of intervention planning—from needs assessment to intervention design to program implementation and evaluation—and within different planning frameworks. In this paper, we illustrate how the use of these “Core Processes” provides expert, empirical and theoretical guidance to planners from problem definition to problem solution. Specific emphasis is put on finding theories that are potentially useful in providing answers to planning questions using a combination of approaches to access and select theories (i.e., the topic, concept, and general theories approaches). Furthermore, emphasis is put on the logic of answering planning questions in a specific order by first brainstorming before consulting the literature, then applying theories, and finally collecting additional data.

Temporal dynamics of sitting behavior at work

Sitting for prolonged periods of time impairs people's health. Prior research has mainly investigated sitting behavior on an aggregate level, for example, by analyzing total sitting time per day. By contrast, taking a dynamic approach, here we conceptualize sitting behavior as a continuous chain of sit-to-stand and stand-to-sit transitions. We use multilevel time-to-event analysis to analyze the timing of these transitions. We analyze ∼30,000 objectively measured posture transitions from 156 people during work time. Results indicate that the temporal dynamics of sit-to-stand transitions differ from stand-to-sit transitions, and that people are quicker to switch postures later in the workday, and quicker to stand up after having been more active in the recent hours. We found no evidence for associations with physical fitness. Altogether, these findings provide insights into the origins of people's stand-up and sit-down decisions, show that sitting behavior is fundamentally different from exercise behavior, and provide pointers for the development of interventions.

Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction

BACKGROUND

Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments.

METHODS AND RESULTS

The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants.

CONCLUSIONS

This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.

The Effects of a Patient and Provider Co-Developed, Behavioral Physical Activity Intervention on Physical Activity, Psychosocial Predictors, and Fitness in Individuals with Spinal Cord Injury: A Randomized Controlled Trial

BACKGROUND

Physical activity (PA) interventions in people with spinal cord injury (SCI) have been limited by a shortage of (1) evidence for sufficient increases in unsupervised PA to improve aerobic fitness and (2) stakeholder involvement in intervention design.

OBJECTIVES

This study examined the effects of a theory-based PA intervention, developed in collaboration with nearly 300 stakeholders, on PA levels, aerobic fitness, and psychosocial predictors of PA among individuals with SCI.

METHODS

A randomized controlled trial (RCT) was conducted with 28 men and women with chronic SCI (age 45.0 ± 11.5 years, years post-injury 16.4 ± 12.4). Participants randomized to the intervention group (n = 14) received an introductory personal training session followed by eight weekly 15-min PA behavioral coaching sessions per week. PA was assessed using self-report and accelerometers. Aerobic fitness and psychosocial predictors of exercise were evaluated using an incremental exercise test and survey methods, respectively.

RESULTS

At post-intervention, controlling for baseline, the intervention group showed fivefold greater self-reported moderate to vigorous physical activity [mean difference 247.9 min/day; 95% confidence interval (CI) 92.8-403.1; p = 0.026, d = 1.04], 17% greater accelerometer-measured PA (mean difference 3.9 × 10⁵ vector magnitude counts; 95% CI 1.1 × 10⁴-7.7 × 10⁵; p = 0.014, d = 0.31), and 19% higher peak oxygen uptake (VO_2Peak; mean difference 0.23 L/min; 95% CI 0.12-0.33; p < 0.001, d = 0.54) compared with the control group. Mean values of psychosocial predictors of PA were also significantly improved in the intervention group compared with controls.

CONCLUSION

To our knowledge, this co-created behavioral intervention produced the largest effect size to date for change in self-reported PA in an RCT involving people with physical disability. This is also the first RCT in people with SCI to demonstrate that a behavioral intervention can sufficiently increase unsupervised PA to improve aerobic fitness.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03111030, 12 April 2017, https://clinicaltrials.gov/ct2/show/NCT03111030?term=NCT03111030&rank=1 .

Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: a systematic review and meta-analysis

Physical inactivity is a key risk factor for non-communicable diseases, and there is a need for interventions to increase the adoption and maintenance of regular physical activity. Interventions based on Acceptance and Commitment (ACT) have shown promise for promoting a range of health behaviours, including physical activity. The aims of this review were to (1) determine the effectiveness of ACT interventions for physical activity; and (2) identify the ACT processes, behaviour change techniques (BCTs) and intervention characteristics associated with ACT interventions. Eight electronic databases were searched for ACT interventions that aimed to increase physical activity. Seven eligible studies were included in the systematic review, and ACT processes, Behaviour Change Techniques and other intervention components and characteristics of the included interventions were coded. Six studies were randomised controlled trials that were included in a random-effects meta-analysis, which indicated small-to-moderate effects on physical activity (SMD = 0.32, 95% CI (0.07, 0.57), p = 0.01). ACT interventions show promise for increasing physical activity, but very few of the 'active ingredients' of ACT interventions could be characterised as BCTs. Future development of ACT interventions for physical activity should attempt to describe and name the ACT processes targeted by the intervention, and the BCTs used to target those processes.

Efficacy of theory-informed workplace physical activity interventions: a systematic literature review with meta-analyses

This review aimed to assess the efficacy of workplace physical activity interventions; compare the efficacy of those that were and were not informed by behaviour change theory, and outline the effectiveness of different intervention components. A search was undertaken in Medline, Embase, PsycINFO, Ovid Emcare (previously CINAHL) and SportDiscus. Randomised, non-randomised and cluster-controlled trials with objectively measured physical activity and/or measured or predicted maximal oxygen uptake (VO_2max) as outcomes were included in the review (83 papers from 79 trials). Random-effects meta-analyses of mean differences were undertaken. Workplace physical activity programmes demonstrated positive overall intervention effects for daily step counts (814.01 steps/day; CI: 446.36, 1181.67; p < 0.01; i² = 88%) and measured VO_2max (2.53 ml kg^-1 min^-1; CI: 1.69, 3.36; p < 0.01; i² = 0%) with no sub-group differences between theory- and non-theory informed interventions. Significant sub-group differences were present for predicted VO_2max (p < 0.01), with a positive intervention effect for non-theory informed studies (2.11 ml.kg^-1 min^-1; CI: 1.20, 3.02; p < 0.01; i² = 78%) but not theory-informed studies (-0.63 ml kg^-1 min^-1; CI: -1.55, 0.30; p = 0.18; i² = 0%). Longer-term follow-ups ranged from 24 weeks to 13 years, with significant positive effects for measured VO_2max (2.84 ml kg^-1 min^-1; CI: 1.41, 4.27; p < 0.01; i² = 0%). Effective intervention components included the combination of self-monitoring with a goal, and exercise sessions onsite or nearby. The findings of this review were limited by the number and quality of theory-informed studies presenting some outcomes, and confounding issues in complex interventions. Future researchers should consider rigorous testing of outcomes of theory-informed workplace physical activity interventions and incorporate longer follow-ups.

The effectiveness of health professional-delivered interventions during the first 1000 days to prevent overweight/obesity in children: A systematic review

Childhood obesity is a global public health challenge. Early prevention, particularly during the first 1000 days, is advocated. Health professionals have a role to play in obesity prevention efforts, in part due to the multiple routine contacts they have with parents. We synthesized the evidence for the effectiveness of obesity prevention interventions delivered by health professionals during this time period, as reviews to date have not examined effectiveness by intervention provider. We also explored what behaviour change theories and/or techniques were associated with more effective intervention outcomes. Eleven electronic databases and three trial registers were searched from inception to 04 April 2019. A total of 180 studies, describing 39 trials involving 46 intervention arms, were included. While the number of interventions has grown considerably, we found some evidence for the effectiveness of health professional-delivered interventions during the first 1000 days. Only four interventions were effective on a primary (adiposity/weight) and secondary (behavioural) outcome measure. Twenty-two were effective on a behavioural outcome only. Several methodological limitations were noted, impacting on efforts to establish the active ingredients of interventions. Future work should focus on the conduct and reporting of interventions.

Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

Background

The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual's changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual's state can change rapidly, unexpectedly, and in his/her natural environment.

Purpose

Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap.

Methods

Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration.

Conclusions

As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention.

Organizational Wellness Program Implementation and Evaluation: A Holistic Approach to Improve the Wellbeing of Middle Managers

: Employee wellness programs can provide benefits to institutions as well as employees and their families. Despite the attempts of some organizations to implement programs that take a holistic approach to improve physical, mental, and social wellness, the most common programs are exclusively comprised of physical and nutritional components. In this study, we implemented a wellness program intervention, including training using a holistic approach to improve the wellbeing of middle managers in several multinational organizations. We included control and experimental groups to measure wellness and teamwork with two repeated measures. Our results indicated that employees receiving the intervention had improved measures of wellness and teamwork. A positive relationship was found between wellness and teamwork in the experimental group when compared with the control group. Taken together, the data suggest that implementation of these programs would provide valuable outcomes for both employees and organizations.

Social identification-building interventions to improve health: a systematic review and meta-analysis

There is growing evidence that social identity processes play an important role in a range of health outcomes. However, we know little about the nature and effectiveness of interventions that build social identification with the aim of promoting health. In the present research, we systematically review and meta-analyze interventions that build social identification to enhance health and wellbeing. A total of 27 intervention studies were identified (N = 2,230). Using a three-level meta-regression, results indicate that social identification-building interventions had a moderate-to-strong impact on health (Hedges g = 0.66; 95%CIs[0.34, 0.97]). Analyses revealed significant variation in intervention effectiveness as a function of its type: group-relevant decision making (g = 1.26), therapy programmes (g = 1.02), shared activities (g = 0.40), and reminiscence (g = -0.05). By contrast, there was much less variation across health outcomes: quality of life (g = 0.80), physical health (g = 0.76), self-esteem (g = 0.69), well-being (g = 0.66), (reduced) anxiety (g = 0.61), (reduced) depression (g = 0.58), cognitive health (g = 0.55), and (reduced) stress (g = 0.49). Finally, speaking to the mechanism of the interventions, interventions tended to be more effective to the extent that they succeeded in building participants' social identification with the intervention group. We discuss the theoretical and practical implications of social identification-building interventions to foster health and outline an agenda for future research and practical application.

Process Evaluation of the BearStand Behavioral Intervention: A Social Cognitive Theory-Based Approach to Reduce Occupational Sedentary Behavior

OBJECTIVE

Describe the process evaluation of the behavioral intervention group of a multicomponent workplace intervention, BearStand, to reduce employees' sitting time using sit-stand workstations and behavioral strategies.

METHODS

Process evaluation metrics: dose delivered, dose-received exposure, dose-received satisfaction, and context were collected using an online survey. Participants included employees of a US university.

RESULTS

Overall, 38 of 52 participants completed the process evaluation. The majority were satisfied (53%) with the intervention. Participants' interactions with intervention materials decreased over time (73.7%, week 1, to 52.6%, week 13), and 42% and 33% of participants used suggested videos and apps, respectively. Participants found goal setting and self-regulation strategies to be the most helpful and identified workplace-related contextual barriers that impacted intervention engagement.

CONCLUSIONS

Future interventions should incorporate more engaging materials for participants, reduce contextual barriers, and facilitate use of apps and videos.

How is the theoretical domains framework applied to developing health behaviour interventions? A systematic search and narrative synthesis

BACKGROUND

Enabling behaviour change in health care is a complex process. Although the use of theory to inform behaviour change interventions is advocated, there is limited information about how this might best be achieved. There are multiple models of behaviour change, however, due to their complexity they can be inaccessible to both researchers and healthcare practitioners. To support health care practitioner behaviour change, this was addressed by the development of the Theoretical Domains Framework (TDF) in 2005. Citations of the TDF and associated papers have increased exponentially. Although not predicted or intended by the authors, the TDF has also been used to investigate health behaviour change interventions. Therefore our aim was to narratively synthesize empirical evidence on how the TDF and subsequent iterations have been applied in health behaviour change to inform future intervention development.

METHODS

Systematic search of four online databases, combined with searches for citations of key papers and key author searches, resulted in 3551 articles eligible for screening. Of these 10 met the pre-determined inclusion criteria. Screening of full-texts, data extraction and quality appraisal were independently performed by both authors. Disagreements regarding eligibility were resolved through discussion.

RESULTS

Of the 10 included studies three used the TDF and seven used subsequent iterations, the Capability, Opportunity, Motivation to Behaviour / Behaviour Change Wheel to assess and /or categorise behavioural determinants to identify relevant behaviour change techniques. Two studies reported feasibility testing. Most interventions were targeted at diet and exercise. Eight reported an explicit and systematic process in applying the framework.

CONCLUSION

There is limited evidence of how the framework has been used to support health behaviour change interventions. In the included studies the process of using the framework is not always reported in detail or with clarity. More recent studies use a systematic and judicious process of framework application. From the limited evidence available we tentatively suggest that the steps proposed in the BCW appear to be sufficient for development of interventions that target health behaviour change interventions. Further research is needed to provide evidence in how the framework may be most effectively applied to intervention development.

PROTOCOL REGISTRATION

PROSPERO CRD42018086896 .

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

Background

The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery.

Methods

Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed.

Results

A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others.

Conclusion

This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7144-z) contains supplementary material, which is available to authorized users.

Reported theory use in electronic health weight management interventions targeting young adults: a systematic review

This review assesses the extent of reported theory use in electronic health weight management interventions targeting young adults aged 18-35 years. Twenty-four eligible studies were identified. Two independent reviewers extracted data and coded for theory use using the Theory Coding Scheme. Overall, the mean total use of theory score was 6/23 (SD = 5; Min. = 0, Max. = 17); 17 studies were classified as having weak application of theory, five as moderate, and two as strong. The majority (N = 18) of studies mentioned theory, however, most (N = 14) did not report how intervention techniques related to theoretical base. No study used theory to select intervention recipients and only four used theory to tailor intervention techniques to recipients. Limited studies reported theory testing (N = 6) and no study used intervention results to build and/or refine theory. Results indicate that weight-related outcomes may be enhanced when at least one or more theoretical constructs are explicitly linked to an intervention technique and when theoretical constructs are included in evaluations. Increases in theory application and reporting are needed to assist the scientific research community in systematically identifying which theories work, for whom, how, why, and when; thereby delivering an advanced understanding of how best to apply theory to enhance intervention outcomes.

Barriers and facilitators of midwives' physical activity behaviour in hospital and community contexts in Scotland

AIMS

To investigate barriers and facilitators of physical activity in midwives in hospital and community environments.

DESIGN

A sequential mixed-methods approach.

DATA SOURCES

Focus groups and subsequent questionnaire survey.

METHODS

Four focus groups were conducted in urban and rural areas with community and hospital-based midwives in Scotland in 2015. Topics were based on the behaviour change theories via the Theoretical Domains Framework. Findings informed development of a questionnaire, sent to midwives in 2016 in Scottish health boards via managers, or online survey.

RESULTS

Thirty-three midwives participated in focus groups. Workplace environmental context and resources were both barriers and facilitators. Similarly, negative social influences were barriers, whereas positive social support facilitated physical activity. The questionnaire was completed by 345 midwives. Most (90%) were physically active with high levels of activity. Commonest activities included walking, swimming and housework. Physical activity facilitators included subsidized classes and protected breaks. Barriers included tiredness, stress, family responsibilities, unpredictable breaks and shift patterns.

CONCLUSIONS

Interventions should address midwives' workplace context and resources and interpersonal factors such as stress and social support.

IMPACT

Midwives' high levels of overweight/obesity and stress impact on their own health and delivery of patient care. More workplace physical activity could help. We found most were physically active but identified workplace barriers and facilitators, including resources, shift patterns and breaks. Findings could help midwifery managers to recognize and reduce barriers, thereby improving midwives' physical activity in the workplace, supporting weight management and enhancing their health and well-being.

Using theories of behaviour change to transition multidisciplinary trauma team training from the training environment to clinical practice

Background

Major trauma patients—such as patients who have experienced road injury, high-impact falls or violence—require complex, intense and rapid resuscitation from a multidisciplinary team of clinicians. These ‘flash teams’ must form quickly and function effectively, often having never met before. There is evidence that multidisciplinary teamwork training improves the performance of the trauma team in simulation. However, the translation of learnt resuscitation teamwork skills from simulation into clinical practice has had modest and variable effects. This paper outlines a method for developing an intervention designed to translate the teaching from a simulated training environment into clinical practice using the theoretical domains framework, behaviour change wheel and behaviour change techniques as the theoretical and empirical basis for the process.

Methods

The data used to inform the intervention development process were collected during an implementation evaluation study of the trauma team training programme at the busiest level 1 trauma centre in Sydney, Australia. A detailed barrier and enabler assessment were conducted using qualitative and quantitative data. The theoretical domains framework was used to integrate the results. Implementation interventions were selected using the behaviour change wheel.

Results

Twenty-three facilitators and 19 barriers were identified to influence the implementation of trauma team training in the clinical setting. The facilitators and barriers corresponded to all 14 domains of the theoretical domains framework. Seven intervention functions and four policy categories of the behavioural change wheel were selected to address the target behaviours, and a multimodal relaunch of the revised trauma team training programme was developed.

Conclusions

This study offers a framework for deductively employing the theoretical domains framework, behaviour change wheel and behaviour change techniques to assess and develop intervention strategies to improve the functioning of trauma resuscitation teams.

A life fulfilled: positively influencing physical activity in older adults - a systematic review and meta-ethnography

BACKGROUND

Increasing physical activity in older adults remains a key public health priority in countries with a high burden of non-communicable disease, yet current interventions have failed to substantially increase population uptake with UK data suggesting that only half of 65-74 year olds report meeting recommended levels. The aim of this study was to conduct a systematic and inductive qualitative synthesis of the large body of qualitative research describing what influences physical activity at this age, and older adults' experiences of physical activity.

METHODS

A qualitative meta-ethnography was chosen as the study design as this inductive approach can provide novel insights and generate new theory about physical activity and ageing. Papers were identified by searching electronic databases and key citations. Peer-reviewed primary qualitative studies and systematic reviews were included if they met the following inclusion criteria: community-dwelling participants aged 60 years or older or in the retirement transition period; reporting on leisure-time physical activity; utilising a rigorous qualitative methodology. A line of argument approach was employed to generate a theory about how older adults think and feel about physical activity.

RESULTS

Thirty-nine papers met the inclusion criteria and were synthesised. The emergent theory suggested transition to older age can challenge people's sense of self and their role in life. Physical activity can help in regaining feelings of purpose, of being needed in collective group activity, and by creating habitual routine and structure to the day. In overcoming real and perceived barriers, and by taking up or sustaining physical activities, older adults can further build self-esteem all of which contributes to a fulfilling older age.

CONCLUSION

Current failures to increase population levels of physical activity in older adults may be explained by an approach overly focused on the health benefits of activity. Insights from this study suggest we need to reframe our approach to consider the wider set of goals and aspirations which are of greater personal importance to older adults, and future interventions should focus on how physical activity can contribute to life satisfaction, sense of purpose, and sense of role fulfilment in older age.

TRIAL REGISTRATION

Registered prospectively on PROSPERO on 29th March 2013: CRD42013003796 .

Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

OBJECTIVE

A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n = 63, aged 35-69).

DESIGN

Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email.

MAIN OUTCOME MEASURES

Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect.

RESULTS

Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level.

CONCLUSION

Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.

Development of a Self-Determination Theory-Based Physical Activity Intervention for Aged Care Workers: Protocol for the Activity for Well-being Program

Despite the well-established benefits of regular participation in physical activity, many Australians still fail to maintain sufficient levels. More self-determined types of motivation and more positive affect during activity have been found to be associated with the maintenance of physical activity behaviour over time. Need-supportive approaches to physical activity behaviour change have previously been shown to improve quality of motivation and psychological well-being. This paper outlines the development of a need-supportive, person-centred physical activity program for frontline aged-care workers. The program emphasises the use of self-determined methods of regulating activity intensity (affect, rating of perceived exertion and self-pacing) and is aimed at increasing physical activity behaviour and psychological well-being. The development process was undertaken in six steps using guidance from the Intervention Mapping framework: (i) an in-depth needs assessment (including qualitative interviews where information was gathered from members of the target population); (ii) formation of change objectives; (iii) selecting theory-informed and evidence-based intervention methods and planning their practical application; (iv) producing program components and materials; (v) planning program adoption and implementation, and (vi) planning for evaluation. The program is based in Self-Determination Theory (SDT) and provides tools and elements to support autonomy (the use of a collaboratively developed activity plan and participant choice in activity types), competence (action/coping planning, goal-setting and pedometers), and relatedness (the use of a motivational interviewing-inspired appointment and ongoing support in activity).

Knowledge translation of clinical practice guidelines among neurologists: A mixed-methods study

Objectives

Clinical practice guidelines have the potential to improve care, but are often not optimally implemented. Improving guideline use in clinical practice may improve care. The objective of this study was to identify the barriers and facilitators (determinants) of guidelines use among neurologists and to propose a strategy to improve guideline implementation.

Methods

This was a mixed-methods study design. A quantitative, population-based, cross-sectional survey of Canadian neurologists was conducted. Associations between guidelines use and determinants of guidelines use were examined. Focus groups and interviews were conducted using purposeful sampling of the population. Determinants of guideline use were mapped to interventions to establish a strategy for guideline implementation among neurologists.

Results

38.7% (n = 311) of neurologists responded to the survey. Typically, respondents had been practicing for 16.6 years and worked in an academic institution in an urban setting. Being male and having an academic affiliation was associated with guideline use. Determinants of guideline use differed between guideline users and non-users; non-users consistently rating determinants lower than users, especially applicability. Two focus groups and one interview (n = 11) identified six main themes of determinants of guideline use: Credibility, knowledge, applicability, resources, motivation, and target audience; which was congruent with the quantitative data. The proposed knowledge translation strategy contains three pillars: guidelines development, dissemination, and interventions.

Conclusions

Several determinants of guideline use not commonly discussed in the literature were identified (applicability, target audience, credibility). The proposed implementation strategy is a valuable resource for guideline developers and policy/decision-makers to improve knowledge translation of guidelines among neurologists.

Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review

BACKGROUND

The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking.

OBJECTIVE

The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth.

METHODS

Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool.

RESULTS

A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item.

CONCLUSIONS

Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery.

Development of a Workplace Intervention for Child Care Staff: Caring and Reaching for Health's (CARE) Healthy Lifestyles Intervention

Child care staff are among the lowest wage workers, a group at increased risk for a wide array of chronic diseases. To date, the health of child care staff has been largely ignored, and there have been very few interventions designed for child care staff. This article describes the development of the Caring and Reaching for Health (CARE) Healthy Lifestyles intervention, a workplace intervention aimed at improving physical activity and health behaviors among child care staff. Theory and evidence-based behavior change techniques informed the development of intervention components with targets at multiple social ecological levels. Final intervention components included an educational workshop held at a kick-off event, followed by three 8-week campaigns. Intervention components within each campaign included (1) an informational magazine, (2) goal setting and weekly behavior self-monitoring, (3) weekly tailored feedback, (4) e-mail/text prompts, (5) center-level displays that encouraged team-based goals and activities, and (6) coaching for center directors. This multilevel, theory-driven intervention is currently being evaluated as part of a larger randomized controlled trial. Process evaluation efforts will assess the extent to which child care staff participated in, engaged with, and were satisfied with the intervention. Lessons learned will guide future intervention research engaging child care workers.

Are digital interventions for smoking cessation in pregnancy effective? A systematic review and meta-analysis

Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of 9 databases resulted in the inclusion of 12 published articles (n = 2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04-2.00, p = .03) in favour of digital interventions compared with comparison groups. Computer-based (OR = 3.06, 95% CI 1.28-7.33) and text-message interventions (OR = 1.59, 95% CI 1.07-2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy.

Using Intervention Mapping for child development and wellbeing programs in early childhood education and care settings

Supporting children's social and emotional learning benefits all elements of children's development and has been associated with positive mental health and wellbeing, development of values and life skills. However, literature relating to the creation of interventions designed for use within the early childhood education and care settings to support children's social and emotional skills and learning is lacking. Intervention Mapping (IM) is a systematic intervention development framework, utilising principles centred on participatory co-design methods, multiple theoretical approaches and existing literature to enable effective decision-making during the development process. Early childhood pedagogical programs are also shaped by these principles; however, educators tend to draw on implicit knowledge when working with families. IM offers this sector the opportunity to formally incorporate theoretical, evidence-based research into the development of early childhood education and care social and emotional interventions. Emerging literature indicates IM is useful for designing health and wellbeing interventions for children within early childhood education and care settings. Considering the similar underlying principles of IM, existing applications within early childhood education and care and development of interventions beyond health behaviour change, it is recommended IM be utilised to design early childhood education and care interventions focusing on supporting children's social and emotional development.

Are Financial Incentives for Lifestyle Behavior Change Informed or Inspired by Behavioral Economics? A Mapping Review

OBJECTIVE

To identify the behavioral economics (BE) conceptual underpinnings of lifestyle financial incentive (FI) interventions.

DATA SOURCE

A mapping review of peer-reviewed literature was conducted by searching electronic databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were real-world FI interventions explicitly mentioning BE, targeting individuals, or populations with lifestyle-related behavioral outcomes. Exclusion criteria were hypothetical studies, health professional focus, clinically oriented interventions.

DATA EXTRACTION

Study characteristics were tabulated according to purpose, categorization of BE concepts and FI types, design, outcome measures, study quality, and findings.

DATA SYNTHESIS AND ANALYSIS

Financial incentives were categorized according to type and payment structure. Behavioral economics concepts explicitly used in the intervention design were grouped based on common patterns of thinking. The interplay between FI types, BE concepts, and outcome was assessed.

RESULTS

Seventeen studies were identified from 1452 unique records. Analysis showed 76.5% (n = 13) of studies explicitly incorporated BE concepts. Six studies provided clear theoretical justification for the inclusion of BE. No pattern in the type of FI and BE concepts used was apparent.

CONCLUSIONS

Not all FI interventions claiming BE inclusion did so. For interventions that explicitly included BE, the degree to which this was portrayed and woven into the design varied. This review identified BE concepts common to FI interventions, a first step in providing emergent and pragmatic information to public health and health promotion program planners.

Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used

Behavior change interventions typically contain multiple potentially active components: behavior change techniques (BCTs). Identifying which specific BCTs or BCT combinations have the potential to be effective for a given behavior in a given context presents a major challenge. The aim of this study was to review the methods that have been used to identify effective BCTs for given behaviors in given contexts and evaluate their strengths and limitations. A scoping review was conducted of studies that had sought to identify effective BCTs. Articles referring to "behavio(u)r change technique(s)" in the abstract/text were located, and ones that involved identification of effective BCTs were selected. The methods reported were coded. The methods were analyzed in general terms using "PASS" criteria: Practicability (facility to apply the method appropriately), Applicability (facility to generalize from findings to contexts and populations of interest), Sensitivity (facility to identify effective BCTs), and Specificity (facility to rule out ineffective BCTs). A sample of 10% of the studies reviewed was then evaluated using these criteria to assess how far the strengths and limitations identified in principle were borne out in practice. One hundred and thirty-five studies were identified. The methods used in those studies were experimental manipulation of BCTs, observational studies comparing outcomes in the presence or absence of BCTs, meta-analyses of BCT comparisons, meta-regressions evaluating effect sizes with and without specific BCTs, reviews of BCTs found in effective interventions, and meta-classification and regression trees. The limitations of each method meant that only weak conclusions could be drawn regarding the effectiveness of specific BCTs or BCT combinations. Methods for identifying effective BCTs linked to target behavior and context all have important inherent limitations. A strategy needs to be developed that can systematically combine the strengths of the different methods and that can link these constructs in an ontology of behavior change interventions.

Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study

Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.

Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression

BACKGROUND

Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this.

OBJECTIVE

The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness.

METHODS

Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models.

RESULTS

Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations.

CONCLUSIONS

Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories.

Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study

Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

BACKGROUND

Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited.

OBJECTIVES

To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention.

DATA SOURCES

All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014.

REVIEW METHODS

A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation.

RESULTS

Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation.

LIMITATIONS

There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity.

CONCLUSIONS

Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention.

FUTURE WORK

There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity.

STUDY REGISTRATION

The study is registered as PROSPERO CRD42014009500.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Work Site-Based Environmental Interventions to Reduce Sedentary Behavior: A Systematic Review

OBJECTIVE

The purpose of this investigation was to systematically review work site-based, environmental interventions to reduce sedentary behavior following preferred reporting items for systematic reviews and meta-analyses guidelines.

DATA SOURCE

Data were extracted from Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials, and Web of Science between January 2005 and December 2015.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were work site interventions, published in peer-reviewed journals, employing environmental modalities, targeting sedentary behavior, and using any quantitative design. Exclusion criteria were noninterventions and non-English publications.

DATA EXTRACTION

Data extracted included study design, population, intervention dosage, intervention activities, evaluation measures, and intervention effects.

DATA SYNTHESIS

Data were tabulated quantitatively and synthesized qualitatively.

RESULTS

A total of 15 articles were identified for review and 14 reported statistically significant decreases in sedentary behavior. The majority of studies employed a randomized controlled trial design (n = 7), used inclinometers to measure sedentary behavior (n = 9), recruited predominantly female samples (n = 15), and utilized sit-to-stand desks as the primary intervention modality (n = 10). The mean methodological quality score was 6.2 out of 10.

CONCLUSION

Environmental work site interventions to reduce sedentary behavior show promise because work sites often have more control over environmental factors. Limitations of this intervention stream include inconsistent measurement of sedentary behavior, absence of theoretical frameworks to guide program development, and absence of long-term evaluation. Future studies should include clear reporting of intervention strategies and explicit operationalization of theoretical constructs.

A computational model for designing energy behaviour change interventions

The conflicting evidence in the literature on energy feedback as a driver for energy behaviour change has lead to the realization that it is a complex problem and that interventions must be proposed and evaluated in the context of a tangled web of individual and societal factors. We put forward an integrated agent-based computational model of energy consumption behaviour change interventions based on personal values and energy literacy, informed by research in persuasive technologies, environmental, educational and cognitive psychology, sociology, and energy education. Our objectives are: (i) to build a framework to accommodate a rich variety of models that might impact consumption decisions, (ii) to use the simulation as a means to evaluate persuasive technologies in-silico prior to deployment. The model novelty lies in its capacity to connect the determinants of energy related behaviour (values, energy literacy and social practices) and several generic design strategies proposed in the area of persuasive technologies within one framework. We validate the framework using survey data and personal value and energy consumption data extracted from a 2-year field study in Exeter, UK. The preliminary evaluation results demonstrate that the model can predict energy saving behaviour much better than a random model and can correctly estimate the effect of persuasive technologies. The model can be embedded into an adaptive decision-making system for energy behaviour change.

Improved latrine cleanliness through behaviour change and changes in quality of latrine construction: a longitudinal intervention study in rural Burundi

Latrine cleanliness increased in the intervention group compared to the control group (increase from 21 to 31 % of latrines classified as clean in intervention [N = 198] and decrease from 37 to 27 % in control [N = 91]). Improved habitual latrine cleaning lead to latrines being 3.5 times more likely to improve in observed latrine cleanliness (χ² = 16.36, p < .001) and so did improvements in quality of latrine construction, eg households that had installed a lid were 7.39 times more likely to have a cleaner latrine (χ² = 4.46, p < .05). Changes in psychosocial factors, namely forgetting, personal norm, satisfaction with cleanliness, explained much of the change in habitual latrine cleaning (adj. r² = .46). Behaviour change interventions targeting psychosocial factors and quality of latrine construction seem promising to ensure clean and hygienic latrines.

The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol

BACKGROUND

Numerous psychological risk and protective factors have been identified as contributing to or preventing the development of the prevalent issue of chronic pain. Systematic reviews of studies on psychological interventions that tackle these factors have shown limited effects on chronic pain. Therefore, implementing psychological interventions before pain becomes chronic has been put forward. However, the efficacy of such interventions in preventing the transition from acute to chronic pain has not yet been systematically assessed.

METHODS

The aims of this systematic review are to assess the effects of psychological interventions applied in the acute pain phase on pain severity as well as on physical, psychological, and social functions at 3 months and beyond. Randomized controlled trials including psychological intervention as a treatment of primary interest and participants with pain of less than 3 months duration will be considered. The following comparisons will be undertaken: psychological interventions with (1) standard treatment, (2) information, (3) waiting-list, and (4) active treatment. The primary outcome will be pain severity using indicators such the presence or absence of pain and self-report measures such as the numeric pain intensity rating scale. Secondary outcomes will include pain-related disability, mood, coping with pain, quality of life, health care utilization, and work capability. A systematic review of English and French articles in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials will be conducted without date restriction. Extracted data will include demographics and clinical characteristics, sample size, intervention and control group types, assessment tools used, time interval of measurement, fidelity of the intervention, and attrition rate. Standardized mean differences (SMD) and risk ratios with 95% confidence intervals (CI) will be used to assess treatment effects.

DISCUSSION

This systematic review is the first in examining the effects of psychological interventions implemented in the acute pain phase with the objective of preventing chronic pain. Results of this systematic review could provide information on psychological intervention characteristics that are most helpful for individuals with pain and guidance as to when such interventions should be applied in the continuum of care.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016049312.

National policies for the promotion of physical activity and healthy nutrition in the workplace context: a behaviour change wheel guided content analysis of policy papers in Finland

Background

Health policy papers disseminate recommendations and guidelines for the development and implementation of health promotion interventions. Such documents have rarely been investigated with regard to their assumed mechanisms of action for changing behaviour. The Theoretical Domains Framework (TDF) and Behaviour Change Techniques (BCT) Taxonomy have been used to code behaviour change intervention descriptions, but to our knowledge such “retrofitting” of policy papers has not previously been reported. This study aims first to identify targets, mediators, and change strategies for physical activity (PA) and nutrition behaviour change in Finnish policy papers on workplace health promotion, and second to assess the suitability of the Behaviour Change Wheel (BCW) approach for this purpose.

Method

We searched all national-level health policy papers effectual in Finland in August 2016 focusing on the promotion of PA and/or healthy nutrition in the workplace context (n = 6). Policy recommendations targeting employees’ nutrition and PA including sedentary behaviour (SB) were coded using BCW, TDF, and BCT Taxonomy.

Results

A total of 125 recommendations were coded in the six policy papers, and in two additional documents referenced by them. Psychological capability, physical opportunity, and social opportunity were frequently identified (22%, 31%, and 24%, respectively), whereas physical capability was almost completely absent (1%). Three TDF domains (knowledge, skills, and social influence) were observed in all papers. Multiple intervention functions and BCTs were identified in all papers but several recommendations were too vague to be coded reliably. Influencing individuals (46%) and changing the physical environment (44%) were recommended more frequently than influencing the social environment (10%).

Conclusions

The BCW approach appeared to be useful for analysing the content of health policy papers. Paying more attention to underlying assumptions regarding behavioural change processes may help to identify neglected aspects in current policy, and to develop interventions based on recommendations, thus helping to increase the impact of policy papers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4574-3) contains supplementary material, which is available to authorized users.

The effect of self-compassion on the self-regulation of health behaviors: A systematic review

The purpose of this review was to systematically review the published research on the effect of self-compassion interventions on health behaviors. A self-regulation intervention was defined as participants engaged in goal-setting behavior, goal-directed behavior, monitoring, and/or adjusting health behavior. Seven studies met the inclusion criteria and were analyzed in this review. Self-compassion interventions were just as effective as other behavior change techniques at improving self-regulation of health behavior. The review discusses sample characteristics, study design, health behavior measures, self-compassion intervention implementation, and the theoretical frameworks of the studies, along with limitations of the research and suggestions for future researchers.

Understanding perceived determinants of nurses' eating and physical activity behaviour: a theory-informed qualitative interview study

BACKGROUND

Unhealthy eating and physical activity behaviours are common among nurses but little is known about determinants of eating and physical activity behaviour in this population. The present study used a theoretical framework which summarises the many possible determinants of different health behaviours (the Theoretical Domains Framework; TDF) to systematically explore the most salient determinants of unhealthy eating and physical activity behaviour in hospital-based nurses.

METHODS

Semi-structured qualitative interviews based on the TDF were conducted with nurses (n = 16) to explore factors that behavioural theories suggest may influence nurses' eating and physical activity behaviour. Important determinants of the target behaviours were identified using both inductive coding (of categories emerging from the data) and deductive coding (of categories derived from the TDF) of the qualitative data.

RESULTS

Thirteen of the fourteen domains in the TDF were found to influence nurses' eating and physical activity behaviour. Within these domains, important barriers to engaging in healthy eating and physical activity behaviour were shift work, fatigue, stress, beliefs about negative consequences, the behaviours of family and friends and lack of planning. Important factors reported to enable engagement with healthy eating and physical activity behaviours were beliefs about benefits, the use of self-monitoring strategies, support from work colleagues, confidence, shift work, awareness of useful guidelines and strategies, good mood, future holidays and receiving compliments.

CONCLUSIONS

This study used a theory-informed approach by applying the TDF to identify the key perceived determinants of nurses' eating and physical activity behaviour. The findings suggest that future efforts to change nurses' eating and physical activity behaviours should consider targeting a broad range of environmental, interpersonal and intrapersonal level factors, consistent with a socio-ecological perspective.

Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses

Purpose

This systematic review aims to explain the heterogeneity in results of interventions to promote physical activity and healthy eating for overweight and obese adults, by exploring the differential effects of behaviour change techniques (BCTs) and other intervention characteristics.

Methods

The inclusion criteria specified RCTs with ≥ 12 weeks’ duration, from January 2007 to October 2014, for adults (mean age ≥ 40 years, mean BMI ≥ 30). Primary outcomes were measures of healthy diet or physical activity. Two reviewers rated study quality, coded the BCTs, and collected outcome results at short (≤6 months) and long term (≥12 months). Meta-analyses and meta-regressions were used to estimate effect sizes (ES), heterogeneity indices (I²) and regression coefficients.

Results

We included 48 studies containing a total of 82 outcome reports. The 32 long term reports had an overall ES = 0.24 with 95% confidence interval (CI): 0.15 to 0.33 and I² = 59.4%. The 50 short term reports had an ES = 0.37 with 95% CI: 0.26 to 0.48, and I² = 71.3%. The number of BCTs unique to the intervention group, and the BCTs goal setting and self-monitoring of behaviour predicted the effect at short and long term. The total number of BCTs in both intervention arms and using the BCTs goal setting of outcome, feedback on outcome of behaviour, implementing graded tasks, and adding objects to the environment, e.g. using a step counter, significantly predicted the effect at long term. Setting a goal for change; and the presence of reporting bias independently explained 58.8% of inter-study variation at short term. Autonomy supportive and person-centred methods as in Motivational Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, explained all of the between study variations in effects at long term.

Conclusion

There are similarities, but also differences in effective BCTs promoting change in healthy eating and physical activity and BCTs supporting maintenance of change. The results support the use of goal setting and self-monitoring of behaviour when counselling overweight and obese adults. Several other BCTs as well as the use of a person-centred and autonomy supportive counselling approach seem important in order to maintain behaviour over time.

Trial Registration

PROSPERO CRD42015020624

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0494-y) contains supplementary material, which is available to authorized users.

Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses' use of electronic medication management systems in two Australian hospitals

Background

Medication errors harm hospitalised patients and increase health care costs. Electronic Medication Management Systems (EMMS) have been shown to reduce medication errors. However, nurses do not always use EMMS as intended, largely because implementation of such patient safety strategies requires clinicians to change their existing practices, routines and behaviour. This study uses the Theoretical Domains Framework (TDF) to identify barriers and targeted interventions to enhance nurses’ appropriate use of EMMS in two Australian hospitals.

Methods

This qualitative study draws on in-depth interviews with 19 acute care nurses who used EMMS. A convenience sampling approach was used. Nurses working on the study units (N = 6) in two hospitals were invited to participate if available during the data collection period. Interviews inductively explored nurses’ experiences of using EMMS (step 1). Data were analysed using the TDF to identify theory-derived barriers to nurses’ appropriate use of EMMS (step 2). Relevant behaviour change techniques (BCTs) were identified to overcome key barriers to using EMMS (step 3) followed by the identification of potential literature-informed targeted intervention strategies to operationalise the identified BCTs (step 4).

Results

Barriers to nurses’ use of EMMS in acute care were represented by nine domains of the TDF. Two closely linked domains emerged as major barriers to EMMS use: Environmental Context and Resources (availability and properties of computers on wheels (COWs); technology characteristics; specific contexts; competing demands and time pressure) and Social/Professional Role and Identity (conflict between using EMMS appropriately and executing behaviours critical to nurses’ professional role and identity).

The study identified three potential BCTs to address the Environmental Context and Resources domain barrier: adding objects to the environment; restructuring the physical environment; and prompts and cues. Seven BCTs to address Social/Professional Role and Identity were identified: social process of encouragement; pressure or support; information about others’ approval; incompatible beliefs; identification of self as role model; framing/reframing; social comparison; and demonstration of behaviour. It proposes several targeted interventions to deliver these BCTs.

Conclusions

The TDF provides a useful approach to identify barriers to nurses’ prescribed use of EMMS, and can inform the design of targeted theory-based interventions to improve EMMS implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0572-1) contains supplementary material, which is available to authorized users.